![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by whitmore on December 5, 2010, at 14:37:22
My family practitioner is pretty open-minded when it comes to prescribing meds. Serzone, T3, she's ok within reasonable limits. I am in crisis right now with terrible cognitive decline, anxiety and depression, but am convinced I have something physically wrong with me. I have suffered from anxiety my entire life, but this desperate depression and confusion is new. I used to have quite a high IQ, but now have trouble with speech, which is the most frightening aspect of the whole thing. My FP suggested I go and see a pdoc in order to get a referral to a neurologist in NYC or Philly(I'm in Princeton NJ). She did not think I'd find any meaningful neurological help locally. I was recommended a pdoc by my old one(not taking new pats. at the time) and went for an initial evaluation. He talked of memantine or stimulants to help with attention/cognition, which seemed encouraging, and prescribed ritalin--sounded like he might be creative. However, ritalin made me more confused. During the intitial session, he suggested that I get tested for learning disabilities(I'm nearly 60 years old for God's sake--what on earth would the benefit of this be?). Anyway, I went back again, and he gave me Xanax SR to keep me asleep(I take regular Xanax, but have to take it twice during the night, to stay asleep). It sounded like a good idea at the time, but when I looked up the half-life on the internet I felt I could not risk being even more confused during the day at work. I went back again(now $600 out of pocket) when he gave me a lengthy story about someone similar to me who was convinced something was wrong, no-one could find anything, until eventually she had a very sensitive test which found a tumour on her pituitary. After surgery, everything was resolved. Then he started to talk about the fact that he couldn't help me unless I accepted my condition. I asked him if he would prescribe Serzone. He said he wouldn't because of the liver issues. T3 up to 50 mcg only--because of the perceived risk of osteoporosis, even though I take estrogen. The only thing he suggested was to increase my Zoloft to 25 mg, advice I could have got from my family doctor for the cost of co-pays.
I believe at this point I am wasting my money. How could I have interviewed him ahead of time and prevented having to waste $600 of my hard-earned money? Also, is it OK for me to call him and try to get the name of someone who could give me a brain scan? Do docs. answer questions like this outside of session? Or is that another $150?
Posted by B2Chica on December 5, 2010, at 18:47:24
In reply to How could I have avoided this? New pdoc--bad!!, posted by whitmore on December 5, 2010, at 14:37:22
first, just call the office for a referral for the brain scan. or depending on what you need... MRI? there are so many 'freelance' places out there popping up everywhere, for the MRI, they just take the pictures its the doc that does the diagnosis.
and as for this doc?? i say questioningly. you CAN interview them. just say your in for a consultation. period!!
you dont ever have to go back.
also, you can just switch that easily too!
have any friends that could give you referrals too? or if you have another phsysician you can ask them as well...it sounds funny but i ALWAYS trust my OB...she Rocks!best wishes to you and let us know how things turn out.
i'll try to respond more if i can.
b2c.
Posted by Phillipa on December 5, 2010, at 21:37:35
In reply to Re: How could I have avoided this? New pdoc--bad!!, posted by B2Chica on December 5, 2010, at 18:47:24
About 7 years ago a microadenoma was found during an MRI of my brain and told don't worry. Was done for permanent loss of taste and smell. Well had it repeated by my endocrinologist it hadn't grown so dismissed still there. So lots of docs can order an MRI of the brain or pituitary specifically. If you google pituitary tumors lactation is one of the signs and they are easily removed through the nose. I think meds used also?. Phillipa I do know how scarey this is.
Posted by Phillipa on December 5, 2010, at 21:46:30
In reply to Re: How could I have avoided this? New pdoc--bad!!, posted by Phillipa on December 5, 2010, at 21:37:35
Personally I'd see your GP as this pdoc I don't think I would like at all but that's me. Here is a quick overview of symptoms of pituitary tumors. Phillipa
Posted by ace on December 6, 2010, at 0:20:30
In reply to How could I have avoided this? New pdoc--bad!!, posted by whitmore on December 5, 2010, at 14:37:22
> My family practitioner is pretty open-minded when it comes to prescribing meds.
Generally they are more so than psychiatrists!
I am in crisis right now with terrible cognitive decline, anxiety and depression, but am convinced I have something physically wrong with me.
You mean you are concerned about the way a body part looks? Or you are concerned about a possible health prob?
I have suffered from anxiety my entire life, but this desperate depression and confusion is new.A desperate depression requires intervention ASAP.
I used to have quite a high IQ, but now have trouble with speech, which is the most frightening aspect of the whole thing. My FP suggested I go and see a pdoc in order to get a referral to a neurologist in NYC or Philly(I'm in Princeton NJ). She did not think I'd find any meaningful neurological help locally. I was recommended a pdoc by my old one(not taking new pats. at the time) and went for an initial evaluation.
I would see the family doctor, get complete tests, exclude any physical diagnosis, and if necessary then get a referral to a neurologist from the family practitioner.
He talked of memantine or stimulants to help with attention/cognition, which seemed encouraging, and prescribed ritalin--sounded like he might be creative. However, ritalin made me more confused.
Be vary vary wary of these psychostimulants. Drinking an energy drink is not so bad, but I've seen kids who have been on Ritalin for years become extremely disordered in many ways. These drugs are basically speed!
During the intitial session, he suggested that I get tested for learning disabilities(I'm nearly 60 years old for God's sake--what on earth would the benefit of this be?)Why? A learning disability in what? You seem to articulate yourself well enough here. Your complaints are not congruent with someone suffering a 'learning disability'
. Anyway, I went back again, and he gave me Xanax SR to keep me asleep(I take regular Xanax, but have to take it twice during the night, to stay asleep). It sounded like a good idea at the time, but when I looked up the half-life on the internet I felt I could not risk being even more confused during the day at work.
Xanax, IMO, is a very very good drug, for a wide spectrum of problems. However it has been abused by people who do not need it, and cognitive impairment is possible s/effect.
I went back again(now $600 out of pocket) when he gave me a lengthy story about someone similar to me who was convinced something was wrong, no-one could find anything, until eventually she had a very sensitive test which found a tumour on her pituitary. After surgery, everything was resolved. Then he started to talk about the fact that he couldn't help me unless I accepted my condition.You should say "Let's listen to each other and accept and reflect on what we both say" If he doesn't like that I'd find a new one.
I asked him if he would prescribe Serzone. He said he wouldn't because of the liver issues. T3 up to 50 mcg only--because of the perceived risk of osteoporosis, even though I take estrogen.
That risk is very low.
The only thing he suggested was to increase my Zoloft to 25 mg, advice I could have got from my family doctor for the cost of co-pays.Increase to 25mg???
what dose are you on??
I know you are near 60 y/o but less than 25mg seems like a ridiculous dose (even though Zoloft on any dose doesn't seem to help the majority of patients)
My advice is to DROP the Zoloft. and go back and ask for a TCA or an MAOI. if they say no, find the one who says yes.
> I believe at this point I am wasting my money. How could I have interviewed him ahead of time and prevented having to waste $600 of my hard-earned money?Ring them up. It sounds mean, but a lot of them will happily take your money without a conscious.
Also, is it OK for me to call him and try to get the name of someone who could give me a brain scan?
Yes! Of course it is! You have the right to call any doctor in the world to find out who can.
Do docs. answer questions like this outside of session? Or is that another $150?
In Australia they DO. I would assume they would where you are located.
These doctors are only human too, a lot of them aren't always as stable as they appear!
Posted by bleauberry on December 6, 2010, at 19:37:19
In reply to How could I have avoided this? New pdoc--bad!!, posted by whitmore on December 5, 2010, at 14:37:22
I can sure relate to your frustration. The problem with pdocs, and many docs actually, is that they often fail to put the clues together. Anytime a patient presents with relatively rapid mental decline and clusters of other new symptoms, a red flag should go up. This isn't depression. This is something else. But it is too easy to label it depression and completely blot out anything else.
He said "accept your condition?' Well, ok. I would have challenged him on that. I would have asked, "Is my condition Lyme, or is it dementia, or is it MS, or is it a food allergy, or is it a metal accumulation, or what is it?" He wants you to accept your condition but he never diagnosed what it was! He never did indepth testing and confirmation.
Whenever a psychiatrist sees "brain fog" or "mental confusion", that to me is a clear signal to begin some detective work. Sure there are some drugs, herbs, and supplements to help improve the symptoms, but they do nothing to identify why it is happening or to stop its progression.
A problem with specialists of all kinds, including pdocs, is that they don't see the whole picture, the whole patient, the whole body. They only see the part they studied in school.
Neurologists frequently treat people with powerful and dangerous drugs for MS, chronic fatigue, pain, and such, when the whole time they had Lyme disease and not any of those. But they didn't know the proper ways to test for Lyme, or ways to do challenge tests for Lyme, because it wasn't part of their training. Likely Lyme never even crossed their minds, even though it can exactly duplicate all of the conditions neurologists deal with every day. I just used Lyme as an easy example to illustrate the point.
The people with the best success stories are the ones that took responsibility for learning about their own symptoms, possible causes, and treatments, upon themselves. The doctor is useful as a partner in the journey, but not necessarily the one behind the steering wheel. If you've ever seen the documentary shows on TV like Mystery Diagnosis, it is almost always the patient that pointed the way for the doctor.....12 doctors later and thousands of dollars later.
The Lyme example again. Do you know where most doctors send their Lyme patients? To a psychiatrist. Why? Because they have depression commonly, or stuff that looks enough like depression to conclude it is. Lyme was not even considered, and in rare cases when it was it was tested for improperly and came back negative. I'm sorry, but Lyme patients don't see their depression get better on antidepressants, they get better on antibiotics. And some herbs.
With the mental fogginess and decline, it's the same scenario. Something is going on. You need someone with some creativity to look deeper, and you need a lot of research on your own.
Posted by whitmore on December 6, 2010, at 20:01:12
In reply to Re: How could I have avoided this? New pdoc--bad!!, posted by bleauberry on December 6, 2010, at 19:37:19
I agree with you Bleauberry. I believe there is something else going on and intend to pursue it with an alternative doctor. In the meantime, for psych. meds. I will go to my regular family doctor, since I feel I have nothing to gain by continuing to see him. I know that I have a severe reverse t3 problem, and a TSH of 3.75, which is high, though, since this is 'subclinical', doctors do not accept that it needs to be treated. I came off a supervised trial(my hormone doctor) of T3 as the mainstream docs. were yelling at me for taking so much(100 mcg)(though I felt better on it, and feel wretched now). I'm going to leave it for 8 weeks and get re-tested, probably to try again. I was arguing with the Pdoc. who said that he would give T3 up to 50 mcg as an adjunct to SSRI's as studies have shown the T3 to act as a 'booster', even in the 'euthyroid'. My point was that perhaps the patients were not in fact 'euthyroid' at all and the T3 was just restoring the missing hormone. He would have none of it. I just felt I wasn't being listened to at all. He even joked about when he was drooling in a nursing home, that would be his childrens' problem not his, thereby trivialising my very real fears.
Anyway, as far as the Lyme is concerned, what test can be done to rule it out? I know the Elisa test gives many false negatives, but there doesn't seem to be a positive one, or is there? Antibiotics are not benign treatments for imagined illnesses, especially in cases of chronic disease, where people have become very very sick after taking antibiotics for long periods of time.
Posted by whitmore on December 6, 2010, at 20:10:37
In reply to Re: How could I have avoided this? New pdoc--bad!! » whitmore, posted by ace on December 6, 2010, at 0:20:30
Thanks for the reply and suggestions. I'll give him a call and see if he can recommend a big city neurologist.
I know I'm approaching the 'elderly' category med wise, but actually I've always been super sensitive to meds.--2.5 mg of Paxil worked for a decade to stave of anxiety. So 12.5 mg of Zoloft is not quite as crazy as it sounds. And Serzone seemed like a good option as it helps with sleep, which has always been a problem.
I'm not very good at all this negotiating with doctors--although I live in the USA now, I grew up with the NHS in the UK, where the doctor was God plus have the whole stiff upper lip going on.
So perhaps some of this is a communication issue. Anyway, unless things get sig. worse, I'll just go to my own family doctor. At least I won't be spending days being furious at having thrown my money away.
Posted by merpmerp on December 6, 2010, at 21:18:45
In reply to How could I have avoided this? New pdoc--bad!!, posted by whitmore on December 5, 2010, at 14:37:22
Whitmore, I am sorry to hear about this (I came and read this thread after you posted in my thread about my pdoc). It's too late right now for me to write a long response but I just wanted you to know I do feel for you, and if you have the feeling that something is seriously wrong (and I agree from your symptoms it should not be dismissed as "simply depression" without a full workup) then stick to your guns until you find a doc who will help you. Best of luck, I will be thinking of you.
Posted by Phillipa on December 6, 2010, at 22:22:39
In reply to Re: How could I have avoided this? New pdoc--bad!! » bleauberry, posted by whitmore on December 6, 2010, at 20:01:12
Got you beat almost 65 and have tested positive for lymes through Western Blot still six bands positive but took antibiotics for over two years. As my infection control doc said when trying to think of something else to help me think of lymes like a bullet that entered your body and did damage and now try to fix the damage. Was given the option of more antibiotics didn't but for six weeks of doxycycline. No change and since the antibiotics are not good to be on for extended periods of time went off them. You can get a spinal tap and an MRI of brain to see if MS, or lymes antigens in the spinal fluid also. Phillipa
Posted by ace on December 7, 2010, at 0:54:02
In reply to Re: How could I have avoided this? New pdoc--bad!! » ace, posted by whitmore on December 6, 2010, at 20:10:37
> Thanks for the reply and suggestions.
My pleasure.
I'll give him a call and see if he can recommend a big city neurologist.
> I know I'm approaching the 'elderly' category med wise, but actually I've always been super sensitive to meds.--2.5 mg of Paxil worked for a decade to stave of anxiety. So 12.5 mg of Zoloft is not quite as crazy as it sounds. And Serzone seemed like a good option as it helps with sleep, which has always been a problem.
> I'm not very good at all this negotiating with doctors--although I live in the USA now, I grew up with the NHS in the UK, where the doctor was God plus have the whole stiff upper lip going on.
> So perhaps some of this is a communication issue. Anyway, unless things get sig. worse, I'll just go to my own family doctor. At least I won't be spending days being furious at having thrown my money away.One thing have you considered low dose benzodiazepines?
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.