![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by ksvt on November 30, 2000, at 22:43:10
Today, with some prodding from my therapist and following the recent suggestions of Noa, I called my pdoc to set up an appointment to discuss some possible med changes. He told me that he had decided that he was going to retire in a few months and had been discussing with my therapist to whom I should be referred. (A salient point she neglected to relate to me before I made this call) He sort of left the door open for me to say that maybe I should just go see the new person, but i foolishly, I think, didn't bite. Now I have an appointment set up for next week that i really don't want. I've been through 5 or 6 meds changes with this doc over the 5 or so years he's treated me, and I've always felt a little bad that I haven't been more of a success story for him, because he's certainly stuck with me and put alot of effort in. For about 2 of those years he was my therapist also. I hate the whole process of trying to evaluate and adjust to new drug regimens and I think I've had a tendency to bail out on these things too soon. My attitude about them probably sucks - at least I'm real pessimistic about finding a combo that might really work. There's such an approach avoidance because I can't bear the thought of another drug failure, and I don't have alot of confidence in my ability not to make another failure a self-fulfilling prophecy. As soon as I got off the phone, I felt that I had made an immense mistake making the appointment. I don't think I have the energy and level of commitment to give another combo the opportunity to work, and I'm not sure he has the energy, commitment etc. to help keep me on course. I'm sort of thinking that having someone with a new perspective might be a good thing, but I don't quite know how to say that. (I have a highly developed sense of loyalty) I thought about just calling him back and telling him that upon reconsideration, I realize that I'm just not committed enough to make any changes now, and just putting things off until he's closed his practice. That's a pretty truthful statement but maybe not a wise choice given the fact that I'm really not doing very well now. Any ideas? ksvt
Posted by stjames on December 1, 2000, at 0:13:48
In reply to I could use some advice, posted by ksvt on November 30, 2000, at 22:43:10
At present do you need to change your meds ? If not there
is no reason you cannot continue with someone else
what already works.James
Posted by Racer on December 1, 2000, at 0:24:29
In reply to I could use some advice, posted by ksvt on November 30, 2000, at 22:43:10
Ugh, not fun for you, eh?
Here's my advice: Make a list of all the drugs and combos you've tried so far. Add another column with the benefits you got from these. Another column with the side effects. A fourth column detailing why you finally changed from this.
Look over the resulting spreadsheet, and think about the good there. Then take that to the doctor, discuss it with him, see if he has any words of wisdom after looking at it in black and white.
First of all, he may see something that hadn't struck him before. Secondly, you may feel a little better, enough to help you hold on, just because you're doing something positive. Third, it gives you a reason to see him one last time, which will help soothe your guilt at 'rejecting' him.
So, it's a win-win situation. You won't feel bad about putting him off, you will get some sort of help right away, and it's going to do you good with any new p-ddr too.
Good luck, and hold on!!!
Posted by Racer on December 1, 2000, at 0:26:00
In reply to I could use some advice, posted by ksvt on November 30, 2000, at 22:43:10
And about that pessimism:
I was sure, certain sure, that no drug would help me and the only choice was suicide. Then I tried one last drug combo, which was the last because it worked. I didn't expect it to, it just DID.
Good luck.
Posted by Emmanuela on December 1, 2000, at 0:50:09
In reply to Re: I could use some advice PS, posted by Racer on December 1, 2000, at 0:26:00
Noa - just want to tell you how loving and sweet your advice was! Great idea! And if I send you a big carton of my life, could you please get in onto a spreadsheet for me?
Posted by shellie on December 1, 2000, at 8:29:48
In reply to I could use some advice, posted by ksvt on November 30, 2000, at 22:43:10
Hi Ksvt. If I were you, I would take this opportunity to interview this new pdoc--I would not assume they he/she will be it. This can be a consultation. Now, while your old pdoc is still around, should be the time you are interviewing others. You can be open about your question as to your commitment to change drugs, as well as the fact that you're not doing well. See what direction this new doc would go in IF she/he was your doctor. You really have nothing to lose. And you gain the possiblity of receiving a new point of view as well as deciding if this the pdoc you want to work with next.
btw, maybe your therapist didn't tell you because she felt it was appropriate for the pdoc, who is retiring, to break the news.I really think you should go. Shellie
Posted by Noa on December 1, 2000, at 14:02:18
In reply to Re: I could use some advice » ksvt, posted by shellie on December 1, 2000, at 8:29:48
1st--Emanuela--the advice I cannot take credit for, alas--it was Racer's.
The only thing I would add is to maybe put it on a timline.
I think the advice to go to the doc at least one last time is good. Take the documented info and go in to review it with him, kind of sum up together so you have an idea of what you are asking of a new pdoc. Plus, you worked with this guy a long time (in therapy, too), so I think a proper goodbye is a good idea.
As for the pessimism about anything helping--I'm with Racer. Last year you could not have convinced me that we could find a combo that would help. Now I know that it is possible. This combo has helped. It is amazing. The pessimism is a symptom.
It can be discouraging, I know. But I am sure you have not tried every possibility of combinations, and perhaps, as you mentioned, not tried some things for sufficient time to know if they work.
BTW, I know we must have discussed this before, but have you had an endocrinology workup?
Posted by ksvt on December 1, 2000, at 16:16:44
In reply to Re: I could use some advice, posted by Noa on December 1, 2000, at 14:02:18
>Hey - I really appreciate your helpful responses. It's amazing how disconnected your thinking can be about things when you're anxiety level is up. Racer I wish you'd put your spreadsheet to work on my Xmas shopping. The idea of mapping out my drug history is a good suggestion. I sort of started to do that on the phone with him yesterday because I honestly couldn't remember, with 1 drug anyway, how long I was on it and why I quit.
It occurred to me that I probably have an easy solution, which is to temporarily anyway, just increase the dosage of what I'm already taking. I decreased it last spring to introduce an augmentation drug, and never brought it back up again when the trial was unsuccessful. I am by no means at the upper limit of this drug. This is not a great solution in my mind. I went the augmentation route to begin with because higher amounts of this drug weren't providing me with enough of an AD effect, but it may for the short term anyway, give me a much needed boost. I think my pdoc will want to sell me on a different augmentation strategy, but I feel so pessimistic right now, I don't trust myself that I'll give it a decent shot. I think I am pretty persuaded that I really shouldn't (maybe even can't) wait 3 or 4 months until this guy retires.Shellie - your suggestion about interviewing pdocs is the kind of thing that never occurs to me. I'm much to apt to just go where I'm sent. My pdoc gave me a name suggested to him by my therapist. I'll obviously need to talk to my therapit about her suggestion. To be honest, I'm not sure I'd know how to go about interviewing a pdoc, or what questions I should be asking. Do you have any suggestions? I'm sure you're right about my therapist not wanting to be the one who told me about the impending retirement. (my guess is that my pdoc asked her not to tell me) I understand this and even feel that this was the appropriate thing to do. I just felt alittle ambushed because I probably would have come out of this conversation differently had I known in advance.
Noa - my pdoc orders blood work on me about every 2 years or so and I know that checks thyroid function. Is this what you meant?
Thanks again everyone. I think part of my reticence to try somethiing new right now is that I have developed certain kneejerk conditioned responses to this pdoc, and maybe even he to me and that this is not very helpful when you're trying to do something which for me, seems to be so difficult and anxiety-producing. The other thing is that while I feel very shaky now, this is not an all-the-time feeling. I'm capable of coming out of this for a few days at a time. Because of this, it's very difficult for me to evaluate whether a drug is working other than over a long time. This may require more perseverance than I'm capable of at the moment. Additionally, I've been dealing with this for what seems like so long, that I've forgotten what "normal" feels like. I'm not sure I know how an effective drug is supposed to make me feel. Sorry for such a long-winded discourse. ksvt
1st--Emanuela--the advice I cannot take credit for, alas--it was Racer's.
>
> The only thing I would add is to maybe put it on a timline.
>
> I think the advice to go to the doc at least one last time is good. Take the documented info and go in to review it with him, kind of sum up together so you have an idea of what you are asking of a new pdoc. Plus, you worked with this guy a long time (in therapy, too), so I think a proper goodbye is a good idea.
>
> As for the pessimism about anything helping--I'm with Racer. Last year you could not have convinced me that we could find a combo that would help. Now I know that it is possible. This combo has helped. It is amazing. The pessimism is a symptom.
>
> It can be discouraging, I know. But I am sure you have not tried every possibility of combinations, and perhaps, as you mentioned, not tried some things for sufficient time to know if they work.
>
> BTW, I know we must have discussed this before, but have you had an endocrinology workup?
Posted by Noa on December 1, 2000, at 16:53:19
In reply to Thanks for alot of good advice, posted by ksvt on December 1, 2000, at 16:16:44
If waiting is hard, go ahead and start the process of transferring to a new doc now.
About the thyroid---what I have learned is that many docs trust the statistical norms for TSH results as the "Truth" for everyone, but the real TRUTH is that for some people, the edges of the normal range is not normal for them.
My TSH tested at the border of normal, but I felt horrible. One review in the Brittish Journal of Medicine found that a TSH of 2 or above (when TSH is high, it can indicate hypothyroidism, when it is low, it can indicate hyperthyroidism) was highly correlated with later overt thyroid disease. But docs consider anything between .5 and 5 (approximately--it can be differnt for different labs) to be "normal". Mine tested at about 4.5. I was in horrible shape. Not until I was on enough thyroid hormone that my TSh went down to below 1 did I start to really feel better.
What were your TSH, Total T4, and T3 results numbers? (Do you mind my asking?)
Lots more info in the THyroid and Depression folder--link at top of PSB page.
Posted by allisonm on December 1, 2000, at 22:04:20
In reply to I could use some advice, posted by ksvt on November 30, 2000, at 22:43:10
ksvt,
You've already gotten lots of good advice that I cannot improve upon. I kind of like your idea of increasing the dose of what you're taking for the moment. Does your pdoc know you reduced the dose?Speaking for myself, I'm not sure I would want to be going through a med change with the holidays so near knowing that it can take weeks for a new one to reach the point of efficacy. Or maybe I'm just a chicken, but holidays are stressful enough without added uncertainties.
Best wishes,
Allison
Posted by shellie on December 2, 2000, at 10:57:53
In reply to Thanks for alot of good advice, posted by ksvt on December 1, 2000, at 16:16:44
Hi ksvt:
My situation in finding a pdoc was a bit different, because my therapist was not involved with helping me find a new one (the doctors she works with I already knew from being in the hospital years ago--they all work with dissociative disorders.) The one we both really liked wasn't accepting my insurance anymore, so that's why I was leaving. So I didn't have to deal with treading on her toes, if I disagreed with her re pdocs.For me, these were my issues that I asked: (1) Had they had experience with hard to treat depression (and in my case dissociative disorders also) (2) Would they be willing to combine drugs with an MAOI if there was literature about it, even if it wasn’t sanctioned by the PDR. (3) How available are they by phone? I said I needed a lot of support when I am changing meds and would they be willing to provide frequent five minute conversations. (4) Would they trust me, if I said, "this doesn’t feel right to me." –actually trust my many years of experience.
I tried two docs , one who saw you often for less than fifteen minutes, and one who had twenty minutes appointments: these particular physicians were known in my area for treating depression. The shorter appointments did not work for me, and I ended up leaving both of them and going back to my first pdoc, paying her out of pocket, and figuring when I am again stable then I will switch pdocs.So next time I look for a pdoc I will also ask how long their medication appts are; as opposed to the first appointment. Fifteen minutes is not acceptable to me because I come in with a lot questions, and 1/2 hour until I am stable on a med is the least I would be willing to accept.
Our needs may be different, so you need to take some time to think about what YOU need from a pdoc, and articulate that to them. Mostly I used the things I liked from my old pdoc, so it wasn’t that difficult to come up with a list; and you also have that advantage.
During most "interviews", the pdoc is quite willing to ask all the questions, so I found it helpful to bring in my list in written form. That way they knew I had concrete questions and allowed me the time for them. Somehow it helped shift the interview from them interviewing me to me interviewing them.
Hope this is a bit helpful, shellie
Posted by ksvt on December 2, 2000, at 14:29:39
In reply to Re: I could use some advice » ksvt, posted by allisonm on December 1, 2000, at 22:04:20
>Allison - I think this is one of the reasons that I pretty instantly regretted setting up an appointment. I can get very overwelmed just thinking about it being December without adding another stressor. I've done very little shopping and have few ideas about what to get people. I have to fly to Atlanta for the weekend before XMAS for a surprise bday party for my sister, and will probably have 6 extra people staying in my house for the holidays. I'm keeping my fingers crossed that it doesn't also get real crazy at work like it very frequently has in prior years. Thanks for your response. ksvt
ksvt,
> You've already gotten lots of good advice that I cannot improve upon. I kind of like your idea of increasing the dose of what you're taking for the moment. Does your pdoc know you reduced the dose?
>
> Speaking for myself, I'm not sure I would want to be going through a med change with the holidays so near knowing that it can take weeks for a new one to reach the point of efficacy. Or maybe I'm just a chicken, but holidays are stressful enough without added uncertainties.
>
> Best wishes,
>
> Allison
Posted by ksvt on December 2, 2000, at 14:35:17
In reply to Re: Thanks for alot of good advice » ksvt, posted by shellie on December 2, 2000, at 10:57:53
> Shellie - how long did you stick with the 2 pdocs you eventually left? Was it awkward making that switch? Thanks ksvt
Hi ksvt:
>
> My situation in finding a pdoc was a bit different, because my therapist was not involved with helping me find a new one (the doctors she works with I already knew from being in the hospital years ago--they all work with dissociative disorders.) The one we both really liked wasn't accepting my insurance anymore, so that's why I was leaving. So I didn't have to deal with treading on her toes, if I disagreed with her re pdocs.
>
> For me, these were my issues that I asked: (1) Had they had experience with hard to treat depression (and in my case dissociative disorders also) (2) Would they be willing to combine drugs with an MAOI if there was literature about it, even if it wasn’t sanctioned by the PDR. (3) How available are they by phone? I said I needed a lot of support when I am changing meds and would they be willing to provide frequent five minute conversations. (4) Would they trust me, if I said, "this doesn’t feel right to me." –actually trust my many years of experience.
>
>
> I tried two docs , one who saw you often for less than fifteen minutes, and one who had twenty minutes appointments: these particular physicians were known in my area for treating depression. The shorter appointments did not work for me, and I ended up leaving both of them and going back to my first pdoc, paying her out of pocket, and figuring when I am again stable then I will switch pdocs.
>
> So next time I look for a pdoc I will also ask how long their medication appts are; as opposed to the first appointment. Fifteen minutes is not acceptable to me because I come in with a lot questions, and 1/2 hour until I am stable on a med is the least I would be willing to accept.
>
> Our needs may be different, so you need to take some time to think about what YOU need from a pdoc, and articulate that to them. Mostly I used the things I liked from my old pdoc, so it wasn’t that difficult to come up with a list; and you also have that advantage.
>
> During most "interviews", the pdoc is quite willing to ask all the questions, so I found it helpful to bring in my list in written form. That way they knew I had concrete questions and allowed me the time for them. Somehow it helped shift the interview from them interviewing me to me interviewing them.
>
> Hope this is a bit helpful, shellie
Posted by shellie on December 3, 2000, at 10:26:05
In reply to Re: Thanks for alot of good advice » shellie, posted by ksvt on December 2, 2000, at 14:35:17
> > Shellie - how long did you stick with the 2 pdocs you eventually left? Was it awkward making that switch? Thanks ksvt
>Hi ksvt (and I do think of you by your name!).
Both of these pdocs were extremely easy to leave. The twenty minute pdoc got very snappy at me during our fourth session when I went five minutes overtime. We started late; I didn't keep track of time, and feel that is her responsibility to end the session. I think she was already upset that she had gotten off of schedule. I didn't feel a rapport with her yet, although I did think she was very knowledgeable. She seemed very cold to me, and when I told her twenty minutes didn't seem long enough when I am just starting a med, she was unwilling to make any adjustments. I e-mailed her that because of conflicts in personality, I would not be returning.
When I tried again (just over a month ago), I was in a desperate state. I was not in agreement with my pdoc about many things and wanted to get someone else's imput. I didn't formally terminate with her, told her I had made an appointment for a consultation. I saw this guy four times in two weeks; I always had to wait about 45 minutes to see him for 10; By the third appointment, I realized he double scheduled for 15 minute appointments! It was like a zoo in there. Once he didn't have my chart, and I had to quickly go over everything again. I was in horrible shape and really needed someone to connect to to get me through this. Plus, he didn't seem to have anything to offer anything that I didn't already know. So, I just never went back after the last time I saw him, and again ran back to my old pdoc (paying out of pocket).
If I didn't have an former pdoc-I don't know what I would have done in either case. My guess is I still would have left, but gone to someone else that I had known from the past--just to get me through. Even though I have lost some trust in my pdoc during the past six months, I don't know anyone smarter, or who is willing to give me as much time, or relate to me as personally. She's been my pdoc for about ten years; and during that time became very well known in my city, but she was my doctor before she became known as "the expert" in depression. It's going to be very hard I think, to disengage from her and find a new pdoc (but I can't afford to continue to pay out of pocket) and I will wait until I am stable.
I went to a new gyn and think she's terrific, and like the rest of my doctors, so I think it is possible for me to like doctors. For some reason, pdocs seem particularly difficult to me--probably my expectations are a lot higher and my needs are a lot greater. I think it has to do with a contradiction I set up: a confusing mix of wanting to be taken care in a childlike way when I feel so suicidal, AND wanting to be respected as a adult.
Anyway, I know it is much more difficult to leave a pdoc you really like, so I would guess if you like this new person, you're still going to have to work really hard to take the time to build up an alliance. Maybe this could have happened with me and the twenty minute therapist, if I didn't know I had someone for me to run back to. Maybe I would have taken the time to try to make it work, since she did have the knowledge and experience I needed.
btw, I did interview two other pdocs when my pdoc stopped accepting my insurance and found neither of them acceptable. One thought, when I told him I took codeine for pms, that I wasn't admitting that I was an addict, and if I wanted to work with him I had to go to a twelve step group. (He called my therapist and told her this). The other framed questions to me in such a way that I felt like she only wanted to take med cases on if they were not a bother, and I didn't want to be in that position.
I hope this post is not too discouraging. You have to keep in mind that my expectations are probably not reasonable, but I go for them anyway.
shellie
Posted by allisonm on December 3, 2000, at 16:11:28
In reply to Re: I could use some advice » allisonm, posted by ksvt on December 2, 2000, at 14:29:39
I suppose I'm lucky. The few friends and relatives that I have left live in fairly far-flung areas. I bought them all amaryllis plants through a catalog. For the non-plant types, I sent dates stuffed with pecans from another catalog. The couple of closer friends I have I bought presents for at an art festival over the summer when I wasn't stressed out about Christmas. Now I only have my dad left and my best friend and her two children. The children should be simple -- their mother gives me a list. For my dad I also ordered nuts, pumpkin seeds and candied ginger from the nut catalog. He doesn't really need anything, so maybe that will be it unless I think of something else.
Candles. Candles make a nice present. They're pretty and you can use them. Can you do any shopping while you're in Atlanta? It might not seem so much like Christmas shopping and you might find something you'd not find at home.
Easier said than done, but try not to beat yourself up about what you're giving. Think more about yourself this Christmas and what will be less stressful for you. They won't know, and ten years from now, or even a year or two from now, no one will remember what you gave them anyway. I think I remember what I gave people more than they remember what I gave them because I have trouble remembering what they gave me. (Did that make sense?)
Just some thoughts off the top of my head.
Allison
Posted by ksvt on December 3, 2000, at 21:06:54
In reply to Re: I could use some advice » ksvt, posted by allisonm on December 3, 2000, at 16:11:28
> Allison - thanks for the ideas. Your post actually gave me a real chuckle for the first time in an otherwise pretty hectic day. Here's why:
1) I gave every elementary school teacher i ever had, bayberry candles for Xmas.
2) My 12 year old daughter is going with me to Atlanta, and altho she claims to understand the significance of it being my sister's 50th birthday, she really thinks we are just going to shop. I'll be lucky if i don't have to spend a huge chunk of time in Claires or Afterthoughts or any of the other myriad of mall accessories stores where nothing seems to cost more than about $6, everything seems to look the same, and my daughter takes hours making each decision. There are no malls where I live so I rather look forward to getting into one.
3) I find it incredible that you can remember what you gave people. My husband gives me a chenille sweater every year that looks suspiciously close to the color of the one he gave me the year before. My sister gave me the book Bird by Bird 2 successive years for my birthday. The next year she gave me a different book but made a very clever book cover which matched the cover of Bird by Bird altho hers was marked a "special birthday edition."
My husband made me sort of run through a list of things I thought we should get for people. Somehow enumerating things made it seem like it wasn't going to be so hard. At some point I'll panic, lose track of what I've done, and probably start way overspending, mostly on my husband or kids. My husband's attitude about my doing this is don't sweat it, it's Christmas. I guess that's probably a healthier way to look at things, but runs against my rather puritannical inclinations. Thanks ksvt
I suppose I'm lucky. The few friends and relatives that I have left live in fairly far-flung areas. I bought them all amaryllis plants through a catalog. For the non-plant types, I sent dates stuffed with pecans from another catalog. The couple of closer friends I have I bought presents for at an art festival over the summer when I wasn't stressed out about Christmas. Now I only have my dad left and my best friend and her two children. The children should be simple -- their mother gives me a list. For my dad I also ordered nuts, pumpkin seeds and candied ginger from the nut catalog. He doesn't really need anything, so maybe that will be it unless I think of something else.
>
> Candles. Candles make a nice present. They're pretty and you can use them. Can you do any shopping while you're in Atlanta? It might not seem so much like Christmas shopping and you might find something you'd not find at home.
>
> Easier said than done, but try not to beat yourself up about what you're giving. Think more about yourself this Christmas and what will be less stressful for you. They won't know, and ten years from now, or even a year or two from now, no one will remember what you gave them anyway. I think I remember what I gave people more than they remember what I gave them because I have trouble remembering what they gave me. (Did that make sense?)
>
> Just some thoughts off the top of my head.
>
> Allison
Posted by Noa on December 4, 2000, at 6:39:10
In reply to Re: I could use some advice » allisonm, posted by ksvt on December 3, 2000, at 21:06:54
K,
That idea--that getting through the holidays is the primary goal--sounds good. Then, upsetting the system to try new meds can be something to take up afterward.
Go easy on yourself, like Allison says.
Funny about the suspiciously similar sweater---somehow I can picture a lot of guys doing the repeat sweater thing--you know, if he bought the sweater one year and you liked it, heck, it was successful, go for it again this year! To guys, having multiples of a favorite clothing item is nirvana anyway, is it not?
Posted by ksvt on December 4, 2000, at 13:37:29
In reply to Re: Thanks for alot of good advice » ksvt, posted by Noa on December 1, 2000, at 16:53:19
> Noa - I just found my most recent bllod work results (March, 2000). I don't know what any of the tests are for or, obviously, what the results mean. My T4 was 8.7 and my TSH was 1.99. There was no T3 (I think you mentioned this one). Could you fill me in on what all this means? Thanks k
If waiting is hard, go ahead and start the process of transferring to a new doc now.
>
> About the thyroid---what I have learned is that many docs trust the statistical norms for TSH results as the "Truth" for everyone, but the real TRUTH is that for some people, the edges of the normal range is not normal for them.
>
> My TSH tested at the border of normal, but I felt horrible. One review in the Brittish Journal of Medicine found that a TSH of 2 or above (when TSH is high, it can indicate hypothyroidism, when it is low, it can indicate hyperthyroidism) was highly correlated with later overt thyroid disease. But docs consider anything between .5 and 5 (approximately--it can be differnt for different labs) to be "normal". Mine tested at about 4.5. I was in horrible shape. Not until I was on enough thyroid hormone that my TSh went down to below 1 did I start to really feel better.
>
> What were your TSH, Total T4, and T3 results numbers? (Do you mind my asking?)
>
> Lots more info in the THyroid and Depression folder--link at top of PSB page.
Posted by ksvt on December 5, 2000, at 21:03:05
In reply to Noa - thyroid results, posted by ksvt on December 4, 2000, at 13:37:29
> > - I wish I could take some of you with me on pdoc appointments. I might do alot better job at maintaining my focus. I saw my pdoc this morning and as is typical, came away feeling that I really hadn't explained myself very well, or made him understand what I was trying to accomplish. I got him to increase the dose of the drug I'm taking now. He tried to suggest that i try another augmentation drug, but his effort seemed really half-hearted, and he rather quickly backed off one we had discussed before (celexa) because it's an SSRI and I haven't responded to those all that well in the past. So I sort of ended up where I wanted to before I went but I still felt so crummy about it afterwards. I think it's because what I really wanted from him, and didn't get, was some acknowledgment that it is worth the trouble to explore meds alternatives - that there is room for improvement and that improvement is a viable goal. Unfortunately, I've been in pretty good shape for the last couple of days so I don't (at least didn't today) present as someone in distress. As horrible as I feel sometimes, there is still a quantitiative difference between now and when I first started seeing him. I don't see him very often now, so unless I'm sitting in his office with a gun pointed at my head, he just sees how much better I am. I realized after the fact that I had spent a chunk of the time trying, in my rather awkward way, to convince him that I wasn't just some hypochodriacal woman who can't tough out a little mood shifting. (he seems to think alot of it may be PMS) I don't know why this is important since my therapist was pretty encouraging that I go so I don't think she feels that was. I decided that if I'm going to get anywhere with a new doc, I'm going to have to do a better job of explaining the frequency and severity of my depressive feelings. So I came up with the idea (ala Shellie's spread sheets) of trying to chart my moods like by diary entries or something. Have any of you tried this and if so, was it helpful?? ksvt
Noa - I just found my most recent bllod work results (March, 2000). I don't know what any of the tests are for or, obviously, what the results mean. My T4 was 8.7 and my TSH was 1.99. There was no T3 (I think you mentioned this one). Could you fill me in on what all this means? Thanks k
>
>
>
>
>
> If waiting is hard, go ahead and start the process of transferring to a new doc now.
> >
> > About the thyroid---what I have learned is that many docs trust the statistical norms for TSH results as the "Truth" for everyone, but the real TRUTH is that for some people, the edges of the normal range is not normal for them.
> >
> > My TSH tested at the border of normal, but I felt horrible. One review in the Brittish Journal of Medicine found that a TSH of 2 or above (when TSH is high, it can indicate hypothyroidism, when it is low, it can indicate hyperthyroidism) was highly correlated with later overt thyroid disease. But docs consider anything between .5 and 5 (approximately--it can be differnt for different labs) to be "normal". Mine tested at about 4.5. I was in horrible shape. Not until I was on enough thyroid hormone that my TSh went down to below 1 did I start to really feel better.
> >
> > What were your TSH, Total T4, and T3 results numbers? (Do you mind my asking?)
> >
> > Lots more info in the THyroid and Depression folder--link at top of PSB page.
Posted by quilter on December 6, 2000, at 1:20:25
In reply to RE: pdoc appt., posted by ksvt on December 5, 2000, at 21:03:05
I have been using a calendar kind of thing I got from the Stanley Bipolar Foundation to chart moods, meds, sleep, monthly cycle, and side effects. They also supply a Life Chart to keep track of long term patterns and med history. I haven't tackled the Life chart but the calendar has been invaluable since my med cocktail got so complicated.
My memory for when things happen is really poor, so it's been helpful to be able to look back and see that my back has been sore since the middle of last month, or I decreased that med on the 14th, for example. I'm not bipolar but it still really helps anyway. I also make a list before I see my pdoc so I don't forget what I intended to cover with her.
I found the Foundation by doing a search but will try to dig up an address If you have no luck. There is no charge for these things. They even returned my check when I tried to send a donation.
Quilter
Posted by shellie on December 6, 2000, at 15:26:10
In reply to RE: pdoc appt., posted by ksvt on December 5, 2000, at 21:03:05
Hi ksvt. I wasn't the spread-sheet person, I think that was Racer. I have the same problem that you mentioned both in therapy and with my pdoc. I can only relate to how I am on any particular day--forget if I felt suicidal two days before. But I don't have the patience to fill out daily forms.
With my pdoc, I always take notes with me. How I've been feeling, and specific questions about drugs. This week all my questions will have to do with lamictal and breast pain and weight gain. I've already sent her a fax with my issues. It seems to save time to have her know, the questions I want to ask her, both to allow time and in case she wants to look something up before I go. Also, it keeps me on track. I've gotten so efficient with faxes, that when I ask the secretary to leave my podoc a message, she asks me please to send a fax (I mean why should she bother to write anything down, when I do it all).
Actually, in regards to my pdoc in general, I am a frequent faxer. She, on the other hand, returns my faxes with phone calls. Shellie
Posted by ksvt on December 6, 2000, at 17:57:08
In reply to Re: RE: pdoc appt., posted by quilter on December 6, 2000, at 1:20:25
> Quilter - thanks for the tip. I think I found what you were talking about and if I filled everything out correctly, I think I'm going to receive a life chart. I didn't see anything about the calendar. Did it automatically arrive with the chart? Thanks again ksvt
I have been using a calendar kind of thing I got from the Stanley Bipolar Foundation to chart moods, meds, sleep, monthly cycle, and side effects. They also supply a Life Chart to keep track of long term patterns and med history. I haven't tackled the Life chart but the calendar has been invaluable since my med cocktail got so complicated.
>
> My memory for when things happen is really poor, so it's been helpful to be able to look back and see that my back has been sore since the middle of last month, or I decreased that med on the 14th, for example. I'm not bipolar but it still really helps anyway. I also make a list before I see my pdoc so I don't forget what I intended to cover with her.
>
> I found the Foundation by doing a search but will try to dig up an address If you have no luck. There is no charge for these things. They even returned my check when I tried to send a donation.
> Quilter
Posted by ksvt on December 6, 2000, at 18:02:42
In reply to Re: RE: pdoc appt. » ksvt, posted by shellie on December 6, 2000, at 15:26:10
>Shellie - I like the fax idea, altho I'm a little wary about the privacy of faxing. I haven't seen my pdoc much - we've communicated mostly by phone, which isn't a great medium for me. I did write him a long letter in advance of one meeting and that certainly was helpful in making sure all my issues got addressed. Maybe I'll do better with the next pdoc. thanks again ksvt
Hi ksvt. I wasn't the spread-sheet person, I think that was Racer. I have the same problem that you mentioned both in therapy and with my pdoc. I can only relate to how I am on any particular day--forget if I felt suicidal two days before. But I don't have the patience to fill out daily forms.
>
> With my pdoc, I always take notes with me. How I've been feeling, and specific questions about drugs. This week all my questions will have to do with lamictal and breast pain and weight gain. I've already sent her a fax with my issues. It seems to save time to have her know, the questions I want to ask her, both to allow time and in case she wants to look something up before I go. Also, it keeps me on track. I've gotten so efficient with faxes, that when I ask the secretary to leave my podoc a message, she asks me please to send a fax (I mean why should she bother to write anything down, when I do it all).
>
> Actually, in regards to my pdoc in general, I am a frequent faxer. She, on the other hand, returns my faxes with phone calls. Shellie
Posted by quilter on December 6, 2000, at 23:15:29
In reply to Re: RE: pdoc appt. » quilter, posted by ksvt on December 6, 2000, at 17:57:08
It did come with the packet. I just found the envelope and I haven't looked at any of the other stuff at all by the looks of it. Guess I should give it a try.
Quilter
This is the end of the thread.
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