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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by floatingbridge on January 24, 2010, at 4:47:17
Hi, I have a psych consult Monday. I feel fairly focused and prepated. After a very helpful visit w/ my pdoc on Friday, I'm presenting with a diagnosis of MDD redcurrant and chronic ptsd. My doc's own belief is that my condition is 60% psychological, 40% biological--hpa dysregulation of some sort.
What I want is a more stable, higher
baseline with less susceptibility to triggers and hyper-arousal. He suggested, perhaps the anticonvulsants
lamical or lithium (600 which seems way
too high!). I'd like to jettison my 50mg of pristiq.He is against AP's in my case. And kinda
Blew off parnate (due to washout).So, I'm bringing:
mood / med chart
list of somatic symptoms
list of all psych meds ever taken plus current supplements and herbs
concise history of traumas in addition to usual treatment summary and dates of onset
a trusted friend-- possibly my husband--could this be helpful, having someone quietly sit in with me?
Should I bring a recorder in case that is permitted?
Anything else I should or shouldn't bring?
I'm feeling o.k. about this.
fb
Posted by janejane on January 24, 2010, at 6:05:18
In reply to pre-consult checklist?, posted by floatingbridge on January 24, 2010, at 4:47:17
You sound very prepared, fb. I think bringing your husband sounds like a great idea. Will they let him in with you at your appointment? Even if he only sits in the waiting room while you're in there, at least you could gets hugs and reassurance before going in and after coming out. I think there's a really good argument for him to accompany you during the actual consult, though, since he might notice things you're not aware of that would be helpful in your assessment. I like the idea of bringing a recorder too, or at least a notebook. Do you have a list of questions to ask?
I know you're going to a different clinic than Peanut, so I really hope you get more out of your experience than she did. Will this just be a drive for you? That would certainly make it less stressful.
Posted by bleauberry on January 24, 2010, at 6:06:47
In reply to pre-consult checklist?, posted by floatingbridge on January 24, 2010, at 4:47:17
> My doc's own belief is that my condition is 60% psychological, 40% biological--hpa dysregulation of some sort.
You would need an Integrative MD, Alternative MD, or Naturopath Clinician to accurately test suspected HPA dysregulation and try treatments. That said, the proper meds can restabilize the dysregulation, the wrong meds can either cause it or make it worse. My opinion, purely unscientific, is that anything focused on serotonin without equal balance to NE will eventually cause HPA dysregulation, despite initial acute normalization shown in clinical studies.
>
> What I want is a more stable, higher
> baseline with less susceptibility to triggers and hyper-arousal.Me too. I would set the goal even higher...total remission. Don't cut yourself short. Tell the doc you insist on remission.
He suggested, perhaps the anticonvulsants
> lamical or lithium (600 which seems way
> too high!). I'd like to jettison my 50mg of pristiq.Lithium. It has the longest track record, and I like that it is a natural substance. Lamictal's benefits, if they happen, usually do not last but 6 months to a year in longterm studies. I'm sure someone could debate successfully on this and there will always be isolated success cases, but in general I personally do not see lamictal as a longterm treatment. It just isn't supported in literature and I hardly ever see it in the real world. Lithium, different story. I do not believe shooting for a predetermined dose based on the general pattern seen in larger populations is a good strategy...start low...100mg-300mg...and feel it out from there. Listen to your body to find the right dose.
>
> He is against AP's in my case. And kinda
> Blew off parnate (due to washout).Too bad. That is ruling out some excellent candidates. If I were you, I would ask him for specific detailed reasons why they are being ruled out. I would challenge him on that. After all, me the paying customer, and me owning my body, and me being the boss of what I ultimately do with my body, I have the right to ask questions, challenge ideas, and negotiate for the treatment I believe in. His ideas are important in that mix, but should not by any means be final.
You can always bring in literature from pubmed or the worldwide web to support any of your own ideas. The more the better. For example, trying to "sell" the idea of Savella+Risperdal, or Zoloft+Nortriptyline, or Prozac+Zyprexa, would be strongly supported by the large body of evidence on these things.
>
> So, I'm bringing:
>
> mood / med chart
>
> list of somatic symptoms
>
> list of all psych meds ever taken plus current supplements and herbs
>
> concise history of traumas in addition to usual treatment summary and dates of onset
>
> a trusted friend-- possibly my husband--could this be helpful, having someone quietly sit in with me?
>
> Should I bring a recorder in case that is permitted?
>
> Anything else I should or shouldn't bring?I'm not sure about the recorder thing. Never thought about that. But everything else, definitely. The partner/witness/spouse is great strategy for a variety of reasons.
>
> I'm feeling o.k. about this.
>
> fb
>I hope it goes real well!
Posted by Phillipa on January 24, 2010, at 11:06:37
In reply to Re: pre-consult checklist?, posted by bleauberry on January 24, 2010, at 6:06:47
FB you've been very busy. I always bring my husband and yes he is in the room with me. I'm very anxious and don't hear things sometimes the way he does so he will bring to my attention or we discuss a point in question. They should let him it's your right. Maybe if questions about marriage etc he could be asked to leave. The tape recorder I still think is an excellent idea. Me I'd be climbing the walls waiting and wondering you sound remarkably in control. Write more later. Love Phillipa
Posted by polarbear206 on January 24, 2010, at 23:47:07
In reply to Re: pre-consult checklist?, posted by bleauberry on January 24, 2010, at 6:06:47
> > My doc's own belief is that my condition is 60% psychological, 40% biological--hpa dysregulation of some sort.
>
> You would need an Integrative MD, Alternative MD, or Naturopath Clinician to accurately test suspected HPA dysregulation and try treatments. That said, the proper meds can restabilize the dysregulation, the wrong meds can either cause it or make it worse. My opinion, purely unscientific, is that anything focused on serotonin without equal balance to NE will eventually cause HPA dysregulation, despite initial acute normalization shown in clinical studies.
>
> >
> > What I want is a more stable, higher
> > baseline with less susceptibility to triggers and hyper-arousal.
>
> Me too. I would set the goal even higher...total remission. Don't cut yourself short. Tell the doc you insist on remission.
>
> He suggested, perhaps the anticonvulsants
> > lamical or lithium (600 which seems way
> > too high!). I'd like to jettison my 50mg of pristiq.
>
> Lithium. It has the longest track record, and I like that it is a natural substance. Lamictal's benefits, if they happen, usually do not last but 6 months to a year in longterm studies. I'm sure someone could debate successfully on this and there will always be isolated success cases, but in general I personally do not see lamictal as a longterm treatment. It just isn't supported in literature and I hardly ever see it in the real world. Lithium, different story. I do not believe shooting for a predetermined dose based on the general pattern seen in larger populations is a good strategy...start low...100mg-300mg...and feel it out from there. Listen to your body to find the right dose.
>
> >
> > He is against AP's in my case. And kinda
> > Blew off parnate (due to washout).
>
> Too bad. That is ruling out some excellent candidates. If I were you, I would ask him for specific detailed reasons why they are being ruled out. I would challenge him on that. After all, me the paying customer, and me owning my body, and me being the boss of what I ultimately do with my body, I have the right to ask questions, challenge ideas, and negotiate for the treatment I believe in. His ideas are important in that mix, but should not by any means be final.
>
> You can always bring in literature from pubmed or the worldwide web to support any of your own ideas. The more the better. For example, trying to "sell" the idea of Savella+Risperdal, or Zoloft+Nortriptyline, or Prozac+Zyprexa, would be strongly supported by the large body of evidence on these things.
>
> >
> > So, I'm bringing:
> >
> > mood / med chart
> >
> > list of somatic symptoms
> >
> > list of all psych meds ever taken plus current supplements and herbs
> >
> > concise history of traumas in addition to usual treatment summary and dates of onset
> >
> > a trusted friend-- possibly my husband--could this be helpful, having someone quietly sit in with me?
> >
> > Should I bring a recorder in case that is permitted?
> >
> > Anything else I should or shouldn't bring?
>
> I'm not sure about the recorder thing. Never thought about that. But everything else, definitely. The partner/witness/spouse is great strategy for a variety of reasons.
> >
> > I'm feeling o.k. about this.
> >
> > fb
> >
>
> I hope it goes real well!
>
>
I think your well prepared. Revolution Health thread on Lamictal ratings are mostly positive. Keep in mind that I've been on it over 10 years with great success. Good luck with whatever plan of action you and your doc decide to start with. Keep us posted. :)
Posted by janejane on January 25, 2010, at 18:15:39
In reply to pre-consult checklist?, posted by floatingbridge on January 24, 2010, at 4:47:17
So how'd it go?
Posted by Phillipa on January 25, 2010, at 19:40:45
In reply to Re: pre-consult checklist? » floatingbridge, posted by janejane on January 25, 2010, at 18:15:39
Floating Bridge hoping your're now home and things went well. Been thinking of you all day. Love Phillipa
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