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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Dinah on March 21, 2007, at 10:51:30
I see that the facility mentioned above gives them, but I don't suppose my illness qualifies as severe enough to bother them.
The lack of integration in treatment bothers the heck out of me. I strongly suspect that there are any number of factors that play into my mood extremes. Sometimes my problem is anxiety/agitation.
Right now it's grogginess and stupor.
It could have something to do with my diabetes, yet my diabetes doctor says that my A1c's are fine, so I shouldn't worry myself with fluctuations in daily readings. Yet fluctuations in daily readings would have an impact on grogginess, I'm thinking.
My psychiatrist points me to my sleep neurologist for any physical causes and to my therapist for ones that involve my tendency to dissociate.
But not only do I worry about my sleep neurologist's ethics for a few compelling reasons, but my sleep neurologist clings to the idea of narcolepsy despite sleep lab results that don't support that diagnosis, and despite my trying to tell him that I can't help but think that my tendency to dissociate is also at play here.
My therapist thinks that it doesn't matter why I'm groggy, that the important thing is to take medications to combat it so I can do my job, and then work out the causes later.
And then there's the fact that at other times, somnulance and stupor aren't a problem for me at all. I'm wide awake and often overstimulated and anxious. Any medication for sleepiness at that time is wildly out of place, just as any treatment for anxiety is wildly out of place when I'm half dead with tiredness.
I'm sick of dealing with little pieces here and little pieces there.
Posted by Racer on March 21, 2007, at 12:22:40
In reply to I'd love a comprehensive evaluation consultation, posted by Dinah on March 21, 2007, at 10:51:30
Yep, that totally [emulates a Hoover]. I've felt that way, myself. Of course, in my case it seems much simpler: if a medication combo treats my anxiety, it makes the depression worse -- and if it treats my depression, it makes the anxiety worse. And add in the insomnia, and the somnolence, and the other issues that have gone along with everything for me...
Sure makes me wonder why I bother trying sometimes.
I haven't had a full on eval, but at least my current pdoc seems to be a keeper. I know you've had trouble finding anyone -- other than Dr Wacko -- to see down there, but maybe it's worth trying to find a good internist and asking about integration? I'd think that a GP or internist would be a good starting place for integration, but maybe I'm wrong. (I even like my current GP, amazingly enough.) Even a gynecologist might be a good coordinator for care, if he/she is anything like mine.
Just an idea. It would be good to get better integration. I know some of my physical issues have an impact on my psychological well-being. I have a hip problem that causes a lot of pain, and often keeps me awake at night, or wakes me up. I know that that sort of pain is Not Good for my mental health, it wears me out. Diabetes is similar in that sense -- it's chronic and wears you out. My beloved husband has a hell of a time when his blood sugar is too high or too low, and I know that times when his sugar is out of whack for a while, his mental state suffers. And that despite good A1c readings. (His are great -- but he still has problems day to day.)
Anyway, when I take over the universe, I'll make sure that comprehensive evaluations are offered to all Dinahesque types. And Racers, too. And everyone else...
Posted by Dinah on March 21, 2007, at 12:40:41
In reply to Re: I'd love a comprehensive evaluation consultati, posted by Racer on March 21, 2007, at 12:22:40
I'm on my way to my internist right now to try to pin down this intermittant fever. I will suggest the idea to him if I get the nerve, and see if he has any ideas.
Of course, he's likely to refer me to an ENT or someone as it is, so what good he'll be I'm not sure. :)
I'm not entirely confident in the abilities of my current team. My psychiatrist seemed unfamiliar with Provigil other than it was a stimulant (which I think is unfair, because I wouldn't classify it with stimulants in general). I am looking particularly askance at my sleep neurologist. My ob/gyn and internist are both so new that I have no real feel for them yet.
All the doctors I adored, my headache neurologist and my eye doctor, are gone. :(
Posted by scratchpad on March 21, 2007, at 13:30:43
In reply to Re: I'd love a comprehensive evaluation consultati » Racer, posted by Dinah on March 21, 2007, at 12:40:41
It frightens me to think that I have these different doctors and the only person who is driving the bus is me, with intuition as my guide.
I try to give them each the comprehensive picture of me when I'm at appointments - tomorrow it's the GP about my blood pressure (and his glibly offered advice to "cut down on the salt" in order to reduce my weight) and next week an allergist (wouldn't I love to get seasonal shots and say goodbye to sinus troubles!). I have pretty much abandoned the alternative medicine route apart from following recommendations for supplements. No lasting relief there for depression or anxiety. The chiropractor who looks at my sore lower back declares, "it's an emotional issue. There's nothing wrong structurally with your back," and I'm left holding a couple of ibuprofen and wondering whether another 800mg will send my liver off to never never land.
It's an issue.
scratchie
I guess in this age of medical specialty practices, we are our own team leaders.
Posted by Dinah on March 21, 2007, at 14:22:45
In reply to Re: I'd love a comprehensive evaluation consultati » Dinah, posted by scratchpad on March 21, 2007, at 13:30:43
I suppose so. :(
I just told my internist that I felt like the elephant being examined by the blind man. Each specialist takes a very narrow view, and none seems inclined to try to make a coherent whole.
I'd think it would be the psychiatrist that would try to balance all the factors influencing his patient's mental health, but this is clearly not the case.
My internist was quite sympathetic, even perhaps taken with the concept, but said that in today's New Orleans, if you have any psychiatrist at all it's best to hold on tight. I guess I sort of knew that, even if it's a psychiatrist who isn't that familiar with Provigil.
For the record, he didn't think my diabetes could be a contributing factor since my quarterly results were just fine. :) And he thought maybe it might be time for another sleep test.
Arrrgh. I don't feel competent to be my own team leader.
It did occur to me to try to start keeping records again. I think I got too fancy in the past with recording my mood, and ended up neglecting it because it was too much trouble. Instead, I think I'll just look at monthly calendars and make nonspecific standardized notations so that I can see, for example, when my long periods of grogginess start and end, or when I am having a period of anxiety, or feeling good, or overstimulation.
I doubt I'll be able to see causes or triggers, but it might give the professionals a better picture of what general period of time my cycles come in.
Posted by Declan on March 21, 2007, at 16:00:30
In reply to I'd love a comprehensive evaluation consultation, posted by Dinah on March 21, 2007, at 10:51:30
My nutritional doctor thought glucose/insulin/cortisol problems were implicated in my insomnia and fatigue.
The feeling during a Glucose test, you know the one where they give you this glucose to drink, and then take readings?
When that glucose kicks in there is tiredness, and when the insulin lowers the glucose level the cortisol will kick in to raise the insulin, making you nervous, or somesuch if you get my drift.
Posted by Dinah on March 21, 2007, at 16:47:37
In reply to Re: I'd love a comprehensive evaluation consultati » Dinah, posted by Declan on March 21, 2007, at 16:00:30
See, I tend to think that too, and it's kind of discouraging to have my doctor more or less dismiss the psychological effects of my diabetes.
I quit testing in a snit when my doctor told me to ignore my daily readings, but perhaps I'll start again for my own purposes.
Posted by gazo on March 21, 2007, at 16:55:24
In reply to I'd love a comprehensive evaluation consultation, posted by Dinah on March 21, 2007, at 10:51:30
I am sorry, it all sounds very complicated. It's enough to deal with just any one of those things. I wish I had help to offer..:(
Posted by annierose on March 21, 2007, at 19:55:24
In reply to I'd love a comprehensive evaluation consultation, posted by Dinah on March 21, 2007, at 10:51:30
Just offering my support. I hope you feel better - all of you and just bits and pieces.
Posted by Dinah on March 22, 2007, at 10:07:04
In reply to Re: I'd love a comprehensive evaluation consultation, posted by annierose on March 21, 2007, at 19:55:24
I guess in this day and age, compartmentalization is necessary and time is short with each patient. But I think they take it a bit too far.
Posted by Happyflower on March 22, 2007, at 19:18:29
In reply to Thanks :), posted by Dinah on March 22, 2007, at 10:07:04
Dinah,
Do you get any kind of cardio exercise? It might help some of the anxiety, sleep problems, and diabetics and it costs nothing but 30min. a day and might give you more energy during your waking hours where you won't miss the 30min., and it certainly is good for you.I know it is easier said than done, but for me, I think it made a huge improvement in many areas of my life and I wasn't an exerciser before. In fact I hated it.
Posted by Dinah on March 23, 2007, at 10:02:56
In reply to Re: Thanks :), posted by Happyflower on March 22, 2007, at 19:18:29
That's the message I get, and I really will try to follow it when I have room to breathe. But at the moment, cardio exercise would pretty much do me in, and I'd be useless for the rest of the day.
Exercise may energize eventually, but until eventually, it exhausts.
Once I catch up on my work (if such a happy day ever comes) I may try to follow that excellent advice.
Posted by Happyflower on March 23, 2007, at 17:37:41
In reply to Re: Thanks :) » Happyflower, posted by Dinah on March 23, 2007, at 10:02:56
Hi Dinah,
I am glad you are open to the idea, but just another thought for you . You tell me that it would exhaust you, but how much energy do you think you are using being anxious and not sleeping well?
What I mean by cardio would be like a 30 min walk and doesn't have to be fast or anything. But I know it is easier said than done, so you can tell me to shove the idea! LOL It is okay it won't offend me! LOL
Posted by Dinah on March 23, 2007, at 17:41:48
In reply to Re: Thanks :), posted by Happyflower on March 23, 2007, at 17:37:41
The weird thing is that I'm not at all anxious right now, and haven't been for weeks.
I really need to keep track of my mood cycles, even if just roughly.
I'm sleeping fine, except that I want to do it all the time.
I was talking to my therapist about it today. I told him that I frequently joke that if I wasn't anxious I wouldn't have any energy at all. But maybe it's not a joke.
This is the end of the thread.
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