Well, I went to the pdoc (1st time)...

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Registered: 04-24-2003
Well, I went to the pdoc (1st time)...
11
Fri, 07-14-2006 - 4:17pm

Caution, some mention of SI further down, possible triggers.

Sorry, it's long, too.

Ok, well, I went. I did what I was supposed to do. Whoopie. Sorry, I'm a little bitter right now. I was there about 10 minutes early for the noon appt. I got taken back with the doctor at 12:25, fuming inside, but of course not saying anything. He never apologized for being 25 minutes late for the appt. You've all been there: first question, why are you here. My answer: because my tdoc told me to come. Next question: tell me about your moods (or something along those lines). I told him all the stuff I could as he kept changing the subject or not letting me finish. I was out of there within 30 minutes. He told me tdoc sent some information over stating she thought I was bp. He totally agreed, no questions asked. He mentioned bpII, he felt that was what the dx was. It didn't make sense to me, as my most recent episode was mixed, and if you have a mixed episode, you automatically get bpI dx. Of course, I didn't question him.

He was surprised that I was just on an a/d and was very sure that I should also be on a mood stabilizer. He wants to up the bupropion (wellbutrin) but refuses to do it until I have a mood stabilizer in me and he is sure it is working. He thinks the bupropion is a good choice for me but again, not alone. He discussed the three main bp meds and told me there was no way he was going to give them to me because since I am so against meds, he figured the side effects would make me stop taking them very quickly and he would never see me again. He had a smirk on his face when he said that. I appreciated his trying to get me to put my guard down. He wants me to take topomax and said he will start me out at 25mg and very slowly work me up to a theraputic dose. Once I am there, he will increase my bupropion to help me out, but not until then. He was not pushy about the meds but did tell me he was "going to twist my arm to take it" as he was really concerned the a/d alone was causing me some of my current problems and that I could get worse if I continue on this path. He went through a lot of information about other meds but really wanted to be careful with my lupus. He would not give me lamictal because of the potential of a serious rash and he wanted to make sure that we could distinguish a lupus rash vs. a med reaction. He really wanted me to take the lamictal; he thought it would be best for my symptoms, but he was very considerate of my underlying medical condition. I was very appreciative that he listened to me about that and was sensitive about my med anxiety.

Before I left, I asked when I should call regarding side effects. He said he wants me to call about anything. He wants me to feel comfortable with the meds and if anything bothers me, I should call, even if it is something that seems trivial. He understands my anxiety and wants to decrease that as much as possible.

I was very annoyed with the visit, as it started out pretty crappy, but by the time I left, I felt pretty good about it overall. I'm still upset about some parts, but the things that were really important (my lupus and my med anxiety) he really listened to me and tried to help me feel better about it all.

When I left, my head was spinning. I was clenching my teeth and I had major thoughts of SI. I was on the verge of tears and slipped pretty quickly into a minor depression. I was feeling very mad at my tdoc for "making" me go and felt like calling her and leaving a very ticked off message on her voice mail. But, I didn't. I filled my rx and came home. I'm still not real comfortable with everything, but I've resigned to the fact that I really need to deal with this, as it is definitely getting worse as time goes on (dh said it's been noticable for almost 2 years, but he still thinks I have a very "mild" case of bp).

The bill I got from pdoc actually stated the dx as bpI, most recent episode mixed, which was what I was expecting it to be. I don't know where the bpII statement came in during the session, but that is not what he dx'd me with. He also said I had many traits of borderline personality disorder because of the SI and the experiences I had as a child (being abused) also made that dx possible. He did not put that as a dx though, he just mentioned it in passing.

So, I guess it's all officail. I'm starting the topomax tonight. If anyone has any input about topomax, good or bad, I'd appreciate the information.

If you read this far, thanks for listening. I needed to vent a little, as I'm still not feeling real good about this yet.

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iVillage Member
Registered: 04-07-2002
Fri, 07-14-2006 - 4:55pm

Good for you, going to see the pdoc! Every bipolar should have one. But, they do do crappy things, like keeping appointments late, cancelling on you (I had one that did that a lot), etc. They seem to forget that we have important schedules, too. My current one gets me in and out of his office in about five minutes, but that's OK with me, as that's all I seem to need him usually. Besides, I often get to see him earlier than my scheduled time, so that's a bonus a lot of times.

I've noticed that bipolar I, II and III get confused a lot. I don't care what they call me personally as long as my problems are fixed. Dx and personal etiology can change over time, too. When I was in my early 20s, I believe I was bipolar III, but then I shifted over time to bp I.

Good luck with your new meds!

Express!
Beth "Petrouchka"

iVillage Member
Registered: 07-14-2005
Fri, 07-14-2006 - 10:26pm

Peg-

I know it's hard to hear the diagnosis, even when you know it before you even step into the office like I did. If yours is anything like mine, there's so much you want to say but so little time, and they just want to medicate you and get you out of there. I'm sorry you couldn't take the lamictal as it has had less side effects so far for me than anything, but I hope that tomapax works out for you! I do think it's supposed to cause weight loss though so you may have to start eating more ;) Good luck dealing with the diagnosis, I know it's hard but like you said in the end it's best to deal with it. I know I still haven't quite accepted it. Let me know how the topamax goes! Did he say what to expect at all or how long it would take to be theraputic?

Hang in there,
Meg

iVillage Member
Registered: 05-02-2006
Fri, 07-14-2006 - 10:55pm

Hi Peg. I'm glad you went to your pdoc. Yes, sometimes they can be very annoying, especially when they keep us waiting. Maybe he will get better.


As for the topamax, I take it, but not for a mood stabilizer. I only take 50mg a day to off-set the weight-gain effect of the zyprexa that I take. I wish I could be of more help on that.


As Beth pointed out, whether

Avatar for suziq_3
iVillage Member
Registered: 03-25-2003
Sat, 07-15-2006 - 9:08am
i feel for you.actually your pdoc sounds better than most.give him a few sessions & see how you feel.
i am pdoc bitter right now.i have been to pdoc hades & back.
one who fell asleep during sessions.one who never returned one call i ever made.one who talked about my breasts every session.oh,& saw a patient attack me in his waiting room & ran & hid in his office(REALLY!LOLLOLLOL)that was our LAST session.one that said i was just a very very bad person who didn't have proper respect for my husband AND the one who let me tell my story & told me i was waAAAAY too sick to be her patient.
then i found the dr. i fell in love with.so what that he cost 500$ the 1st visit & close to 400$ each visit thereafter.so what that the average waiting time in his office is AT THE VERY LEAST AN HOUR even if you are the 1st patient(??????????????)& you have to find impossible parking close enough so you can re-feed your one hour parking meter
& now that he's comfortable with me being stuck with him he has begun to blow me off & twist my emails begging for some sort of help.
even my tdoc says he does it because he CAN& he's the only gig in town.
i'm seriously thinking of forgoing treatment altogether & just having my tdoc.
now that i'm thru talking about ME(i'm sorry)
i think you are very observant & very smart.
also i hear only good things about topomax.i think i took it.don't know why i stopped.but i never had problems or side effects.
iVillage Member
Registered: 10-23-2004
Sat, 07-15-2006 - 11:18am

Peg,

Good for you for seeing a pdoc. I've had a few different ones (I usually see residents and they rotate out). I've had a couple I didn't like and I always count on them being at least 20 minutes late (it seems like every doctor is at least that late). I just wanted to chime in with my $0.02 on mood stabilizers. I was on a/d's alone for a while and they made me really crazy. Only when I started on a mood stabilizer did things start to calm down. For me it also took an anti-psychotic but the mood stabilizer made a huge difference. There's no way I would give mine up now (even with the side effects). My pdoc said Topomax is one of the best. I had a choice between that and Lamictal and I chose Lamictal (pdoc thought it might work a little better in my case). Let us know how the Topomax works.

Morgaine

Avatar for suziq_3
iVillage Member
Registered: 03-25-2003
Sat, 07-15-2006 - 2:06pm
oh yes...i remember.topomax can make you "stupid" for a while till you get used to it.that's why it's increased slooowly.it's sometimes referred to as "dope-amax" as it can give one the appearance of being drunk.i suppose some people take it at night...but as you get used to it the side effects subside.
Avatar for peg_t
iVillage Member
Registered: 04-24-2003
Sat, 07-15-2006 - 9:43pm

Hi Beth,

I agree, pdocs (well, any doc really) are prone to do crappy things...I think it is part of their schooling LOL!

I really don't care about the technical dx- just like you, I just want the problems fixed. My ds has had a list of dxs since he was 18mos old. They keep changing...but as long as he gets help in school and therapy, I don't care what they call it. When I'm in a defensive mode, as I really tend to be when doing something I don't want to do, I just look for things that are "wrong". I did a lot of research about bipolar so I felt confident that I knew what the dx was going to be. When he stated bpII, it was just an open door for me to find fault with the pdoc. It's stupid, but that's what I was thinking at the time.

I'm over it now ;-).

Peg

Avatar for peg_t
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Registered: 04-24-2003
Sat, 07-15-2006 - 9:53pm

Hey Meg,

I think the pdocs all want to just get to the point as quickly as possible, write the rx and charge for an hour! It's such a scam how they fleece the insurance companies. My pdoc charges for a full visit for a 10 min. med check! I'm going to call to see what they would charge me out of pocket- if it's about the same as my copay, I'll just pay it so I don't use all my visits.

He did not say how long it would take to be theraputic. I am guessing quite a while. I am starting at 25mg for 2 weeks, then upping it to 50mg. I will be on that dose for a week before seeing him again. At my next visit, he will tell me how long to stay at 50 before going to 75, then eventually 100. He made it sound like that was the dose he thought would work for me. So, it may take a while. I researched dosing on the internet and some people find that 50mg is enough to help. I hope I'm that lucky.

Unless my tdoc told him about my weight loss in her very brief letter to him, pdoc has no idea about that problem. I didn't really have the chance to bring it up and I didn't really know that topamax had a weight loss side effect until I researched it more when I came home. I will let him know when I see him again because it is something I need to be aware of. I'm not supposed to be weighing myself more than once per week, but I am, just to keep a handle on where I am. I would hate to loose 2-3lbs or more in a week then have to try and play catch up or have tdoc admit me cuz she thinks I'm doing it on purpose. I will discuss that with her when I see her next week- I know she will not be thrilled that I am now on 2 meds that may cause weight loss.

Take care,
Peg

Avatar for peg_t
iVillage Member
Registered: 04-24-2003
Sat, 07-15-2006 - 10:03pm

Traci,

As much as I just really wanted to only find faults with this guy so I had a reason to bail, I have to give him credit for being aware of the lupus. I dislike doctors, but I have been very diligent about letting them know about any new symptoms etc, even if they don't seem to be concerned, I still let them know. I am learning to do this for myself, as I typically do nothing to take care of "me". That is why going to the pdoc was even more of a challenge. I had to tell myself that I was doing it for dh and the kids. Eventually, I accept I am doing it for myself, but sometimes I need to do that to take the first step.

I'm not really sure about the bpd side note, maybe tdoc wrote something in her letter to him. I don't know what she told him. Or, maybe that is just his experience- that many SIers are bpd.

I am really glad I have this place to vent. You "guys" understand that sometimes, you just have to do that, even if it's over something little.

Thanks!
Peg

Avatar for peg_t
iVillage Member
Registered: 04-24-2003
Sat, 07-15-2006 - 10:17pm

Wow, you have been through pdoc h*ll! I can't imagine waiting for an hour and being the first patient...that would send me over the edge! I'm going to stick with him, if only for the fact that he was very sensitive to my lupus and to my aversion to medication.

Don't apologize for talking about your experiences...I learn a lot from hearing other people! Often, I find that more helpful than "text book" stuff.

Thanks for your support and encouragement.

Peg

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