hi.

not much today, but something anyway. still feeling a strangling emptiness inside.

i dragged myself out of bed and cooked peppers that otherwise would have gone bad. mom had mentioned she would do them i.e. along with dinner. so i know this saved her some time since she is out all day.

it didn't require a lot after everything was cut up. it did require me to get up about every 10 mins to check/stir. the stupid things took an hour and a half! probably i had the heat too low for that quantity - often i cook just one, so have to be very careful. and it usually takes about an hour.

in between and in the afternoon i read. i am having trouble focusing at times. find my eyes sort of glazing over, skipping lines, losing my place, losing train of thought, words just not sinking in, etc. i find some of the book semi-boring/dragged out too but it makes the time pass. it is a historical thriller. not typically my genre but, that considered, not bad. it is archeological-historical, as opposed to say, "victorian high society" historical which would really have me bored off my gourd.

that's all i did today. with "home base" being bed (as usual).

i watched 30 mins of tv. sabrina the teenage witch. and they run the episodes out of order which is annoyinng. there isn't MUCH of a story line... but there is something of evolution of events in the series. grr.

waves

i am relieved i don't have to make a change right now.

but i am not convinced he is the best therapist for me in many ways. supportive therapy, ok. but not in other areas - not even cognitive therapy.

he does not seem on top of the pharmacology much. and he basically lets me run that. which is "ok" under usual conditions, but i'd like someone who can give me cutting edge news... hey, this new med is out... etc. and someone who can DRIVE when there are UNusual conditions.

the best he could do was when i asked if i should increase the depakote again,was to say no. and when asked if tacking on a bit of extra benzo might help, to say yes. totally passive. when asked why he didn't suggest it he said because by now i know best how these meds work on me.

yeah, well... sometimes WE as patients don't think of things. and in one particular case he left me in a state of delusional fear and went on vacation. when one is delusional one does not "figure it out" until later, so one does not think "oh, I need to take some Zyprexa!" that time it could have got worse. fortunately, some of the triggers disappeared, and it remitted after a few weeks. no thanks to him though.

after that i have been sort of waiting for Godot ... something to force me to change. but seeing him free i do not feel like i can quit and then go back.

so while on the one hand i am relieved, i also feel stuck.

waves

I am sorry that you feel stuck waves. maybe you could see someone in addition to him> why not?
bizi

the only no-cost alternative is state and if they take over they do everything, psych and meds. and two pdocs obviously isn't viable.

for now, i am ok with just not having to "do anything."

and i don't think i'm at risk for becoming psychotic real soon, so.

Waves,
Here's my score on him. My numbers might be far off.
For Cognitive Therapy he might get a 7 or 6 out of 10. For supportive therapy he might get an 8. I think for meds he gets a 9 out of 10.

Of course he takes input from you. He can read your moods and needs as well as a person not you can but he checks with you. You case is complicated and you would not allow a new guy/gal to give you quick facile answers. The current pdoc and you have developed a short hand that serves you for now.
When you feel more settled and you get information on a very good pdoc in a good location, you will be ready for a change.

For him to leave you to yourself totally stinks.

I understand your stuck-ness feeling right now. I think you will feel unstuck at the right time. Get yourself in a better place and things will open up for you.



M.

Dear Mari

the bad delusional time when he SHOULD have put me on an antipsychotic and DID NOT. input from me was irrelevant then because my mind was past where i could know i needed that. rather than spend the ENTIRE hour losing logic games to my contorted mind which made me even more fearful, he needed to switch gears at some point and tell me - if need be convince me - to take Zyprexa until he got back. even proposing it as the only calming agent that would help with the fear, whatever - anything to get me to take it. i needed medicine. he didn't even SUGGEST it.

there were other briefer incidences of the same, but that was the worst.

also the time i agreed to retry Paxil, warning him it had made me full manic the first time - he prescribed 40mg (that is the MAX dose), no titration. I may even have taken less on my own caution, but I still ended up with EPS in few days - less than it took to get manic the first time... but since when do you max out the start dose for a pt that has already had an adverse reaction to a med? helloooooo?????

NOW do you still think in terms of 9/10 on meds?????????

for CBT, knock that down to 2/10. that's supposed to be his main therapeutic area but what few CBT techniques i might have learned have come from elsewhere. we have not done CBT to speak of, no goals, no structure, no exercises, nothing resembling CBT.

he gets a 9/10 for being collaborative, that's what. he will write me scripts for just about anything "reasonable" including non-psych scripts. but also at one point i had valid scripts for no less than 5 different benzos for different uses. i doubt most docs would do that, and i doubt he would with most pts either. he knows i know how to mix and not overdo, moreover that i am more conservative than he is wrt benzo use.

he does get 8/10 for supportive therapy.

yes, that is true.[quote]a new pdoc may well adopt an attitude of arrogance if i asked too much and/or questioned what they prescribed or made suggestions.

if my line of work lets me afford it. chances are i will have to do state, but i might look for a tdoc to do specific work with on an infrequent basis. like hypnosis or dream work or working with feelings in a more direct way. i feel like he turns expression of feelings into a type of dialogue which defuses the intensity and derails the feelings that instead needs work. then i leave feeling like lots of threads were pulled out... and left hanging, despite a seemingly "logical" conversation.

you are right. one step at a time. first i was just scared he'd drop me. but after it seemed that way i think i got defensive about the imminent rejection. and the long-standing ambivalence got me thinking maybe it would be for the best. but i know it would be very hard for me right now too.

and also, a state pdoc or tdoc would not be someone i could text or call whenever most likely, either. besides, good or bad practices aside, my pdoc is a good guy overall and i have an emotional attachment at this point.

~ waves ~

Dear Waves,


That sounds like the complete opposite of what he is supposed to be doing period -- whether it is CBT, supportive, or any type of therapy. It sounds like he does BS.

C. He gets a 1/10 for CBT.

D. He gets on F on meds. He is supposed to prevent emergencies or medicate with an emerging one. 4/10 for meds.

E. How would you score the emotional attachment?

F. How would you score his availability via text and so on?


Now rank these. Put A,B,C,D,E,F in order of importance for you
1. right now today
and
2. six months from now when you are in a better place for considering a new pdoc.


I'm trying to see if which aspects of his work with you is the most important to you and which is less meaningful to you.

When you say that you are going to have to go "state" I don't know what that means exactly. Does that mean that some people go outside of the state for certain issues or is it only with regards to finances.

Do you have any say so in the state pdocs or does a computer randomly generate a pdoc for you based on your location? Do you have any say in the pdoc's experience, language, age, gender, type of work?

M

sometimes i really do feel like that. at times i feel like he just plays yes-man. like, i talk for 10-20 mins. then he re-iterates what i said, but not like a confirmation, as if it is some sort of answer. this is why he only gets an 8 for supportive. and sometimes i get the same yes-man feeling with meds - which just ain't right.

i don't think i can do this properly tonight, with the numbering... too deeply decisional ... i can say supportive/sounding board and availability off the bat are probably at the top right now. meds not right now because i don't feel fearful or lost in a pre-paranoid sense or have any other "weird" stuff going on. maybe some omens but... ok, i better not go there. i don't know.

state-managed health care. it works a lot like an HMO but even less freedom. you might have an eye problem and the first person who sees you is not the same doctor as the one who does the followup. they changed these rules only recently, used to be you could pick whom you saw. i don't know, if i went through state care, whether i'd get to see the same pdoc every time - they may treat psych care differently because of the personal nature. there are copays for doctor visits, exams labs everything, but i have a bipolar exemption that gives me free psych visits, some free labs, and a notch off med copays for those few that are "admitted" by state (eg, benzo's are NOT.) i got this thanks to my excellent GP from years ago who suggested it and helped me - a couple of years after i was seeing current pdoc at the state clinic, and PAYING the stupid clinic, and he never told me a darn thing about it btw.

sort of, and no no no no no, where "sort of" = you can go to any clinic that is state-conventioned. there aren't any nearby, only the main state psych clinic. but i will say their pdoc who renewed my exemption last time was very kindly...........unlike the nurse who screened me.... "you're bipolar but you have 2 degrees??? [diffident tone] how did you manage that??? answer: ... "the second one only after expulsion, readmission, many Fs and retakes?" grr. idiot.

did not kay jamison do her complete doctoral thesis manic?
not sure if I remember that right....
bizi Hugs to you tonight.
I wish you felt better, sorry you are going thru this. and sorry that you have not been able to train your pdoc....

that's possible i don't know. she was manic as an intern i seem to recall. i don't know if she'd been dx'd yet.

i had bipolar onset midway throuhg first degree with a couple of long manic episodes of varying severity, but only mild depression or euthymia between them. and even though i didn't try very hard - was not focused on school, i performed well.

it was during my second degree that i started having long, horrific depressions. when i had manic sx they were brief, or most often, superimposed on the overwhelming depressive episodes, i.e. subclinical mixed states / agitated depression. i also had long apathic depressions. it was a dreadful period. it's pretty hard NOT to fail if you skip class AND don't read AND miss tests.

also don't forget

jamison was PASSIONATE about what she was doing.

mine was a "practical decision"... not something i loved, something i thought could get me a day-job i could tolerate. but i did not even want to be in school any more at that point. practicality kinda falls apart when all you want to do is party or you are so depressed you hardly do anything at all besides contemplate death in so many ways.

pdoc... i guess i've trained him to the extent that is possible.... sigh.

thanks (((hugs)))