need a psychiatrist
 

my current psychiatrist just dropped me. he is switching offices....i came in and said i was anxious about jury duty(he wrote a letter for me to get off of it) and told him i was anxious that he would drop me when he moved. he said no he was taking me with him. as the session progressed he changed his mind and implied that i needed more care than just seeing a psychiatrist. he told me to go to metropolitan hospital for their psy clinic which has psychologists, social workers and psychiatrists. i said i didn't want to go there. i said the last therapist i went to I viewed as a punishment because she didn't help me even though she was a nice lady.
I called and left a message with Dr.Moussavian to see if he had an opening at his office on the west side in the seventies. he told me before he was there only once a week.
i am still in shock......
bobby

oh Bobby

i'm so sorry this is happening! :( i don't even know what to say. that sounds awful what he did. :mad:

i wonder if Dr. Moussavian will be able to fit you in that one day per week with enough advance booking. but i don't know do you really want to go back to Dr. M ... he had become very complacent with your meds i thought.

what about, can your GP keep writing your scripts in the meantime? if necessary maybe the the most recent pdoc should be able to provide a simple document for the GP with all your meds and dosages - until you find someone new... it might take time to look. maybe you could talk to your GP ... maybe she could even recommend someone and/or get you in soon.

lots of love and ((( BIG HUGS )))

waves

hi
he wrote me enough for two months. i looked at the medicare list of psychiatrists that are accepting new patients in my area. I will give dr.m. a few days to respond. i dont know if he will like that i am off topamax and on 300 welbutrin. i am really in a funk and up in the air.
love
bobby
ps you are right about the ambivalence....

Bobby

Sending you good thoughts.

Donna:grouphug::hug:

I'm sorry Bobby. I'm sending hugs your way. BF:hug::hug::hug:

my anxiety is through the roof right now. I wonder if dr.m. can see me and when he will call me back. I have three other names to call. I really don't want to go to metropolitan hospital's clinic

Bobby, can you call the other three names?

Mari

thoughts - safeguarding your options, meds, relaxing for today
 

Dear Bobby

I think it's great that you already went through the list and took those names down. try to soothe yourself. maybe tomorrow you can call one of them.

given your ambivalence, i personally think it would be better to leave Dr M. for last... my thought is suppose you met one of the other docs and want to give them a chance... it may work out or it may not, but if it does it could be very helpful.

if you went to Dr M, and then for whatever reason, left again and then the new person didn't work, i'd be afraid your options to see Dr. M would be burned at that point - most docs would not allow a person to "yoyo" back and forth. if possibilities are exhausted, then going back to Dr. M makes sense... if you think you can deal with the availability issues on top of the complacency.

If you feel most comfortable seeing Dr M for now, one way I can see to do this is to ask him upfront if he can "help you out temporarily" while you find someone more accessible. You can be totally honest and tell him you are scared. I mean I'd be having horrible feelings of abandonment from what happened - and that turnabout all in one session! He knows you left him because of accessibility issues, so if you put it as needing a hand in the interim, it wouldn't be like running back to him. Then all the cards are on the table. If you end up wanting to stay with him... that could happen. But if you didn't, it would not rule out his helping you out in the future if need be.

--------------

regarding the meds, Dr M may not have made the same choices the other doc did but he will respect your regimen as part and parcel of your working with a different professional - with different ideas. it's not like you "disobeyed' him. ;) i don't even think he will necessarily try to put you back on, if your feedback about the changes made is positive.

--------------

do something good for yourself tonight. maybe have a scented bubblebath or brush Pudge and close your eyes and feel her fur against your skin. anything to try and take the tension down. tomorrow you can step up to the plate again. you did very well today.

lots of love

waves

oh bobby,
I am so sorry.
(((((HUGS)))))
bizi

Dear Bobby,

I am sorry that you are going through this.
He is not a good man.
It does seem he straightened out your meds a bit and that is something. But he should be looking after your interests. In the end, I believe things will turn out such that this terrible thing he did turns out to be a good thing for you.

You are strong. You will be able to work this out and be in very good shape soon. Keep faith that you can handle the steps it takes to find a new pdoc.


M

thanks so much
i thought i would wait until Monday to call the other doctors. I was hoping that dr.m. would call today or tomorrow....i am so confused and yes frightened.
I don't feel abandoned....more upset that he implied i really need full help therapist case worker psychiatrist.....I already put in the call to dr m and would feel strange to ask him if i could see him temporally. He might also not get my message til wednesday when he goes to the office i called him at.
I still am frightened although i had very pleasant dreams last night.
love
bobby

I really appreciate what you said and i am strong and in very good shape. that helps big time and should lessen my panicky feelings. I didn't go through the total medicare assignment doctors and might have to. i don't know if i will call any today
bobby

i decided to wait until wednesday to see if dr m. returns my call. if he doesn't or if he says he is booked up then i will make some calls. I have about four months of medication i think
bobby

Do what ever feels right bobby.
((((HUGS))))
bizi

right now nothing feels right. i don't like waiting. I like to know what is going to happen. I am trying to be positive and am telling myself that i felt uncomfortable with the psychiatrist and he probably felt uncomfortable with me.
I got unnerved when he said or implicitly said I need a team to help me. I have been doing better than i have in years. I started losing weight again. I am calmer now than i thought i would be and i am trying to have a positive attitude.
i mailed in the jury excuse this morning so hopefully that will go okay
love
bobby

Bobby

Today I think you are handling this very well. I believe waiting till Wednesday, and looking through the list. And even maybe seeing if
anyone you know goes to any of this psychiatrist. Would be a good idea.

You can always do some research till then.

Even contact the local NAMI organization they might have some information
for you.

Donna:grouphug::hug:

thank you
my case worker from lenox hill called this morning and i told her the story and she said she would help me find a psychiatrist. I don't know if she can.
so far dr. m. has not returned the call
bobby

I agree with Donna... you are doing really well. :):Heart:

Good for you for getting that letter in the mail today and i am still really wowed that you were able to get right on this thing and look up other possible Dr.s. i understand if you want to wait and see what happens with Dr M at this point, and it is ok to play it by ear too. (sometimes that's the best way.)

i didn't know you were losing weight again! congratulations! :):cool: (you haven't been mailing it to me have you... ? ... because i've been putting it on! :eek:) anyway that is great.

good that you are calmer than you were.

i appreciate being upset by what he told you. i think most psychiatrists want us to have therapists etc etc. but Bobby, i don't believe he was trying to deny that you were making improvements. maybe he just saw room for more improvement than could be had with meds and made a suggestion he felt was most suitable all round, considering your payment plans etc. i still don't like the fact that he integrated this suggestion with dropping you. but it doesn't take away your progress - don't let it undermine your progress and you get lots of credit for that. if this is upsetting you maybe it would be best to put aside his reasonings for now and process it later - when you have recovered a bit more.

i think you are doing great recovering though. it's splendid that you are making positive steps and thinking forward, and not paralyzed by your fear.

keep it up!

love

waves

That is good news. She might indeed be able to find you a psychiatrist. It is a good sign that she called you today. She seems on top of things.

M

i am feeling incredibly lonely right now. I think this is a repercussion of what happened yesterday. a friend is taking me out to lunch tomorrow....i haven't seen her in months and this was planned before the news....I had better focus on that. I wasn't attached to the doctor but his insistence that i needed care is making me focus right now on that i am aging and what will become of me.....
my birthday is in a couple of weeks and i will be 69......I don't feel it but when i think it, it is scary
bobby

i am sorry you are feeling so lonely Bobby.

sounds like what happened hit a nerve and that you are feeling extremely vulnerable too. it is understandable.

we are here for you.

i hope you have a great lunch with your friend tomorrow.

love

waves

Yes,

You will feel settled when you eventually get an appointment.

In the meantime, live one day, one moment at a time and enjoy the lunch.

Mari

you are so right. I have to remember at the senior center there are so many people older than me. at my table four are in their eighties and they live alone and they see a psychiatrist and one of them sees a therapist also.
another one who is 75 sees dr estrada. One of the eighty four year olds gets electric shock treatment and the eighty five year old had it in the past and now just wants to suffer with his depression. Another eighty five year old says he suffers from depression also.
I somehow don't think i will make it into my eighties but since i stopped taking topamax I am starting to feel like my old self. I think i even have more energy. I am getting really angry that both he and that other psychiatrist i saw once, imply that i am in bad shape. dr. m didn't think i was in bad shape and he saw me for ten years....not one session like one of the psychiatrists or the five or six times i saw Dr. Estrada.
I am scared of these psychiatrist's power.
I am also trying to calm myself down and saying worse comes to worse and i will see a therapist plus psychiatrist. I have had such poor luck with therapists. Your insight outways all the ones i have seen!!!!!!!!!!!!!!!!!!!!!!
I am glad i am seeing Stella today so I won't be alone today. I am seeing my friend alice in two weeks. Last night I spent a long time on the phone with my girlfriend and she made me feel good. I hope i didn't come across as too needy.
I got on the scale this morning and lost more of the weight i had gained.
for dinner I have been eating a bag of frozen broccoli or string beans and sprinkle breadcrumbs on them and a bit of butter with lemon. I am also taking triphala an ayuvedic which is non habit forming laxative with other great properties and dr.oz said it helps with weight loss. I really recommend triphala. If you google it with asking for benefits you will see.
love
bobby

thank you Mari
how true...it is just this fear of the unknown that is really upsetting me.
thanks about lunch
bobby

Bobby

You really sound so good. I think you are going to be able to handle
waiting.

donna:hug::grouphug:

I hope you had a nice visit with stella today.
YOur broccoli sounds very good! and so good for you! I have heard we should be eating from the cruciferous family of veggies every day. cabbage, califlower, brousel sprouts, broccoli....(I will try to eat more veggies!)
bizi

Hi Bobby

how was your lunch with Stella?

How are you holding up?

I too love the sound of your dinners. we pretty much have to have more elaborate per my father's requirements (substantial meat/fish component, plus 2-3 sides). now i surely cannot complain - might as well eat while the eatin's good, but sometimes i really miss the simplicity of having something simple as i sometimes did when i lived alone.

anyway, post when you can and give us an update. i will check back.

love

waves

the lunch with Stella went really well. the food was delicious ....all organic...then we went somewhere else for coffee. we talked mostly about diet. she is going for a certificate in guiding one towards diet. then i wanted to go home.....
i am in a very strange mood. I still am very upset about finding a new psychiatrist and have the impulse to cut back on my medications so i won't need one. I ordered more ayuvedic medicine.
wow your meals really sound formal.
love
bobby

ayuvedic triphala is working for me, so happy to say that, don't know if it was the 3rd cup of coffee but I don't think so because coffee stopped working for me a while ago.
hugs to you dear bobby
love bizi

Hi, Bobby,

I do not remember taking any Indian herbs. I did try (or consider trying -- it was such a long time ago) some Chinese herbs.
I wish I knew more about them because they are an interesting and important avenue to explore.

Mari

http://www.articlesbase.com/wellness...es-110876.html
this is the article i used to order more ayurvedic remedies. I went overboard.
bobby

ayurvedic treatments and your meds
 

everyone should be aware that herbs (including but not limited to "cleansing" and "detoxifying" herbs) can raise or lower medication levels by increasing or decreasing the rate at which the liver breaks down the medication. i tried to look into this wrt triphala in this regard.

[EDITED TO SAY: I have found more precise information than the following...] i was able to find one study a showing a small amount of enzymatic inhibition on CYP3A4/5. Thsi is an enzyme pathway common to many drugs. the degree of inhibition was very small compared to ketoconazole (a known inhibitor). the article did not state this, but looking at the data charts it does not look significant to me in terms of interactions.[EDIT: There IS interaction potential with some drugs. see later post.]

I started looking for information on induction but got distracted. enzyme induction would mean more rapid elimiination of affected drugs (lower plasma levels, reduced drug effectiveness). if i resume that search i will post.

i also found notes suggesting triphala should not be used long term. probably, as with many herbs, it might be best to use it for limited periods of treatment at a time, with periods of suspension in between. i do not know what the suitable time frames would be for triphala or its constitutents. this varies with different herbs.

in general, i would recommend those seeking ayurvedic treatments to seek advice from an ayurvedic practitioner. there are MD's who are also certified in ayurvedic medicine.

if you think ayurvedic medicine and other herbal treatments are "mild and natural" just because it doesn't come from a lab, don't kid yourself. the same way it produces effects on the body it can interact with a "lab" drug. remember that even foods affect some medicines.

beware of health stores telling you there are "no interactions." that can mean:
1. the supplier does not know of interactions
2. there are no documented interactions - possibly because there haven't been adequate studies in this regard.

those who use ayurvedic medicine traditionally, in India, often use only that and see practitioners who have a wealth of knowledge spanning generations regarding how to combine the treatments. often a specific discipline and diet is also prescribed.

mixing and matching with western medicine is a whole other kettle of fish.

waves

triphala drug interactions via enzyme inhibition
 

J Ethnopharmacol. 2011 Jan 7;133(1):120-5. doi: 10.1016/j.jep.2010.09.022. Epub 2010 Sep 29.
http://www.ncbi.nlm.nih.gov/pubmed/20883765

I frankly found the wording of both the results and the conclusions hard to interpret, but I would be wary of potential interactions by enzyme inhibition ==> higher drug levels. This study tested the enzymes CYP3A4 and CYP2D6 specifically. The break-down of a great many drugs involves CYP3A4. CYP2D6 is also fairly common.

I would caution everyone taking or wishing to take triphala to speak with your doctor. As many docs are unaware of herbal pharmacokinetics so I would write down the bolded enzyme names above and tell the doctor that triphala is a mild to moderate inhibitor. The question then is whether, in light of that, it would be safe to take with your meds. (Your doctor will know whether your meds use those enzymes or not.) You should also ask about any OTC drugs you take regularly or occasionally including cough and cold medicines etc.

Another thing. If you are told it is ok, I would still suggest you avoid taking triphala with your meds. I would take it as far away as possible, timewise, from meds, to reduce the impact of these but also of other possibly undocumented interactions.

waves

DrM. didnt call me back. I am very upset. I just called another psychiatrist and left a message about accepting new patients. I am also upset about my weight. My appetite has returned big time. I also seem to be constipated again even tho i took the triphala. the constipation started when my welbutrin dosage was increased. I am a mess. I almost started crying and i haven't cried in years.
bobby

the triphala stopped working for me too....sigh
I feel your pain. I am sorry about your pdoc not returning your call. Good for you for calling another office. They may be able to see you sooner than later.
hugs to you today.
(((((((HUGS)))))))
bizi

I am sorry it stopped working for you....rats.....
right now i feel a little better. I am telling myself that this is an adventure to find another psychiatrist. I am forcing myself to go to the senior center....
thank you so much
love
bobby

Sending you some thoughts.

I'm glad your going to the senior center.
Also I think not hearing from the psychiatrist is a sign.

So calling another is a good idea.
Donna:grouphug::hug:

I just called another psychiatrist and left my number. her voicemail sounded nice.
i didn't sleep well last night. ....maybe got two hours. I am just worried about everything...physical and mental. I go to Bellevue on the 31th for a consultation for my dentures. that is going to be a lot of stress. i cut back a little on risperdal and am going to try to cut down a little on klonopin. It is probably notthe right time but I want to see what happens. I went without medication up until ten years ago and was able to make it. Now i have a lot less stress in my life. being dependent on a psychiatrist for medication is the pits. I am so ambivalent about seeing a therapist. the last one was like a punishment. she gave me support yes but i get support from my friends who know a lot more than she knew. I went to another therapist before that who wound up stealingh 180 dollars from me...that was about ten or eleven years ago. I paid her in advance and stopped seeing her and she never refunded the money. she said she needed it more than i did.
I guess i will go to the senior center today. i almost backed off going for a walk with my neighbor. she was in a bad mood but didn't take it out on me. she suggested my going to metropolitan hospital clinic. I don't want to go there.
bobby

Bobby

Glad you called another psychiatrist. This means you are really
trying to get someone else to work through this with you.

Keep up the work.

Donna:grouphug:

Dear Bobbygood for you, Bobby. You are moving forward. That is great. I'm sorry about Dr.M not calling back but I also agree with Donna... I kind of take these things as a sign. Or it could be that he is out sick or something - but I don't see any good in waiting. I think it's great that you are making other calls and seeing it as an "adventure" is a good outlook. :hug:
Ok, here I would like to suggest that you move cautiously. It is always inadvisable to change two meds at once, and in this case they are both meds with sedating effects. Reducing both in proximal time frames is particularly inadvisable. Please, first adjust to the reduction on the risperdal for a week or 10 days before making further changes.

Now as to the Klonopin. Regardless of stabilizing on less Risperdal, I think it best not to touch the Klonopin at very least until after that consultation at Bellevue. I also think you should probably settle the pdoc thing first. Both these processes are stressful and ...

IMHO, reducing a benzo at such a time is, if I may be completely frank? - a bad idea. :o Forgive me if I speak out of turn.

I do not wish to tell you want to do, but I really hate to see you suffer, and with your anxious tendency and current heavy stressors, I truly believe reducing your Klonopin would be a ticket to suffering. Klonopin is potent and you would not be able to make tiny enough reductions as to go unnoticed.

I hear you loud AND CLEAR! ... oh boy! This totally resonates with where I am... sigh. But this also makes me think about another aspect of Klonopin reduction, the last thing you want to do is risk presenting to a new pdoc as a nervous wreck. Also, there will be the problem of explaining or not explaining the dose tweak. It would be best if you presented as hitherto adherent to medical advice, and expressed a desire to taper to the new person.

I am so sorry about the negative experiences with therapists. I hope that it is possible for you to hold off on this... that the new pdoc will not insist. Then, you can think about it later. You have more than enough challenges to face right now as I see it.

Keep on taking yourself to the senior center. I think that is good for you. Glad you went out with Cecilia today despite your reticence. She sounds nice... being in a bad mood but not taking it out on you... she sounds self-aware, and also aware of you. As for the suggestion to go to the metro hx clinic, I know such suggestions can be irritating especially after the Nth person puts it forth. I'm sure she meant well - I just hope she accepted your rejection of the idea. You need to go where you feel comfortable.

lots of love

waves

p.s. You are being really brave... i see you really taking a couple of bulls by the horn right now and I'm ever so proud of you!! :) :heartthrob: