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Saturday, February 12, 2005

Open Letter (RANT) to my Psychiatrist


I really wonder about you.

I came into the office Thursday, and you were late, as usual. So I waited the 1/2 hr you were behind and got into see you. You mentioned that you received some test results from my family doctor and seemed a little surprised that you did. You're the one that referred me back to him for the tests because of the elevated liver enzymes. But maybe I just misread your tone. But I told you that my family doctor was sending me to a liver specialist because of the results on the ultrasound.

Oh? What did the ultrasound show? you asked me, with the results in the file right in front of you.

It showed, I said, a spotty texture of my liver which is consistent with a fatty liver. And Dr. P, my family doctor said that it's likely due to the weight that I've gained since being put on the valproic acid. He knows how active I am and that the weight is a side effect of the medication. Dr. P knows, though, that he's not a liver specialist and is sending me to one to get a second opinion on the results. And, I said, my life is basically in limbo, waiting for the three of you doctors to decide what is happening and where I go from here.

You read through the results and then said, do you drink?

No, I haven't had a drink in 10 years or so.

Well, there's a test we do that if people show a problem with their enzymes and they say they don't drink, we do this test and your results are consistent with someone who drinks.

(are you calling me a liar) I don't drink, I repeated. You looked at me patronizingly. (don't do that)

You nodded and said well, we would have to consider what alternatives we have.

Now, I had asked you a few months ago about Topamax as a possible alternative, that I was sick of this weight and was willing to try something different. At that point you said no, that you knew Topamax to be a less effective mood stabilizer and wouldn't prescribe it. So, I figured knew what was coming when I asked: what alternatives do we have to the valproic acid?

Lithium, says you.

I said that I understood lithium to be equally hard on the liver.

No, no, not the liver, you said. The thyroid.

WELL! I said. THAT's JUST what I need, throwing my hands in the air. Another 30 lbs! You were pushing my buttons, whether you knew it or not. You'd started the engine cycling. But I doubt that someone with their head so far up your own ass would realize what you were doing, what effect you were having.

You seemed shocked by my reaction. Understand this: I keep myself in tight control when around you. I have for the last year and a half since you wouldn't let me out of the hospital til I conformed to your treatment program. Deep down I don't trust you to not sign me back in again. Your shock was exhibited by your increased fidgeting. You never sit still. Are you bipolar too? Or do I make you nervous???

Well, you said, there are two other drugs: Topamax (?!@?!?!?) and Lamictal (a bottle of which was RIGHT ON YOUR DESK IN FRONT OF ME). But I don't know a lot about them (your fidgeting increases) and don't prescribed them very often at all. (So, you don't want to prescribe the medications not because they don't work but because you don't know about them....what about learning?)

I said well, if the valproic acid is causing my liver problems...

You interrupted: I doubt that it's the valproic acid.


Because it wouldn't cause your spleen to be enlarged as well.


Your test results show moderate (technical word for spleen enlargement). That wouldn't be caused by the valproic acid. I've NEVER had a patient with those kind of results so I really don't think it's the Epival.

My head was immediately full of static. White noise. I couldn't think, I couldn't concentrate. DONT YOU UNDERSTAND? Do you NOT realize how people like me think? Do you NOT know that this kind of information, and dropped on my head in the manner you did, will make me obsess on it until it is all I'm thinking of, to the detriment of most other things including sleep?

So, you said. What do you want to do with your medication?

white noise
can't think

I don't know. You have to understand that I'm also starting a new job on March 1. I can't have myself be unstable. I need to be sure I'm on an even keel.

What do you want to do with your medication?

white noise white noise white noise

I turned my head to look out onto the dark street below and watched the snaking line of brake lights heading up the hill.

I'll tell you what my suggestion would be, you said. Let's cut the valproic acid in half (WHAT?!?!?!?) and see how you are.

white noise gets louder and panic drops in from the sky - meds in half means i'm gone

My leg starts jiggling up and down, my fingers tapping against my knee. Wind it up baby, you're winding me up. And somewhere I think you know it too, you dusky little leprachaun. You were pushing my buttons because I'm not fitting into your mould of a good compliant patient. My body isn't reacting to the medication the way all your others are and you don't like being wrong.

What do you want to do with your medication?

white noise STOP white noise
dammit I'm scared

The panic was getting worse but I knew I had to say something. I measured my words and tones carefully, like a conductor trying to slow down a runaway orchestra. I could feel the tears in my throat, backing up and up. I could feel myself vibrating inside like a tuning fork, ready to get up and sprint out of there.

I said slowly, not looking at you, looking around from wall to corner to wall, unable to rest my eyes: Put yourself in my shoes. I am starting a new job. I got that job because I WOWED them. I was rational, stable and calm. I have made my decision to change jobs based on logic and a rational comparison of environment and finance. I have never done that before in my life. My husband was pleasantly surprised. He is even PROUD of me. (tears threaten) *I* am proud of me (my voice cracks). I cannot give that up. I have fought too hard for this.

I look at you and you're just staring at me, not saying anything. Then:

So, what do you want to do with your medication.


I put my face in my hands and bowed my head. I CAN"T THINK, I said. I was coming apart and I was trying so hard not to let you see it.

Do you want to talk to your husband? you said., sanity, security....yes

I called on the cell: no answer either at work or on his cell. I called home. Adam said Rob wasn't home yet but immediately knew something was wrong from my tone of voice. I said nothing and that I'd be home shortly.

You then repeated your suggestion about cutting things in half.


I struggled with the white noise, but with the thought of Rob being able to help me, I was able to push it back a bit.

What if you and your husband come in and we talk about it, you said.

Ok....that's good, I said. But I need the prescription today. I am almost out.

Ok, you said. Then let's cut it in half.


I took a deep breath, trying to control myself.

I can't do that. I can't take that risk with my new job.

You gave me a queer little smile and said, yes but you're risking things if you STAY on the medication as well.

Thanks for clarifying that, you turgid little man. I'm either on medication and risking (further) damage to my liver (and now my spleen????), or I am lowered/off medication and risk damage to a fantastic new job I'm starting in two weeks.

I said: if I lower the medication now, it'll just be hitting me in two weeks, just when I start the new job. I can't risk that.

You're risking it the other way too, you said.

I know, I know, but I can't risk the other. I don't know what else to do. Put yourself in my shoes, I said again. And if we find out that the valproic acid is causing this, then I am willing to try a new medication whose side effects we don't know rather than have the other two options, neither of which are acceptable.

So, you wrote me the prescription.

Do my husband and I still need to come in?

You and your husband talk about the dosage. If you want to change it, come and we'll talk. But it's very important you get that gastro consult immediately, you said.

Thanks for the parting shot out the door, Napoleon.

As it stands, Rob and I figured we'd be several weeks getting a specialist appointment. That's the way things work here.

I got called at work Friday. I have an appointment at 11.30 Monday morning. This Monday. It surprised me a great deal to get one that fast. I'm trying not to read anything into that, telling myself that just because it's fast doesn't mean that there's some urgency to my situation. Most of the time, it works and I believe myself.

But my visit with you Thursday has me keyed up and strung like a tightwire, Dr. J. And when Rob finished listening to my explanation of the appointment, he is now also in my corner. Whereas before he told me to be patient with you and to trust in your expertise, he now is pissed at your arrogance (your constant habit of going "sure, sure, sure" while I speak is very rude and demeaning - you really aren't listening to me) and he would like me to speak to Dr. P the family dr about getting a new pdoc.

I've done some reading on all this (even though Rob tells me I'm just making it worse for myself, I can't help it....obsess obsess obsess), and I realize that there may be a need for a liver biopsy to determine the extent of things there. That doesn't please me in the slightest and makes me more nervous for disrupting things at the new job (drs appts etc).

But I'm away from you now, for another month. I have my family and my life, my very active life, to keep me occupied, trying to stay positive and away from the I felt Thursday.

I hope that you felt even a little nervous or bad about your behaviour. But I doubt it.

Blogger Dreaming again said...
I came extremely close to LITERALLY passing out while reading this. Then realized I was not breathing. My heart was breaking for you and I was holding my breath!

I think you're on the right track about finding a new pdoc. Definitely something that needs to be done, you don't deserve this treatment in the LEAST. Then you need to send this letter to him. Maybe you need to send it to him anyway!

Did you know that pigs will eat an entire human body and digest it, teeth, bones and all, leaving no evidence of a murder that has taken place? I have a cyber pig named Gwen (acronym for Grinning While Eating Nincompoops) She's just perfect for this pdoc. Would you like to borrow her?  

Blogger blondzila said...


He's a small man. It'll just be a toothpick for Gwen and I'll have her back in short order.  

Blogger moodymicello said...
The man should be drawn and quartered, no question. He has more than short man syndrome. His brain is not engaged to his awareness of humanity. The man shhould not be allowed to practice. I am so sorry that you had to undergo such an ordeal and the constant questioning is almost badgering. I think you did well to put him off on the guise of talking to Rob and hope that you are both successful in getting your medical doc to refer you to a pdoc who is knowledgeable about Topamax and Lamictal. (Lamictal is getting very good reviews. I was so hopeful when my pdoc put me in a study for it. It has been great for people like me with the rapid cycling. Unfortunately, I had a rash from it and couldn't take it. But many people are finding it a great medicine.) I just have the most positive feeling that a different drug is going to work perfectly for stability and that you will see a weight loss and your liver back to healthy when the epival goes away.  

Blogger Dreaming again said...
I don't know how Topomax is for a mood stablizer, I'm on it for migraine prevention.

My psych that quit on me 2 years ago to see inpatient only, agreed to see me again when he found out about the autoimmune insulin resistence (which is what he'd tried to tell me was my weight problem 3 years ago! But I wouldn't believe him when he said it wasn't my fault, I was so evil, it HAD to be my fault ya know?) Anyway ...

When he found out I was on Topomax for migraines he said "oh good, that will be good for your bi polar too"

OK ...I'd forgotten he keeps trying to say I'm bi polar and OCD.

This is an ongoing argument between us.

I say I'm not, I'm just hyperactive or depressed.

The fact that I can completely identify with your posts(winding up? Been there, done that... 4 am spouting off an email to special ed director of my sons school), Cliff's posts, Dangerous Mind's posts ...has nothing to do with it. right?

RIGHT!!! Tell me I'm right!
(nooooooooo no OCD there either right? RIGHT!? )

Anyway ...

I DO like the Topomax, once I FINALLY was able to titrate up ..the side effects really got to me ... I was totally wimpy about it ... mouth tastes ..soap & metal taste ...couldn't even get past 25 mgs for 3 months!

I'm still only at 50, and they want me at 100 ..maybe up to 200 ... LOL I started it in September. Told ya I was wimpy.
My son takes it for his Tourette's Syndrome and just has had a ball laughing at me over 'mom's wimpy dose'.

I've lost weight on it too ..30 lbs. Since september ... slowest weight loss I've ever done! Which for me ... is a VERY big deal to have done it slowly.

geesh, I'm talkative! shutting up now.

You may keep Gwen as long as you need her. I trust you to take care of her and not to use her on unnecessary people.  

Blogger Veritee said...
He is a small man and not just in height, but his heart.

You are much bifgger than this.

This patronisation is somehting I have experieced just so much myslft duing my life and by women on the site I run for sufferers of Post Natal

If you suffer a mental illness you suddenly are treated as if you are a lot of other things , unreliable, lie, incopedent, unemployable - I'll stop ranting on your blog - but dont let them get you down


My closest friend is also by polar and she suffers it as well  

Blogger girldiaries said...
Hang in there! Life is chaos, we just have to find our rythm inside it.  

Blogger xxan said...
Blondzila, the fact that your pdoc says that "he doesn't really know about this med or another" is not normal. (too put it euphemistically) As a pdoc he has to know the right meds for the right illnesses/people, and if he doesn't, he has to look to into it. (I mean to study it)

Extremely peculiar is that he doesn't know Lamictal "that well". As Michèle said (my pdoc said the same) Lamictal is a med with very high hopes for Bipolars.

I'm not saying, of course, you have to take Lamictal, I'm only saying your "pdoc" should absolutely know this med inside and outside.

For the lithium: after YEARS it can cause a small thyroid problem, I say small because it's solved with a little extra pill. I take Lamictal and lithium: good results.

I know the above is not immediatly a solution for you. But take into account carefully all you know and take another pdoc. There are better ones, I am so sure of that!



Blogger Meitar said...
I'm going to have to echo the comments already left here.

1) I can't believe this "doctor" is still practicing psychiatry. How can he not know about the medications?!?!?! That's just...AUGH!

2) As far as I know, lithium, in controlled doses, is one of the safest drugs around. I took it for four years on a relatively high dose and the biggest problem I ever had was that it was _too_ effective. You will certainly want to keep close tabs on it (regular blood tests, etc.), but that's true with any medication.

3) You deserve better care than what you've been getting, if this last Thursday was any indication of the norm. Yuck. I'm sorry you have to deal with that.

Best wishes,

Blogger Franikins said...
I was totally in shock reading about your experience. What a pompous incompetent boob that "doctor" is!

He's shown his true colors and their not compatable with improving your health.

I wish you much success in finding a new pdoc. Trust is essential in any relationship, especially so in a doctor-patient relationship. Even more so when it comes to psychiatrist-patient relationships.

Sorry you had to experience that. Kudos for you for holding your own and achieving your goal-getting your prescription refilled. You were effective.  

Blogger Polar Bear said...
Get a new pdoc. Quick!  

Blogger Bipolar Creative said...
Wow. That is intense. Psychiatrists SUCK.  

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