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Tuesday, May 10, 2005

Second Opinion

Rob came with me to the pdoc's last Wednesday. He asked me later on: Was I there to be your muscle? I said, something like that. More specifically he was there to be my witness, to confirm for me that my impressions of the doctor are not just bipolar tinted paranoid fantasy, that he really does not listen to me.

We went through the story of me reducing my meds and he didn't freak out like I thought he would. Whether or not that was due to the fact that Rob was there, or that I had prefaced my explanation with a reminder that he had been willing to cut my medication in half and that I had only cut it by a quarter, I'm not sure. The end result was the same: he took the information somewhat in stride. But when I gave him one of my reasons as being that the liver specialist was giving me til September to take some steps to reduce the liver enzymes, which includes losing weight, and since the medication makes losing weight very difficult: well, he didn't like that.

He told me that if we go off Valproic Acid, the only other choice is Lithium. (Yes, Michele, I know he's a doofus). I said, yes, Lithium is an option, but from what I understand, Lithium can cause thyroid damage and because I sincerely believe in Murphy's Law, if anyone would get thyroid damage, it would be me.

His response:

Well, if the valproic acid is causing the liver damage, that is bad, but if you have thyroid damage from Lithium, all you have to do is take synthetic thyroid hormone for the rest of your life and you'll be fine.

What a fucking idiot.

Rob was sitting there, listening to me argue back how I thought those choices were like the devil and the deep blue sea: neither was acceptable.

Then the pdoc said that he wasn't really sure that the valproic acid was causing the liver trouble anyway because I was the only patient of his that was having this trouble. I said NO, very calmly, and said I've read the medical literature and (here's a rough quote of what I said, vocabulary and all):

The liver enzymes become elevated as a result of an injury to the literature. Published pharmaceutical studies show that drugs such as valproic acid, which they specifically name, are known to cause liver injury. The metabolites of valproic acid attack the liver. The metabolites of Lithium do not. Since the valproic acid is known to attack the liver anyway, AND it is also known to increase weight gain, which can accelerate the condition known as fatty liver, it is not a medication suitable to someone who is visibly demonstrating the early signs of potential liver damage.

End quote.

Rob said later on that the doctor doesn't like the fact that I'm not one of those zombie-medicated schizophrenics that he centres most of his practice on, that I'm not "sick" enough for this doctor, and as a result, he doesn't like the fact that I don't just sit there and say yes sir, no sir, three valproic acid full sir. He may be right.

Then the doctor said, while I continued to argue why both medications are unacceptable, he said the words I've been longing to hear for so long.

Perhaps you might want to get a second opinion. "I don't want to dump you off onto someone else, but maybe another doctor could find some option that I can't". Oh yeah, baby. I'm pretty sure on that one.

And the heavens opened and the angels did sing.

He also wants me to get another series of blood tests done to see where the liver enzymes and the valproic acid levels are at. I will, but I haven't had a chance yet (the new job is a long way from the lab I have to go to for the tests).

But I damn well made sure I have an appt with my family doctor to get a referral for a second opinion.

That appt is at 8 pm tonight.

My family doctor thinks very highly of my pdoc because of some charity work he does in the outlying regions of Newfoundland where psychiatry options are scare. But Hitler liked his dog. Doesn't mean he was a good leader.

Wish me luck tonight.


Blogger Becky said...
Darling! It's so good to hear that you're proactive in your own treatment and willing to tell that doc of yours to shove it. Honestly! We might be psychiatric patients, but that doesn't mean that we're simply waiting for a magical cure given by the all-powerful doctor! Ugh!

And dude, as soon as I read that your doc said that lithium dosn't make people gain weight, I was like, omigod, she needs to kick him in the shins and run away! I gained 35lbs with lithium, and they just so happened to be the 35 lbs that I had spent 9 months trying to get off! Trust me, that will make you depressed!

Anywho! It's awesome that your tribulations helped Shrinkette too! Fabulous!  

Blogger moodymicello said...
Phantabulous! I love it when you talk like that. It's probably the only intelligent conversation your pdoc has had in the last year and I'm betting he didn't imderstand parts of what you said. That is HIS reason for getting a second opinion! Way to go, girl.  

Blogger Coach Rob said...
Hey there world.

It's this character Rob that Blondy speaks of in her May 10th post here. I was there, I saw it, Blond called it bang on. This guy is, as we Canadians say, a knob. He's right, everyone else is wrong.
Trouble is, he, apparently only has experience with meds that have nasty side affects. Imagine him in the lab with Dr. Frankenstein. What kind of a monster would they have created.

It was very interesting for me to see this exchange, as I have only ever had blond's side of the discussions. What she tells you all is, pretty much, fact. What was also funny is that, after a while, he'd talk to and looked at me about Blondy as though she was not even there. When things got technical, I just looked at her, basically saying "take it baby".

This place seems to help Blond deal with all this shit. You who read her blog and provide input are helping more then you will ever know. She talks about you as though you live down the street. I just wanted to say thanks. It's a big help.

That's it for me for now. If you want to see a totally different type of blog, come visit mine and read about the wild wonderful world of hockey in our corner of the world. No medicine issues there, except for Asperin or Tylenol. It's not as cerebral is this blog, but then again, she's the brains (and the beauty), I'm just the muscle.

Till next time......  

Blogger moodymicello said...
So what did the family doc say?  

Blogger The Geefos said...
It rocks to hear about patients who know their options, risks, and what they want for their lives. My occassional desire to go off meds entirely gets a big no with my pdoc. Most of the time I think she is right on with that one.
I hated taking Valproic Acid. I gained weight and got lazy. I have been lucky with Lamictal - the hideous headaches aren't fun, but moods and weight have been, well, as stable as they can be I suppose.  

Anonymous Anonymous said...
Liz here from http://lizditz.typepad.com.

I think that more people of all kinds of diagnoses should take a "designated listener" to doc visits -- especially if it's emotionally charged.

My dad was diagnosed with an agressive form of cancer and that was the first recommendation from his best pal, a thoracic surgeon.

The second recommendation is prepare with:
1. Chart of symptoms
2. Questions about symptoms
3. Questions about med interactions.

The job of the "listener" is to take notes and prompt.

I think my dad got much better more complete care, because one of the kids went with him EVERY TIME and then issued a bulletin on what was done, said, and decided.

With video cameras being as cheap as they are, if I had a difficult disease now I'd ask my docs if they minded me videoing the visit, just so I could refresh my memory about what was done and said.

That's in addition to the "listener" or the prompter.  

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