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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 7 to 31 of 38. Go back in thread:
Posted by jealibeanz on August 18, 2006, at 1:46:31
In reply to Re: OK, I'm over my self-imposed leave... update » jealibeanz, posted by mayzee on August 18, 2006, at 1:02:28
Yes! Studied like crazzzzzy and did great on my remediations! So I'm still eligible. Whether or not I truely want to pursue such an important and influential career at this current time in my life is another story. I don't feel emotionally stable or ready to be working as a professional, yet that is 1-2 years away. A lot can happen by then. Right now I'm just a student and perfectly comfortble in that role.
I'm taking .5 mg Xanax t.i.d and 3 mg Lunesta. All for now... hopefully some mood enhancements at a later date to help out the slightly dysfunctional brain of mine.
Posted by jealibeanz on August 18, 2006, at 23:20:46
In reply to Re: OK, I'm over my self-imposed leave... update » jealibeanz, posted by Jost on August 17, 2006, at 22:44:20
Do you think next time I happen to be in the office, I should ask my doc when I should make myh next appointment? (sorta a subtle hint, when I realize he's not scheduling a recheck). The funny thing is that my PA alllways scheduled a recheck for meds, be it 2 weeks or 3 months into the future. I wasn't just left hanging there indefinitely. (He's pretty young though... therefore very thorough with correct procedures and realizes he needs to do such things for his own protection.)
P.S. Jost... I'm jealous of your AD!! :)
Posted by UgottaHaveHope on August 19, 2006, at 14:56:12
In reply to Re: OK, I'm over my self-imposed leave... update, posted by jealibeanz on August 18, 2006, at 23:20:46
Maybe you were meant to go through all of these emotional challenges to help hundreds of patients when become a PA. Heck, I know that stinks for you, but if you start to see things in a great purpose or greater good, then it might help you in dealing with your own situation.
They say, what, 75-percent of time someone sees a doctor for the first time about a particular issue, that issue is tied to emotional issues? Is that the stat? It is high up there, I know that. My internist said he learned real quick about that, and if someone thought they had something, but really didnt, he would go ahead and diagnose them with something (minor, like Irritable Bowel Syndrome), just so they would think they would have something and then know they have something concrete to deal with, rather than saying "Hey you got some emotional issues here ... "
I will say one thing: I would much more prefer to go see someone like you, who I could relate to, rather than a doctor who has never felt my experience and just writes out a prescription for the drug that whichever drug rep brings in the best lunches when they drop by samples.
You are going to touch so many people's lives for the better.
Posted by UgottaHaveHope on August 19, 2006, at 15:00:31
In reply to Maybe, Jealibeanz ...., posted by UgottaHaveHope on August 19, 2006, at 14:56:12
JB, I am sorry to hear about your sleep issues. For me personally, nothing is worse than a lack of sleep, simply because it intensifies everything else. It's likes makes everything 100 times worse. It's like if I don't get my sleep, I have started off the day on the wrong foot, etc.
I would advise you to try 25mg of Seroquel (or even half of that if you can cut it). You will not have to wait 3-4 weeks to feel it. You will know that same day whether or not it works. You seem to function well, however, on fractured sleep. Perhaps you could take the Seroquel on an as needed basis. Good luck
Posted by jealibeanz on August 19, 2006, at 17:30:26
In reply to Maybe, Jealibeanz ...., posted by UgottaHaveHope on August 19, 2006, at 14:56:12
Honestly, I'm OK with my suffering. It's not absolutely horrible, terrible, and completely disabling. It does, however, decrease my quality of life. I had come to accept that my life would always be like this until I made my first attempt to seek medical treatment four years ago. I've never found that "magic bullet", but in my heart feel that it's out there somewhere.
The lack of sleep is bad, but like I've said before, I'm used to being very fatigued from my days as an athlete. This time, the fatigue just happens to be caused by something out of my control.
Yes, I do believe, if I do decide to continue and am confident and emotionally stable enough to practice as a PA, I will great (that is, after I learn what I'm doing! everyone says you'll be clueless for the first few years). Having emotional problems is not something others can even begin to empathize unless they've experienced issues themselves.
Most patients, regardless of the reason for the visit, are very emotional and vulnerable (both b/c of illness or causing a physical manifestation of illness). I actually just did a report on a particular minor, common disease. It turns out, that although there are many medications used to treat physical symptoms, they rarely work because the disease is rooted in severe anxiety. Treating the anxiety is actually the best approach, although not currently taken by many practitioners at this point. (most patients don't want an SSRI because they're stomach hurts)
Posted by jealibeanz on August 19, 2006, at 17:32:53
In reply to Re: On sleep, posted by UgottaHaveHope on August 19, 2006, at 15:00:31
What is Seroquel? Is it an antidepressant?
I can't think of the other meds off the top of my head... Prosom, Sonata, what else is available specifically for sleep?
Posted by Jost on August 19, 2006, at 17:35:41
In reply to Re: OK, I'm over my self-imposed leave... update, posted by jealibeanz on August 18, 2006, at 23:20:46
Jealibeanz,
Next time, maybe tell your Doctor that you'd "like" to schedule a follow-up. Sometimes (I'm not the best example of this-- but makes me more aware of it), you can be perfectly nice, when you can say, "I'd like to do x," rather than "would you like to do x," or "would it make sense to do x? "
Because you're the one who knows what you want/need. It's not really about whether you GP wants it-- you know? and he sounds like if he knew that you wanted or needed it, he would be happy to.
Plus: it would be great if you tried Emsam.
I honestly think it's also great that you're more confident. This is probably part of the work of getting to be the professional that you want to be. Knowing your gut reaction, and trusting that, and your judgment. You're definitely getting there.
Jost
Posted by Phillipa on August 19, 2006, at 19:53:59
In reply to Re: On sleep, posted by jealibeanz on August 19, 2006, at 17:32:53
Seroquel is an atypical antipsychotic used a lot for sleep and anxiety. Hope that helps. Love Phillipa
Posted by jealibeanz on August 19, 2006, at 20:40:17
In reply to Re: OK, I'm over my self-imposed leave... update » jealibeanz, posted by Jost on August 19, 2006, at 17:35:41
Whoaa... must apologize for the incredibly long post up-front, but I assure, it's an easy read!
Yeah, I think that since it's a fairly busy office, (They're overcrowded/overbooked... as a coincidence, this week, my father and I both had 1PM appts w/ the same doc! It's supposed to be every 15 min or so, plus my was a full physical, not a quick med check!) He may not reschedule unless it's something completely new and he really feels the needs to checkup on the patient for safety/compliance issues. I know enough to call and leave a message or get myself an appt if I feel it's necessary, as proven in the past. Although, I tend to wait til things are on the brink of causing a meltdown! So early and often checkups would be good for my over-reactive personality and ever changing disorders (in relation to their relevance in my life).
I really don't have a problem asking him when he wants me to come back. Like I said, I know he is aware of the fact that I'm not local, and can usually only come on the half-day Saturdays, which he rotates with his partners. He just figures if there's a major problem I'll call and tell him.
Strange how my PA doesn't feel that way. He does have more flexibility and time just to do med check ups, but aren't doc's supposed to bedoing this as well? (i.e. my Wellbutrin example- me, with 4 refills and no rechecks, as an uninformed 18 yr old!- This was before the careful monitoring of teens and AD's though,(But was I a teen or, part teen/part "college student who wants to be in the adult category")?.
MY PA checked up on my Lunesta at least every couple months (and what ever meds I was supposed to be taking at the time, but prob wasn't cause I like to control and D/C myself when I feel the need... and I'm psycho and have moved on to a different subcatergory of my illnesses... Anxiety/Insomnia/Depression/ADHD which needs to be treated).
Hmm... maybe my goal at my next appt. will be treat all 4 at once! This would be a better approach than collectively deciding than one or two have subsided for the moment and the other, more serious and prominent matters at hand need to be stabilized. While I realize polypharmacy is difficult when starting new meds- you don't know what's contributing to side effects, all my conditions are chronic and DO need to be medicated for me to be at my best.
i.e.
1. Insomnia would lessen if depression and anxiety were controlled. We need to move past the fact that I don't like SSRI's and just therefore treat only other symtoms w/o lessening the depression itself. I need to be sure to tell him it's recurrent since high school. It may go away, but will certainly come back. It's been building over the past year, with the exception of my Effexor trial, which saved my life, but was unwilling to continue.
I neeeed a long term tolerable med. This means not going through SSRI's like he would I'm a typical patient. I'm not his typical patient. Although modest, I'll admit that I'm more intelligent than most, as demand to live a high quality life. Although I haven't been presenting any examples of meds, it's obvious I know there are atypical treatments out there for all my disorders, as well as unorthodox methods of treating side effects. This ultimately is what I will need to achieve success.
I also, probably due to my high anxiety nature and very intolerant to adverse effects, while some patients might just put up with them or not even correlate the occurances to meds. So sticking me with the lastest and greatest from the drug rep might not work out, esp. b/c I want better/more specific treatment!
2. Improved sleep would result in less depression, anxiety, moodiness, and better concentration and energy levels overall to be at my best and most productive.
3. If ADHD were controlled, I wouldn't always be frantically scrambling to study and catch up on classes lectures, while at home, that went way over my head b/c I wasn't listening in the first place due to my ADHD. (I have the inattentive subtype- I'm horrible at listening to lectures and internalizing verbal directions, although on a personally level, one on one, I'm the best and most empathetic friend/listener you'll ever meet!-- often recruited as mediator or counselor to good friends)
4. If the ADHD didn't have me scrambling, I'd certainly have much less anxiety, annnd more free time, to relax, and thus decreases anxiety.
4. And of course, depression worsenes if any of these factors is out of balance b/c I feel bad that I can't control my life and that I was born with my "messed up" brain. None/most of my friends don't have these issues. They don't have severe problems w/ classes, studying, emotionally, and socially that just pop up out of nowhere when my brain goes slightly wacky and meds are correcting the balance. I do realize evenyone struggle to some degree with these issues, but mine are related to clinical disorders, making it a little more difficult to manage and cover up.We're getting there though... My doc is beginning to realize this. It's good that I'm sticking with just one practitioner now. It's also helping that he's beginning to see me more and more as a peer (in training!) every time he sees me. He realizes that I'm able to assess and report my symptoms well. And he can describe certain things to me in detail that he wouldn't do for most patients.
I'm glad I stuck with him! Even though I don't feel like I'm emotionally better or made and great improvements with meds, if I'm persistent, we may reach the finishline together someday.
Posted by jealibeanz on August 19, 2006, at 20:45:03
In reply to Re: On sleep » jealibeanz, posted by Phillipa on August 19, 2006, at 19:53:59
Yes, Phillipa, I thought so. That scares me and I'd rather not go that route right now!
Posted by Phillipa on August 19, 2006, at 20:58:28
In reply to Re: On sleep, posted by jealibeanz on August 19, 2006, at 20:45:03
Me either and despite our age difference we're a lot alike symptom wise med wise. Love Phillipa
Posted by jealibeanz on August 19, 2006, at 21:50:57
In reply to Re: On sleep » jealibeanz, posted by Phillipa on August 19, 2006, at 20:58:28
I'd like to stick to meds FDA approved for sleep right now. The only off label med I'd consider is a benzo, but not Xanax since I take it during the day. I just don't see that as a good plan to be 24/7 Xanax'd!
You think we're similar? Maybe you're confusing me with someone else, or I with you. I'm not so sure if I remember correctly. Haven't you had meds that you responded to for a while?
As for depression:
I did respond a little to the Effexor, maybe Wellbutrin, but never gave the Paxil or Buspar a fair trial. They all induced extreme apathy and weight gain. Effexor made me nauseous.
Anxiety:
Klonopin was depressing slightly and very sedating. Made me feel drunk too. Xanax is much better. I don't slur my words, it's not depressing, and not too sedating. Xanax actuallys calms me, while Klonopin just knocked me out to the point where nothing could bother me.
ADHD:
You don't have this do you? Mine is inattentive, caused by anoxia from a collapsed lung at premature birth. The combo of Klonopin + Adderall induced terrrrble depression. Can never be sure which is was. I think it was the combo. I've taken the small amounts that I had of each left at separate times and never had such a horrible reaction, just a slight decline in mood.
Straterra did seem to help with the ADHD symptoms dramamtically at first. After a while it was less noticeable. Maybe I should have titrated past 60 mg since I had been on it for 6 months. But I also think it contributes to anxiety, insomnia, and depression. We have since stopped this med.
Posted by Phillipa on August 19, 2006, at 22:37:36
In reply to Re: On sleep, posted by jealibeanz on August 19, 2006, at 21:50:57
No I don't have AdHD at least I don't think so. But the benzos and anxiety was what I was referring to. At one time I did take xanax at bedtime for sleep. Four hours later lmg more. But I slept. Now its's valium. Love Phillipa
Posted by UgottaHaveHope on August 20, 2006, at 10:02:59
In reply to Re: On sleep, posted by jealibeanz on August 19, 2006, at 20:45:03
Even though Seroquel is classfied as an Anti-Psychotic drug, doctors are now using it ALSO as a treatment for anxiety (you can ask your professors to confirm).
When it is used for AP, it is prescibed in much higher doses (600-900mg). For anxiety, it's more like (25-200mg). For your insomnia, I would try 25 mg or even cut it in half at 12.5 mg. Again, the good thing is that you will know THE FIRST DAY whether or not it helps.
If you are taking other meds, I cant say whether or not it will help you (you will have to find out by experiment). However, if you are taking nothing else, I can assure you it will make you sleep, which goes against my "every med affects everyone differently" mantra. It's like taking a Benedryl on steriods!
Posted by jealibeanz on August 20, 2006, at 11:16:54
In reply to Re: Have no fear of Seroquel, posted by UgottaHaveHope on August 20, 2006, at 10:02:59
Yes, but I do fear drugs I don't understand and don't have experience with. Atypical antipsychotics? Tricyclics? MAOI's? (although intrugued by EMSAM). Yikes!!!! I'd like to put on my running shoes and sprint away as fast as I can!
Remember, I'm the one who's always concerned with the potential for weight gain, since if it's a possible side effect (even when NOT "possible" Re: Wellbutrin), my metabolism gets wacked and this happens to me! (I'm still working a little on getting back to my norm after what Effexor did. I don't want to make life more difficult than it already is.) Plus I'm afraid of any other odd side effects that may occur with such complex medications.
Since Lunesta was so great before, I think I actually may be OK with a medication with less "punch" than Seroquel. My body has just grown accustomed to the Lunesta and needs to be tricked back in to sleeping. I was going through a very busy and stressful time (at the same intensity that I'm currenty dealing with) last year when I began Lunesta, and even then it was a wonderful Godsend and cure to my sleep issues.
BTW... if it's annoying anyone to death that I use so many parentheses in my posts, I'll gladly stop. I don't want to add to the irritability than many of us face. It's just my way of posting in a manner that makes sense to me, as if it were a speech, not a written essay.
Posted by jealibeanz on August 20, 2006, at 11:59:37
In reply to Re: Have no fear of Seroquel, posted by jealibeanz on August 20, 2006, at 11:16:54
As a side note... my depression is now manifesting in a new manner.
I've gone from the anxious, fearful, teary-eyed, hopeless depression to the hypersomnia type. I'm usually extremely active and athletic. Right now, I'm glued to my computer because I'm too tired to move. This could be due to my lack of sleep for months. This could be due to withdrawal from Straterra, which is activating. However, based on past experience, this is not the case.
During my freshman year in college I was sooo depressed that basically hibernated. I slept a good 15-18 hours a day and was alllways tired and sleepy. I had slight insomnia, but it was just occassional waking, and would fall back to sleep.
It was my reaction to the overwhelming stress, anxiety, and depression I was faced by my new environment. I actually had no idea at the time, because I was basically a walking zombie. I wish I or someone around me had reacongnized this incredible abnomality. I seriously was in need of an antidepressant and stimulant.
I Didn't care about life. Didn't care about anything. I hated school and everyone around me (distorted thinking... these are the people who are now my very good friends!). I just wanted and desperately needed to sleep at all times of the day. This is how I feel right now.
Posted by UgottaHaveHOPE on August 20, 2006, at 14:48:57
In reply to Re: Have no fear of Seroquel, posted by jealibeanz on August 20, 2006, at 11:16:54
Jelly, again, Seroquel may or may not be good for you. The good thing about it is that you will know the first day whether or not it will help you. You won't have to wait 4-6 weeks like with an SSRI. If it doesn't help. dont take it again, and it will be out of your system quickly.
They give away Seroquel in samples for free at the doctor's office. Id get the 25mg tab and cut it in half.
PS You do a great job of expressing your feelings on here. Thanks for sharing and hope you feel better soon.
Posted by jealibeanz on August 20, 2006, at 16:14:27
In reply to Re: One day, Jelly, posted by UgottaHaveHOPE on August 20, 2006, at 14:48:57
Thanks to everyone for their input and support. It really helps to be able to bounce ideas off others. It's like therapuetic journaling, but with more purpose.
This is such a pivotal point in my life. I really do need to become much much more stable within the next year to continue with my professional course. Part of me wants to stop all treatment though. My doc did have to document a "positive" on my physical form on the emotional treatment line. He just wrote insomnia/anxiety. While it was barely noticeable and no description provided, I worry that in the future, disclosure of current treatment will hurt me.
However, I don't think I'm soooo far off that remission is out of the question, but I do believe medication needs to play a big part. (not spirituality/therapy/ect- although I admire those who can recover on such resources alone/in conjunction w/meds. I don't believe that's the optimal route for me.)
I'm young enough that my life can be turned around for the better. But this really needs to occur sooner, rather than later.
Posted by Jost on August 20, 2006, at 21:43:18
In reply to Re: One day, Jelly, posted by jealibeanz on August 20, 2006, at 16:14:27
One thought, Jelly.
Seroquel sounds a lot worse than it is. It's used a lot for anxiety and especially for sleep. My pdoc is very cautious and doesn't take chances. There's a lot of fear surrounding the concept of APs, but it's an atypical AP with the lowest chance of causing problems.
A low dose like 25 mg, or even half that, might help you get sleep. It's effective and very simple. Even if you needed more (say 50 mg), it's a very low dose, of a drug where even much higher doses are unlikely to cause problems.
Even if your mood wasn't great, you might be much more effective and able to study, and work.
I'm glad anyway that you're determined not to let your life be stymied. You'll figure it out, I'm sure.
Jost
Posted by jealibeanz on August 21, 2006, at 0:03:48
In reply to Re: One day, Jelly, posted by Jost on August 20, 2006, at 21:43:18
I'm not terribly concerned about the sleep right now. I'm most likely going to take some time off. Relax as much as possible, and obviously pursue a new career path since, they don't allow you to start and stop midyear. It probably was a poor choice given my tendencies toward minor, but chronic mental health problems. I'm thinking I need something a little less challenging, less stressful, and with more flexibility. Because right now I've gone into sleepy apathetic mode when I need to be into focused passionate overdrive!
Posted by UgottaHaveHOPE on August 21, 2006, at 1:28:57
In reply to Re: One day, Jelly, posted by jealibeanz on August 21, 2006, at 0:03:48
Jost brough up a great point that I had forget to make the whole time: The 25 or 12.5mg of Seroquel is just a minor, minor dose, like 1/32 of the dose it is given for AP issues.
Wishing you well, Michasel
Posted by jealibeanz on August 21, 2006, at 16:43:02
In reply to Re: JB, in context, posted by UgottaHaveHOPE on August 21, 2006, at 1:28:57
Alright, I'm little less frightened of Seroquel if it's only needed in a miniscule amount for insomnia.
At the moment, I wondering what issues I actually want to bring up to my doctor. I still have insomia problems, although not quite as bad as before when I was sleeping 2-3 hours a night. However, I also am now sleeping a good portion of the day, and when I'm awake I feel horribly drained of energy and want to crawl back into bed.
I'm afraid that if I tell him I'm sooo tired during the day he'll take away the Xanax (which does cause some drowsiness, but not to extreme extent that I'm currently experiencing). He may also tell me that I'm not going to be sleeping well at night if I nap during the day. While I understand this is true, I simply cannot function well enough to be anywhere near my normal level of activity during the day right now. I don't feel my insomnia is ever due to lack of need for sleep, rather, it's caused by anxiety.
At any other point in my life I'd be willing just to wait for things to get better. I've experienced these symptoms before when going through depression, eventually I do stop sleeping sooo much, but it certainly doesn't happened overnight! Right now I can't even afford to have one week when I'm at such a poorly-functional state.
I don't want to be one of those psycho hypochondiac patients they dread b/c new illnesses pop up every week or two. However, I am admitting that I am one of those psycho patients- my main problem is anxiety and it's clear that it's the central cause of all my ancillary issues.
So, I guess I'm just wondering if it does seem logical (from a doctor's point of view) for a patient to from the agitated, energetic, anxious state right to the fatigued, depressed state (while experiencing the anxiety/depression/insomnia at all times, but resulting in different physical presentations.) I don't want to have to lie to my doctor to get what I want/need, but I'm afraid of complicating things by showing up two weeks later with completely different complaints.
I'd love a stimulant right now (I like Provigil, but he's not usually one to prescibe it, so am willing to settle for Ritalin or Adderall). I'd also like a sleep med that works, to continue with my Xanax, and have an AD that I tolerate. While some of these meds basically contraindicate with each other to some degree, it's what I need. Is this too much to ask of him?
Posted by UgottaHaveHOPE on August 21, 2006, at 21:57:20
In reply to Re: JB, in context, posted by jealibeanz on August 21, 2006, at 16:43:02
Go to your pdoc with 1 issue per visit. If you try to address all of these things at once, then your world could be turned upside down by all the changes he makes. Thats just me though. Do what is best for you. Michael
Posted by jealibeanz on August 21, 2006, at 23:12:47
In reply to Re: 1 at a time, posted by UgottaHaveHOPE on August 21, 2006, at 21:57:20
Although it's an ideal approach, it's not very helpful unless I plan on seeing him every week or two, which isn't possible. Plus, all the problems are interrelated, so just bring up only one at a time seems to me like I'm holding back important diagnostic information.
But again, I worry that if I mention the enormously overwhelming fatigue me Xanax may be D/C'd. If I bring up the need for a stimulant or stimulating AD, that also affects the insomnia. Yet, I think he'd like to know about all of them, then we'd address the most dire and easiest to treat.
That's actually what we just did. My depression and ADHD went untreated b/c we were unsure about how to go about making so many changes at once and whether or not each of those conditions were exacerbated by sleep deprivation and medication.
We did decide to continue treating the anxiety with Xanax and the insomnia with an increased dose of Lunesta.
So, my next appt... concerns will be a follow up on the Lunesta, better, but really not strong enough to allow me to ever sleep more than 2-3 hours a night at a time. However, I am able to get back to sleep and am now getting at about 4-5 hours at night, an improvement.
I'd assume he'd want to know how the mood levels have been since D/Cing the Straterra. I will say that they have not improved, actually worse. Coffee is really the one thing that helps the sad feelings and tears. It's not because it's giving me a kick of energy that I need. I actually don't feel too stimulated by caffeine. It's very calming and produces a serene feeling. Is this completely abnormal or do others understand this too?
And now I am beginning to feel so overwhelmed that I feel the new to sleep constantly, which I don't believe is related completely to the insomnia. It's a totalllly different type of tiredness.
Insomnia tired is kinda cranky, achy, disoriented, but almost easily able to get through the day without stopping.
Depression tired is like a huge heavy weight on your body. You can barely get out of bed. You can barely muster up the energy to complete normal everyday tasks. In the end, you neeeed a nap, maybe several, if you day allows it. The extra sleep doesn't alleviate the fatigue though, nothing does.
OK, I suppose I just answered my own questions. I could leave things out, however I'm really hesistating to do so.
But does this seem to make sense to others? Is this a fairly clear presentation of symptoms of my already diagnosed disorders? They aren't new, they just now need to be treated differently as my life, circumstances, body, and neurotransmitters get misaligned. Right?
Posted by Phillipa on August 21, 2006, at 23:15:48
In reply to Re: 1 at a time, posted by jealibeanz on August 21, 2006, at 23:12:47
Write the post down while it's fresh in your mind and give it to you pdoc. Love Phillipa
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Dr. Bob is Robert Hsiung, MD,
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