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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Amelia_in_StPaul on May 18, 2009, at 23:26:00
When you see a new pdoc, what do you prepare ahead of time? A list of med trials, diagnoses--anything else?
Should I bring in a list of drugs that people have recommended I try, or would that turn off a new pdoc. Maybe I should be wary if a pdoc doesn't want to hear ideas? Or perhaps, from a professional standpoint, I might be annoyed if I were a pdoc and someone came in with a grocery list of meds, and without really a whit of knowledge about the whole field (I mean, I basically understand the neurotransmitter theories, but I go cross-eyed reading about chemistry, you know? Not my thing).
Any ideas appreciated. ~ Amelia
Posted by Phillipa on May 19, 2009, at 0:01:37
In reply to Appt with new pdoc Thursday--preparation?, posted by Amelia_in_StPaul on May 18, 2009, at 23:26:00
I'd bring a list of the meds you've been on and in what combos and what happened with each, then listen to what he/she has to say then might slip in you know I've thought that xxxx might work did read a bit. They don't want in my opinion someone telling them. I did that once and boy it sure didn't work out. But different docs are different. Feel this one out. Love Phillipa
Posted by desolationrower on May 19, 2009, at 0:19:44
In reply to Re: Appt with new pdoc Thursday--preparation? » Amelia_in_StPaul, posted by Phillipa on May 19, 2009, at 0:01:37
well if you don't suggest something, you aren't going to increase your odds of getting it. it kind of depends, i think some docs are more about the 'trust me' and some are more open to discussing. exactly what you say might depend on which drugs are are considering though; whats your list right now? are you sure you'll be seeing her for a while, or are you auditioning her?
also, nice to see you, even though, it is like saying 'welcome back to the poor house!' :)
-d/r
Posted by Amelia_in_StPaul on May 19, 2009, at 11:40:51
In reply to Re: Appt with new pdoc Thursday--preparation? » Amelia_in_StPaul, posted by Phillipa on May 19, 2009, at 0:01:37
thanks Phillipa! ~ Amelia
> I'd bring a list of the meds you've been on and in what combos and what happened with each, then listen to what he/she has to say then might slip in you know I've thought that xxxx might work did read a bit. They don't want in my opinion someone telling them. I did that once and boy it sure didn't work out. But different docs are different. Feel this one out. Love Phillipa
Posted by Amelia_in_StPaul on May 19, 2009, at 12:07:13
In reply to Re: Appt with new pdoc Thursday--preparation?, posted by desolationrower on May 19, 2009, at 0:19:44
hey d/r!! thanks for the welcome back. poor house, indeed. feels a little like living a charles dickens novel, crashing against the tides of forces beyond myself. when will my long-gone rich relations make an appearance to save me from the poor house? um, I hope you've read much dickens. otherwise, I'm babbling. ;-)
okay, here's the landscape I was thinking of in terms of meds:
Memantine, in combo with something else?
Provigil, to counter SSRI fatigue and help with ADD?
Drugs low on the antimuscarinic scale
Luvox
Sleep drug with shorter half-life (Doxepin? would like to avoid Remeron, as I ate half a grocery
aisle of junk food in the time I was on it)Last ditch effort--add an atypical AP like Abilify or very low dose Risperdal
Not anafranil or other TCAs that are metabolized by 2D6--my intermediate metabolization means I could be at greater risk, I think, for heart effects (trying to avoid early fatal heart attacks rampant in family)
Guanfacine (not sure about it--I have orthostatic hypotension already)
Lamictal
An AD I haven't tried--Pristiq? Or?
----
It's a fuzzy-headed list, but it's a start I guess. I just know that I can't stand the apathy that occurs once I'm ramped up on fluoxetine. Kills my spirit.
Good to hear from you. How are you?
> well if you don't suggest something, you aren't going to increase your odds of getting it. it kind of depends, i think some docs are more about the 'trust me' and some are more open to discussing. exactly what you say might depend on which drugs are are considering though; whats your list right now? are you sure you'll be seeing her for a while, or are you auditioning her?
>
> also, nice to see you, even though, it is like saying 'welcome back to the poor house!' :)
>
> -d/r
Posted by Amelia_in_StPaul on May 19, 2009, at 12:20:05
In reply to Re: Appt with new pdoc Thursday--preparation? » desolationrower, posted by Amelia_in_StPaul on May 19, 2009, at 12:07:13
after reading http://www.dr-bob.org/babble/neuro/20090129/msgs/895324.html
I am definitely thinking strongly about memantine (Namenda) and Lamictal, and/or Neurontonin. With OCD and PTSD, images, sounds, thoughts, do imprint on my memory--not to the point of hallucinations, but nearly so.
> hey d/r!! thanks for the welcome back. poor house, indeed. feels a little like living a charles dickens novel, crashing against the tides of forces beyond myself. when will my long-gone rich relations make an appearance to save me from the poor house? um, I hope you've read much dickens. otherwise, I'm babbling. ;-)
>
> okay, here's the landscape I was thinking of in terms of meds:
>
> Memantine, in combo with something else?
>
> Provigil, to counter SSRI fatigue and help with ADD?
>
> Drugs low on the antimuscarinic scale
>
> Luvox
>
> Sleep drug with shorter half-life (Doxepin? would like to avoid Remeron, as I ate half a grocery
> aisle of junk food in the time I was on it)
>
> Last ditch effort--add an atypical AP like Abilify or very low dose Risperdal
>
> Not anafranil or other TCAs that are metabolized by 2D6--my intermediate metabolization means I could be at greater risk, I think, for heart effects (trying to avoid early fatal heart attacks rampant in family)
>
> Guanfacine (not sure about it--I have orthostatic hypotension already)
>
> Lamictal
>
> An AD I haven't tried--Pristiq? Or?
>
> ----
>
> It's a fuzzy-headed list, but it's a start I guess. I just know that I can't stand the apathy that occurs once I'm ramped up on fluoxetine. Kills my spirit.
>
> Good to hear from you. How are you?
>
>
>
>
> > well if you don't suggest something, you aren't going to increase your odds of getting it. it kind of depends, i think some docs are more about the 'trust me' and some are more open to discussing. exactly what you say might depend on which drugs are are considering though; whats your list right now? are you sure you'll be seeing her for a while, or are you auditioning her?
> >
> > also, nice to see you, even though, it is like saying 'welcome back to the poor house!' :)
> >
> > -d/r
>
>
Posted by Zana on May 19, 2009, at 13:32:54
In reply to P.S. d/r - glutamate hyperactivity? » Amelia_in_StPaul, posted by Amelia_in_StPaul on May 19, 2009, at 12:20:05
DK about a lot of what you're considering. The more imformation you can provide the better. I think any pdoc would be glad to know your background and what's worked and what hasn't. Provigi is certainly more and more widely used for both daytime fatigue and ADD. Pristiq is not a SSRI/SDRI so theoretically it hits both serotinin and norepinphrine receptors. I must be the only person in the world who hasn't gained weight on remeron. Its a great sleep med for me and is supposed to have good additive AD effects when combined with effexor or pristiq. I am having good luck with the combo of remeron and prisiq. Effexor was too agitating for me so whatever the reasons for introducing a new med, pristiq, when effexor was going off patent, it is definitely a different beast. I had terrible apathy on prozac as well. Provigil helped and I am not having the same reaction to prisiq.
Hope this helps. Good luck. Be prepared to go slow. In my experience, most good docs don't like to change more than one thing at a time. If you change two things at once, you can't tell what's what. Makes sense to me.Zana
Posted by Amelia_in_StPaul on May 19, 2009, at 15:07:30
In reply to Re: P.S. d/r - glutamate hyperactivity?, posted by Zana on May 19, 2009, at 13:32:54
Hey thanks Zana. I appreciate your perspective. I'm SO GLAD that you have something that works for you. That's great!! I'm soooo jealous that you did not gain weight on Remeron. I loved the med--it put me to sleep and took the nightmares away--but I would wake up kinda stimulated (I mean, lightheaded and spacey) and yeah, eventually, packed on the pounds. It was nice at the time because I couldn't eat and had lost 12 lbs. in a week (the anxiety) but then it started to go overboard. Anyway, thanks Zana!
> DK about a lot of what you're considering. The more imformation you can provide the better. I think any pdoc would be glad to know your background and what's worked and what hasn't. Provigi is certainly more and more widely used for both daytime fatigue and ADD. Pristiq is not a SSRI/SDRI so theoretically it hits both serotinin and norepinphrine receptors. I must be the only person in the world who hasn't gained weight on remeron. Its a great sleep med for me and is supposed to have good additive AD effects when combined with effexor or pristiq. I am having good luck with the combo of remeron and prisiq. Effexor was too agitating for me so whatever the reasons for introducing a new med, pristiq, when effexor was going off patent, it is definitely a different beast. I had terrible apathy on prozac as well. Provigil helped and I am not having the same reaction to prisiq.
> Hope this helps. Good luck. Be prepared to go slow. In my experience, most good docs don't like to change more than one thing at a time. If you change two things at once, you can't tell what's what. Makes sense to me.
>
> Zana
>
>
>
Posted by bleauberry on May 19, 2009, at 20:42:39
In reply to Appt with new pdoc Thursday--preparation?, posted by Amelia_in_StPaul on May 18, 2009, at 23:26:00
Be honest.
Be authentic.
Be unique.
Show your wisdom.
Include all history and information, no matter how trivial.If you get a negative sense about the pdoc, maybe perhaps some intimidation, rigidity, unskill, uncreative, contradictory, whatever, turn and run.
It is the pdoc on trial during this first visit, not you. And after all, who is paying who for a service?
Posted by Amelia_in_StPaul on May 19, 2009, at 22:11:34
In reply to Re: Appt with new pdoc Thursday--preparation?, posted by bleauberry on May 19, 2009, at 20:42:39
Thank you, bleauberry. What a great pep talk. Thank you!!!!
> Be honest.
> Be authentic.
> Be unique.
> Show your wisdom.
> Include all history and information, no matter how trivial.
>
> If you get a negative sense about the pdoc, maybe perhaps some intimidation, rigidity, unskill, uncreative, contradictory, whatever, turn and run.
>
> It is the pdoc on trial during this first visit, not you. And after all, who is paying who for a service?
Posted by desolationrower on May 20, 2009, at 13:20:26
In reply to Re: Appt with new pdoc Thursday--preparation? » desolationrower, posted by Amelia_in_StPaul on May 19, 2009, at 12:07:13
> hey d/r!! thanks for the welcome back. poor house, indeed. feels a little like living a charles dickens novel, crashing against the tides of forces beyond myself. when will my long-gone rich relations make an appearance to save me from the poor house? um, I hope you've read much dickens. otherwise, I'm babbling. ;-)
ha, i read dickens in high school, never again. he babbles far too much :) actually i don't like much from 19thc, maybe dostoyevksi. between the romantics and wilde, nothing....
> okay, here's the landscape I was thinking of in terms of meds:
>
> Memantine, in combo with something else?hm. while its pretty low in side effects, its not really a 'proven' antidepressant. but might help OCD. I might leave that aside, although perhaps you want to mention it as something to try later on, so your doc isn't totally surprised next time you do ask for it.
Have you gotten NAC yet? I might try that before the memantine.
As far as excess/insufficient glutamate, i don't know theres a clear syndrome for each. THe excitotoxicity is related to excess phasic glutamate, not the basal level.
> Provigil, to counter SSRI fatigue and help with ADD?
could be helpful. it is $, i forget your insurance quality?
> Drugs low on the antimuscarinic scale
>
> Luvoxit sounds like you've tried a few ssris, and fluoxetine works the best. i probably would stick with it, at least at a low dose.
> Sleep drug with shorter half-life (Doxepin? would like to avoid Remeron, as I ate half a grocery
> aisle of junk food in the time I was on it)that will probably be the case with any antihistamine. so i think gabapentin might be a good choice for sleep.
> Last ditch effort--add an atypical AP like Abilify or very low dose Risperdal
>
> Not anafranil or other TCAs that are metabolized by 2D6--my intermediate metabolization means I could be at greater risk, I think, for heart effects (trying to avoid early fatal heart attacks rampant in family)it would just mean you would need a lower dose than some other people. theres plasma monitoring for levels with tcas. And intermediate is only a bit less than normal. i don't think this is a risk to worry about. so i still think nortryptaline would be the best thing to try; both to improve energy, apathy, etc, and to improve slow wave sleep. it has a bit more anticholinergic properties than desipramine (though low compared to other TCAs), but it has 5ht2 antagonism which improves sleep quality.
> Guanfacine (not sure about it--I have orthostatic hypotension already)
yeah. its complicated treating anger/apathy and low energy at the same time. probably not a first choice.
> Lamictal
probably worth trying. it isn't fatiguing generally. some evidence for it in ptsd too.
> An AD I haven't tried--Pristiq? Or?
>
> ----
>
> It's a fuzzy-headed list, but it's a start I guess. I just know that I can't stand the apathy that occurs once I'm ramped up on fluoxetine. Kills my spirit.i'd suggest only taking as much as you need to keep ocd/anxiety stuff at bay, and finding something else (non-sri) to most of the mood correction.
I guess the thing i'm not sure of, is what symptoms are you needing help with the most?
> Good to hear from you. How are you?
>last month not good, but last week has been better.
-d/r
Posted by metric on May 20, 2009, at 17:56:35
In reply to Re: Appt with new pdoc Thursday--preparation? » Amelia_in_StPaul, posted by Phillipa on May 19, 2009, at 0:01:37
>I'd bring a list of the meds you've been on and in what combos and what happened with each, then listen to what he/she has to say then might slip in you know I've thought that xxxx might work did read a bit. They don't want in my opinion someone telling them. I did that once and boy it sure didn't work out. But different docs are different. Feel this one out. Love Phillipa
I don't understand why some people feel intimidated by doctors, or feel the need to drop subtle hints or engage in various mind games.
I encourage clear communication. If a doctor doesn't take seriously what you have to say, get a new one.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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