![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 35 to 59 of 59. Go back in thread:
Posted by Phillipa on November 17, 2009, at 19:14:20
In reply to Re: Dangerously close to the end of the road. Help » floatingbridge, posted by delna on November 17, 2009, at 18:26:22
A sedimentation rate can be an indication of inflammation or infection. High WBC same. There are various kinds of WBC's some indicate allergies, some infections, some viruses. Love Phillipa
Posted by kirbyw on November 18, 2009, at 1:26:31
In reply to Dangerously close to the end of the road. Help, posted by delna on November 15, 2009, at 7:38:46
Delna
If you go to New York I strongly recommend that you see Dr. Ivan Goldberg. It was you who actually "recommended" him to me, as you copied some correspondence with him on a posting. Then I happened to be in New York for 3 days, (just last week) and was able to get in to see him.
He is over 70. We shouldn't let age fool any of us. He knew more about Parnate, which I take, than the whole generation of fast talking Psychiatrists under 50 that are practicing now. He was extremely thorough and extremely wise. He states on his website that his speciality is treatment resistent depression, and clearly he knows what he is doing. If I lived in New York, he would be my Psychiatrist, and perhaps even my therapist. A two hour consultation was $650. This was expensive for me but it was worth it, and I am now going to be following his recommendations.
He is located near 88th and 3rd avenue. Very humble, somewhat cluttered office, and books and papers all around. Looks the office of the typical absent minded professor!
Prior to the appointment, his secretary mails you a very large number of test to fill out and bring with you. 90% are scales to measure how you feel so you can do them very quickly.
For example, questions such as
I am more depressed
a) in the morning
b) at night
c) after eating
d) in social situationsetc. etc.
There are about 70 pages of these questions. Some are as above and some are true false. I was very impressed with how he used these questionaires during the interview to kind of fine tune his analysis of my condition/diagnosis
.
Anyway, if you get to New York, I would strongly suggest that you go see him, maybe see him regularly for a month or so, and see how you do.
Rick
PS Anyone interested can find his website and contact info just by googling "Ivan Goldberg" or Ivan Goldberg Depression, etc.
Posted by Katgirl on November 18, 2009, at 9:15:41
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by Phillipa on November 17, 2009, at 19:14:20
I did not do ECT. I don't think it would have been offered to me and I would have been much to scared to try it. (Although, if rTMS had failed I would have tried) I basically "sent" myself to Canada for rTMS because either none of the medications worked or they made me worse. At that point I had been abjectly suicidal for almost two years and knew that I couldn't hang on any longer. It was my last hope.
Posted by floatingbridge on November 18, 2009, at 15:43:54
In reply to Re: Dangerously close to the end of the road. Help, posted by kirbyw on November 18, 2009, at 1:26:31
Kirbyw,
What a great recommendation--! My pdoc is over 70, too. A great age, I think.Delna, how did it go with your new doctor today?
fb
Posted by floatingbridge on November 18, 2009, at 15:47:36
In reply to Re: Dangerously close to the end of the road. Help, posted by Katgirl on November 17, 2009, at 11:17:24
> The only thing that helped me at that time was rTMS. It didn't cure me, but it took away my suicidality immediately and gave me enough biochemical stability from which to build from. At the time I went, rTMS was not yet approved in the U.S. (it was in trials) so I had it done in Canada. Again, I am so sorry things are so tough for you right now. Take care!
Katgirl, I'm curious about the idea that the rTMS gave you biochemical stability. If you ever care to expand on that, I'd be interested in hearing what you have to say. You can babble me, because I think it's a bit off thread topic.
best,
fb
Posted by delna on November 18, 2009, at 16:17:50
In reply to Re: Dangerously close to the end of the road. Help » Katgirl, posted by floatingbridge on November 18, 2009, at 15:47:36
> > The only thing that helped me at that time was rTMS. It didn't cure me, but it took away my suicidality immediately and gave me enough biochemical stability from which to build from. At the time I went, rTMS was not yet approved in the U.S. (it was in trials) so I had it done in Canada. Again, I am so sorry things are so tough for you right now. Take care!
>
> Katgirl, I'm curious about the idea that the rTMS gave you biochemical stability. If you ever care to expand on that, I'd be interested in hearing what you have to say. You can babble me, because I think it's a bit off thread topic.
>
> best,
>
> fb
>
>hi
just got up for a drink- saw this post
please discuss it here , if its okay by you guys It doesn't matter if its off topic or anything like that, (does it? not sure of the rules). because i too would love to know all abt it and maybe others might too. Change the thread topic if you want to..
But only if you guys are happy to talk about it here and not only on babble mail. whatever suits you guys.
TC
Gnite
Love D
Posted by floatingbridge on November 18, 2009, at 16:20:04
In reply to Re: Dangerously close to the end of the road. Help » floatingbridge, posted by delna on November 18, 2009, at 16:17:50
Delna, that's fine with me, if it's alright with you. I didn't want to be rude.
How have you been today?
fb
Posted by delna on November 18, 2009, at 16:26:20
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by floatingbridge on November 18, 2009, at 16:20:04
> Delna, that's fine with me, if it's alright with you. I didn't want to be rude.
>
> How have you been today?
>
> fbThanks for asking
Am not good- physically. I have fever, threw up and have a headache that wont go away. And am really tired. Going back to sleep.
its totally cool by me. thanks for being so considerate, though!
Gnite
Love D
Posted by delna on November 19, 2009, at 13:27:45
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by maxime on November 17, 2009, at 12:03:38
Posted by delna on November 19, 2009, at 13:44:43
In reply to Re: Dangerously close to the end of the road. Help, posted by kirbyw on November 18, 2009, at 1:26:31
> Delna
>
> If you go to New York I strongly recommend that you see Dr. Ivan Goldberg. It was you who actually "recommended" him to me, as you copied some correspondence with him on a posting. Then I happened to be in New York for 3 days, (just last week) and was able to get in to see him.
>
> He is over 70. We shouldn't let age fool any of us. He knew more about Parnate, which I take, than the whole generation of fast talking Psychiatrists under 50 that are practicing now. He was extremely thorough and extremely wise. He states on his website that his speciality is treatment resistent depression, and clearly he knows what he is doing. If I lived in New York, he would be my Psychiatrist, and perhaps even my therapist. A two hour consultation was $650. This was expensive for me but it was worth it, and I am now going to be following his recommendations.
>
> He is located near 88th and 3rd avenue. Very humble, somewhat cluttered office, and books and papers all around. Looks the office of the typical absent minded professor!
>
> Prior to the appointment, his secretary mails you a very large number of test to fill out and bring with you. 90% are scales to measure how you feel so you can do them very quickly.
>
> For example, questions such as
>
> I am more depressed
> a) in the morning
> b) at night
> c) after eating
> d) in social situations
>
> etc. etc.
> There are about 70 pages of these questions. Some are as above and some are true false. I was very impressed with how he used these questionaires during the interview to kind of fine tune his analysis of my condition/diagnosis
> .
> Anyway, if you get to New York, I would strongly suggest that you go see him, maybe see him regularly for a month or so, and see how you do.
> Rick
> PS Anyone interested can find his website and contact info just by googling "Ivan Goldberg" or Ivan Goldberg Depression, etc.Thanks for that info Rick. Glad you found some good help. Will your current pdoc take into account his recommendations?
Actually, I do believe age and experience are a good thing. I have seen pics of him in his office so I know what you mean about the mad professor thing.
I just wrote to him again regarding my bizarre TD symptoms on Geodon and he told me pretty flat out that I should not touch any other AP, except clozapine. And that too only if I have psychosis.What worries me about seeing him is that he seems to treat depressed bipolars with Lamictal and I just don't find that helpful at all (for depression). Plus he doesn't seem keen on treating bipolars with ADs- more with mood stabilizers which have never helped me with the depression. Still I think he is really into treating patient fully and thoroughly as he answers questions just to be helpful and that is so rare. If I am in NYC, I will surely see him. I had wanted to once 4-5 years ago but I thought his fees were really high. But now I think my sister will sponsor me.
I somehow feel he will change my dx (which is a good thing) because although my last two diagnoses (by pretty senior pdocs in the US) have been BP I, I don't think I have that.But I think I fall somewhere on the BP spectrum.... so maybe he will treat me with ADs afterall.
Thanks again
Take care
Love
D
Posted by Katgirl on November 20, 2009, at 8:19:38
In reply to Re: Dangerously close to the end of the road. Help » kirbyw, posted by delna on November 19, 2009, at 13:44:43
Hi, I will post my response here because I have no idea how to do babble mail! Unfortunately, I had a no sleep night last night, so you may not get a response until tomorrow when I'm more coherent, but I just wanted to let you know that I had seen your response and I will be posting about rTMS!! Take care, K
Posted by delna on November 21, 2009, at 0:25:13
In reply to Re: Dangerously close to the end of the road. Help, posted by kirbyw on November 18, 2009, at 1:26:31
Hi Rick,
How difficult is it to get an appointment. Do you have his email- its the weekend so I can't get in touch with his secretary. I want to email him urgently. I need to go to NYC because of a crisis situation there, anyway.
Thanks alot
D
Posted by Katgirl on November 21, 2009, at 10:30:34
In reply to Re: Dangerously close to the end of the road. Help » Katgirl, posted by floatingbridge on November 18, 2009, at 15:47:36
OK, here is my experience with rTMS:
After severe and protracted withdrawal to paxil (lesson here: if you are on a drug that works, don't go off of it!!) I ended up with treatment resistant, suicidal depression that swung between severe agitation/anxiety or all the way to the other end of the spectrum with psychomotor retardation. (The wide spectrum of symptoms may have been due to the all the failed drug trials and subseqeunt withdrawals I went through because of the failed drug trials).
As I've stated previously the rTMS, after a few days left me very overstimulated, but they said this was the "Prozac" effect and that I would probably be a responder after I returned home. They also indicated that the two weeks directly after treatment I would feel worse. Boy, were they right. I cried for two weeks. BUT after those two weeks ALL of my suicidal thoughts were GONE. I can't tell you how huge that was. Killing myself had been in my thoughts literally every second of everyday for two years. It was horrific.
And after that I slowly started to get better. At the time, I think it was hard to gauge just how much it had helped for several reasons: 1)I had expeced rTMS to be like a medication, I was either going to be "all better" (like when I first took paxil) or it was going to fail. I didn't know you could land somewhere in the middle. And so my dissappointment at not being "all better" for awhile made me not fully appreciate some of the benefits I had received. 2) when the trial didn't make me immediately "all better" my now ex-husband left me (he is the one that pressured me relentlessly to go off the paxil. Nice, huh?) So then I was dealing with the stress of a divorce, which doesn't do the most for mental stability.
Upon reflection, I can say that rTMS was the only thing that helped me. It removed the suicidal thoughts and while I wasn't "all better" I at least had enough biochemical stability so that other long terms fixes like therapy, exercise, meditation could actually be helpful. When I was so biochemically messed up therapy etc didn't do ANYTHING for me. I guess you are really bad off when you are too biochemically messed up to be helped by therapy!!
Am I all better today? Not by a long shot. Am I so much better than I was a few years ago. YES YES YES. Is it constant work to get better. YES YES YES. (BUT as I stated previously, WITHOUT the biochemical stability that rTMS gave me, all the "practices" I do now would not work.
So, rTMS helped my depression enough that other things could then be helpful for me. Unfortunately, rTMS did nothing for my anxiety, which continues to plague me horribly. My concentration is also still very poor and I still have mild depression.
Like I stated before, I don't have the life I want, but I DO have a life, which I didn't have at all for five years. I hope that I continue to slowly get better (If I could just get some help with sleep and anxiety, I know it would make a huge difference in my quality of life!) and that maybe in my lifetime some new medications will come out that I can take.
Hope this was helpful! K
Posted by delna on November 21, 2009, at 11:43:27
In reply to Re: rTMs info, posted by Katgirl on November 21, 2009, at 10:30:34
> OK, here is my experience with rTMS:
>
> After severe and protracted withdrawal to paxil (lesson here: if you are on a drug that works, don't go off of it!!) I ended up with treatment resistant, suicidal depression that swung between severe agitation/anxiety or all the way to the other end of the spectrum with psychomotor retardation. (The wide spectrum of symptoms may have been due to the all the failed drug trials and subseqeunt withdrawals I went through because of the failed drug trials).
>
> As I've stated previously the rTMS, after a few days left me very overstimulated, but they said this was the "Prozac" effect and that I would probably be a responder after I returned home. They also indicated that the two weeks directly after treatment I would feel worse. Boy, were they right. I cried for two weeks. BUT after those two weeks ALL of my suicidal thoughts were GONE. I can't tell you how huge that was. Killing myself had been in my thoughts literally every second of everyday for two years. It was horrific.
>
> And after that I slowly started to get better. At the time, I think it was hard to gauge just how much it had helped for several reasons: 1)I had expeced rTMS to be like a medication, I was either going to be "all better" (like when I first took paxil) or it was going to fail. I didn't know you could land somewhere in the middle. And so my dissappointment at not being "all better" for awhile made me not fully appreciate some of the benefits I had received. 2) when the trial didn't make me immediately "all better" my now ex-husband left me (he is the one that pressured me relentlessly to go off the paxil. Nice, huh?) So then I was dealing with the stress of a divorce, which doesn't do the most for mental stability.
>
> Upon reflection, I can say that rTMS was the only thing that helped me. It removed the suicidal thoughts and while I wasn't "all better" I at least had enough biochemical stability so that other long terms fixes like therapy, exercise, meditation could actually be helpful. When I was so biochemically messed up therapy etc didn't do ANYTHING for me. I guess you are really bad off when you are too biochemically messed up to be helped by therapy!!
>
> Am I all better today? Not by a long shot. Am I so much better than I was a few years ago. YES YES YES. Is it constant work to get better. YES YES YES. (BUT as I stated previously, WITHOUT the biochemical stability that rTMS gave me, all the "practices" I do now would not work.
>
> So, rTMS helped my depression enough that other things could then be helpful for me. Unfortunately, rTMS did nothing for my anxiety, which continues to plague me horribly. My concentration is also still very poor and I still have mild depression.
>
> Like I stated before, I don't have the life I want, but I DO have a life, which I didn't have at all for five years. I hope that I continue to slowly get better (If I could just get some help with sleep and anxiety, I know it would make a huge difference in my quality of life!) and that maybe in my lifetime some new medications will come out that I can take.
>
> Hope this was helpful! K
>
>It was very helpful.
Does that mean you are on no meds at all right now?
Posted by Katgirl on November 21, 2009, at 12:26:50
In reply to Re: rTMs info » Katgirl, posted by delna on November 21, 2009, at 11:43:27
I am on no meds, but not by choice! If I could take a medication that would help, I would be on one and have my life back!
Posted by Katgirl on November 21, 2009, at 13:54:38
In reply to Re: rTMs info » Katgirl, posted by delna on November 21, 2009, at 11:43:27
Oh, and I was probably a bit optimistic in saying mild depression. probably closer to moderate most days. Feels mild in comparisson to the "should be in the psych ward, can't walk can't function type of depression I was suffering previously.
Posted by delna on November 21, 2009, at 13:59:12
In reply to Re: rTMs info, posted by Katgirl on November 21, 2009, at 13:54:38
hey,
that sounds bad
is it that you are intolerant to meds or does nothing help you even a bit?
love
D
Posted by floatingbridge on November 21, 2009, at 20:18:50
In reply to Re: rTMs info, posted by Katgirl on November 21, 2009, at 10:30:34
Katgirl,
Thank you so much--your post is very helpful. So you, too, do different adjunct therapies and activities to keep your self well (enough)? That's important for me as well.
My first questions echoes Delna's--are you med intolerant? Like to benzos or typical sleep aides like lunesta?
I was also wondering if you've considered ADD? I'm assuming your Dx was major depression.
Would another round of rTMS benefit in the future?
Thank you so much for sharing--I've switched meds often in my ten years of treatment--self-withdrawing, etc. Yes, I don't think that was good for my health at all--though I never did find anything that worked the way you described your prozac working.
best to you!
fb
Posted by SLS on November 25, 2009, at 18:00:45
In reply to Re: rTMs info, posted by Katgirl on November 21, 2009, at 13:54:38
Have you tried Nardil?
Thanks for sharing so much of yourself.
I hope you find that "all better" place. You may have tried many drugs, but how many drug combinations have you not tried? That's the question I learned to ask myself. It yielded more possibilities and hope. Given your description, it is likely that you will need to take a combination of drugs in order to achieve remission.
- Scott
Posted by Katgirl on December 1, 2009, at 10:26:24
In reply to Re: rTMs info » Katgirl, posted by SLS on November 25, 2009, at 18:00:45
Sorry for the delay posting on this Delna, FB and Scott! I think I'm a bit fearful of posting my response, because I don't want to be seen as being unwilling to try meds or God forbid as being seen as anti-med. TRUST me, I am a BIG proponent of staying on your meds!!
So here goes:
Even before the paxil withdrawal, stuff that works on Gaba does not seem to work well with my particular neurochemistry. I seem to have either a paradoxical reaction to them (Klonopin made me feel like I was climbing the walls--it was actually the very first psych drug I was ever given) or they just make me severally depressed (I cry the whole next day after a single dose in the evening). Like I said this was before the brain scramble, so I must just be weird.
Can either not tolerate any of the SSRI's anymore or none of them work anymore, or they make me worse depending on the particular drug
Didn't tolerate Nortrypyline or Amytriptiline. Nortryptyline actually made me tired and more anxious at the same time and I couldn't get up to a therapeutic dose anyway (I have really low blood pressure already 90/65 amongst other things)
Ambien/lunesta etc don't work for sleep.
Trazadone does work for sleep but upsets my stomach so badly that it is really not an option anymore.
Neurontin made me suicidal and slurred my speech even on a low dose.
Basically, (and here is the part I was afraid to say for fear of shunning) ever since I started to do better after rTMS, I have not wanted to risk another drug trial and end up back in the horrible place I was a few years ago. I spent three years getting worse and worse and worse with each successive failed drug trial and then withdrawal. I don't want to end up suicidal again from another drug withdrawal.
So, no Scott I haven't tried Nardil. I can't recall if any of my pdocs even brought up MAOI's, to tell you the truth. But like I said, at this point I'd be too scared to take it. Please don't judge me as not trying hard enough to get well. I work really hard at dealing with my condition everyday, truley I do. And REALLY, I do wish I could take a pill and be all better again. (I really need to go back to school but I know that would just be way to much for me right now. Sigh)
It seems from some of the reading I've been doing on this board that people who are treatment resistant, can often take large quantities of different drugs but they just don't work. I'm different. For me, tolerating anything is the problem. I am hypersensitive to drugs now.
Anyhow, that is where I'm at. I had a really nice 4 day stretch over the holidays where I actually slept and felt good but then I came down with the virus from hell and have been feeling pretty downcast. Getting sick is a scary time for me because I can't exercise and do all the things I need to do to stay stable.
This fall has been rough, I've had major surgery, followed three weeks later by anyphalactic shock and now I'm sick. REALLY REALLY REALLY trying to stay positive, but right now I think I am looking forward to saying goodbye to 2009 and hoping for bigger and better things in 2010. (Wow, 2010! when I was a kid I thought we'd all be living in dome houses and zooming around on hovercrafts by now. Probably giving away how old I am with that one!!)
OK, now I'm just babbling. Apparently the virus has not helped my ability to focus. Hope I've managed to make sense and answer everything.
Thanks so much for your interest and kind words and I hope I have not offended anyone.
Posted by floatingbridge on December 1, 2009, at 10:58:44
In reply to Re: rTMs info, finally answering med inquiries :), posted by Katgirl on December 1, 2009, at 10:26:24
Katgirl,
Thanks so much for sharing your on-going experience. And no judgments here--really. Some people have strong opinions and there may be squabbles--hey you do what you need to do--and feel good about taking care of yourself. Your posts and sharing have only been helpful and supportive. Thank you for answering so many questions!
I was just reading an article that mentioned rTMS as neurogenetic. I think I understand more why you used the term 'biostability' in one of your posts in reference to your response to rTMS.
I'm sorry to hear about your health challenges and how that interferes w/ your ability to do your maintenance activities. I do wish you a brighter 2010.
And yea, I thought we'd be living on the moon by now ;-)
kindest regards,fb
Posted by SLS on December 1, 2009, at 11:32:38
In reply to Re: rTMs info, finally answering med inquiries :), posted by Katgirl on December 1, 2009, at 10:26:24
Don't be a silly Katgirl!
Of course you won't be shunned!
I'm sure that most everyone is very grateful to you for posting and sharing your thoughts and experiences. I am.
Thanks.
- Scott
Posted by SLS on December 1, 2009, at 11:37:22
In reply to Re: rTMs info, finally answering med inquiries :), posted by Katgirl on December 1, 2009, at 10:26:24
I apologize if you have already addressed this issue. I probably missed it:
Do you go for maintenance rTMS?
- Scott
Posted by Katgirl on December 1, 2009, at 11:50:09
In reply to Re: rTMs info, finally answering med inquiries :) » Katgirl, posted by SLS on December 1, 2009, at 11:37:22
I actually don't go for maintenance rTMS. But if I ever go into another full blown clinical depression or think I'm moving in that direction I'll be there in a heartbeat.
I think its approved in the U.S. now, right? So then I wouldn't have to go to Canada this time. (Although with our healthcare system, it might still be cheaper to go to Canada!!) I should probably look into that just in case.
Thanks so much for the reassurance Scott/FB. I have just had so many experiences with judgements about meds from both "factions" (for and against) that I'm afraid to even open my mouth!
Posted by Katgirl on December 2, 2009, at 9:56:08
In reply to Re: rTMs info, finally answering med inquiries :), posted by Katgirl on December 1, 2009, at 11:50:09
Oh, and I forgot, I was also on Remeron for 8 months. That was the last AD I took. The only good thing it did for me was make me sleep, which at the time I desperately needed. But it made me very "shaky anxious", very angry and I was still suicidal and crying all the time on it. I finally had to go off of it when it made my GERD so bad that I got erosions in my esophagus even on prilosec.
I think that covers the meds I've tried!
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.