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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by markwell on December 21, 2011, at 18:29:37
I have been seeing the same dr for about 1.5 years. We have been through a host of medicine trials. I am currently taking tegretol and nac. I have huge anxiety and unresolved depression. My dr sent me a letter saying I have 4 options to consider in order for me to remain his patient. 1)add lithium to the tegretol. 2)add depakote to tegretol. 3)add seroquel or clozaril to the tegretol. 4}ect treatments. I am stressed out as to what to try. Lithium may help with depression but will probably not help anxiety. I have no idea what depakote will do. I tried seroquel for about 4 months several years ago and I was irritable and I couldn't get on my lawnmower to mow. Made me extremely lazy. Clozaril doesn't sound like much fun either. Ect is only good if you have a med that will work after the treatments stop. I don't know what to do. The dr is well respected in his field and I really like him. He is familiar with my med sensitivities so I have a lot invested with him. I don't know what to do. I appreciate any insights. I have bipolar1 and gad.
Mark
Posted by Phillipa on December 21, 2011, at 19:04:34
In reply to Dr's ultimatum, posted by markwell on December 21, 2011, at 18:29:37
Personally a letter with an ultimatum is rather cold. Personally I'd seek another doc. But this is me. Phillipa
Posted by Christ_empowered on December 21, 2011, at 19:35:31
In reply to Dr's ultimatum, posted by markwell on December 21, 2011, at 18:29:37
I don't know. I don't like the idea of paying a doctor AND being told that in order to keep the privilege of paying him, I'd have to do 1 of 4 things. Seriously? Plus, if he's that great a doctor, why are you still having this many problems?
Posted by sigismund on December 21, 2011, at 19:47:19
In reply to Dr's ultimatum, posted by markwell on December 21, 2011, at 18:29:37
I don't like the sound of him. I am too ignorant to comment on those meds, but some professional humility from him would go a long way with me if I was you. Very likely these things won't work. ECT? Goodness.
Posted by Raisinb on December 21, 2011, at 22:24:56
In reply to Dr's ultimatum, posted by markwell on December 21, 2011, at 18:29:37
I'm with the others. I don't understand why a doctor would give you an ultimatum. If anything it should be the other way around. Is this common where you are?
Posted by floatingbridge on December 21, 2011, at 23:15:52
In reply to Re: Dr's ultimatum, posted by Raisinb on December 21, 2011, at 22:24:56
1.5 years isn't that long for a difficult to resolve case. Idk, something doesn't sit well with me either. Patients with anxiety take time to treat because they are anxious (for crying out loud). Ultimatums don't usually have a positive psychological effect upon an anxious person.
Have you seen doctors prior to him? Why a letter? Are you able to get a second opinion easy enough?
I know. I asked you so many questions! But you don't seem too keen on any of these options he's presented, and this seems odd to me.
Posted by markwell on December 22, 2011, at 5:11:03
In reply to Re: Dr's ultimatum, posted by floatingbridge on December 21, 2011, at 23:15:52
I think what generated the letter is the last drug we tried made me much more depressed with suicidal ideations. I texted him and i think he had his limit with my drug sensitivities. He has overall been the most sensitive doctor i have had. I think he is very frustrated with me. I feel i have to choose one of these options and its scary to me.
Mark
Posted by floatingbridge on December 22, 2011, at 9:50:27
In reply to Re: Dr's ultimatum, posted by markwell on December 22, 2011, at 5:11:03
So maybe with the event of your suicidiality and he wanted to document he response formally.
Have you spoken to him in person or by phone since the letter? (I can't see you're first post now.)
Clorazil sounds alright, but such sides. Was .lithium one of your options? That would be by far the safest. ECT seems extreme, but it always does.
Posted by floatingbridge on December 22, 2011, at 9:52:32
In reply to Re: Dr's ultimatum » markwell, posted by floatingbridge on December 22, 2011, at 9:50:27
If you added lithium, say, would you not be allowed anything else to relive anxiety?
Posted by creepy on December 22, 2011, at 18:41:17
In reply to Re: Dr's ultimatum, posted by markwell on December 22, 2011, at 5:11:03
Tell him what you feel, exactly as you just said it.
Perhaps whats going on is your doc feels it may be some sort of unconscious need to control med choices, or sabotage yourself. And yes those things can start so deep down you are not aware of (or in control of) them. Might even be worth seeking a therapist out and trying to find out if this is the case and why.
Also, my doc has admitted that many of her patients, especially those with PTSD like me, are very sensitive to certain meds. I dont think all of it is explained by placebo, anxiety or hypochondria.
Not sure if there is any medical literature to support this, but if there is it may be worth showing your doc.
Posted by bleauberry on December 22, 2011, at 19:15:02
In reply to Dr's ultimatum, posted by markwell on December 21, 2011, at 18:29:37
I know you have a lot invested in this doctor and you've been through a lot with him. We've all experienced that I think. I know I have.
There is no question in my mind the last appointment I have with that doctor is the last one I had. He doesn't need to know why I left, no conflict, no big deal....I'm just seeking a second opinion which is standard procedure in medicine.
Look he basically wants to treat you as manic. All those meds he listed are antimanic. They are not usually antidepressant and it's hit or miss for anxiety.
I do not see a single ingredient in your cocktail that addresses either anxiety or depression, or some common causes of them. Those things might be supportive as minor role in some other cocktail, but the way they are being used right now, along with the rigid path the doctor has presented you, would not surprisingly do zilch for depression or anxiety. In my predictions anyway.
Look, this might sound harsh, and I could be totally wrong because all I know is what you wrote in your post, but there are thousands of stories out there where it was actually the doctor unintentionally keeping the patient sick not the disease. In those cases, the best thing for the patient....even though they don't realize it at the time and it scares them to death to even consider it....is to see a new doctor, if only for second opinion or consultation is nothing else, bare minimum. I've had some experience with that myself. It's not uncommon that patients have to heal themselves, and part of the process of doing that is to choose doctors of good chemistry.
It's sort of like finishing a chapter of a book and flipping the page to start a new one.....the book is the same, the story is the same, it's just a new chapter and new things happen in that chapter.....time to meet a new doctor.
If a doctor makes ultimatums like he did with you, that's it, end of journey, bye bye, time for a new chapter with a new doctor.
Let me get this straight. The last time you saw your doctor, you had anxiety and depression that day yet he sent you home with your tool chest consisting of tegretol and nac? Wow.
Posted by Emme-V2 on December 22, 2011, at 20:09:47
In reply to Dr's ultimatum, posted by markwell on December 21, 2011, at 18:29:37
You need a second opinion and/or a new doctor. 1.5 years may seem like a long time (and it's a long time to be ill), but it's not super long in terms of working through all of the med options and combinations that could be tried. Certainly not long enough to boil down to 4 rigidly presented choices. I have never heard of a pdoc presenting an ultimatum like that.
Even if you choose to stay with him, it really sounds like you could benefit from a consulting opinion. If your doctor isn't on board with getting some extra fodder for discussion, then he's putting his ego above your well being.
Good luck.
emme
Posted by alchemy on December 24, 2011, at 15:57:33
In reply to Dr's ultimatum, posted by markwell on December 21, 2011, at 18:29:37
Wow. What an ___, well I better not say it here. Especially when you are dealing with people who are already depressed? It sounds like he has some ego issue or something. I wish there was a way to report that "Written Ultimatum", he shouldn't be as "honored" as he is. Was it notarized even- jk.
The ideas he has should be a discussion of options in your session.
Posted by Phidippus on December 24, 2011, at 19:45:56
In reply to Dr's ultimatum, posted by markwell on December 21, 2011, at 18:29:37
>1)add lithium to the tegretol.
If you're having a lot of agitation and depression, this may be a very good way to go. You'll have to tackle the GAD after you're stable.
>2)add depakote to tegretol.
Yuck. No way. This will cause loads of depression.
>3)add seroquel or clozaril to the tegretol.
I think I suggested Seroquel to you already-Seroquel will be good for both depression and anxiety symptoms. Again, unresolved GAD issues will have to resolved once you're stable.
Clozaril might be overkill, but willl definitely help with agitation.
4}ect treatments.
ECT when used to treat bipolar disorder is usually followed by treatment with Lithium. If you're hella depresssed and medication isn't hellping, this is worth a look at. It will do nothing to treat your anxiety, unless the anxiety is a component of an unstable mood, which ECT willl help with
Eric
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Posted by markwell on December 27, 2011, at 11:20:15
In reply to Re: Dr's ultimatum » markwell, posted by Phidippus on December 24, 2011, at 19:45:56
I'm thinking of trying lithium. Does lithium help with agitation? Depakote and ect are a definite no for me right now. Seroquel I tried for 4 months or so and couldn't get out of bed. I tried lithium for a month and I was irritable. I don't know if that goes away.
Mark
Posted by ed_uk2010 on December 27, 2011, at 12:49:36
In reply to Re: Dr's ultimatum, posted by sigismund on December 21, 2011, at 19:47:19
>ECT? Goodness.
You might not remember whether it worked!
Posted by Christ_empowered on December 27, 2011, at 15:18:41
In reply to Re: Dr's ultimatum, posted by markwell on December 27, 2011, at 11:20:15
I'd seriously get a brand spanking new doctor.
Posted by sigismund on December 27, 2011, at 22:17:33
In reply to Re: Dr's ultimatum » sigismund, posted by ed_uk2010 on December 27, 2011, at 12:49:36
>You might not remember whether it worked!
That's about all these is to be said for it.
Posted by ed_uk2010 on December 28, 2011, at 17:12:36
In reply to Dr's ultimatum, posted by markwell on December 21, 2011, at 18:29:37
>My dr sent me a letter saying I have 4 options to consider in order for me to remain his patient.
Was it actually worded like that?
I don't understand why a doctor would write an ultimatum unless a patient was refusing all of their treatment suggestions, in which case remaining a patient would not serve much purpose.
Posted by markwell on January 5, 2012, at 18:41:59
In reply to Re: Dr's ultimatum » markwell, posted by ed_uk2010 on December 28, 2011, at 17:12:36
I went to my pdoc last week. He gave me gabapentin to help with anxiety. So far it hasn't helped much and it seems to make my depression worse. Is that possible? Everything I take either makes my depression worse or my anxiety. The dr wants to try mirapex for depression. Any thoughts on gabapentin or mirapex?
Mark
This is the end of the thread.
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