Friday, March 31, 2006

 

The Doctor and I

Being nominally healthy, I'm not as terrified about HMOs as I will be when I'm older and less healthy. But hey, having worked in a call center before, I kind of understand the procedure - we've got to make sure you've really got a problem that we can't fix before we send you on to a manager.

I think that's what makes HMOs so repugnant to a lot of people. As Americans, we seem to have been given a right to "Speak to your manager!" about this or that if we so demand it. HMOs violate this by saying "You are not a special and unique snowflake, and having a sprained ankle does not mean you can demand to talk to an orthopedic surgeon and incidentally drop by the oncologist's office and have him look at this little bump right here."

Distracted again.

Anyway. Your MD is the best place to start anyway. If he's done his homework, he's seen a lot of people just like you. If you've done your homework, you can run down all the symptoms and he'll write you a prescription for a Schedule II doozy like Ritalin and hey, there you go.

If he's conscientious, he'll recommend you see a psychiatrist, or a psychologist, and might write you a prescription right there.

My visit went like so:

Go in, get vitals taken, wait in the waiting room. Doctor comes in, we chat:
Dr.: What are you here for today?
Me: I'm here for an ADD screening or referral.
Dr.: Why do you think that?
Me: Well, I have this long list of symptoms that I've found from reputable sources that tend to indicate ADD, but "Only My Doctor Knows For Sure."
Dr. : Hmmm. Any history in your family.
Me: My Dad is one distracted dude.
Dr.: Does this come in cycles?
Me: Not really. Like many of the references say, in some time periods I'm capable of great things. In others, I'm not so much. I test and interview really well, but the work I turn in is worthy of a C student.
Dr.: Any addictions - drugs, alcohol, gambling?
Me: There's one addiction, and it's _____.
Dr.: Hmmmm. What about sleep?
Me: What is it? I don't get a lot of sleep and I don't miss it. I feel rested after six hours, but I can go as low as four hours without feeling bad the next day. I don't cheat and nap or sleep late on the weekends, either.
Dr.: Hmmm. Ever been treated for depression?
Me: Yeah. I was diagnosed by an MD and under the care of a psychologist for about six months, and for that I took Zoloft.
Dr.: Hmmm. And how did that work?
Me: I noticed an immediate effect on day one of the Zoloft - I was focused, alert, had no problems with energy or dealing with distractions. After about 4 weeks, the Zoloft had installed this floor underneath me where I felt like I just wouldn't be that depressed anymore.
Dr. : Hmmm. A reaction on day one?
Me: Yeah.
Dr.: Hmmm. Well, here's what I think. I think you're bipolar.

Me: What?

Dr.: In fact, I think that one day, ADHD will be diagnosed as Bipolar III.
Me.: Okay....
Dr.: What makes me think that are three things you mentioned - not missing the sleep you're not getting, the immediate effect of Zoloft, and the nature of your addiction.

The Doctor then went on to explain that, even though I'd protested that I had never, ever had a manic episode in my life, that I had actually described HYPO-manic episodes. And that a hypomanic episode included symptoms that included my addiction, my sleep patterns and my distraction and/or flight of ideas.

Well then.

He then had me fill out a couple of screening questionnaires, both quite obviously provided by the pharmaceutical manufacturers, and looked at them. He said that while those results were positively inclined toward ADD, that I was also positive towards Bipolar II.

He said it would take about three weeks to see a psychiatrist, but that he could start a medication right now if I felt I was up for it.

See the post where I just want to be better. Of COURSE I would take whatever he gave me right there.

So he brought out the Seroquel. He started in on the side effects first, talking about the possible drowsiness, dizziness and vaguely disconnected feelings. I asked what the primary effects might be and he said that after a while I'd be able to focus, there'd be less noise in my brain, and I'd be better able to deal with distractions.

He also said that I should start it on a Friday, seeing as how I could have a weekend to be drowsy if I needed to be, and that we'd start with two doses of 25 milligrams and move on to the higher doses, maximum being about 800 or so, but most daily doses maintaining at 400 mg or so. Again, I'm not the doctor, he is, and if your doctor says you better be taking 600 or 800 mg of your medication, you follow his recommendation.

Dr. : Call if you need anything, and I'll see you in a week.

Remember, he said start on a Friday so that I'd have the weekend to be drowsy.

Remember, I said I'd do anything to be better.

So I got home, it was still Thursday morning, and I took the first 25mg pill. This is what is known as not following a doctors' suggestion. They weren't orders, but they might as well have been...

More in the next post.

As always, check out reputable sources of information like NIMH for the best information. I'm just some guy on the Web.

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