After three years of being treated by residents at one of the "best" university teaching hospitals, I got fed up with what I felt was inadequate care. I found a pdoc locally who isn't part of any insurance network, but has great qualifications and a willingness to work with me. I like her. I think she is a keeper.
I was in there for 90 minutes, which surprised me but apparently not her. I had brought some things with me and we went over them. I made a list of meds, past meds, concerns, etc. I brought my last blood test results since they always wanted them at the teaching hospital. I also brought my health summary from my primary care doc, since they have an electronic My Chart function that allowed me to download a history.
Most importantly, she's totally fine with my taking Klonopin. My previous resident started me on Klonopin for my agoraphobia and severe daily panic attacks, back at the end of June. The next resident took me off in September. I'd been dying since then, calling out at work too much, and just generally putting my job in jeopardy (those who know me know that I've already lost one job to agoraphobia).
She found it odd that I was concerned she wouldn't want to treat me because of my DID. She said, she's a psychiatrist, why wouldn't she treat DID? I know some pdocs don't though, they see it as being too high maintenance.
She lowered my nighttime Haldol dose because she thinks 5 mg is too much at a time for me. So I will be taking 5 mg a day instead of 7.5 mg. She questioned why my previous resident increased my anti-psychotic rather than keep me on the Klonopin that was helping my agoraphobia. Upping an anti-psychotic will not help a patient with a panic attack, I was like THANK YOU.
She agreed that 250 mg is too much Lamictal so we are staying at 200 mg. Again, this was a move by the resident to avoid Klonopin, and again, she said that increasing a mood stabilizer is not going to benefit someone with a panic attack.
We talked a lot about my psychotic episodes and she at one point asked me point blank, but not in rude way, "do those residents there have supervising doctors?" They diagnosed major depression with psychotic features. She is not 100% putting her money on it yet, but she thinks it's schizoaffective disorder, depressive type. Reason being - the psychosis should go away if my depression is under control, so I shouldn't need Haldol (or the Geodon or Abilify I previously took) when the Effexor is working for my depression.
Because I still experience more than one type of significant psychosis with controlled depression, she believes it's a psychotic disorder not just a mood disorder. I felt like saying THANK YOU again, because I expressed this at the teaching hospital and was brushed off. She wants to talk more at the next visit before officially making the diagnosis, but she said it changes how she wants to treat me.
She did say that my peri-menopause could contribute to my panic, and that it's a hormonal imbalance that makes the brain misfire and read panic, even though it's really something wrong with your hormones. Regardless, the way they treat this is with benzos - like my Klonopin the other guy was adamant to take away from me.
She said normally people don't gain weight on Geodon or Abilify, but obviously it can happen, and she's sorry I've gone through a 100 pound weight gain without them re-evaluting things and just sticking to their scripts.
I had said that I wanted to try to find something besides Buspar to augment my Effexor because Buspar makes me tired and doesn't do anything for my anxiety anyways. She said she's never seen Buspar work for anxiety so she's not surprised about that. She said we'll look into a different med at my next visit, and that one possibility is very low dose thyroid that can not only boost an anti-depressant, but also address the crippling fatigue I have. I'll ask about the potential for it making me anxious, but it sounds like she has an open mind as far as treatment options are concerned and I like that.
She knows her stuff and she definitely knows how to conduct a new patient interview. She used my things I brought as a guide and then asked me a lot of other questions about things like family histories, social (or in my case, chosen lack thereof) life, and said she agrees with the schizotypal personality diagnosis, and that I am in the wrong job. I need to not have a lot of exposure to people in order for a job to suit me, and I don't have that now, spending some of my time at a reception desk. My job will soon focus more on imaging to digitize our department's files, and she said I may find that easier, but I should still look for other employment. I'd told her that a psychiatric nurse at my employer assistance program said that about my job, and the new pdoc agreed.
So I see her again on February 4, that will be an hour, which was both of our preferences to do another long appointment before we start doing 25 minute sessions. We want to get my diagnosis solidified, I want to find a different Effexor augmentation agent, and I want to get to know her better too. I need a very competent psychiatrist since I have so many psychiatric diagnoses. She kept saying compassionately, "you really have a lot going on," and she kept saying she wants to help me.
Since she's out of network with my insurance, it'll be subject to deductible and paid only 50% after that, but I don't care. It's been way too long since I had a competent psychiatrist. You can't have DID without a really good pdoc, and if she's right about the schizoaffective, that's another serious issue in addition to the PTSD and the agoraphobia...and of course the depression. It's just a question of where that fits into the diagnostic equation. I obviously have severe depression.
Wish me luck that I have just as good a session in four weeks as I did today. I'll be saying lots of prayers between now and then.