...so...my prescriber is trying to get rid of me.
Let me just...okay first, I don't think he's a terrible prescriber (it's about to sound like I think that, so consider the record pre-emptively cleared).
That said...it's pretty frustrating to see your prescriber once every 4-6 weeks...have awkward to bad reactions to most of the meds you try...have your prescriber argue with you about what you need (Ex: he thinks I need a long acting med for ADHD...I prefer shorter spurts because I simply can't be that focused all the time with the way my life operates...he kept prescribing the long acting ones...)...and then...after a billion trials of different meds and combos...have him say things like "I'm not convinced you have an anxiety disorder. I think you would have been fine without any treatment at all. I think we're just chasing a dragon here. You would have been fine if you'd never walked into this office. You cope just fine.".
Uhhh....what?!
Way to minimize my difficulty, dude. Way to make it sound like "coping" is a great way to live. You seem like a nice guy and you seem smart. But my appointments are 20 minutes long...every 4-6 weeks. We don't really get into a lot of substance. And luckily for YOU, I'm able to be really articulate about my mental health experiences, for the most part. I also spent 33 years coping my ass off to learn ways to "do" life and get things done and it was stressful to the point that it probably shortened my life span, and certainly affected my health (let us all recall the bizarre migraine incident).
I think he's mistaken my articulation and ability to "pass" for lack of impairment. Aw...that's cute. Wait...not, it's not.
I know I'm not the most impaired person around...but is it "normal" for it to take a person with exceptional reading ability 12 hours to get through an article that should take an hour to read? That trivial little impairment made grad school AWESOME times, like 1000.
I'm feeling shy about some of my other impairments right now so I'm not going there.
But...you get the idea. It felt pretty crappy to be told that he thought I was normal...HAHA...which sounds all wrong. I assure you, I'm very interested in improvement, and in mental healthiness. My therapist certainly agrees.
But what the hell was he thinking?! He seems to be thinking that I'm a waste of his time. And so, we are in agreement...I will likely be switching my prescription care over to my GP after my next appt. We are in agreement on this switch, but for totally different reasons.
He acts like I'm a waste of his time...in a polite way...but really, I wonder if he isn't just frustrated with how difficult it has been to find meds that work for me. Incidentally, we finally seem to have hit on a good combo and it happily treats my migraine issue as well. But...I think sometimes that maybe he's taking this all a little personally. I might represent failure to him in a way that he may not even notice in the front of his mind. Maybe that's a strange thing to think...but I've learned over the years that I'm generally more perceptive about people than I think I am.
For me...the switch will be less precarious than it would be for many people getting psych meds from a GP...because I have busted ass to educate myself about what all the meds are and what they do and what their side-effects are. Unfortunately I also learned a lot of it the hard way, through first-hand experience. I've also learned a lot about what DOES NOT work for me and I know what questions to ask...so I'll be pretty well equipped to shoot down insane suggestions from my GP if I'm not feeling okay about them. And I can request a referral if I need one...
So...the switch might be good. I like him as a person, in the short spurts we've spent together, but he might not be the best fit for me as a provider.
I shouldn't have had to fight for a year to simply be prescribed 5 mg of Ritalin to use at my discretion depending on my activities. For the record, it seems that for me, 25 mg of nortriptyline a day and 5 mg of Ritalin for days when I'm desk-bound are about all I need. Seems like not a lot, but my med sensitivity means that for me...these tiny doses make a huge difference. (For some reason, now that I take the nortriptyline at a higher dose, the Concerta is just too much, even at 18mg...though in general, in my experience, I think it's a GREAT, and subtle drug.... The nortriptyline itself makes me feel a little calmer and more focused...so that the Ritalin booster is just the right amount to put me in a subtly quiet and focused mood. I officially cannot even believe that at one point I was taking 70mg of Vyvanse...what the frigoriffico!? I'll own that though...I just knew something wasn't right...so I thought I needed more...not less...one of us should have figured it out...!)
Change...I have complained a lot about it this year (on and offline) but I feel like this change will be good. What do I say on this occasion..."Thanks for finding me annoying because I'm not a quick-fix patient?" or "Thanks for minimizing my relative difficulties because I'm not actually mentally ill?".
I think I'll just go with "Thanks..." and "...later!".
Let me just...okay first, I don't think he's a terrible prescriber (it's about to sound like I think that, so consider the record pre-emptively cleared).
That said...it's pretty frustrating to see your prescriber once every 4-6 weeks...have awkward to bad reactions to most of the meds you try...have your prescriber argue with you about what you need (Ex: he thinks I need a long acting med for ADHD...I prefer shorter spurts because I simply can't be that focused all the time with the way my life operates...he kept prescribing the long acting ones...)...and then...after a billion trials of different meds and combos...have him say things like "I'm not convinced you have an anxiety disorder. I think you would have been fine without any treatment at all. I think we're just chasing a dragon here. You would have been fine if you'd never walked into this office. You cope just fine.".
Uhhh....what?!
Way to minimize my difficulty, dude. Way to make it sound like "coping" is a great way to live. You seem like a nice guy and you seem smart. But my appointments are 20 minutes long...every 4-6 weeks. We don't really get into a lot of substance. And luckily for YOU, I'm able to be really articulate about my mental health experiences, for the most part. I also spent 33 years coping my ass off to learn ways to "do" life and get things done and it was stressful to the point that it probably shortened my life span, and certainly affected my health (let us all recall the bizarre migraine incident).
I think he's mistaken my articulation and ability to "pass" for lack of impairment. Aw...that's cute. Wait...not, it's not.
I know I'm not the most impaired person around...but is it "normal" for it to take a person with exceptional reading ability 12 hours to get through an article that should take an hour to read? That trivial little impairment made grad school AWESOME times, like 1000.
I'm feeling shy about some of my other impairments right now so I'm not going there.
But...you get the idea. It felt pretty crappy to be told that he thought I was normal...HAHA...which sounds all wrong. I assure you, I'm very interested in improvement, and in mental healthiness. My therapist certainly agrees.
But what the hell was he thinking?! He seems to be thinking that I'm a waste of his time. And so, we are in agreement...I will likely be switching my prescription care over to my GP after my next appt. We are in agreement on this switch, but for totally different reasons.
He acts like I'm a waste of his time...in a polite way...but really, I wonder if he isn't just frustrated with how difficult it has been to find meds that work for me. Incidentally, we finally seem to have hit on a good combo and it happily treats my migraine issue as well. But...I think sometimes that maybe he's taking this all a little personally. I might represent failure to him in a way that he may not even notice in the front of his mind. Maybe that's a strange thing to think...but I've learned over the years that I'm generally more perceptive about people than I think I am.
For me...the switch will be less precarious than it would be for many people getting psych meds from a GP...because I have busted ass to educate myself about what all the meds are and what they do and what their side-effects are. Unfortunately I also learned a lot of it the hard way, through first-hand experience. I've also learned a lot about what DOES NOT work for me and I know what questions to ask...so I'll be pretty well equipped to shoot down insane suggestions from my GP if I'm not feeling okay about them. And I can request a referral if I need one...
So...the switch might be good. I like him as a person, in the short spurts we've spent together, but he might not be the best fit for me as a provider.
I shouldn't have had to fight for a year to simply be prescribed 5 mg of Ritalin to use at my discretion depending on my activities. For the record, it seems that for me, 25 mg of nortriptyline a day and 5 mg of Ritalin for days when I'm desk-bound are about all I need. Seems like not a lot, but my med sensitivity means that for me...these tiny doses make a huge difference. (For some reason, now that I take the nortriptyline at a higher dose, the Concerta is just too much, even at 18mg...though in general, in my experience, I think it's a GREAT, and subtle drug.... The nortriptyline itself makes me feel a little calmer and more focused...so that the Ritalin booster is just the right amount to put me in a subtly quiet and focused mood. I officially cannot even believe that at one point I was taking 70mg of Vyvanse...what the frigoriffico!? I'll own that though...I just knew something wasn't right...so I thought I needed more...not less...one of us should have figured it out...!)
Change...I have complained a lot about it this year (on and offline) but I feel like this change will be good. What do I say on this occasion..."Thanks for finding me annoying because I'm not a quick-fix patient?" or "Thanks for minimizing my relative difficulties because I'm not actually mentally ill?".
I think I'll just go with "Thanks..." and "...later!".
Could you print out some of the articles, written by degreed professionals & researched, you see on the ADHD/ADD blogs which go into detail on the problems YOU & others like us face...We have to be "tuned" like a violin daily, hourly depending on conditions and play/work.These doctors are like mechanics, they don't always fix things right. He is making assumptions on limited knowledge...You do what you need to to get right balance.
ReplyDeleteHe is a psych prescriber but you ARE correct, even many psych prescribers are not totally up on the latest. And of course many prescribers have their heads stuck too far up the DSM to really look at the person sitting in front of them, lol.
ReplyDeleteI'd love it if he spent a little time getting cozy with the writings of Dr. Parker :)
http://www.corepsychblog.com/adhdbook/
You make a good point about the need for us to actively advocate for ourselves...I'm pretty good about that...but it's an ongoing process and I learn new stuff all the time.
Geez, it's like the autumn of prescriber discontent. Mine's fired, too.
ReplyDeleteHope the GP switch works out alright!
Katy, maybe I'm missing something, but he might be confused by your wanting to stick to the short-acting meds. You say you can't be that focused all the time due to the way your life operates. What does that mean?
ReplyDeleteI could see why he might be confused, and probably frustrated. Perhaps he's trying to give you the best standard of care, as many people understand it, and that is long-acting formulations that are smoother, less roller-coasterish, etc.
Even though the eyeglasses analogy is used with ADHD meds, it really doesn't work that way in the body. In other words, it's not as simple as taking glasses on and off. Every time you take the stimulant, there is a cascade of reactions throughout the body, with various systems, neurotransmitters, etc. adjusting. Then when you stop, all that has to re-adjust, and re-adjust again when the stimulant is active again.
We are learning now that even sleep is affected by untreated ADHD in many people, which means important things like cellular repair and hormone production aren't happening as they should.
Have you already done the NeuroScience Inc testing with Dr. Parker? That could give you some useful data. Insurance usually covers the testing.
I've come to think it's nutty NOT to do this testing as part of treatment for ADHD (or anything else, really, including chronic pain, thyroid, allergies, etc.).
I stopped seeing a psychiatrist and started seeing a neurologist. With the psych prescriber he rushed me in and out in 10 minutes. My neuro doctor got me on better meds and actually took 50 minutes to talk to me. i could email him in between appts if i had anything bad going on....
ReplyDeletemaybe a good route for you to explore.
hope your having a good day!
I really liked my neurologists who were helping me with my vestibular migraine problem Dana :) Perhaps they will again become a useful resource...
ReplyDeleteGina: as always, great questions. This is a great one in particular because it's causing me to seriously reflect on an answer and the answer is important...
I read once about an attorney who takes stimulants when he's in the office working, but can't function in a courtroom if he takes them on those days. I run an event every weekend and it involves day-long constant interruptions and people juggling...that's nearly impossible (for me) with stimulants.
And one of my day-job bosses is VERY hyperactive ADHD-guy. When he's around it's like a freight-train coming into the office and knocking over my entire desk and work list so that I can be completely derailed by something that has nothing to do with what I'm paid to be here for.... Even if I choose to close my door, he will pop into my office every two minutes or talk to me from the other room and I can't get anything done. It's crazymaking. At least if I'm not taking stimulants I don't care so much that I'm not getting anything done...and I'm not trapped in a 12-hour medication that is only creating the condition for me to be frustrated. I believe it's what my prescriber calls a "socio-environmental factor" and that factor isn't going anywhere right away. The stimulant is the thing I CAN control in that situation and therefore is the only realistic thing for me to try to manage.
But...it's also the case that because of my anxiety AND med sensitivity...if my body isn't digging the stimulant that day, and I take a long-acting stimulant, I'm trapped in the extreme anxiety dungeon for the next 12-14 hours. It's a bit horrific really. I think it's mostly related to hormones and there are times of the month now where I simply won't take stimulants at all.
So really...it's just a matter of priority juggling. I'm aware that I lose some benefits...on those days when I don't take it, it would be nice to be able to be more organized...but as my life is right now I just feel I need more manual steering capability to maintain my sanity. Even if that manual steering might be a little clunkier, I feel it's a better choice for me right now. And...my prescriber at this point is like "okay fine". I just hate getting that vibe, even if I'm happy with what I'm taking...and I don't like it that it took this long for him to finally just let me try it.
Having ADHD means I have to spend a little extra time thinking through certain kinds of things. But it doesn't mean I have no knowledge about my own life and the factors I'm juggling. And I did try it "his way" over and over, which honestly made big chunks of my week difficult to deal with for a long time. When a few things shift in my life I'll be happy to try Concerta again, because on the days that it works for me, it's really great.
As always, short question, long answer, but I wanted to illustrate that in case someone else (besides you, Gina, lol) might find it helpful. I know that for many, the longer acting stims are a better choice, and it's great they they're out there :)
Side note: my GP just did some basic testing like my thyroid and such and...they all came out great...but I'll poke about into Dr. Parker's testing info...
Yes, the long-acting stuff does not work for me either...
ReplyDeleteHi Katy,
ReplyDeleteSorry if I seemed to be questioning your judgment. I know you are very smart and astute about such things, and that you're making the best choice given the circumstances.
But given all the above, I could just see how the doc might not get it. After all, so many don't even get the basics of ADHD. :-) So, I probably went into lecture mode. Sorry. Occupational habit.
The NeuroScience testing does more than examine thyroid issues, etc. It looks at the building blocks of neurotransmitters (amino acids) by correlating with metabolites.
I was just throwing that out there in case you (or anyone else here) has decent insurance. The testing itself is typically 75% covered, which is a refreshing change for ADHD-related diagnostics.
The point is that, by targeting amino-acid-related issues, you can often minimize the amount of medication or the side effects (such as the anxiety you mention).
It's ironic that the "general public" thinks that ADHD meds represent the "easy way out." There is NOTHING easy about optimizing the Rx for ADHD. And the stimulant alone, for many people (especially adults) with ADHD, can often create a host of other problems.
Just FYI....
No no, no worries. This is the kind of issue that I like to clarify in this blog, for the purpose of effective information sharing :) Plus, there are many different flavors of ADHDer...so there may be others who can totally relate to my experience...where others might not at all. But if we don't talk about it, we don't learn and connect as well. Right? Right.
ReplyDeleteThat is very interesting...I seem to have a quirky, lightning-fast metabolism...would be interesting to see what I might learn from that testing. It's certainly not always been fun learning the hard way...trial and error is no way to approach the brain...as I write this I'm recalling some bizarre Remeron-induced hallucinations where I would fall asleep sitting up with my eyes open and see "things" crawling out of the television. Then wake up and go "damn...I'd better just go to bed if it's gonna be like that...". Ha. Medication experiments...nothing "easy" about meds...and even with them, when they're working, there is still personality, and free will to contend with. As I've said to my therapist many times: there are some things in life that no amount of stimulant medication can make me focus on...lol...
Oh...and yes, there's a lot of reasons that I can see my provider being confused about the situation :) Why should 18mg of Concerta give any grown up that much anxiety on an "off" day? Who knows...why should 25 mg of nortriptyline have the same effect on me that it has on "other" people at 70mg? Not a clue. Just another reason that more subtle testing might be a great investment...subtle testing, and a pack of Hostess Cupcakes please...
ReplyDelete