Tag Archives: doctors

Brain and Body – One Unit

With my next surgery only three weeks away, any sort of mental stability has been… skittish, at best. The nice weather has helped instill some good hypomanic moments, but I have been randomly transforming into a raging hose-beast from anywhere to 5 minutes to several hours at a time. Highlights include when my lawyer told me to “call him back when I felt more emotionally stable,” (good luck there buddy), or my explosion at my boyfriend for [me] not being able to find a reasonable anniversary gift for him. Whoops.

Overall, pain and eating issues/the fact that my body isn’t interested in going more than 15-45 minutes without requiring a restroom has been a large stressful addition to an already jacked up mental state. Not being able to eat the food I want (that would normally comfort me in times of stress) has been pretty difficult, and the embarrassment of having to ask the deli clerk to watch my basket at the grocery store while I use the bathroom three times in one 15 minute visit doesn’t feel so nice either.

Ultimately, the issue that my surgeon found during the last surgery is that my uterus (having grown diseased endometrial tissue) has become connected to my colon. While this seemed weird (and the doctors expressed that feeling too) I imagined the two bound by a small, maybe quarter size area that could be sliced apart… case closed right?

Uterus vs. Colon

Unfortunately that isn’t the situation. My uterus is now holding my colon hostage and is connected for a long stretch of both. I am happy that this explains the pain, nausea, and inability to eat… as well as some other, less pretty problems I’ve been having, but the fix isn’t quite so quick as I might have imagined.

Why even write about that here? I mean, I thought about that, and I thought about not going so in-depth about a health problem that isn’t mental health related.

Oh wait! But it IS!

The biggest issue my doctors and surgeons have had to wrap their head around is that I have a pretty severe case of bipolar disorder. Because of this, many aspects of my symptoms, my treatments, and my recovery are different from most people.

My symptoms include physical pain, but this is a big purveyor of emotional stress for me, which means triggers for emotional outbursts and episodes . At the same time, my symptoms of being unable to eat a long list of yummy things (dairy, beef, spices that aren’t salt, fatty or fried foods, seafood, acidic foods, the list goes on…) disrupts my typical “self-care” routine when it comes to finding joy in what I am eating. Having less options to draw on in maintaining my mental stability means less stability!

My treatment of this health problem is atypical because all typical treatments (using hormone therapy) trigger severe emotional reactions for me. That means the best option I have is a procedure (hysterectomy) that is normally reserved for women much older than me. Granted, I have never been interested in having children (so I dodged a bullet there) but upcoming surgery is, again, stressful, and despite my disinterest in having children my subconscious is still grappling with the idea and I’ve had nightmares every night.

My recovery will also be different than the norm because I have the added risk of post-surgery medications triggering episodes (like last surgery). Once again, the pool of self-care resources I will have will diminish as I will be immobile, and feeling “trapped” has always been a big trigger for me. The physical pain will continue to be an issue for a while and there is the possibility I will need to be on a liquid diet for a while as well (depending on how much surgery is done on my colon). So, um… stress much?

All in all, there is no separating my mental and physical health from one another. Even though my brain isn’t down in my abdomen having tug-of-war party with my uterus and colon, they are connected. It’s called a body! It is generally considered one unit.

At any rate, this is a situation that I know will require physical work. It will require mental work. It will require emotional work. If that is the price it takes at a chance of feeling better, as usual, I will take it.

 

Back to the Basics

Things seem to have reverted back into a state of normalcy for me. Of course, when I say normalcy, I mean my normalcy. This change definitely has it’s plusses and minuses (less physical pain and vision problems, a return to a flip-flopping of psychotic mixed and depressive states, and the typical health care team issues I tend to run into every six months or so) but I wanted to address this return “back to the basics” that has occurred over the last two weeks before writing about anything else that has been on my mind.

My current psychiatric medications have returned to a regimen of  lithium only. 

I’m sure it was pretty clear that the seroquel I tried the last few months brought on some serious health problems, but it wasn’t until the issues with blurred vision, dizziness, nausea, and light and motion sensitivity that I began to suspect the wellbutrin I’d began in the last two months might be contributing to the problem. After having my eyes, ears, and stomach checked out I began a systematic stop and start of the medications I was taking at the time to see if any changed occurred. I pulled the plug on the 150 mg of wellbutrin I was still taking (after decreasing a week earlier and seeing some improvement and speaking with my psychiatrist) and about ten days later (Saturday) I was able to sit through watching a movie for the first time in five weeks without thinking I was going to vomit.

Not having been able to watch tv or movies for that long was pretty agonizing, movies are one of the few things I generally still feel passionately about and being without that sense of comfort was very jarring.

I was a little surprised (but glad I didn’t have to go see a neurologist about this) because the warnings for wellbutrin list “eye pain and vision problems” but that isn’t very specific. What really tipped me off was that I found out that wellbutrin can trigger problems with vertigo, and though I have experienced plenty of vertigo in the past and what I was dealing with this time was different, there were aspects of my symptoms that felt similar. At any rate, this issue is improving… and I wont be taking anymore wellbutrin in the foreseeable future.

The swings are back in action. 

While the seroquel seemed to keep me from swinging around the mood spectrum, it also kept me in the depressive end where I was sinking very quickly into a dangerous place. Now that I’ve stopped it, I’m back to my typical, sporadic swings lasting anywhere from thirty minutes to days or weeks at at time.

“From your perspective, which is worse?” I asked my boyfriend. “When I am depressed all day every day, or when I seem ok one second and then fly off the handle the next?”

He paused for a moment before replying, “I can’t really call one ‘worse’. They’re both equally devastating.”

I feel like I ask myself the same question a lot, because remaining in a single state (like depression) can sometimes feel better, more stable to me than rapid cycling because I can often do a better job of predicting my future mood; depressed. At the same time, everything shuts down and my mood rarely stays “somewhat depressed”, usually moving toward “earth-shatteringly depressed”.

If I’m rapid cycling, I can usually experience one or two hours a day where I feel relatively ok, and if I’m really lucky, maybe one day in a week where I feel relatively stable. Sometimes, just the fact that these moments are possible makes rapid cycling feel somewhat better to me.

I find the negatives of rapid cycling to be much worse though. It grinds on my relationships, I have no way to make any kind of predictions about how I will be feeling from one moment to the next, and switching into mixed episodes (which has become more and more common for me) becomes extremely dangerous.

Annnd health care team problems… as per usual.

I feel confident today in saying my concerns about my healthcare team the last week have had nothing to do with delusions.

Usually when I have problems with healthcare, it has been because of insurance coverage, or co-pays, or my old doctors not taking new insurance, or whatever element of the system seems broken at the time. This time, my concerns are a little different.

October has always been a fishy month to me, and I don’t consider myself superstitious but usually when something weird goes down or people are acting very strange, it is in October.

Anyway, first my general doctor started acting very strange and making me incredibly uncomfortable. He’s began giving me these long “pep talks” about how I need to look inside myself and find happiness, naturally this is one of the biggest turn-offs you can come across when you have a mood disorder. This has happened twice now, and though I understood when it happened the first time (I had a breakdown in his office) the second time it was completely unwarranted and generally had nothing to do with anything we spoke about in my appointment (regarding stomach pain). This man has always been a good doctor to me, very smart and professional for several years, and I know he is coming from a place where he is intending to help me, but for the most part while I was stuck in that little cold room with him trying to make extended eye contact it felt like if either of us is insane, it is definitely him.

Next it was my GI specialist. I needed a prescription refill order and she failed to return any of my calls, messages, or emails for three days. When she finally did send the order, she sent the wrong order to the pharmacy and never called me back. After calling the office again (to make another appointment) all of the notes from our last appointment have mysteriously vanished and there is no record of it. Needless to say, this (even more than the above problem) makes me extremely nervous. I realize she is a busy woman, but I feel like my experiences last week are definitely bordering on (if not already) unprofessionalism. I ran out of medication saturday, I still haven’t heard from her or her office.

Finally, my therapist quit unexpectedly two weeks ago. He had scheduled a follow up appointment with me last week, but the receptionist called me that day and said he never showed up. By the time this happened I couldn’t help but laugh.

I don’t have much of a plan of action for the first two doctors (maybe they’ll get their sheezy together?) but as far as therapy is concerned, I’m ready to switch clinics. The one I have been going to the last three years I’ve had a lot of problems with, and the people who work there are very inexperienced. Instead I’ve began pursuing a community clinic specializing in patients on medicaid with more significant mental health problems (me!), at this point I’m just hoping to get in before next month when things become extremely (more) stressful.

Tonight I have an appointment with my psychiatrist and I am keeping my fingers crossed he hasn’t completely fallen off the deep end too.

Finding a Primary Care Provider

Recently, more and more health insurance providers are moving toward a system where signing up for care means being assigned a primary care provider (general physician) until you choose to change that physician to someone else.

The trouble is (and I’ve found this on more than one occasion) many of the lists these primary care providers (or PCPs for short) are coming from are outdated. These lists on record often contain the names of physicians that no longer work for the hospitals and clinics found on the list, or they are no longer accepting new patients.

Yesterday I found myself in something of a pickle. My medicaid plan (signed up for near the end of the affordable care act enrollment time) assigned me a sub plan automatically (until I chose another) which also assigned me a primary care doctor that didn’t exist.

What’s worse is that when I tried to fix this (and pick another plan under medicaid) I found out it wouldn’t kick in until May, leaving me a window through April with a wonky plan and no doctor.

Fifteen minutes of tears and a panic attack later, I made an attempt to find a new primary care physician under the plan I was stuck with, only to have the plans’ customer service people assign me a second, non existent doctor. 

The point of this story, to me, is pretty clear. Relying on someone in a cubicle and a phone to choose my doctor for me is ridiculous. Trying to pick a doctor out of a list of names also seems ludicrous, after all… how do I even know which ones are good?

In a blog about mental health, you might be wondering just how important general physicians are anyway… but there are many reasons having a good primary care doctor can work in your favor.

Primary physicians can be the gateway to mental health treatment. I know several people who are prescribed mental health medications by a primary physician (though I’ve had terrible luck with that myself). On top of that, many insurance plans require a primary physician to refer (basically give you an “in” and a stamp of approval for mental health treatment to your insurance provider) you to mental health specialists before you can get treatment.

Primary physicians are often a gateway to all realms of physical health. If your insurance doesn’t require a referral for mental health services, it is much more common to require referrals to all other specialists, including anything from dermatology to neurology to allergy specialists. Doing what we can to help our minds is only half the battle, we need to be able to take care of our bodies as well. This might even include a primary physician helping counteract physical side effects of psychiatric medications, something that has been super important in my own search for better health!

Yes, these people are important, but when being assigned phantom PCPs, how do we find good doctors accepting new clients who also take my insurance??

My advice is not to start too small. Start by looking for locations that generally accept your insurance. You can do this by doing a search online at your insurance provider’s website (usually, you might have to google the addresses you find to see the actual locations), or you can call your insurance customer service line (though I’m warning you, this can be a huge headache). Something that worked for me was calling the office of my phantom PCP (via a number on my new insurance card) and finding out there were several (real) doctors there that do take my insurance.

I find that if you need to choose between calling insurance people or calling clinics, you will often get much more help from the clinic receptionists. As long as you try to remain calm and friendly, they can usually point you in the right direction.

We have several hospital systems in Seattle, so finding out what hospital system takes the health insurance in question can also help you find primary care doctors and specialists in your area. I called my usual hospital (who didn’t take my new insurance) but found out another hospital down the road who does. 

Don’t underestimate the knowledge of friends, family, or co-workers who have the same insurance as you. If you know someone on your plan who claims they have a great doctor, ask for their information! This rings true for not only primary care doctors, but psychiatrists, therapists, and any other specialist you might be interested in seeing.

Once you’ve found out if a location (or if doctors at a given location) take your insurance, you can call and ask the receptionist if anyone is accepting new clients. I’ve met some really wonderful receptionists who have even gone so far as to give me brief descriptions of the available doctors dispositions!

Writing down the name of the doctor (with correct spelling), the phone number of the location, and the address is important. Once you have this information, you can go back to the insurance website or customer service line and request a change of primary care physician.

This last step is IMPORTANT, because if you don’t follow through with the choice that you’ve made your insurance company can potentially deny your claim (aka not pay for it) if the doctor you see doesn’t match the doctor listed in their database.

Some insurance companies will allow you to change this information on their website, while others have an automated phone system. On occasion you might need to speak to a customer service representative (who may also put you on hold to call the clinic you just talked to and verify the information). In any case, once you have finished the process you can expect to receive a new ID card in the mail with your new (and correct) PCP information listed.

I realize this is a lot of information, and I know nobody likes insurance nonsense, but finding and selecting a primary care physician before attempting to interact with insurance representatives can save you a lot of hassle. I know it would have saved me a panic attack, and three hours of yesterday’s morning!

Good Doctor, Bad Doctor

I have been lucky in finding a general physician who I really trust and like, but lately it seems like others have suddenly caught on -his schedule has been packed leaving me seeing someone else for a recent sinus infection.

It never ceases to amaze me how great one doctor can be, and how awful the next might be. I found myself met with zero bedside manner, a doctor who downplayed my symptoms, and then prescribed me (knowing I was uninsured) the most expensive medication possible for my ailment.

Now, I just wanted to take a brief moment to remind you that seeing a doctor should be like any other business. I expect to be a customer who is listened to and respected, and when I am not, I do not give repeat business.

There is no way to know what a doctor will be like until you work with them firsthand, but I urge you all to stand up for yourselves to demand a level of care you deserve. If a doctor is treating you poorly, chances are there is another doctor out there who you can work with more comfortably.

Finding a good doctor may mean having to deal with busier scheduling on their end, but in the end it is usually worth it.

As true as I believe this to be with my general physician, I think it is twice as true with my psychiatrist. Psychiatry is a very complicated practice, and finding a good psychiatrist who treats you with respect is often worth their weight in gold.

I just wanted to leave a reminder today that you are worth being treated with respect, but it is also up to you to find a doctor that treats you fairly.