Tuesday, October 17, 2006

The Psychiatric Medication Banancing Act.

After almost two hours of very thorough work, on my HMO's part and mine, I give these people an "A". What frightened me so seriously about starting over with a new Psychiatrist, was the very assertive tone this woman took with me over the phone. We were going to change my medication. That's fine, but all she had was my past medical charts. When I have been in the hospital I've seen the hell some patients had to go through when their medication was adjusted incorrectly.

The application of medication to serious mental illness is part science and part art. Some patient's body chemistry doesn't take to, or reacts to well with a given medication, or set of medications. I have seen some of the most compassionate and hard-working behavior while in the psychiatric hospital. It is a life and death battle where the doctors and staff, at times weep right along with the agonized patient. Medication is not a magic bullet, or a cure-all. But for me, and patients like me, it has been a gift from God.

So, since I knew I was in for a fist-full of forms, I gave myself an extra hour before my scheduled appointment. It was one hell of a walk down memory lane. The first set of questions deal directly with the most common reason for becoming a patient, suicide. The last time I filled out this sheet I was critically ill for all questions, in 90% of the areas covered. Today, I truthfully answered "no" to 99% of these critical questions.

I have always believed and strongly advise, any psychiatric patient to tell the truth - all of it, to the best of your ability. I have a sleep disturbance problem. I've had it all my life. When I've gotten special medication to deal with it, I become groggy, almost to the point of being in a stoopper. So, I let myself sleep in shifts. I also drink a lot of coffee every day.

Both of these conditions can be reasons to change, or eliminate a particular medication. I told the truth anyway. I carefully explained how I was stable, even with my strange sleep schedule and high consumption of coffee. A 12-cup pot a day, spread out pretty evenly throughout the day.

Even with an hour to fill out all the forms, I wasn't finished by the time my appointment rolled around. I had put out the word to several close friends to pray that the correct medical decision would be reached. I prepared myself to make a serious effort to give this lady psychiatrist a real chance to do her job.

This was no fifteen-minute medication check-up. I was in her office for over forty-five minutes. I could actually sense the effort she was putting into searching for the answers she needed. It turns out that one of the drugs I take, a tricyclic is toxic and dangerous when taken correctly. It is also a guaranteed death sentence if used as as over-dose. For this reason, I'm not divulging the name of the drug. If you're on it, you probably already know about it.

The problem with this older medication is what it can do to a patient's heart. This was totally new information for me. This kind lady apologized for scaring me about her desire to change my medications. But I now understand why my chart was such a red flag for her. I have a heart murmur - I think that is what it is called. My heart's normal rhythm is abnormal. I skip beats, here and there, but in a way that is not dangerous to my health. It figures, my general chemistry and hormones are all messed up, so why not have a flukey heartbeat? Sheesh! I think the fact which proved the soundness of my current medications was my declining cholesterol readings. In spite of what this drug can do, I'm getting healthier!

As we talked this doctor kept misquoting my information. After three or four fumbles, I was getting confused. I had to stop and think: when do I nap in the morning? I now realize I was being tested for something. I then told her about the rare use of my emergency sedatives. I documented in this blog about a relapse I experienced. I had to take these pills to force my body to stop chemically over reacting. The doctor laughed, examining a nearly full bottle of pills over three years old!

Somewhere in this intense interview, the doctor came to the conclusion, that I really was stable and it was not a good idea to change my medication at this time. After discovering how dangerous one of my medications actually is, I was told that for a small percentage of patients, who don't quite fit the normal Bi-Polar profile, these medications make us thrive. All my heart and liver related readings are well within the normal range.

I'm not the classic Bi-Polar who swings equally from too high down to too low, but I hover on the depression side of things. I also have (or had) mild psychotic symptoms. When I'm really upset and remember an incident, I forget where I really am and what year it is. But, the doctor finally arrived at the happy conclusion that I was stable. I don't need to see her for another six months to a year, unless I run into a problem.

She gave me a slip to get my heart checked, with an EKG. We shook hands and I left her office thanking God that I didn't have to change what seems to be working so well. I was taken seriously, treated fairly and respectfully. I also now have a new Psychiatrist. Once she got the real picture of why I had the strange prescriptions I possess, she said that it was the best solution for my type of patient, but she was relieved to be sure that I was indeed stable.

I passed the EKG, which, has changed since my last one in 1984. In '84 you could hear every little heart beat, or in my case, every skipped beat. I found that feedback scary. The new test is silent. So, they put some electrodes on your chest and in five minutes, you are dressed and out of the lab. Very good. My doctor would like me to cut back on the coffee. I let her know that I really didn't want to do that, but I'd (sort of) think about it. So, to celebrate not messing with success, I went downstairs to the coffee bar and had a cranberry scone and a small mocha. See the whole culture is hyped on caffeine, a small is an eight-ounce cup! Usually I'd go for the twelve-ouncer, so, I'm sort of cutting back.

No comments: