Posted by: Jack Hope | Friday August 31, 2012

Report From the Psychiatric Trenches

So a few days ago I had my first meeting with my new psychiatrist. After being in Alberta since the beginning of May and on the waiting list to continue the treatment from British Columbia since mid-May. I was originally advised that my wait would be between a minimum of 4 months (warned that was unlikely) to a more likely 9 months wait.

Just to get basic treatment, a 9 month waiting list.

It still blows my mind to this day that this is what I was being advised of. You can read my initial response to this absurdity in my post ‘No Exit.’

Obviously, thanks to the help of my regular Doctor and a few other people affiliated with Alberta Health Services I was able to cut through that waiting list and get in to see someone after a wait of only 3 and 1/2 months.

By contrast my wait to see someone in Vancouver was only a few weeks.

I have to admit I was very nervous going into this meeting, largely because if this relationship didn’t start off well, I could find myself back to the bottom of that queue again, waiting to see someone more to my liking. Fortunately I can say that my meeting with Doctor Z (obviously a pseudonym) was an unqualified success.

First off, I was the last scheduled appointment for the day with a half hour allotted. I was on time for the appointment, but Doctor Z was a bit late bringing me in. That was fine, that often happens with Doctors. I figured, since the appointment started about ten minutes late, that I would lose five minutes on the end of it, also not a big deal.

My appointment with Doctor Z ran 45 minutes long, which really impressed me. I know how busy most Doctors in the public health care system are and him making sure to take the extra time to get all the information he needed really stands out.

Second, as he had me go through my previous experiences, basically relating what I had been through, it was very obvious that he had prepared by going through the material provided by my previous psychiatrist. While he had me go through my past experiences, he asked intelligent and pointed questions, which had me feeling that I wasn’t just regurgitating the same information that I’ve gone through a million times before.

Third, in regards to my previous incident that I was concerned might be a warning sign of Bipolar Disorder, his conclusion was that while continued monitoring on that was appropriate, one incident does not make a Bipolar Disorder. Its something we’ll continue to watch for, with more vigilance than before, but for now Bipolar doesn’t seem to be one of the things that I have to worry about.

Doctor Z also prescribed some new medication to supplement what I am already taking. That was another concern that I had, that a new psychiatrist would decide to change my current medications completely. Given that I have had some fairly reasonable success with my current medications (and given that I’ve had some very negative experiences with others) I was leery about abandoning my current regime in favour of something different. So, attempting to supplement my current regime rather than replace it is a good place to begin.

As well, we did also discuss the possibility of Electroconvulsive Therapy (ECT) and while he’s not a specialist in that, he does consider it a viable treatment option for the future. That being said, I have recently been on a slow upward trend of late and if this new medication helps then proceeding with ECT may not be necessary.

A couple of other small but interesting things that came out of this appointment: he wholeheartedly approves of my taking up running, which while not exactly a surprise, is nonetheless gratifying and encouraging. As well, I’m also going to begin a regular mood monitoring to help get a better idea of where I’m tracking. I did this informally with my previous psychiatrist but as I’m not going to be able to see Doctor Z as frequently, some regular monitoring is a good idea.

So that’s my first report back from Doctor Z. Definitely feeling that this is the start of a very promising doctor-patient relationship. It’s nice to feel this optimistic and this secure after so many months of struggle.

If anyone has used any online mood monitors that they would be willing to suggest, I would be most appreciative. Suggestions can be made in the comments or via Contact Me.

All other comments are, as always, welcome.

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Responses

  1. ECT is used as a last resort. I would be cautious. There are many people that it saves their lives but it is usually the very last option. I was out of options in 2003 and we decided that was the only thing that would help keep me alive. I was one of those that it did not help. I had twelve great days and then I crashed. My memory is not the same and my advice to anyone would be to make that decision with a lot of research, thought, and prayer if you are a religious person. My husband and I can’t look back and second guess our our choice because it was the only thing that we could do at that point. I am stable now but I live within a very small bubble with limitations in place to keep me well. So, my advice again, is to be so cautious in making such a big decision.

    • Hello Dina Marie, and thanks for sharing your experience. First off, I want to say that what you went through sounds absolutely terrible. Your story is a very good reminder of the risks and limitations of modern medicine. You have my sincere best wishes in dealing with all of this.

      Your story and similar stories were one of the reasons I was very hesitant (actually outright rejected the idea for a long time) to even consider the idea. Some of the follow up research I did though moved the idea into the realm of consideration. One of the biggest was the fact that refinements to the procedure as its done in British Columbia have greatly reduced (although not eliminated) the risk of negative outcomes such as yours. My Vancouver psychiatrist was quite the proponent of ECT and he had an impressive rate of recovery with his patients who used the procedure, with none reporting long term lasting consequences. That doesn’t mean that it was risk free option, but it was an acceptable level of risk given the possible outcome.

      Also given the fact that I’ve had two common, standard anti-depressants produce atypical psychotic side effects, my pharmacological options are lot more limited then they might be for other patients. My reluctance also consider anti-depressants (refusing them for nearly 10 years) provided another important lesson in making this decision: never take any options off the table.

      The last thing is that I am in a lot of ways near the end of my rope. A decade of constant decline. In treatment for more than two years. Off of work for almost as long. I need to move past this and if this new treatment doesn’t work out my options for going forward here are going to be further limited. We are rapidly approaching the need for a last resort unfortunately.

      Thanks again for sharing your story and I hope you’ll comment here again in the future. Thanks for reading.

    • Hi, Dina. Just wanted to say that I have never had ECT, but I too live in a very small bubble in order to stay stable. At least we have stability right now. Hoping/praying it remains 🙂

    • Just wanted to jump in and add that I’m also in a very narrow bubble of stability (I’ve been referring to this as my hot house flower stage) also without going through ECT. I’m hoping I can expand my range a bit.

  2. I’ve used a form similiar to the one found on moodtracker.com

    re: ECT, I have not heard anything good about it, unless it is a matter of life and death. Side effects are beyond horrible for people I am friends with or have come into contact with.

    • Thanks for the tip, I will check out moodtracker.com.

      There are a lot of horrible stories regarding ECT (see Dina Marie’s, just awful) that really are out of the psychiatric dark ages. Which wasn’t really all that long ago. Believe me, I feel odd being cast in the role of ‘defending’ it as a treatment option given that up until about a year ago all ECT was to me was some barbaric holdover being used to torture gay people by ‘reparative therapy’ quacks. The kind of people I could have ended up in the hands of if my parents had been a much less enlightened pair when their 16 year old son came out in 1996’s Alberta.

      There is an absolutely ghastly history here and the development of it as treatment for Depression has had some significant failures too. Even now, it’s still not risk free, but neither is any other treatment. My anti-depressants increase my risk of heart attack considerably, for example. But there has been a substantial improvement in the last few years, especially for places employing the state of the art technology for it (such as BC) with real improvements for Depression patients.

      For what its worth, I know personally of two people who underwent ECT here in Alberta and one had excellent results (far above expectations) and the other had fair to middling results, not doing as well as hoped for. Both had some pretty nasty temporary side effects but no long term problems.

      This is obviously a very hot topic and I’m sure we’ll be returning to it, so I encourage everyone to keep sharing their experiences. It’s all helpful to me.

      Although given my recent experiences with Alberta Healthcare, if I do pursue ECT for myself, I will be going back to BC for it!

      • What you said makes sense. I know that today’s ECT is not as barbaric as it sounds. (btw, the fact that it is used to “fix” gay people, or was as recent as the 1990’s, is atrocious!)

        The best thing is to make a well-informed decision which you are obviously doing. A really good friend of mine had it done for schitzophrenic hallucinations that were becoming dangerous to her safety. She had no choice, but afterwards it was the memory loss was extremely difficult for her to deal with both mentally and emotionally (she lost a full year worth of memory that never returned) but I guess that is better than dying, right?

        Others I have talked to report that the some of their memory loss is permanent, too, which leaves them very distraught. I have never experienced it, and hope I never have to. But, for some, I suppose there is no other way unless they want to be locked up, existing in total insanity, in which case there would be memory loss there as well, I would assume…

      • I have actually seen reliable reports that ECT was still being used in that fashion as recently as four years ago. I wouldn’t be surprised if there was still some of that happening in parts of the United States.

        Memory loss was also my biggest fear and I would be lying if I said that I wasn’t glad that I’m not quite at the point, simply because memory is me. Carve out chunks of what I’ve done and then I’m not the same person. From the research that I did, they’ve figured out how get similar effects with much lower voltages which has very much reduced the risk of memory loss, but still, that’s a tough one.

        I am thinking I might do a post or two on the research that I did, not so much to provide any kind of authoritative statement (since I’m not qualified for that obviously) but to show my own thought process in whether or not I was going to consider it as an option.

      • the posts sound like a good idea!

  3. I would have to agree with dina marie in using ect as a last resort. I have however heard that a brain mri can improve depression. Something about the magnets. Anyhoo, on the mood tracker, i find that a journal is the best thing to do. Write every day what you feel, eat, do, etc. Read the period between visits before your appointment and highlight what you feel is important to discuss during your visit.

    • Regarding ECT, check out my replies to Dina Marie and Wil. Although given the level of interest here, I think I might do a post or two about the research I did into and how I arrived at my decision.

      Regarding keeping a journal, doesn’t my blog count? All kidding aside, that’s a good idea, although Doctor Z does specifically want something that’s specifically quantitative (I feel like a 5 today!) instead of qualitative.


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