Wednesday, January 16, 2013

In Which I Am, As Usual, Annoyed

Here's the background: At Snooty U., we all (faculty, staff, students) got some trivial number of 'allowed' psych visits* and then every three weeks,  a meaningless ten-minute 'interview' with a psychiatrist where we said that we were not suicidal and could we please have our !@#$!! drugs now.  If we needed more help, well, we could pay $200 an hour elsewhere.   (On a grad student's salary. In one of the most expensive parts of the country.) 

I'm sure someone was limiting liability, but it was pointless, infantilizing, and condescending.  Especially for everyone over the age of 18, i.e., almost everyone. 

My PCP's nurse called a while ago to request a 'med review' of my antidepressants (which I no longer take) and occasional use of sleeping meds, and my asthma inhalers, although I feel entirely capable of judging if I can or cannot breathe.  Also because I clearly haven't received the 'good sleep hygiene' lecture before!  Did I know that I should read quietly before bed and not drink coffee at 9 PM?  I had NO IDEA!!**

Naturally, I'm not going.  I am also finding another doctor.

(I also realize that the average patient is an idiot.  Not you, dear readers! I am sure you are all very clever!)

An excellent piece in the NYT, which I cannot find, talked about taking sleeping pills for many years.  Otherwise, the author pointed out, he could not sleep, and rapidly became insane.   He had tried everything, and it didn't work.  Which was better for him?  A dependence on the pills.

I have never been a good sleeper.  I have never in my life fallen asleep in less than a half hour.  I am tired of reeling off the list of everything I do.*** The idea that if only I tried harder, I could fall asleep, is moronic.  If I didn't have small children, perhaps I could nap, or exercise more, or sleep in on the weekends, but that won't be happening for many years.

I am also tired of justifying why I do or do not need to take antidepressants.  I am a highly trained analyst, fully capable of recording and interpreting data about my own body, and well-informed on the risks and benefits of my medical choices.  Mild intermittent depression is something I can decide how to manage myself, and, in fact, unless I am a danger to myself or others, a doctor has no legal or moral right to tell me how to deal with it. The doctor may be an expert on medicine, but I am an expert on myself.  

 *At the department of Lemon-Fresh Mental Health! Funnier if you know its real name, but...
**I have already had this whole conversation with this doctor.... twice.
***Exercise, diet high in protein and vegetables, relaxing quietly before bed, low caffeine intake, meditation, routine... I could go on and on.

(P.S. Kindly do not suggest anything I could do to sleep better.  I have, believe you me, tried it all, unless it is Herbal Tincture-y, or clearly insane.) 

18 comments:

  1. I have a horrible urge to suggest a glass of warm milk. Apparently I'm feeling irritating today. I'm terribly sorry, and will just have to blame it on a poor night's sleep. (I was kicking and wiggling last night in my sleep, and Patrick decided to ask me if I was awake. "I am now." I removed myself to the couch to kick and wiggle as much as I pleased.)

    Doctors, ARRG!

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  2. Not a suggestion on how to sleep better, but an observation that historically, humans did not all sleep in one big chunk through the night. In many cultures including medieval Europe they would wake up in the middle of the night for a few hours before going back to bed. Perhaps your body rhythms are more aligned to that sort of schedule?

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    1. Indeed. If only my small children's schedules were likewise aligned to this. Or... I had a wet nurse. Or something.

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    2. darchole7:45 PM

      It seems like a lot of people have screwed up sleeping habits because they canNOT live by their bodies' circadian rhythm. I function much better if I stay up until 3-4am and then sleep till noon, but this doesn't work so well for most jobs. Even working in a lab, I have to be there sometime before noon. I also have to shop and pay bills sometimes, not everything is open 24 hours or available on the internet. And what is it with the melantonin worshipping that goes on every time someone mentions they can't get to sleep?

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    3. I know! And my kids, like most kids, are like "oh, daylight, cock-a-doodle-do, mama."

      Did you know only 40% of doctors 'believe' in evidence-based medicine? Explains a lot, doesn't it? I got a neti pot suggested to me at my last doctor visit despite about zero evidence. (I lied about that too.)

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    4. darchole10:06 PM

      I like what my doctor has to say about things like chiropractors and neti pots, basically it's 'I've done all medicine or your wallet can do for you, so if you want try it and see if it works go ahead and try it and I won't judge you for it, but I don't think it works'. Also I don't get the "talk" about needing to lose weight. It's just the occasional 'you need to lose weight'.

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  3. You probably already know this, but if you are getting a script for sleep meds from any MD, they now will require you to come in every 3mon for this kind of "check-in". Additionally they'll run a KASPER report (well, that's what it's called in my state at least), for the MD to review all the scripts you've ever had filled. It's a new federal law. Now, join the ranks of every one else who's already annoyed and pissy about it ;)

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    1. Ha! I didn't know. This is actually a piece of annoyance from last MAY. And it was a refill of a precription from a YEAR before, for 30, so CLEARLY I was over-using and abusing this drug. Here the med query is all SS-based.

      Clearly I should just have someone prescribe me trazodone, which is not a controlled substance.

      It's mainly the condescending bitchy attitude of this particular doctor, and the way she gives me the same lecture every time, like 'do you eat your vegetables, little girl?'. Really, I need a new PCP, because I can't stand this one.

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    2. One of my docs prescribed trazodone for me, because I OCCASIONALLY have trouble falling asleep because my mind is racing. I took it twice... and both times the "very rare side effect of stuffy nose" made my nasal passages swell to the point that I couldn't breathe through my nose (and I use a CPAP for lord's sake!) and was then having a panic attack because I couldn't get in enough air! I've never had a panic attack before, but thankfully knew what was happening. I was using Afrin like crazy to be able to breathe.

      Then she asked why I stopped taking it. After I had called and said, "Here's why I stopped taking it."

      I would rather only get a few hours sleep than have a panic attack every night and get NO sleep.

      And she wondered why I stopped seeing her. Melatonin has been OK for me.

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    3. Ooooook. Sounds frightening. I've taken trazodone before with no ill effects, so panic due to not breathing is not on the table.

      I can't IMAGINE why you stopped seeing her. I also take some melatonin and it helps but... not always. With the racing mind. Until 3 AM. Or, my personal favorite, the whole-skin itching like fire ants (I am allergic to EVERYTHING).

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  4. Rachael11:21 PM

    I just went to a Dr. for a med check and he started giving me the lecture on cutting out processed foods and tried to sell me on the nutribullet. Without asking what my current diet is like. The snark may have come out after the first attempt at polite deflection... Last time, he tried to convince me to take fish oil. I'm quite skeptical of anything he says.

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    1. I first read that as 'snake oil'. Which is... accurate. The midwives tried to get me to take fish oil (omega-3 fatty acids!) when I was pregnant- I once looked it up for Becca and concluded the benefit was a) shaky; b) minimal; and c) not worth the heartburn. So I just lied and told them I was. (Ever watch House? I totally lie to medical professionals.)

      Also, seriously, jerk doctors of the world: take 30 seconds to not be an ass, i.e. to listen. LISTEN THEN TALK. (Like my advisor's patented tactless way of suggesting things. Never ask "Have you considered?" when you could say "You're doing it wrong!")

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  5. Have you tried grapefruit seed extract? This all sounds a bit horrible. Particularly the inhalers. I mean, okay, maybe there's some logic to occasionally checking in on sleep meds and antidepressants, but inhalers?

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    1. I even have a little peak flow meter to check if I REALLY can breathe or not. And I'm not actually taking antidepressants, so... way to read the chart well.

      I'm sure GSE would sanitize me right up.

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  6. My undergrad institution called their psych services department "Mental Hygiene"- marketing geniuses they were not.

    I hear you about the sleeping pills. I had terrible insomnia in college and grad school. Many nights, just know that I could take a pill at X o'clock if I wasn't asleep and then be guaranteed to fall asleep was a help. Laying there stressing about falling asleep kept me awake. Having an out was helpful.

    That said, I also had trouble staying asleep. So now, while I thankfully haven't needed sleeping pills in a long time, I do have loud white noise AND sleep with ear plugs. Despite all of that, I can still hear my kids when they wake oh so many times a night.

    Not that you need permission, maybe just validation, but stick to your guns and advocate for yourself. It shouldn't be as crucial as it is to good care, but it is.

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  7. You clearly need a new doctor. Since I had one that told me "That's normal, just take some aspirin" until I ended up in the ER and a complex surgery the next day, I'm not so patient with nonsense any more. These days, it tends to help when I tell them I have a PhD -- which I find slightly odd, because, although I agree with you that I am an expert on myself, there may be a number of relevant points I'm clearly not an expert on. Well, it's odd but useful.

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  8. ivfcycler2:08 AM

    a commenter on julia's (hippogrif) blog mentioned it's hard to fall asleep with cold feet, and darned if it isn't true! so now i try to always wear warm socks to bed and it seems to have reduced insomnia a bit. not as effective as drugs, sadly.

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