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RonPrice
Starting Member
21 Posts
Gratitude: 6
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 Posted - 07/06/2007 : 07:34:00
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CONSULTATION-NOTES WITH MY PSYCHIATRIST: 2001-2007
INFORMATION BASE FOR VARIOUS FUTURE USES
COMBINATION MEDICATION & TALK THERAPY
(Also Posted in Medication Section)
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Preamble
The following is a brief sketch of typed notes, transcribed from written notes kept during consultations with my doctor. I updated them several times to keep them useful, current and of value to me for the next visit. They were kept during the six years of occasional and, at certain periods, more frequent visits in Tasmania, Australia. Some of the notes below were not taken during the consultations, but were typed-up after and between visits to provide me with a more comprehensive base for my own further use in future consultations with my doctor and for my own periodic use when required. I post them here, not so much as a model, but more to illustrate to others the very concept of taking notes for one's own sake. We each have to work out our methodology for: survival, comfort, effectiveness and efficiency.
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1. Summary of First Three Visits: 6/9/01, 12/9/01, 12/9/02.
Notes were kept from these first three visits, but discarded after 4th visit on 17/9/03. They were not of any further perceived value.
1.1 Summary of 4th Visit 17/9/03.
Cost: $70.15; medicare gives me: $59.65(2003) Gap: $10.50(send to Medicare, they will send me the cheque and I will top 'the gap' up. 2. The Dept of Social Secuirty(DSS) does a Disability Services Pension review every 5 years: 2001, 2006. GP fills in forms; my psychiatrist is not usually required. In 2003 I gave my psychiatrist a written and general statement of my lifetime bipolar experience and an updated statement again in 2004 and 2007. I gave him my medication/medical info sheets(MIS) in 2003 & 2004 and 2007.
Discussed the following in 2003: (a)sleeping- try to go to bed earlier, say midnight, and get into this new routine--thus stopping the going-to-bed after 2 am routine; (b) next appointment on a needs basis. I decided in Sept 05 that there was no need to visit my psychiatrist in 2005. Discuss this subject again with my wife in 12/06 2 yrs after the previous visit. I went to see him in 1/07 and 2/07 and made the following notes.
1.2 Summary of 5th Visit 9/2/07 .
On 10/1/07 my GP(Dr. Z) gave me a referral to see Dr. R(psychiatrist). My creatinin levels were high(180++) on the Jan/Feb blood test and so I made an appointment to see Dr. R and discussed going on sodium valproate and off lithium. I need to:
1. Get an "indefinite referral" from Dr. Z next time; she does not like the idea.
2. Read about circadian rhythms: not done yet at: 27/4/07.
3. Keep visits at one every year or when I have a particular problem to chat about.
2. Summary of 6th, 7th and 8th Visits: 6/4/07, 13/4/07 & 27/4/07.
1. Go on sodium valproate: will I have dry mouth and lessened sense of smell?—no.
2. Gave Dr. R and Dr. E: a 2 page summary of my BP history(5000 words) and to Dr. R. a few prose-poems since he asked what I wrote.
3. Discussed sleeping, speeding up, sharper focus, behaviour, kidneys and breathing, inter alia.
3.1 Summary of 9th Visit 16/5/07
After a series of consultations with my wife I decided to express as precisely as I could (a) the questions I would ask, (b) the issues that concerned me and my wife and (c) the information I required during my visit with Dr. R on 16 May at 12:15:
What I am trying to do is adjust to the new body chemistry set up by the switch from lithium to sodium valproate. Within the context of compliance, as it is sometimes called, the following are the specific topics and concerns my wife and I discussed today:
3.1.1 sleeping patterns and related problems:
1. Is this frequent sleepiness that comes on due to one or more or none of the following factors:
a. coping with increased OCD activity and their various frequencies.
b. coping with short term memory loss(i.e. forgetting why I came into the kitchen, etc.)
c. increased anxiety/agitation levels(wife’s view). I don’t feel particularly agitated.
d. some psychological/unconscious process; and/or
e. something else.
2. there is a rapid shift from everyday activity to a sleepy feeling & wanting to sleep, but then losing that feeling of sleepiness and not going to sleep. This happens as much during daylight hours as at nighttime. Is this normal? What can I do about it?
3. Do you think separate beds in separate rooms may be the answer to the practical problems that have resulted from this medication change? Chris and I discussed this and decided that, for now, we would stay in the same bed.
3.2 Medication Questions:
1 would it be wise to make some change in the new medication regime with luvox: (a) lowering the luvox level, (b) increasing the luvox level (c) eliminating the luvox entirely or (d) replacing the luvox with some other anti-depressant?
2 with sodium valproate: (a) to some other medication--replace it with something else or (b) keep going as evidences of improved compliance are evident?
3 Other Concerns:
1 thirst seems to have increased especially at night and there also seems to be a shortage of breath.
2 lithium left me with blackness at night, luvox with greyness & sodium valproate has eliminated the grey and given me a new problem with no low feeling at all. I feel wide awake on waking and have a desire to (i) get back to work, to writing and (ii) to whatever activities I have in my world of (a) reading and writing and (b) the personal: eating, drinking, listening to music and resting quietly in my study.
3 can Dr. R. send me a copy of his report to Dr. Z?
3 can I still give blood?
3.2 Summary of Results of Discussing the Above on 16/5
A. Medication
1. keep taking sodium valproate(valpro) at same level of dosage.
4. change the anti-depressant from fluvoxamine(luvox) to venlafaxine on and by
Wed. 23/5--using the schedule Dr. R. gave me today.
3.take last full luvox at the 100 mg tablet dosage on Wednesday 16/5.
4.reduce the dosage of luvox beginning on Thurs 17/5 to ½ a tablet(50 mgs) and
keep the dosage at ½ a pill on Fri and Sat.
5.pick up the prescription for venlafaxine on Friday 18/5 from G’Town chemist.
6.take no luvox and no venlafaxine on Sun, Mon and Tues(20/5 to 222/5 inclusive)
7.on Wednesday begin taking venlafaxine(“effexor”) 150 mgs each morning.
B.1 To Be Done:
1.read about the chemistry and psychopharmacology of venlafaxine ASAP
2.read about the two neurotransmitters (a) noradrenaline and (b) seratonin.
3.after my next visit on 29/5/07 at 5 pm Dr. R will send Dr. Z a report; and
4.then I will make an appointment to see Dr. Z for a blood test (a) for my creatinin levels and kidney function; liver function and NaVal
5.topics needing further discussion
5.1shortage of breath-not related to bipolar problem
5.2 can I give blood?-ask the Red Cross
B.2 Visit on 29 May:Items To be Discussed:
1. Sleeping pattern sheet: hand in and discuss sleep issues(Th-6 hr/night &following)
2. going to bed in the 12 to 1 a.m. and sleeping for 6 hours in one block with six pees in the night-things seem to be okay
3. peeing patterns-discuss-normal
4. sensory emporium alterations
4.1 brighter, more alive, less of the nighttime grey-good
4.2 euphoric, mild high-good
5. lessening of OCD behaviour-good
6. less speeding, less manic behaviour(recognized after 1 day on effexor)-some people get run down by the end of the day
7. got 2 scripts
B.3 Visit on 3 July 2007:
1. discussed items mentioned in B.2 above.
2. got test for NAVAL request form for Dr. Z.(1.8 to 15.8)—make appt. 4/7
3. go back in one year or when a problem arises.
Updated:
4 July 2007
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that's all folks!
Ron Price
Notes Updated
At: 29 /5/07
married for 37 years, a teacher for 35 years and a Baha'i for 47 years  |
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Notes Taken From Visits With My Psychiatrist
