Since he is a new pdoc, it may not be possible to start with the high and see what he can do with that. He's most likely going to want some background on your meds, your cycle, how bad it gets on either end, etc, before he goes off and starts prescribing things. But it definitely needs to be addressed during this first appointment, before you crash.

Or, you can hand him your list of concerns and put the MANIC!!! at the very top. I wouldn't put a lot on the list, you don't want to overwhelm him on the first go-round.

Personally, I'd save the list until after I got to know the pdoc, when I'd know if he would respond positively or negatively to such a list. You could just make a short list for yourself, and check it to make sure everything is covered. I haven't had a doc get mad at me for that. But it's not likely you are going to get all your concerns addressed in the first appointment.