A 2nd Opinion

So, if you read my recent thread, you already know that I have questions about some recent med changes (my pdoc is titrating me up to 800 MG of Lamictal) and some issues with my doctor. In fact, some of you don't like my pdoc and you don't know him, ha! Instead of leaving my pdoc entirely, I intend to get a second opinion. The problem is, few decent pdocs accept my insurance. I looked online and it is full of nurse practitioners, which I prefer not to see, pdocs with bad reviews, and pdocs listed on my insurance that I called and they actually don't accept my insurance. Yay. The only decent pdocs appear to be the one at the local hospital. However, I called and the voice message warned that there is a very long wait to see a pdoc. I am waiting for a call back from the office to find out how long that is. Meanwhile, I found a pdoc that charges $250 for the initial appointment and only $80 for regular visits which is very reasonable. Now, my best friend advised me to go ahead and see a nurse practitioner since it is a second opinion and since there are so many on my insurance. Then, if I decide to leave my pdoc, I can go to the other pdoc (the one who charges $80 per visit). My mom was leery. It was her who suggested I look around for pdocs but then she said she wouldn't be so eager to throw my pdoc under the bus because he has been a great pdoc for such a long time for me. My husband thinks I am being ridiculous by not trusting him and looking around. Anyway, I will need to be seen soon because I am already taking 600 MG of Lamictal and that will be increased to 800 MG soon. If the wait for a pdoc at the hospital is too long, can I trust a visit with a nurse practitioner? Or, should I go ahead and pay the $225 to see the new pdoc? My main concern is if I don't like her or decide to stay with my current pdoc, I will be out the money but I don't know how trustworthy a nurse practitioner's opinion will be.

Well not technical enough to know if 800mg of lamictal is appropriate. But here are simple questions to ask yourself.

How do you feel?
Are you better or worse?
What side affects are you having?

Personally I would not make yourself available to the opinions of people that are not doctors. If your pdoc is not broken or unresponsive, changing sounds like a big bother and expense that is not justified.

Meds alone will not make us happy in my opinion. They are a great tool to help stabilize us but then there is the need to introduce lifestyle changes that add new zest to our life. For me yoga, mindfulness, exercise, cooking and doing chores help me stay in a zone that is comfie.

I'd pay for the pdoc. From what I can tell, your current doc has you on a TON of medications at high doses and wants to put you on a high dose of lamictal, even though it's been shown that the optimum dose for bipolar is 200mg with no additional benefits at a higher dose. Isn't this the same pdoc who shares your cousin's personal info with you? It might be a good idea to "shop" for a new one. It may be more expensive now, but it might be better in the long run.

I've never visited a nurse practitioner, so I don't know if it'd be worth paying a visit to one.

That is a LOT of Lamictal. I'm on 400 mg/day and that's supposed to be where it tops out. You are probably going to have trouble with balance and word-finding, if you don't already. I think a second opinion is definitely in order here.

And as for psych nurse practitioners, don't discount them entirely. These are master's degree or even doctorate level educated people who specialize in mental health. They are more than adequately prepared to diagnose and treat most MI's. I've dealt with a couple and they were every bit as good as my own beloved pdoc. Just so you know that they're a viable option.

I actually just came back to add this to my post. Many of them have doctorates. I'm glad you got to it before me.

I'd go with the nurse practitioner.

I have worked with nurses who weren't nurse practioners but who had extensive psychiatric training and they were better than some psychiatrists I've had the distinct displeasure to have dealt with professionally. They were kinder, more patient, had a better understanding of the need to LIVE while still taking meds and they worked hard to do whatever it took to get that for their patients. I was always glad to find a reason to bring them into a case because they were so kind to the patients and made it much easier for them to cope with not being able to be as independent as they had been. When a case was mainly open for psychiatric care and I was involved for some reason I could always see the patient making progress with their psychiatric goals and getting good help with whatever they needed. After working in a trio of long-term psych facilities for several years with a psychiatrist who preferred to just sedate people into not acting out without much care for the quality of their lives I was really impressed. They couldn't prescribe but they did work with the drs and usually got appropriate meds in place no matter the situation.

I don't hate your dr but I do think you are in a bad situation with him. I think you haven't had a good chance to see what real stability is like and that's because you've not had a med combination likely to produce stability. I would love to know what you felt like on a more typical set of meds, like an atypical AP, a normal dose of lamictal, maybe an AD that helps balance the sedation and maybe something for anxiety as needed. Something like that. Simple yet often effective.

And the confidentiality thing, well, that's a really serious offense as we've talked about already.

I haven't actually had to change psychiatrists really ever (my first died, the 2nd I graduated and moved away from, the 3rd wasn't worthy of the word psychiatrist, the 4th was just for a clinical trial and the 5th is hitting 12 years this month.) So I'm not full of knowledge but I do know with changing therapists I have needed to make myself commit to several visits (with this one it was 3 months) with someone to hold me accountable before I decided I hated him and walked off, just because the transition can be hard. Sometimes it takes a few tries and if that happens that's ok, you still can be strong and take care of yourself and see someone who is prescribing reasonably and not violating confidentiality. (When I think of that situation I think of a quote from one of the Laura Ingalls Wilder books "A dog that will fetch a bone will carry a bone". True of most people willing to gossip a bit I think.....)

I hope you find a decision you feel at peace with.

I see a pnp right now. She's actually quite good. I feel she's the first person who has actually gotten me right, as far as how severe my anxiety is, and she has a lot of experience with mood and anxiety disorders, especially with anxiety (she works in the military and deals a lot with PTSD). And she actually listens to me. Don't discount the pnp.

Though just like there are bad pdocs out there, there are also bad pnps.