I was doing so well...

Well, relatively speaking if you know I mean.

I have been tapering down meds and getting a handle on being less medicated. It is different, no better or no worse than before, but different enough to have needed time to get used to it. The last month or so has been tolerable.

It took a lot of work to get my pdoc to agree to help me taper. He still doesn't agree but is supportive because he knows I am a stubborn old cuss and will do it without him and it would have been much more difficult without him writing the prescriptions so I can do it safely and take as much time as I need. He has always taken my input very seriously(once he realized I spend a lot of time on self-education) and it felt like we were a real team.

I just got a call from his nurse. She tells me that my next appointment is cancelled because he is leaving outpatient to work in the inpatient ward. This is stressful. I can't blame him though. This is at the VA. It is non-stop appointments. He has several hundred patients. It took him about 18 months worth of appointments before he didn't need to spend half the session reviewing my records so he could remember me. He walks one patient out and grabs the next. All day long.

Now this has set me off. My new pdoc is a nurse practitioner, which kind of scares me. I don't know anything about her so this anxiety is unfounded. But when I see her, I will still be tapering off meds. What will her reaction be? That is what really scares me. I have airtight medical reasons for getting off meds but even my supportive pdoc thought it was better to go on hormone replacement than stop taking anti-psychotics.

Granted, I can simply request a different pdoc but I don't know anyone else and it is a stressful process. I always knew what to expect, now I don't and it has really set me on edge. Plus, now I have to start completely over with someone that doesn't know me or my history.

I honestly do not know what is more upsetting: having to get a new pdoc or the fact that it is upsetting.

Good luck with your new NP, qwerty68.

I would say bone up on your knowledge , knowing your "enemy" pays , when dealing with any specialty you need to both the smartest and dumbest person in the room , know your diagnosis and any associated Co morbid conditions, the treatments and the contraindications for them all also the adverse effects associated with any medication they may try and talk you into or out of , knowing this puts them on the defense because they can't ******** you or "scare" you into or out of any particular therapy, go in with notes to reference on anything you don't know cold and be prepared to take notes of what they say , don't get backed into a corner , don't back down and don't be afraid to say I will take it under advisement or I will think about , if you don't control the room they will , nurse practioners tend to think they are God's gift to earth and are the fountain of knowledge , let them know early and often that you are the patient all treatment or care decisions will be made by you , after relevant discussion and input from them , it will tend to obset them, an educated patient is one that they door doesn't revolve for, and they can't have quick turn around rush you in prescribe and rush you out and onto the next case. This will cause a bottleneck in there schedule because most places schedule between 3-5 patients for the same fifteen minutes period , if they are lucky 2 will show up , never miss appointments because they assume you are a push over and not invested in your care. These are how I roll and how I keep my providers in line , one last thought if you see an obvious conflict with there methods or personality don't be afraid to request a different provider if they ask simply say "I can not foster or see a therapeutic relationship with my current provider" if they try and press you for details stick to what you said and just repeat it until they honor your wishes. This will make you an unforgettable patient as they so often think "that was easy, next" .
You were a soldier they controlled you , you are now a Veteran and they will run you over if you let them , the VA has been mistreating our Veterans since time Immortal, we have been continously involved in battle somewhere ever since the American Revolution and not respecting the men that do the heavy lifting . Thank you for serving with pride and honor.
Semper Fi.

Misterpain

I do a lot of that. I have shot down numerous med requests from doctors on the spot. I will study up for her and hopefully we can start out on the right foot. Once I am off everything, there will be little reason to see her since they don't do therapy. I might try therapy again to see if I can manage things better. I got in the habit of making sure I always have lots of treatment records for rating purposes, although I am P&T now and at least theoretically not subject to reviews anymore.

It is much harder for me to push back with someone new. I had a bad experience, the only bad experience with the VA in 20 years, with being "too stubborn" and "total loss of insight" and I got placed on near daily wellness checks with the local police for a while. That was a therapist and she did so much damage that I am not sure I am recovered from it, and I haven't seen her since 1999!

Thanks for the support and thank you for your service.

I did not actually serve, went the other way into public service and C.A.P para medic Firefighter I am an honorary Marine in 81 guns 2nd Mar div , spent a lot of time running guys back and forth to Camp L got tagged for 89 in Virginia by a Trooper and convicted in absentia because all my witnesses were on float in the med ( as you can imagine my nickname on base is "speedy", they would not let me appeal or fight it without a lawyer , I told them good luck with getting the fine , tore up my license and went dark, I hang out at the "dog pound" that's our local VA swaping my "war stories and firefights" with you guys that did do the heavy lifting , I am off the job as of 2003 doctors pushed my papers before even talking to me , you guys appreciate the hell out of decent coffee and smokes out the back door on the patio, I help guys new to being on wheels as a way of giving back , a little friendship coffee and someone who is better than the staff to talk to,what's said to me stays with me , I retired out of N.Y. I am one of the second wave, of first responders from the toxic cloud of **** when the towers fell, my battle was different then yours but we are all human, and all need friends to stand by us , I remember my uncle Charlie coming home from His fourth tour in Vietnam to all the baby killer crap going on and him never feeling like he was welcome in his own country .we all got crosses to bear, and nobody understands PTSD better then another survivor .so I share a lot with you guys and you guys teach me a lot .Yeah she did you hard, that's totally wrong , I used to see a p-doc who was the head of a an army base psyche unit in his civilian office, he would never ever be alone in a room with me, he was scared of me , everybody told him just treat him with respect and you'll never have a problem , instead the guy busted my rocks, so I busted his back, he did some wrong crap with me and I left . Somebody who was not practicing they were good ,LOL , that's why I gave you the advice I did , so you never get pushed around again.if they think they can they will,don't want to get bit don't treat me like an Animal!
Rather simple philosophy, but alien to them .
Semper Fi

Misterpain

Paramedic and Firefighter is a big deal, a really big deal and you guys don't get nearly the praise and credit that you should.

I don't know if many people outside the military know this but a very large percentage of service members are in non-combat support roles and barely know how to shoot a rifle and certainly don't ever have a chance to see anything remotely close to combat. This isn't too dismiss them, they play a vital role in keeping everything running for the front line people to do what they need to without worrying about supplies, pay, family back home, medical treatment etc. They are absolutely critical and deserve recognition but so do you! You have seen more awfulness than the average service member!

I thank you for your service! Paramedics have saved my bacon more than once.

I don't talk to many people at the VA, but I listen. A lot of great stories and characters. Conversing with human beings in the real world seems a bridge to far right now.

Even in the military, I was relatively passive. Lot's of alpha males in the Army, which I definitely am not. Probably the most laid back guy in my artillery battalion, but stress and conflict didn't bother me in the slightest. Everything just slid off my back. Oddly, when I switched to the coast guard, I was regarded as somewhat aggressive and hyper-focused, I was not different in both of them, I kept my military bearing that was pounded into me by the Army, but that was a culture shock for Coasties. That might give you an idea of the differences between services.

Somehow, stress does affect me now. I probably need to be more assertive, but somehow I struggle with that these days. Old age? Collecting MH diagnoses like comics? I don't know.

I feel so freaking stressed, my ex-pdoc who was supposed to make sure I had meds to last until my next appointment completely cancelled the mirtazipine rx. I called his nurse and he thought I was off it when I told him I wanted to stop at 15mg and was going to take my time. She said she would get back to me and it has been days and no word and it is not listed online under my prescriptions. So I have to taper off before I run out which means a miserable xmas for me when I was hoping it would be nice.

Oh well, that gives me motivation to stay out of the psych ward and away from him.

I would guess having to get a new pdoc is the bump in the road followed by having to map the modified terrain ahead. Your current map is still good, but now a bit more "improvise, adapt and overcome" might be needed in the examination room.

Nurse Practitioners usually are good at reviewing whatever history is there for them to see---VA is busy----let us know how it goes----let the NP know how hard this is for you....((((((hug)))))))

Hi Qwerty,
How can a nurse be a PDoc? Don't you have the right to get a real doctor? Sorry I don't want to underestimate nurses but this is your mental wellbeing

Nurse Practitioners can prescribe meds, they are similar(equal?) to a physicians assistant. They are at least one step above an RN.

I can request a different doctor at any time but my last two pdocs have been males, I am going to see if having a female pdoc will provide a different approach. Although, by the time I see her I will likely be completely off meds and might just request a T going forward. She won't be doing any therapy, at least my previous pdocs have never done it.

In the VA specifically there is a shortage of doctors , so the VA has been be pushing for several years to be able to use advanced practice nurses in place of many doctors, I see it as just another way our Veterans are getting screwed and let down by the nation they served, the only thing that has advanced is battlefield medicine , more severely injured people who can have there life saved and then be put back in service,in a lot of cases if you don't have a life threatening wound they are told here's some ibuprofen go rest under that tree for an hour, and it's only going to get worse with the president elects admissions that his campaign promises to get Veterans to vote for him , he has no plans to honor them .if you go AWOL from the military ,they damn sure will track you down ,but magicaly after there service to the country the government can't keep track of them when they become homeless it's a freaking sin ,we need to focus more on insuring the well being of our Veterans and less on which hell hole we are going to send them to fight and die for the countries benefit.

From what I have been told, NP's were used extensively in the military in Iraq and Afghanistan.

The private sector is using them more as a cost cutting sector. They are simply cheaper.

An Advanced Registered Nurse Practitioner ARNP has a Masters in Nursing Science and has chosen a specialty (psyc/pediatrics/family/gerontology etc) to focus on; by fulfilling requirements they can medically diagnose and treat conditions within their specialty. They may be independent, or work with a physician depending on the state. They are more educated, in general, than a PA. But they practice within a specialty.

In Psychiatry? then, why we need psychiatrists for? Sorry, I had bad experiences with Nurse practitioners. Particularly, I distrust their diagnosis capabilities. To me, they have a narrow view by training. But this is me.

The cheaper is true, but long before there were APRNs, the military made it possible for medics to go on to become PAs, to save money, and to give them a civilian pathway to work after service----NPs are working in just about every setting in health care --- they are a lot like what GPs once were, there for the basics of their practice, and able to pass on cases that exceed or fall out of the bounds of their area of expertise (as you would expect an MD who is a Psychiatrist to refer you to an internist for GI illnesses, etc.

I think one can have a bad experience with individuals in any profession.
You might want to do some research re: searching reviews of practitioners in your area/in the VA online----this gives you information from a patient perspective.

I can't seem to get a break.

I had my new appointment scheduled for Feb 1, enough time to get used to the idea and sort out my research so I can set a good tone for the new pdoc. I also wanted to me completely off psych meds by my first appointment.

I finally got a decent sleep last night. The first time in over a week so of course the phone rings at 8:45. It was my new pdocs nurse telling me there is an opening today and asked if I wanted to come in today. I could have said no and probably should have, but I have a tough time saying no. So, now I am trying to collect my notes and sort things out in my mind so I don't come off like the blubbering moron that I am. Psych appointments feel like my master's defense, any hole in my argument gets pounced on and used against me. Maybe that is just my paranoia. It also feels adversarial because they inevitably want to force their will on me and all I really try to do is get out of there without getting tossed into the psych ward.

I am pretty much off meds though, getting off the benzo was easy and I use it on an as needed basis. Being off meds is strange, I am doing about the same off as I was on except my sleep is out of whack, more voices and I have more energy. My depression is better than it has been in at least 8 years.