What is with these pdocs??

I saw my pdoc about 2 weeks ago. He said he would be on vacation for awhile and that he wanted to touch base with me before our next appointment (which is November 6th). He asked me a day and time when he could call me. I told him Monday evening. He made note of this and said he would call. I then asked him if there would be a covering psychiatrist while he is on vacation. He said, "Just call my assistant-- she'll know where to find me."

So Monday came and went and he never called.

I increased my dose of Lithium to 600 mg. Since I have a prescription for 150 mg, that means four pills per day. I did not realize how quickly it would run out. Now I only have enough Lithium for tonight and tomorrow morning.

I called his assistant and told her about this and she said, "Oh, he's on vacation. Call his secretary at the office." So I called her and explained the situation and she said, "Well, he doesn't have a covering doctor.... didn't he ask you to call him before went away?" And I said-- no.. actually he was supposed to call me and he never did. So she took down my information and said, "Well, I'll have to make some calls to find out if there's anything we can do."

How on earth do you go on vacation and not designate a covering psychiatrist? I have never heard of such a thing.

EDIT: Ok, about 10 minutes after I wrote this a very nice doctor called me back and he was very concerned when I told him that my pdoc told me that I don't need to get my blood levels checked yet. He was concerned that my pdoc would put me up to 600 mg and then go on vacation without having me get my levels checked. He asked me how tall I am and how much I weigh and when I told him he said to go back down to 300 mg per day (until my pdoc returns) because he is not comfortable with me taking 600 mg without getting blood levels checked. Then he called back again a couple minutes later because he wanted to ask about my side effects and how I've been feeling. I wish he was my doctor. I'm feeling a little scared right now-- why didn't my doctor order my levels to be checked? Why didn't he call me when he said he would? Why do I feel like all of this is not being properly monitored?

Because it sounds like its not being properly monitored.

I was concerned before about why he thinks that lithium can help you (what studies show that it is effective for people who don't have bi-polar?)

And now the alarm bells are well and truely ringing...

I guess I still don't understand what the lithium is supposed to be doing for you...

I guess that if I were you I stay on the lowest dose (if not stop it all together) and ask your psychiatrist to justify his decision and also to justify his lack of monitoring upon his return.

He might be charming and self confident... But if his answers aren't satisfactory then I'd surely be looking for a new p-doc... Or... I'd perhaps forsake them altogether truth be told...

You did get this other pdocs name, etc. didn't you so you can switch :-) Sorry you're having such an alarming situation; glad the other guy sounds on the ball. How long is your pdoc going to be away?

pink, I agree with Perna. Make sure you have this other pdoc's name, clinic, and phone number, and then switch. You have hardly been with your new pdoc for long at all, so you shouldn't have much of a relationship to worry about jettisoning if you switch to the on the ball guy.

I hope you are doing well with the lithium. It sounds like staying on the lower dose until you get the pdoc and blood levels situations sorted out is a good idea.

I agree with AK, I was concerned that he even prescribed Lithium, I know its hard to tell how a person really is online, but I wouldnt have said you were in need of such a strong drug..and am also shocked by the way his treated you.

"Lithium is also sometimes used to treat certain blood disorders, depression, schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions), disorders of impulse control (inability to resist the urge to perform a harmful action), and certain mental illnesses in children. Talk to your doctor about the risks of using this medication for your condition."

http://www.nlm.nih.gov/medlineplus/d...r/a681039.html

Hmmm

I would be worried but I also remember that you really liked him and he spent a really really long time on the phone with you the first time and you believed he was very responsive then.

Can T help you sort this out/as sort of a consultant? Because although this new guy sounded nice, you don't really know him and he doesn't know your history so it's easy for him to dis the current med.

Good luck.

drugs are sometimes used for all kinds of things - but it was the efficacy studies that i was worried about. or more in particular the absence thereof. it isn't so much about lithium being particularly strong its about the nasty nasty nasty side effects that can result from lithium. typically it is something of a last resort drug for fairly 'organic' looking bi-polar and it is tried when less dangerous options have been exhausted.

i don't really see how pinksoil has a particularly organic presentation...

and i don't see how the less dangerous options have been exhausted...

i do understand the desire to try and instill a little hope... but wtf was he thinking?

no idea.

pink I agree the 1st doc didn't handle this well. sometimes we like the doc but it doesn't mean he's a good doc for us.

I tried lithium for a while. had the regular labs to make sure it remained in the therapeutic range. It was okay and did stabilize my moods a bit, but not enough for me to keep taking it. I didn't like the fact that the therapeutic level is a hair off the toxic level and monitoring was so crucial. But also for me, it interfered with my thyroid that was already functioning chaotically.

Lithium works well for many and is not only a good mood stabilizer but is reportedly good for helping to calm impulsive behavior, I just recently read.

Just be sure you know what needs to be done as far as the blood tests go, and make sure you get them by making sure your doctor orders them when they're due. Your doctor could put in a standing lab order at the hospital lab or whatever lab you use so that you can pop in and get it done when you are free, without having to schedule a doctor's appointment first.

I'm not clear... did the original pdoc prescribe you 150mg/day or 600mg/day?

At 150mg/day, there would've been no need to have your levels checked, as that is way below therapeutic dosing levels. Some docs will go all the way up to 600mg/day still without checking levels.

Generally, however, when people are starting a course of lithium, levels will be checked after the first week or two if they are taking therapeutic dosing or 500-600mg/day. Take what I say with a grain a salt, however (no pun intended), because I'm not a medical doctor.

I agree, docs should *always* have coverage available and clearly communicated to all patients when they go away. It sounds like your original pdoc really dropped that ball there.

DocJohn

Thanks for responding.... my doctor started me on on 150mg per day... then increased to 300mg per day for a couple of days... then finally up to 600mg per day. He gave me no instructions to check my levels at 600mg though. This is the 1st time I am on Lithium and I weigh 105 lbs. so I thought it was weird, but I figured he's the doctor so (hopefully) he knows what he's doing. I'm sure the covering doctor was being extra cautious with his decision. I appreciate that. I have cut back to 300mg and will speak to my dr. about this on Monday.

> Take what I say with a grain a salt, however (no pun intended), because I'm not a medical doctor.

and if you were you probably wouldn't be offering advice over the internet using your real name (given peoples potential to sue if they suffer adverse reactions while following your advice).

tis a tricky thing...