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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Roslynn on May 6, 2009, at 16:11:26
Hi everyone,
Has anyone gone to see an expert for consultation on meds or for a diagnosis clarification? Did you find it helpful?
I am thinking about seeing an expert for a consult and just wanted to see if anyone else had found it helpful. It is expensive.Thank you,
Roslynn
Posted by Phillipa on May 6, 2009, at 17:22:35
In reply to Anyone seen an expert for consultation?pls. advise, posted by Roslynn on May 6, 2009, at 16:11:26
What type of expert? A pharmacologist? Phillipa
Posted by Roslynn on May 6, 2009, at 17:52:31
In reply to Re: Anyone seen an expert for consultation?pls. advise » Roslynn, posted by Phillipa on May 6, 2009, at 17:22:35
> What type of expert? A pharmacologist? Phillipa
Yes, one of the well-known psychopharmacologists.
Posted by garnet71 on May 6, 2009, at 18:27:40
In reply to Anyone seen an expert for consultation?pls. advise, posted by Roslynn on May 6, 2009, at 16:11:26
Well I'm going to a psychopharmacologist in a month and a half...I have no clue whether or not he is "well known" (i'm thinking no), but he's very expensive--so there must be a demand....
I'll let you know how it turns out. Not that it will help or anything....I have a feeling he'll just try to prescribe me pristiq like the last doc..lol. OR - let me keep my current remedy, which seems to be "working" more than it doesn't. Or maybe he'll want to go into "new territory" and prescribe me Lamictal and choose some unknown augment. Yuck!
I don't see how there can be "consultants" in the field of psychiatry. A highly-experienced researcher might not have the clinical experience, and an applicable "expert" would seem to be someone w/advanced education and advanced experience in clinical practice (which really could only be measured by age? unless someone specializes in hard-to-treat/treatment-resistant patients). How long could one spend in school? Psychiatrists already dedicated what like 10 - 12 years for their education? What could incite becoming more educated?
If there is are designated "experts" in this field, it might have more to do with marketing more than anything else. Just a guess.
Posted by Frustratedmama on May 6, 2009, at 19:34:59
In reply to Re: Anyone seen an expert for consultation?pls. advise, posted by garnet71 on May 6, 2009, at 18:27:40
I did this for clarification of my diagnosis. I also got some suggestions (however, since it was a one time visit- the suggestions didn't amount to much as they were not necessarily things that will help- although to be fair my current pdoc and I haven't tried them)
I think it was helpful in some aspects BUT worth the time and money? NO - as I didn't get anything from it and still feel like crap! JUSt my opinion and my experience though! Hope yours is better!
Posted by garnet71 on May 6, 2009, at 20:33:56
In reply to Re: Anyone seen an expert for consultation?pls. advise, posted by Frustratedmama on May 6, 2009, at 19:34:59
Frustratedmama - so what did the consultant advise for you???
Posted by Frustratedmama on May 6, 2009, at 20:43:20
In reply to Re: Anyone seen an expert for consultation?pls. advise, posted by garnet71 on May 6, 2009, at 20:33:56
> Frustratedmama - so what did the consultant advise for you???
The consultant basically just gave me a diagnosis of ADHD and Mood D/O NOS (not bipolar). She recommended trying Cymbalta, Seroquel, or Prazosin... Unfortunatly, I am fairly certain Seroquel is out due to the fact that I can Not tolerate Zyprexa, Risperdal, Geodon, or Abilify (even in very low doses) without feeling like I am DRUGGED- intense paranoia set in within hours/days of taking these meds!
I am willing to try Cymbalta but was looking at Pristiq as I am afraid of sedation (I am a single parent who HAS to work or will lose my home)
I am open to Prazosin but wanted something to work on depression first as I am desparate and suicidal.....
Posted by Zana on May 6, 2009, at 21:14:43
In reply to Re: Anyone seen an expert for consultation?pls. advise, posted by Frustratedmama on May 6, 2009, at 20:43:20
I saw a psychopharmocologist for a consult. He did a psychiatric residency and then an addition 3 yrs doing just psychopharm in a hospital clinic. He came highly recommended by someone who also did a psychpharm residency and was in training at the same hospital at the same time I was doing my post-doctoral training in psychoanalytic psychotherapy. Th4e point being, I knew he had spent extra time doing just psychopharm training, I knew it was in a very good place (Mass General in Boston) and I knew and trusted the source of the referral. I haven't yet received the bill.
It was not helpful. He diagnosed me correctly as having a severe major depression. He did a decent history and remarked that I had suffered from depression over the course of my life. He noted that there was some suggestion of Bipolar 2 in my family and that ADs had not been particularly helpful to me.
He then went on to recommend exactly what my regular psychpharm doc had recommended. (She is the head of the psychopharm clinic at one of the other big hospitals.)
I got dumped by my regular doc whom I had been seeing for 15 years and went to a man who is a psychoanalyst and also does psychopharm but has no advanced training in it but is someone that my analyst uses and trusts. He put me on pristiq and restarted provigil and I have felt like myself for the first time in about 2 years.
The point. I don't know. I think advanced training is a good thing to have and my first impulse was to go to the expert's expert. The end of the story, however, proved me wrong.
Go with your gut. Whoever you see should be someone who knows meds and you probably know enough about meds to suss that out from a meeting. But go to someone who is more than a wonk.
I don't know if this is helpful. I hope you find someone good. It should be someone you trust your life to because that's what it amounts to.Zana
Posted by raisinb on May 6, 2009, at 21:19:16
In reply to Anyone seen an expert for consultation?pls. advise, posted by Roslynn on May 6, 2009, at 16:11:26
I don't know, it's my opinion that mental-health related neuroscience is in its infancy. Really, they still don't know how most meds work. Nor do they know why some meds work for some people and not others.
It seems like most highly trained experts know what the scientific community knows, which isn't that much. My take is that experience counts, and that med adjustment is as much a creative art and intuition as it is a science.
Posted by yxibow on May 7, 2009, at 4:23:23
In reply to Anyone seen an expert for consultation?pls. advise, posted by Roslynn on May 6, 2009, at 16:11:26
> Hi everyone,
>
> Has anyone gone to see an expert for consultation on meds or for a diagnosis clarification? Did you find it helpful?
> I am thinking about seeing an expert for a consult and just wanted to see if anyone else had found it helpful. It is expensive.
>
> Thank you,
> Roslynn
Yes, I've gone to several consultations -- they're generally called second opinions or to see if there is any additional advice for your condition from another point of view.
I have a rare -- please, anyone be the first to describe a somatoform NOS / psychosis NOS disorder that amplifies ordinary visual phenomenon, plus a set of other unrelated and odd things.
So I guess my experience is that I gathered some information both through associates of my doctor, including yes, some notable people in their field (although unfortunately one has moved on), and also someone I wanted to be completely separate from my doctor, who was recommended by another therapist I see --- but I still feel alone in the world having gone through an awful lot of medication combinations.There were some suggestions made, some had already been thought of, some were tried or put on the back burner -- but not everything can be waved away unfortunately by medicine alone, therapy work is really important for complex conditions.
That being said, I don't want this to be a downer for you -- I think when you're in a position where you have something that may seem or possibly be "treatment resistant", a second opinion from a reputable / recommended doctor is worth the cost.It is probably best not to have everything from your doctor sent, but at your choice, a small summary of medications tried, not necessarily diagnostic information, should be sent because otherwise the other doctor has nothing to work with.
You may or may not have to sign a waiver between your doctor and the other psychopharmacologist of personally identifiable information, which is just a common legal practice -- e.g. I have ties between my GP and my psychiatrist, etc, so medications are kept up to date every so often, etc.
And with HIPAA, depending on where your doctors work, this may be a definite requirement, and a long form of signatures and the like, some of which is overkill, but some I believe is important to keep prying noses out of what is not relevant. Thank goodness for that legislation as per insurance. Anyhow, that's just a soapbox.
So -- I guess I've been lengthy, but I would say, if you can afford a private consultation, which may be one or two sessions (followups are sometimes done), then go ahead and get some different clues if you think it is valuable to your condition.
-- tidingsJay
Posted by Roslynn on May 7, 2009, at 15:50:12
In reply to Anyone seen an expert for consultation?pls. advise, posted by Roslynn on May 6, 2009, at 16:11:26
Thanks, everyone, for your replies.
I am hoping this consultation/second opinion guy can suggest some med combos because my current doctor, I think, doesn't like to experiment. I think he likes to stick to the SSRIs for depression. He says we have tried everything, but there are several meds I've never tried.
Posted by Zyprexa on May 9, 2009, at 5:25:09
In reply to Re: Anyone seen an expert for consultation?pls. advise, posted by Zana on May 6, 2009, at 21:14:43
I went to a specialist once. Not sure if it helped any. They prescribed depakote, and I took it for a year. Then me and my pdoc decided it was not doing anything and I stoped taking it with no problems at all. In fact I felt better. Because while taking the depakote I started on zyprexa, which was a maracle drug for me.
This is the end of the thread.
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