Monday, November 30, 2015

Dueling Doctors

So not all has been serene in my world in the last week.  I've been fighting some moodiness and inability to get to sleep, but mostly I've been fighting my doctors.  Actually, I've been the go-between as they fight with each other.  They probably wouldn't call it that, but that's what it looks like from my vantage point.

The calcium blocker, Diltiazem 180mg, that the cardiologist prescribed has a bad interaction with the Latuda 60mg that the psychiatrist prescribed.  The psychiatrist would prefer that I not take the Diltiazem at all.  The cardiologist says I can take both, but I should score the Latuda.  The psychiatrist didn't appreciate the cardiologist adjusting her prescription.  I'm sure the cardiologist doesn't appreciate someone second-guessing his orders.

Apparently the Diltiazem can make the Latuda stay in my system longer, making it like I could be taking 100% greater dosage.  So the cardiologist says to just score it, take half.  But Latuda can't be scored.  Not to mention, there would be no guarantee that the 30mg of Latuda would be kept in my system twice as long, making it like 60mg.  Without a lot of blood work and testing, there's no way to know how long the Diltiazem is keeping what amount of Latuda in my system.

And since I'm much more concerned with my depression than my heart, I've been following my psychiatrists advice of not taking the Diltiazem.  So I've had it for a week and I've taken it once.  I'm sure the cardiologist would not be pleased.  I tried to call him a couple of times last week, but they were off for the holiday.

Today I called the cardiologist's office to tell him the following:

  • Latuda can't be scored, so that's not a solution I can use.
  • There is no 30mg dosage of Latuda, so I can't get to half of what I need to be taking.
  • I've been working too hard with my psychiatrist to manage my depression and my anti-depressants to go backwards.
  • I haven't taken my Diltiazem in a week.
  • The psychiatrist thinks a beta blocker would work better with the Latuda than a calcium blocker.  Can we maybe try that?
  • If you have further questions about any of that, call my psychiatrist.
I'm tired of being in the middle of their little spat.  I wish they'd come up with an appropriate plan of action and just let me know what the answer is.  I don't think I should have to keep passing on messages that start with, "but the psychiatrist thinks..." or "but the cardiologist says...".  Let them have those conversations on the phone without me.

They're causing me stress... which is probably adversely affecting both my depression AND my heart rate.

We'll see if I get a call back and if they're willing to talk to each other.  I sure hope so.  The psychiatrist is calling me tonight.  And I want her to start the conversation with, "well I spoke with the cardiologist...".

Tuesday, November 24, 2015

The Latest

First thing's first.  I was depressed from last Wednesday (the 18th) through yesterday (the 23rd).  But I feel GREAT today.  I was depressed through lots of work, an appointment with my psychiatrist, and an appointment with the cardiologist.  Good times [sarcasm].  But I'm encouraged that my depression only lasted six days.

So my appointment with my psychiatrist didn't go great.  I must first concede, she didn't get on my nerves nearly as much as she has in the past.  Maybe I was too depressed to care.  Maybe she was treating me with kid gloves because I was so obviously down.  And I know it's her job to determine when I should be admitted.  But discussing suicide with someone who is already depressed is not uplifting, needless to say. So I didn't even remotely enjoy the time spent with her.  Nothing new there.

Before I left, I talked with my counselor, who seemed a little concerned with how I was doing.  So he wants us to get together Wednesday.  But I'm feeling MUCH, MUCH better, so that appointment will go well.  Sometimes when I'm not feeling good, I don't look forward to my appointments with my counselor.  Actually that's not true.  ALL THE TIME when I'm not feeling well, I don't look forward to appointments with my counselor.  So I'm no longer dreading this appointment.  Bring it on!  He'll remind me of things I should say to myself when I'm down.  He'll teach me another trick or two to try to get my mind out of that bad head space.  I expect it'll be productive and well-spent.

My appointment with the cardiologist went very well.  He says that my heart is in GREAT shape.  Yea, me!  He also asked me if I was working out.  I told him that my primary care provider had me scared to death to raise my heart rate any higher and suggested that I walk without breaking a sweat.  The cardiologist told me to start working out 30 minutes a day.  So I need to do that.  (This eating 350 calories right before bed to accommodate the Latuda is quickly making me gain weight.)

He was well aware that I was depressed yesterday.  I told him that my psychiatrist has been mucking with my anti-depressants in an effort to get my heart rate to drop.  He wanted to make sure I knew that he never suggested to anyone that my anti-depressants were the culprit.  I assured him that my primary care provider championed that cause and my psychiatrist was more than happy to jump on board.  To help quell the continued science experiment, he suggested that I take a calcium blocker to lower both my heart rate and blood pressure.  I started taking that last night.  I'll follow-up with his nurse practitioner in a month to see if that works.

In the interim, I need to call my primary care provider to see if he wants me to stop taking the pill he put me on a year ago, to help lower my blood pressure.  There's really no need at this point for me to be taking two.  So I need to make that call.

Work has been busier lately.  But depression or not, I've been able to keep up.  Praise the Lord!

No day is better in my world than the day after a depression passes.  "This is the day that the Lord has made; let us rejoice and be glad in it."  Psalm 118:24

Tuesday, November 10, 2015

Just an update...

I know it's been awhile since I've provided an update.  My picture today, chance of sunshine.

First of all, I've still heard nothing concerning my echocardiogram.  Maybe I should call them and simply ask.  But between my other appointments, I'm doctored out.  I figure if it was bad news, I would have heard about it already.  I can wait until the 23rd.  Honestly, I'm trying not to take any of this all that seriously.  It helps me to NOT stress over it.

I made an appointment with my primary care provider's office last Monday (the 2nd) to get my blood pressure and heart rate measured.  Yes, I had to make an appointment.  I'll never do that again.  I'm not going to call the office for more than an hour just to get through, wait in the lobby for 15 minutes, and pay for an appointment, just for a two minute task of getting my blood pressure and heart rate.  Not when I can do it myself.  At any rate, my blood pressure was perfectly acceptable at 117/77.  And my heart rate was still a whopping 103.

My psychiatrist called me three times last week.  One of those conversations took well over an hour.  But I'm not going to vent about that.  One thing I learned though was that I've been taking my Latuda wrong for more than a year.  It says to take it with food.  I do.  But normally medications tell you that to prevent an upset stomach.  I only need a boiled egg or a handful of crackers to avoid any upset stomach and I've never had an upset stomach with my Latuda... so I thought I was doing things perfectly fine.  But no.  When they say take it with food, they mean 350 calories!  Who eats 350 calories at bedtime?!  But at Robin's suggestion, I'm drinking an Ensure Plus with my Latuda every night.  This is going to kill my diet!

As for my moods... I found myself being both angry and weepy last weekend (the 30th - 2nd).  But I've been mostly good since then.  Who knows if it was the increase in calories with my Latuda or not.  But I feel good.  No complaints.

My psychiatrist is going to call me again tonight.  Hopefully we don't have another marathon call.  I'll tell her I've been taking my Latuda with food and that I've been feeling well, and that my heart rate is still averaging over 100bpm.  My guess is that she'll take me off the Fetzima completely.  The only thing I don't know is whether or not she'll increase my Latuda to 60mg.  My guess is that she won't until next week.

Bottom line, I still feel like a science experiment, and I'm still scared of my next crash.  I've credited the medication for making my depressive episodes farther apart and shorter in duration.  But I'm trying to enjoy the current feelings of being good.  No sign of depression today.

But I have been thinking... what if I come completely off the Fetzima and my heart rate STILL doesn't come down?  The assumptions that were made about my medications will be wrong and we still won't know where the actual problem is.  Ugh!