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Old 03-04-2009, 07:34 AM   #1
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Why see a tdoc?

I'm asking because I'm genuinely curious and wondering if I'm missing something important in my treatment.

Why do people reguarly work with a tdoc--is it because insurance doesn't allow them to see a pdoc long enough (I get to see mine for an hour), is it dealing with other stuff in your life, or is it more directly related to bipolar?

I guess I'm asking because I don't really understand what a tdoc has to offer, since bipolar is a brain illness, I don't understand how counseling can really help--the ones I've seen have always tried to ignore the chemical basis of my issues (my last one told me I was too "normal" to be bipolar), and have tried to discourage the use of medications. Maybe I've just seen bad ones?

 
Old 03-04-2009, 08:24 AM   #2
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Re: Why see a tdoc?

My tdoc helps educate me about bipolar so that I can understand how my rapid cycling impacts my daily functioning.

He also informs me of research as it applies to meds, treatment, counseling, etc.

In addition, every week he charts my moods so that I have a clearer picture of how they change as well as what kind of situations may trigger a manic or depressive episode.

Since I have problems with auditory hallucinations, delusions and paranoia, he keeps me grounded by helping me look at situations in a more realistic manner.

I was recently diagnosed with PTSD, so upon my tdoc's recommendation, I have gone from seeing him on a biweekly basis to every week since I have other issues I need to work on.

Finally, my tdoc explains my medical records from my IP stays so that I have a better understanding of what they mean.

I've found therapy to be a tremendous help since it has allowed me to fully accept my diagnosis of bipolar and PTSD, to better understand bipolar in general and to learn various coping strategies to live with this disorder the best I can.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN

Last edited by dreams in neon; 03-04-2009 at 08:27 AM.

 
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Old 03-04-2009, 11:15 AM   #3
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Re: Why see a tdoc?

Well for me, if I didn't have a tdoc, I'd be insane, keeping all my life crap inside of me. I also see my pdoc for at least 30 min once a week, and for 4 months over the summer he did my counseling. Heres my answer to your question:

A very high percentage of BP patients have other problems to deal with besides just the medication/chemical aspects of BP. They may have childhood abuse issues, spouse/partner issues, dealing with the cycling between manic and depression, dealing with being constantly very depressed and contemplating suicide, having duplicate diagnosies, such as PTSD, OCD, SH/SI, and needing to learn alternative coping skills to help manage these conditions.

Most of the time Pdocs are used for Med Management, if they do counseling generally it's a 45 min appt. and when you take 15 or so min of that discussing medication issues, then you only have 30 min. to discuss any/all of the other stuff. That's not very long.

A tdoc gives you that whole 50 minutes to talk about all the stuff that's going on in your life, that can be because of your BP and how it affects all aspects of your life, such as the bad decisions you make when your manic, the total feelings of hopelessness that you have when you're depressed, plus any other "life crap" that may be in part related to the BP, or not. A tdoc also can offer therapies that teach you to cope with your disorders through different therapies.

My pdoc and tdoc check in once a month to go over how I'm doing with both of them, and make sure everyone is on the right page as far as my treatment goes. My BP label is BiPolar w/Severe med. resistant Suicidal Depression. So most of the time I am very depressed and have Suicidal Ideations off and on all day. I also have PTSD/OCD and SH/SI, my tdoc helps me come up with alt. coping skills to manage the SH/SI to help get it under control and hopefully eventually stop.

My pdoc manages my medications and suicidal thoughts ideations, including any risks that I have at my home, and if an active plan has been made, etc.

So, that's my take on why there is a need for a pdoc and tdoc. Hope I didn't go overboard with the Book. From your post, it does sound like the tdoc's you had were not a good fit. I saw my pdoc first and he reccomended me to my tdoc, once he got to know me some, that way he pretty much knew we would all work well together.

If you're thinking of seeing a tdoc again, perhaps you could ask your pdoc for a referral.

Kat

 
Old 03-04-2009, 01:34 PM   #4
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Re: Why see a tdoc?

Kat,

Off-topic...

How does your pdoc help you manage your suicidal ideations?

On another note, I also have problems with SH, but haven't addressed this in T because I have SO many other issues to deal with.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN

 
Old 03-04-2009, 01:48 PM   #5
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Re: Why see a tdoc?

Dreams,

He's kind of got a sixth sense, or should I say he just knows me that well, that almost starts when he gets me from the waiting area as to how I'm feeling that day. So he kind of knows what questions to ask in the beginning....and then once the conversation is started, we just kind of talk it through. He always makes sure that I'm being med compliant, and more importantly that I've got my "pain med" plan in place. Generally in the past when I've OD, it's been on Narcotics or Sleeping meds...so when I'm in a suicidal frame of mind my mother in law comes and takes the key to my med safe and only leaves a days worth of pain meds out for me to take, and even if I took them all at one time, they would make me pretty sick, but not fatally so. He has me call her right there from his office, so he knows that I actually do call her.

So we have various plans, that he and I have worked out, he kind of goes down the list making sure that everything is how it should be. He also checks my blackberry to make sure I have all his and my tdocs private numbers still.

So really it's not so much as him trying to "control" or "talking me out of" the thought of suicide, because honestly I'm not sure that you can really do that with a suicidally depressed person. It's more of him making sure that I am as safe as he can, by making sure that the plans that he and I have devised when I'm not in that frame of mind, are in place. If it's a weekend where Nick would be at his dad's then he wants me to keep him home, plan to talk with my friends, since I've called my mother in law from his office she knows whats going on, so she calls alot and checks in with me....just common sense things like that. Things that at the time, for me, seem incredibly hard and exhausting, but really aren't to a person in a normal frame of mind.

Hope this answers your question.

kat

 
Old 03-04-2009, 02:12 PM   #6
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Re: Why see a tdoc?

Kat,

Yes, it does. Thanks for the explanation!
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN

 
Old 03-04-2009, 02:16 PM   #7
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dreams in neon HB Userdreams in neon HB User
Re: Why see a tdoc?

Speaking of having a sixth sense, this is true of my tdoc as well. I can't hide anything from him. If I fake a smile and pretend that I'm not depressed, he can see right through me. The same thing is true when I'm manic. If I deny being manic, he points out all of the symptoms I'm exhibiting that point to mania so that I know exactly what is happening. He also warns me to be careful when I'm in either a manic or depressed state and oftentimes will end a request by asking me if I promise to do something. That gets me every single time because I can't lie. I don't feel comfortable lying and would feel awful if I did because of the close, professional client/tdoc relationship I have with him.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN

 
Old 03-04-2009, 04:35 PM   #8
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katlin09 HB User
Re: Why see a tdoc?

Dreams,

Well you know me pretty well, and you know I don't get manic very often, usually only when they're changing my meds big time. In these few times my tdoc has a theory/implementation that she calls "putting on the breaks". She explains becoming manic like being in one of those little wood box cars going down a steep hill, and when you first start it feels good, and you're enjoying it but then you go faster and faster and you have to know when to "put on the breaks" which means to stop and call the pdoc and let him know what's going on, and make that choice, otherwise you just sink completely into the manic stage and it's the same as crashing at the bottem of the hill. This correlation works well for me as they really do feel like the same things, and since I'm depressed 99.9% of the time, when I do have a rare manic state, it feels really, really good in the beginning to be happy and energetic, but then it can get out of control really really fast if I don't make a conscience choice to put on the breaks and call my pdoc and let him know, other than not calling him and just thinking that I can handle the manic stage by myself.

On another topic of pdocs/tdocs and sixth senses.....I think that's one of the true signs of the right way to know if you have a proper doctor and if you do have a good doc/patient relationship and you're with the right doctor. Both my pdoc and tdoc can do this, I can't get away with anything. My tdoc knew I self harmed, I never told her, she saw a scratch looking cut on my wrist and she just came out and asked me, I'd went 20 years without anyone guessing my "secret" and after only seeing her for 2 months, she knew because she was so intune with the pain that I was in. IMO, if you don't have that kind of connection or communication with you're doc, it may very well not be the right doc. What do you think?

 
Old 03-05-2009, 02:20 AM   #9
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Re: Why see a tdoc?

I agree Kat. I feel the same way about my tdoc in regards to how quickly he can tell I'm manic or depressed. He's very good at picking up on this that it almost scares me. LOL! I've never been confronted about my SH until I went to the ER last November, December and recently. I'm questioned every time I go, but the way I see it, it's best to be honest. There's no sense in hiding the truth especially when these are trained professionals who could probably see right through a lie.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN

Last edited by dreams in neon; 03-05-2009 at 02:21 AM.

 
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