When do you decide its time to move on dr. wise?

Discussion in 'General Parenting' started by confuzzled, Aug 7, 2010.

  1. confuzzled

    confuzzled Member

    i'm at a loss yet again. i think we have the koi'iest psychiatrist of all time (he was my last resort, but the first i could get in with, that should tell you something)

    he is the Rx'r of the medication, so i cant just drop him without a plan. on one hand, i really dont want to be doctor/medication/diagnosis "shopping". on the other hand, i'm almost afraid to end up in a worse situation and i'm kind of scared to make the move...for a variety of reasons, most but one were beyond my control, this guy is #4 since last winter).

    the deal is that he seems to think abilify is the wonder drug. he completely discounts what i see as pretty serious clinical depression and off the chart anxiety in my difficult child 2 and keeps saying that medications wont fix everything.

    this time, we saw a fellow. if it was *just* a simple medication check/rx renewal i wouldnt have cared much, but i still feel like there is a ton that is unresolved. the fellow actually had the nerve to say there "is no medicine for that, thats what therapy is for", and was lucky i didnt reach over and belt her. all the therapy in the world isnt going to resolve these issues if she's so depressed/anxious that she cant get anything out of it, Know what I mean??

    this appointment lasted exactly 15 min. other than the initial intake, that seems to be standard for this place. and now, a fellow? i think this psychiatrist wouldnt actually know who difficult child 2 *is* if he tripped over her.

    i am not a fan of the overmedicated. i liked the go slow method, only i think we are going down the road to nowhere. i'm not convinced abilify is doing squat.

    again, in our case, its nearly impossible to tease out typical teen, hormonal, difficult child, Autism Spectrum Disorders (ASD)?, ODD-like symptoms, other than to say she's now been tested out the yahoo and we have identified actual things/weaknesses wrong with her, so many things make sense now, and maybe the long road of therapies is the right one (only, it doesnt seem that way to me--she pretty much doesnt want to get off the couch and do anything, and now is ruminating on things that happened when she was little--ie
    "what IF i pee in the pool like i did when i was 4?" or "what IF i suddenly steal some candy from the store like i did that time when i was 3?"--that *cannot* be typical teen, and if it is, its annoying the koi out of me!)

    so i'm open to suggestions either way, but i'm not feeling good about any of this these days....
     
  2. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I take it you go to a clinic where you may or may not see the same doctor every time? At least that is the impression I get from your post.

    I have had problems with that in the past too. I dont do well with multiple choice dxing. It almost feels like they put a bunch of balls in a bowl and reach in a pick a few out and decide those must be it.

    I dont know if talk therapy works well or not for kids. Mine had it for years. He learned to talk the talk but has yet to walk the walk.
     
  3. confuzzled

    confuzzled Member

    yes, its a clinic associated with my major regional hospital, but afaik, he is the only pediatrician.psychiatrist in the group and until this time, we havent seen anyone but him. i was taken back over the fellow this time around (not that she wasnt nice, not that she probably doesnt have a ton of potential, and not that she wasnt capable of renewing an rx...but they seemed to miss the point that we arent quite at the rx renewal stage yet)

    and i hate therapy. i'll make no bones about it. thats a whole 'nother discussion, but seriously she is getting ZERO out of it. last group session they played candyland. the group is 10-12 year olds. are you kidding me? wth is she supposed to take away from that...turntaking???...if she was still at that level, i doubt there would be much diagnosis questioning going on and we'd have a much more serious need for *intensive* therapy.

    i'm exhausted. i am driving this kid all over creation and getting nowhere fast. last night i fell asleep at 7:45 pm on a friday night--husband was seriously worried about me--but he knew i must have driven 500 miles last week, and every.single.day of the week and knew i was done for.

    school starts in a few weeks...i just CANNOT go through another year like last year.
     
  4. hearts and roses

    hearts and roses Mind Reader

    I will tell you that if I had to do it all over again, I would have tried a different approach to medications. I'm not saying that I wouldn't resort to medications eventually, and it did take us 3 years before we finally relented and had difficult child evaluated and eventually put on medications.

    That said, however, if I knew then what I know now, I would have tried other alternative routes to engage difficult child in other outside of school activities. I would have nurtured her quirkiness more, I would have changed our diets and I would have forced supplements before choosing medications. I would have held a harder line with her when she acted out and I would have thrown my computer out the window and smashed it with a sledgehammer. The best 9 months of her teenhood in our home were the nine months following the police confiscating our computer. Suddenly, my dds remembered how to read and play card games and play outside.

    I'm not simplifying our difficult child's issues by saying it's all about diet and outside activities, but I am saying that I would have taken a different approach from the beginning of any symptoms instead of believing that all difficult child's issues were a result of my divorce when she was 2 and forcing family therapy and subsequently seeing a Dr for medications. I mean, really, if it was all about the divorce, why didn't easy child have similar issues, Know what I mean?? Also, it was our counselor who suggested having difficult child tested and evaluated ad nausea until she was accepted into Special Education and received services, which added to her feeling like a cast off and outsider among her peers. The bottom line, I would have done a few things differently and by the time I thought this, it was too late - difficult child was set in her ways, the medications had taken their toll and she was a full blown difficult child and things were so completely out of control with her, it was all I could do to keep my sanity most days.

    Depending on the severity of the issues your difficult child has, you have to find what works best for you and your family. Often, having a spouse and other children makes it difficult to make huge lifestyle changes in your home - I totally understand that. Also, I used to thank God everyday for the medication risperdal because it virtually eliminated my difficult child's meltdowns. I appreciated how celexa helped difficult child with her depression, however, it also made her manic so it was a double edged sword. When the Dr switched her to a mood disorder medication, the poo really hit the fan, so that wasn't the answer either.

    It's a delicate balance and a combination of things that help the poor difficult child get through the teens years and the parents as well. There is no one answer and there is no one technique. The best you can do is research your options and choose what's best for you, difficult child and your family and run with it until it doesn't work anymore. Also, constant communication with the educators really helped me. If they knew I was on constant watch of not only difficult child, but them as well, they seemed to be more cooperative. Some days, I felt like a loose cannon and I think they felt like I was as well, which I think now in retrospect, was a good thing on most days.

    It's tiring, isn't it? Always looking for the right way to do things or handle difficult child? I happen to get a lot out of therapy, but I WANT to be there - and that is KEY. We can drag our difficult children to therapy for years but if they don't want to be there, we're pouring money down the drain, in my opinion.

    Hugs, just hang in there and keep figuring out new ways to approach things.
     
  5. confuzzled

    confuzzled Member

    Also, it was our counselor who suggested having difficult child tested and evaluated ad nausea until she was accepted into Special Education and received services, which added to her feeling like a cast off and outsider among her peers

    well, that about sums up our major issues. there wasnt a damb thing wrong with her except she was brilliantly quirky and a tad lazy with some pizz poor coping skills before we were forced into testing. now she's in Special Education which bores her to tears. :-( i can only imagine what would be wrong with ME if i was subjected to such testing...


    and i know exactly what you are saying...there might have been things i *should* have done differently (you ain't kidding about the computer, LOL). there might *still* be things i need to do differently.

    but my back is kind of up against a wall with the school district...i have to demonstrate i'm *trying* (trying to do what, i have no idea).

    i get a run around--oh, the adhd will resolve once you get all of the other issues resolved. oh, the depression will resolve once you get this resolved. oh, the meltdowns will be minimized with upteen Occupational Therapist (OT) sessions to minimize her psychomotor-fine motor deficits....

    i do think however, she's so on edge that something has to give. i just know if i was clinically depressed people would be pushing medications on me so fast my head would spin. in fact, they did...my general dr. thought i was depressed (here's some zoloft), my gyn thought i was in menopause (here's some effexor) and another dr thought i suffered from Generalized Anxiety Disorder (GAD) (here is some xanax). i actually suffer from PTSD and a lousy life.

    but why it isnt being taken seriously in difficult child i dont know.

    i really seriously would love to drop all the doctors/therapists and be done.

    in a perfect world, i guess....
     
  6. hearts and roses

    hearts and roses Mind Reader



    Well that's just the thing isn't it? You can't just throw it all away because then you would have no alternative methods to handle the situations that arise when you have a difficult child. At least in having a therapist and psychiatrist on hand, you can at least explore options and medications if needed.

    What I found over the years is that it is necessary to do my research on my own. Research the medications, the doctors, everything. At least then you will go into a meeting or appointment with some knowledge and be able to ask questions and have a point of view. As the parent, YOU know your child best and YOU are the advocate!

    Best of luck!!
     
  7. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    If my kid wasn't better in six months, I moved on. Same for myself.
     
  8. TerryJ2

    TerryJ2 Well-Known Member

    Confuzzled, I would move on, but not until I had an appointment with-another psychiatrist, you met him/her in person and really liked them.
    I also think you should do 1-on-1 therapy. Forget the group stuff. If your child is depressed, regardless whether it's the right medication or not, she's got to learn to express herself.
    We spent several sessions together b4 our difficult child really opened up, and even now, it's hit-or-miss. Sometimes difficult child wants to just sit there, but the dr will say, "Talk to me. You're not going to waste my time and I'm not going to waste yours like this. Do you want your parents to leave the room?"
    Sometimes we leave, sometimes we stay. Over the yrs, difficult child has learned to talk. It has been a long, long road.
    Once you have a good talk therapist on board, that person can go to bat for you, along with-the pediatrician, for a medication change. It will add weight to your opinion, which at this point seems to be nonexistent with-the psychiatrist(s).
    Very frustrating, indeed.
     
  9. Fran

    Fran Former Site Owner

    It probably has to do with each specific difficult child. My difficult child, although bright, would have drowned in a mainstream class. Special education depts., as of today, are not developed enough to handle all types of education for all types of children. It is really the weak link in the school system. in my humble opinion. If you make it a program for the lowest common denominator then the children do feel different and like failures. Some children feel safe in the small venue of special education.
    medications are hit and miss. They are better than 15 yrs ago but they have a long way to go. Some of the medications saved our sanity and difficult child's but they weren't meant to continue to do what they do forever. difficult child's system changed and so did the effects of medication. Some of the long term effects are a necessary evil of trying to keep him from getting so bad that he would have long term hospitalization.
    I just kept trying to help difficult child and my family with the least amount of collateral damage.
    Finding a doctor who has a personality that suits us and is at the top of his/her game is a trick. Sometimes you get one without the other. If they helped difficult child then I didn't care that much about personality but in this area of treatment it is important that there is understanding of family dynamics which is very personal and intrusive. I must say I was not wild about that part of difficult child's treatment that required us to be involved. Unfortunately, it is one of the things they insist on.

    I hope you find a way to help difficult child that doesn't feel like it is the wrong step.
     
  10. Allan-Matlem

    Allan-Matlem Active Member

    Hi,

    with medications a second opinion is important. Parents need to be informed so that they can challenge their psychiatrist when they feel that the kid is not responding well to medications.
    medications are only part of the story and each situation and scenario needs to be examined - the kid/ care giver interaction , the missing cognitive skills etc . So try to get a second opinion.

    Our main goal is to promote ' thinking' , medications don't teach thinking , maybe make kids responsive to our teaching. The way we promote thinking is conversation and the best place in my humble opinion is intergenerational activities out of the home , something which Hearts and roses speaks about. Mentors, older brothers, sisters, buddy-tutors promote thinking
     
  11. Josie

    Josie Active Member

    We move on if our child isn't getting better after a certain period of time (for us about a year) or more quickly if the doctor doesn't listen to us or respond to our questions/concerns or if what the doctor says doesn't make any sense. I would not move on without finding and seeing the next doctor, though.

    Your daughter's "what if . . ." scenarios sound like possible Obsessive Compulsive Disorder (OCD) to me. In our experience, most tdocs will miss this or not know how to treat it. Treatment is CBT/ERP which is very different than regular talk therapy.

    My daughter has mostly the Obsession type of Obsessive Compulsive Disorder (OCD) with thoughts bothering her. There doesn't always have to be the obvious compulsions like handwashing.

    CBT/ERP therapy has been very helpful for her.
     
  12. confuzzled

    confuzzled Member

    i appreciate all of the input.

    i guess i'll try to start interviewing psychiatrists and see if i can come up with someone new.

    like most people here, i have ins. company limitations. i ALREADY am stuck with an out of network t-doctor that i'm paying out of pocket, and flat out, i can't afford any more. i have to stay within my ins. network. i have decent ins...really can't complain, BUT as many of you know, its the trend in the mental health field to not accept ins at all, which was another reason she ended up at a hospital linked clinic. many of the private practitioners simply would cost a small fortune, and thats a major problem.

    and while i find allens posts interesting (no disrespect meant by this, i read all of them, and your blog), i dont find them to be of practical value. it all sounds great, and maybe i'm just not a touchy-feely kind of girl, but i have no idea how to implement your suggestions.. i'm NOT a therapist. i'm a mom. i would have zero idea where to find an appropriate mentor and how to pay for it. when i tried to go down that road once before, i was offered a male high school teacher who didnt come cheap...wth is an 11 year old girls supposed to do with a male h.s. teacher??
    he was it--take it or leave it. needless to say, i left it.

    nor do i have any more desire to make this household revolve around difficult child 2 any more than it already does...maybe she does need "different parenting", but then, maybe she needs a "different mom" because i honestly feel that by ignoring my gut on too many occasions at the suggestion of a psychiatrist/therapist/school personnel, et al has gotten us where we are today.

    like hearts and roses said, i shoulda coulda woulda done things differently. but i didnt.

    and like terry's son...my difficult child 2 can talk the talk with the best of them. i have yet to see her put very much of it into action.

    maybe i dont know what i'm asking...i think it comes off like i'm only focused on medications, and thats not necessarily true...but i have no real way of knowing if she needs them, needs a different one, needs specific therapy, or needs a swift smack. i DO know that a 15 min. appointment with a fellow (or the psychiatrist who literally doesnt even look her in the eye) is not ever going to answer any of those questions. and i'm not even as antsy as midwest....i do NOT expect her to be suddenly cured, but i do think in 6 months i should see some quantifiable change....but 6 months *IS* too long to still be spinning our wheels.

    if i had my way, i'd stop the abilify, find a new dr and not turn over a single record to see if they could come up with their own conclusion as a second opinion. unfortunately, thats not too practical either.

    so i guess i'll be on the phone on monday....
     
  13. hearts and roses

    hearts and roses Mind Reader

    Perhaps starting from scratch is the way to go for you, but do remember that starting all over for your difficult child may not be conducive to making progress in the long term. I personally tried to start from scratch with a new psychiatrist and it was difficult due to insurance reasons, but like I said earlier, I tried various techniques and they all only worked temporarily.

    While I do not advocate the household revolving around difficult child, there are times when it is the way it is like it or not, fair or not.

    I hope you're able to find a new psychiatrist who will work with you and take into consideration what you see at home and value your input.
     
  14. susiestar

    susiestar Roll With It

    First of all, do you have a Parent Report for difficult child? If not, do one, the link in my sig is to the thread with the outline. I think you have a CRUCIAL miscommunication problem going on. The docs are not seeing that the primary problem that you see/cope with (from what I am hearing) is the depression and anxiety. While ALL teens experience this to some degree, if it is interfering with normal activities then it is a problem. Period. Having a current Parent Report can help the doctor see this.

    You also MUST start a diary of her daily mood, rages, gfgish stuff, etc... Include how she feels physically if she feels sick often or has headaches, etc.... It doesn't have to be terribly formal, but record how she seemed to feel, when she took her medications, and how she acted. At the next appointment take this and use it to show that the depression and anxiety are keeping her from normal activities. Bring a list of depression medications and anxiety medications. Also research depression and anxiety to find various symptoms that she has that "experts" say should be taken to the doctor for medication (google for articles like "symptoms of depression in teens" "when to treat teen depression" etc...

    Use these to get the doctor to change medications. If doctor will not, do not leave. Sit there when the doctor says it is time to leave and say, I would but my child is not getting better. I have shown you how depression and anxiety are destroying her life and we NEED medication to work with the therapy she is already working at. I will be happy to wait while you figure out what you feel would be best to change her to, but we will not be able to leave until we get some help.

    If it comes to that find another doctor as soon as you leave. Don't stop seeing this doctor until you see the new one, of course.

    Many many many many teens are treated for depression and anxiety each day. Telling you that there are not medications for that is totally nuts. Next time a doctor tells you that, laugh. Ask them if there are NO medications to treat depression and anxiety then why are SSRI medications to treat depression some of the most prescribed and most profitable drugs of medical history? Treat it like they were joking.

    If they still refuse to treat her, complain to the administrator of the practice or the top doctor of the practice.

    As for therapy where she plays candyland, you know how to handle that. It is stupid and ridiculous to take her to therapy where she plays a game designed for 4 yo's. She is gaining nothing and you are paying handsomely for the privilege. You can play candyland at home - the game costs less than $10 - if you REALLY feel it is necessary for her therapy. Find a therapist who will see her one on one. It may even help to give her a couple of months off of therapy if the only available options are this candyland group therapy. Have her meditate at home. Maybe look for some books on anxiety for teens and/or adults. I know there is at least one anxiety book/workbook for adults. Offer to work through it with her for an hour a week at home. Find a book you can agree on and use that hour (plus driving time if you want) to do the exercises together and figure out what to read for the next week. It can hardly do worse than what she is currently doing with the group, can it? It will also save you time, money, and stress, may strengthen your bond with her and might help you with any anxiety issues also. Letting our kids see that we have to work on these things too is not always a bad idea. And if that bombs you problem are not much worse off than you were before, and you can look for another therapist.

    Does your employer have an employee assistance program (EAP)? These are not always widely advertised, but a call to HR or looking over your employee benefits handbook might help you find out. And EAP will usually help you find therapists in your area and pay for the first 2 or 3 appts with the therapist. This goes for EACH PROBLEM, not just once. Here is how it usually works: You call a toll free number and are connected to an intake person. Tell the intake person the problem and they will help you find a professional in your area. You make the appointment and call the EAP with the appointment date. The EAP contacts the therapist and arranges payment for up to 3 sessions. You see the therapist. If you cannot work with that therapist you tell the EAP and they help find someone else and you go through the process again. Any sessions after the initial ones are your responsibility to pay for. When another problem occurs you call the EAP and start the process again.

    Many employers find that this is far less expensive than all the lost work days from stress and problems that occurred with-o the program. Employees are also happier/less upset at work so they are more productive. Check with HR to see if you have an EAP program, it can really help and works even if you have insurance. The first appts are not usually billed to your insurance and the EAP pays 100%. There are a few programs that just pay the copay, but they are not as common and you usually are not bothered with any paperwork.

    I hope some of this helps.
     
  15. Allan-Matlem

    Allan-Matlem Active Member

    Confuzzled,
    thanks for the feedback . The advice is more practical when we are working on unsolved problems. I will try to deal with unsolved problems on my blog.
    As far as mentors etc - try a high school , church , older teenagers who do baby sitting - maybe your local NAMI organization can help

    Allan
     
  16. DaisyFace

    DaisyFace Love me...Love me not

    Confuzzled--

    I'm sorry you are in such a tough spot. We were stuck in a very similar situation. We had the WORST psychiatrist in the world. Dr W - UGH! She was horrible! Not a clue about our situation. Not a clue how to handle kids....and yet she was the "children's psychiatrist" at the clinic. Could NOT get her to listen to me. Took difficult child at her word that everything was fine except for her horrible abusive mother....I wanted to scream!!!!

    After trying in vain to get the clinic to switch us to a different doctor (sorry, Dr W is it - we were told. Nobody else is accepting new patients)...I complained to a therapist working at the same clinic....who went to a supervisor....who FINALLY got us switched to a different doctor.

    Just remember, psychiatrists are people, too....and they have their flaws just like everybody else. If your doctor is not working with you the way that you need, there is probably nothing you will be able to say/show/do that will change him.

    Time to change....
     
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