Here we go loop-dee-loo,
Here we go loop-dee-lai
Here we go loop-dee-loo,
All on a Saturday night.
I used to have a dementia patient who sang this all the time. I suppose it is part of some song from the 1920s. My psychiatrist visit today is best summed up by this song.
First, I've spent the last 3 weeks waiting for her to call back and tell me I could increase my depakote. As I've described, I've not felt well, and I've really needed the change. I thought she was ignoring me, and then that has added to my enormous frustration with not being able to stay well enough to get from appointment to appointment without falling apart. Turns out, after a number of phone calls to various hospitals and labs, that my blood which was drawn February 13th was lost. This is especially annoying to me because the plebotomist punctured my vein and I had to waste time holding my arm in the air and getting a pressure dressing. Apparently only the paperwork went to the outsourced lab and they didn't bother to mention this to anyone. DUH! So now I have to spend Monday tracking this down because I am not paying for a test that wasn't done, nor from them drawing blood and losing it. Then Tuesday I'll have to go get another test done.
And then, the continuing painful discussion of my medication options. I am down to having 3 categories. First is drugs that might work but which the doctor wants to avoid because she is afraid they will cost me my ability to work by causing cognitive impairment at the doses I'd require (neurontin, topomax). Second is drugs I haven't tried (seroquel, zyprexa, and clozaril). Each of these has serious side effects I am afraid of, and each would require taking time off work to adjust to the medication. Third are a few meds which I have tried and stopped for adverse reactions that I am willing to try again (lamictal--we thought it caused vomiting but it could have been lithium; keppra--I just didn't like how I felt, but this was early in the search so I may be able to tolerate it given more adjustment time; and incredibly low dose lithium).
We easily narrowed it down to seroquel, lamictal, or low dose lithium. I have an innate fear of seroquel as I've seen it sedate people and cause weight gain and I've had too much of both of those. Plus taking time off to adjust is really, really inconvenient. So I made that my 3rd option. Lamictal is slower starting and a pain to start, plus I really fear it. She had a coupon for a free starter kit and I did get that script filled so I'm ready if I need it. That left me choosing my known evil.
This probably sounds crazy after all that I've been through in the last year with toxicity. But I went there knowing this was what I'd probably elect today, and I feel I need to try. I'm on even less than ever before, an amount that we won't worry about the level, just the clinical effect. I'm also on a different formulation, leaving some hope I guess that I will be less ill. But I feel most safe tackling this known entity. I know toxicity. Within a few days I'll know probably.
But it also feels like going full circle.......