Steady As She Goes

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I had my first follow-up appointment with my new psychiatrist this afternoon. He asked how things were going, and I told him about the event on Saturday – how I didn’t have panic attacks beforehand like I’ve been doing recently, and how I handled the minor panic attack at the event. He said that it sounds like the Zoloft is working as expected to control my anxiety, perhaps even a little bit better than expected, and he said that he was going to keep my meds where they were. He wanted to know if I felt myself wanting to do things that I had been avoiding and I told him that the event on Saturday was my return to an aspect of the SCA that I hadn’t felt up to pursuing in years, so he was pleased to hear that. He inquired about side effects and I told him that I haven’t seen anything. I was honest – not every day is rosy, but very few days are truly down right now, and he commented on how things seem to have turned around for me pretty notably in a short period of time. He advised that the Zoloft still hasn’t reached maximum efficacy, so I might see that similar attacks like the one I had on Saturday are even easier to deal with in another month or two. He asked if there was anything on the horizon that might test the Zoloft at full strength and I told him that I was returning to school in the fall, and that the plan was for me to be working again about this time next year. He was happy to hear that I’m looking forward to school and to getting back to work. He wants to see me again in August, just to follow-up around the time that the Zoloft has well and truly kicked in. All in all, it was a very good appointment.

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Medicate Me

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Just like yesterday was a big day in therapy, today was a big day in medication management. I met my new psychiatrist today. We had a good session, I talked both about how I got to the point that I’m at and also my more recent successes over my anxiety. He pointed out that my anxiety seems to be more social, with the exception of driving, and that makes sense. It’s not the laundry room that causes panic, it’s the thought that I might be in there with a stranger who’ll judge me. It’s not the store itself that I have a hard time with, it’s the people that fill it. With the exception of my issue with driving, almost every one of my anxieties can be traced back to being in a social situation. So we’re going with a diagnosis of social anxiety rather than generalized anxiety disorder.

He also took me off the medication that I was taking for anxiety, at least, on a regular basis. He explained that the effects of the medication in question only last about four hours, so it’s not designed to be used as a preventative. He likened it to taking Tylenol to keep you from getting a headache. He also mentioned that long-term use of that medication seems to have a tie to dementia, something that runs in my family and that I would prefer to avoid if at all possible. So I’m now only taking that medication when I actively feel anxious.

In its place, he put me on a new-to-me antidepressant that’s indicated for anxiety maintenance. As is typical with antidepressants, I’m starting with half the target dose for a week and then ramping up to the full dose after that. I hope that it’s going to help with the anxiety. Because of how I was taking it, I never really felt anything from my current anxiety medication, and I hope that this changes once the medication has been in my system for about a month.

I’m due back in his office in five weeks – four weeks after the full dose has started. We’ll take it from there and see where we go.

And I’d like to close by pointing out that seeing a male psychiatrist is a huge step for me because of my PTSD. I got a bad case of dry mouth because of the anxiety of being in his office and my blood pressure reflected my nervousness. I hope that gets easier as time goes on.

A Few Hours of Panic

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Some time ago, we got a notification that my psychiatric medication manager was going to be changing practices and that we would need to sign a release in order for my records to follow her to the new practice. Since I’m self-pay under a special arrangement – $75 per visit – we tried to contact the new office to determine whether they would accept my insurance and whether they would match the self-pay arrangement I had in place. And we waited, and waited, and waited.

While I was in Phoenix, I got a call saying that my May 2nd appointment with her would have to be rescheduled. I told them I was out of town and that I’d call them when I got back in to make arrangements. I sent them an email asking why they’re rescheduling an appointment and whether she was in fact moving practices, as that was scheduled to happen April 1st. They said she was still with them and they could reschedule, and gave me options. I chose to postpone it a week, and that’s when they said that she would be at the new practice at that time and have I managed to get my records sent over to the new place?

This prompted another call to the new practice asking about insurance and self-pay options. No, they don’t take my insurance. Self-pay patients will pay $150 per appointment – double my current arrangement.

So I sent another email to the original practice asking if they would honor that $75 agreement with any other medication manager in the practice, and they said no, that the rate would be $125.

So I started looking for a new medication manager.

My insurance company listed 115 providers within 25 miles of my ZIP code. One phone call eliminated all but 39 of those providers, as they were at a practice that does not accept patients from my county. They transferred me to their Travis County counterpart. They don’t take my insurance either, but they have a financial need process to go through in order to determine self-pay rates. I kept moving through the list.

The next call eliminated three more providers by saying they weren’t accepting new patients. And I went through the rest of that list getting some version of why they can’t take me as a patient. One practice only did clinical trials, another only accepted workers’ comp cases, one number was to an architectural firm. Four were eliminated because they only serve children. One practice said to call back on the first day of the month at 9:00 am and talk with a live person to set an appointment for a new patient, but be prompt, since the new patient appointments for the month were usually gone by noon. (Turns out this is the practice my wife uses, and a call to back channels confirmed they weren’t accepting new patients at this time.) I left a smattering of messages, but wasn’t holding out hope that they’d be the one.

Until one of them called back.

He confirmed that he was in-network for my plan, he confirmed that he was taking new patients, and before long I had an appointment in hand and the intake forms already filled out. The appointment is in less than a month, so I won’t be waiting long, and I’m pretty sure that I won’t be running out of any of my medications in the meantime.

I’m looking forward to this new chapter in my psychiatric care, though I will miss my former medication manager – she was the best I’d ever had, and she’s leaving big shoes to fill.