Thursday, August 31, 2006

Meet the new psychiatrist...

I was looking back over old posts to see when or if I'd mentioned that B had lost yet another psychiatrist... I didn't find anything &, to be honest, I think I was too upset at the time to write about it. B has been seeing a child psychiatrist since April of 2004, when his psychologist referred us because of B's increasing anxiety & OCD symptoms, with the idea that therapy alone wasn't going to allow him to cope any more. This first psychiatrist retired less than a year after we started with him due to health problems. We had been seeing his replacement in the practise, Dr. B, for 1 1/2 years when she, too had to close her practise. Her second child was born nearly 3 months prematurely last March & was still in the NICU in July, when she learned that her child would be sent home on a ventilator, still being fed through an NG tube. I fully supported Dr. B's decision to go home & take care of her baby & told her so, but it left us with a major dilemma. The practise was not adding another doctor, but a nurse practitioner to "place hold" for a year, in hope that Dr. B will return to her practise. This did not sit at all well with C (a physician himself), & I had to agree that I think B's needs require someone with a deeper knowledge that nurse practitioner would have. So we asked B's psychologist, Dr. M for suggestions. The most highly-regarded person on the list, Dr. W, came with the caveat "but his practise is closed, so you won't be able to get in..." (so was B's first psychiatrist's, but Dr. M pulled some strings). We called B's pediatrician for suggestions as well, & she immediately mentioned Dr. W, & also that his practise was closed. She said that she'd try contacting him, but not to get our hopes up, & in the mean time C made some calls to other recommended doctors. About a week after my call to the pediatrician, she called me back all excited. Dr. W had returned her email (he'd never returned any of her calls before) & he had agreed to talk to us. This happened the day I had my migraine, last July, & I worked very hard before calling to leave a message with Dr. W, to make sure I sounded coherent. He called me back about a week later & after getting a sense of B's needs, agreed to take B as a patient. Once again the village came through...

So, our first appointment with Dr. W was today. C cleared his morning schedule so he could go with us, & we picked him up at work on the way. I was so grateful- I have terrible anxiety when I meet people for the first time, & meeting my kid's new psychiatrist just makes it worse (you'd think I'd be getting used to it by now, wouldn't you?). B had Rufus tucked in his right armpit & one of the Knight's Kingdom guys clutched in his hand. He & C played a brief game of checkers in the waiting room. Dr. W greeted us warmly & led us to his office. We chatted a bit about our luck with child psychiatrists & he assured us he's very hardy (& plans to be around for a while :). He handed C & I a patient info form to fill out & then turned & spoke directly to B about what sorts of things he likes. B was forthcoming about the things he likes, introduced Rufus & the lego guy, talked about his computers, explained his 3 "disorders" (I decided that B needs a new word... " neurological differences" maybe?). C & I occasionally added something, but tried to shut up & let the kid talk as much as possible. Then we were asked about ourselves. After that we told him about B's present meds regimen. Eventually, when he had a good picture of us as a family & where B was at, we talked about our wishes for B meds-wise. We told him that we'd really like to take him off the seroquel, but every time we try his anxiety becomes overwhelming. Dr. W said that the klonapin working well to help B cope with anxiety when falling asleep could work to our advantage in getting him off the seroquel. His main concern about B's present meds, other than the seroquel's side-effects, was that B is not on nearly enough of the zoloft to be of real help. He explained it to B as "you can't just tiptoe around the OCD, you've gotta hit it hard". He thinks that increasing the klonapin to 2x daily (up from one dose at dinner time) & slowly getting the zoloft up to 200 mg/day (B is currently on 100 mg/day) will allow us to finally get rid of the seroquel. He agrees that depending on an "atypical" neuroleptic for anxiety control was probably not the way to go, but understood how we'd gotten there. We agreed that B will begin the increased regimen of klonapin immediately, but with school starting next week it would be better ot wait a month before starting to slowly increase the zoloft & decrease the seroquel, in case B doesn't respond well. I feel that we are finally getting a ray of hope, meds-wise. I'm really glad that we've found someone that we all feel comfortable with & who is respectful of B (& us). And I'm really glad to finally have a psychiatrist for my kid. These past couple of months have felt like free-fall, with B on medicine & no-one to consult.

B is still in major anxiety mode, although his sense of humour is still in evidence. He is on the 6th or 7th of the Young Jedi Knights series but a character illustrated on the cover on this book triggered him big-time. He explained that this character, who looks like a wolfman, actually ate someone because they had lost a game to him (B told me it was meant to show what a terrible person he was, so I guess he understands why such a character was included in the story...). He requested that we put some tape or something over the character's face. I dug out some stickers & suggested B choose the silliest one he could find, which he took some time doing. Then we covered the face with it. B & I both cracked up when we saw the result :) The first thing B wanted to show dad when he came home from work was the cover of the book & the clever way we coped with the bad picture. I'm really relieved that B feels comfortable holding & reading the book... I told C tonight that I feel very much like I'm back in the days when B was an infant & I was nursing him. In between nursing times B would sleep & I had "stations" around the house where I sat & read, or sat & watched tv, or had something to eat. Each place had to be specially arranged because I couldn't put B down, so my reading station was sitting on the bed propped by pillows with my legs out straight & B laying in the channel between my legs... you get the picture. These past few days at home have felt similarly because B's anxiety requires so much management. He can do things without me, but I am constantly listening to make sure he's doing ok, & if I hear the tics escalate then I have to call to him to see if he wants intervention. Usually he does, so then I put down my book or the computer & go & extricate him from what he's doing (help him finish the computer game, find the lego piece, etc.) & then suggest the next activity. He seems to be floating through the day with little reference to time. He tried to tell C that a PBS show had started at 7:23 this morning... they plan to look it up in the programme guide to be sure. He's doing pretty well when we're out of the house for short times, but is very relieved to come home. I'm trying to get us out for walks as much as possible in the hope that the exercise will help relieve the anxiety. I'm hoping that getting back into the routine of school will help B get his life back. C reminded me that I need to start thinking about what I'm going to do when he goes back... he strongly urged me to make plans to go to lunch with a friend next Thursday because I'm always a basket-case the first day of school. Right now, I don't think I'd know my sewing maching if it bit me. I'm going to have to do some serious thinking & remembering- what projects were put on hold when school got out? What would I like to do? I haven't asked myself these questions in a long time... time to get thinking!


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