Nuts & Bolts of Calling a Doctor’s Office

This subject seems to come up a lot, so I thought I would do a Tutorial on how to get in touch with a person and not a machine when you’re calling a doctor’s office.

My first and probably most important piece of information is:

CALL EARLY IN THE MORNING!

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I cannot stress this enough. Even if you have to wait on hold for awhile. I tend to call about 9:45am. By then the logjam has passed and the way is pretty clear.

Calling in the morning gives the doctor the entire day to get your chart, prescribe meds or answer your questions. Lunch time is the usual time they read your message, so if you call in the afternoon, unless you are in the ER, you will be waiting until the next day for an answer.

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If you are really in a crisis (psych, serious fever or infection), I would call back right after lunch. Be your nicest self! NO yelling about “Why hasn’t she called me back yet?!?” crap. Just kindly say, “I need help. I am so ill. Can I come in tomorrow morning? Or might I talk to the nurse or doctor this afternoon?”

“I need help” is a wonderful way of garnering sympathy for your situation.

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A Practice with a Receptionist

If your doctor is in a practice with a receptionist, it’s easier to get a hold of the doc you’re needing because someone should always be available during the 9-5 workday.

You often will be triaged by a nurse before getting a message to the doctor. Still, the earlier you call, the earlier your voice will be heard.

Most offices close for lunch… either between 12pm and 1pm or between 1pm and 2pm. Calling then, you will get a machine. Leaving a message on a machine is like talking into an abyss. Call back when lunch is over.

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Calling Mental Health Professionals

Therapists especially are meticulous with the timing of their appointments. They are 50 minutes long, beginning at the top of the hour, ending at 50 minutes after. I have great luck calling in that 10 minute window between clients. Some will listen to messages and call back during that time, but many pick up the phone, too.

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Know what you are going to say. They have moments to figure out what you need before the next appointment starts. Write it down if you need to before you call. Be ready!

Psychiatrists’ schedules are a bit more wonky, so leaving a message might be necessary. Just as if you were talking to a person, have what you want to say ready. The more info you can leave in the shortest amount of time… being concise… helps everyone get their needs met.

Playing Dumb

When I really need to get through to someone (and you pick your battles here), I feign accidentally hitting the button that says “If you are a care provider and need to speak to someone now, press 1.” Use that sparingly, especially in the same practice. Really, judicious use, please.

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Bypassing Automated  Menus

If you’ve read this far, I get to teach you a trick I learned from another operator. Not specifically for doctor’s offices, but really helpful for banks, phone companies, cable companies, DMVs… any of the bazillion places that have phone trees you seem to be forever lost in.

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Press 0 (zero) fast, over and over and over again. PressPressPressPressPress a dozen or more times. 8 out of 10 times, this gets me to a person.

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Patient Portals

If you doctors’ office has a Patient Portal, sign up for it asap!

In the portal, you can email your provider, ask for refills, make appointments without calling and see your chart and most lab results.

Patient Portals are the best.

Patient-Portal

If I didn’t answer something, ask me about it!

Bipolar Diary: Incremental Shift

TWMental

Loving Nudge

After my Bipolar Diary: Depression Deepens post, I had several people tell me to call my psychiatrist immediately. I thought I could white knuckle it for another week, but others saw what I couldn’t. I trust those closest to me and picked up the phone, getting pushed into a non-existent spot in his schedule the next day. Wednesday, August 2, 2017.

Office Visit

The crying had been keeping me from functioning and did not abate while in his office.

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I told him about the suicidal ideation increasing… then added the obligatory, “But I have no plans to hurt myself, am not stockpiling meds and promise to call 911 if I do find myself getting too close.” He replied, “I understand how frightening they (the thoughts) can be, even when you aren’t consciously creating them.” I breathed a sigh of relief that he seemed to understand.

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artist: Soren Dreier

I’ve had at least 8 different psychiatrists in 30 years and this one is one of the top 2. He listens to me, takes my preferences seriously like refusing the Risperdal increase and is infinitely patient with my continued distress.

I really am so blessed to have such a kind (and gifted) doctor. I know that is rare and how privileged I am to be able to receive quality medical and psychiatric care.

I OWE MY AWESOME CARE TO THE ACA/OBAMACARE INSURANCE I HAVE.

I would not be alive without it.

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Medication Change… Again

I continued crying while he pondered, looking at his computer, typing some, then thinking again.

He found a medication I had not tried before… Latuda… which I’ve since read is used specifically for bipolar depression. Yes, yes… it does come with a laundry list of side effects, but I’m ignoring them, listening to my body instead.

I know it takes at least 2 weeks (in my body) to 6 weeks to feel the full effect of psych meds, but when I got home from the appointment, I took my first pill. Then the next morning, I took the second. (It is taken once a day.)

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Whether placebo or really working that fast, I did not cry until late evening the next day. I didn’t cry the next night, either. And the ideation has slowed, the thoughts feeling more “transparent,” fewer hard imaginings. The images had been like mosquito bites, begging to be scratched. (Not sure I explained that clearly… I’m having a terrible time writing this, pardon spelling and grammar errors, please.)

August 6, 2017

I’m feeling better still. The doc told me that if I was feeling too sedated, to drop the Risperdal, which I did on day 3 after starting the Latuda. I’ve been on Risperdal since 1995, so it is a major thought process to not take it before bed. I do feel less sedated (I described it like someone spiked my drink), but there’s a lot more room for not dropping into a slumber at any given moment.

Let me get this out so those who are following along know how I am doing. Thanks for you care and attention, my dear friends. Thank you for your love.

free getting
artist: Zenos Frudakis

Bipolar Diary: Depression Deepens

TWMental

Depression

The last 2 weeks have sucked even worse than when I wrote on July 13, 2017. Tears. Tears. Never-ending tears. The suicidal ideation is coming more often and is more vivid than when I started the Paxil. And the damn hallucinations are back.

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Almost all of my time is in bed, either curled in pain (another post), staring at the ceiling or sleeping. I leave I Love Lucy on in the background. Sometimes Friends. I’m listening to Mists of Avalon (a book I love), but when I listen in bed, I fall right to sleep. I’ve replayed Chapter 6 four times already.

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artist: Edvard Munch

An Odd Sorta Depression

When looking for images about depression lying, I came across several pieces like this one below:

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Not sure if I’m just more familiar with my depression than when I was younger or if it has really shifted, but I do not hear the lies the girl in the image does… nothing negative about my body, how alone I am in the world, how fat/ugly/sick I am. I did when I was younger, but not anymore.

I just feel sad. An overwhelming sadness. A pall of melancholia that separates me from the rest of you. I cannot even touch what I am sad about except for the endless distress I have about our country because of 45. But this joylessness is deeper than the fear-for-our-lives kind. I feel like I’m under the thick glass of my Nana’s cake pedestal, so close to others, but unable to penetrate the barrier of dreariness to make a connection.

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Medication Changes

The psych doc upped the Paxil to 30mg after 2 weeks on 20mg. He said he still might have to increase it when I see him in 2 weeks. For fuck’s sake, can’t this stuff take effect already? I hate this waiting part.

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I have weaned off the Cymbalta. Is that the reason for this huge dip? Who knows anymore. He wanted to increase my Risperdal, but I refused; the eating is out of control with more Risperdal… can’t abide by that.

An aside: I despise the new packaging that seems to be taking over the medication world. I am not stupid, can follow directions, but they are incredibly difficult for me to get into. I’ve asked the Pharmacy to open them for me and then I rip the inner blister pack out, throwing the outer box away. If you haven’t see them, let me introduce you.

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“Follow these 3 simple steps,” it says. Push the blister pack all the way in, then press on the “lock release button” on the left . Finally, pull the sliding pack out at the same time as pushing the spot on the left. I wish it was as easy as they make it sound! It’s almost worse that rubbing my head and patting my belly at the same time.

Suicidal Ideation

I’ve had lots of suicidal thoughts. My cub stayed with me one night when they were especially bad, reminding me every few minutes that Depression is a Liar. Hearing that, knowing it for certain, is what kept (keeps) me going. Hearing that so-and-so loves me doesn’t do much for my mindset because I rationalize that away easily. Depression Lies, however, works wonders.

Depression is a lying bastard

The thoughts of suicide are so enticing. They call to me seductively as if they were sirens on the ocean’s rocks.

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I try to block them out listening to various albums I have memorized. The Eagles, Carly Simon, Sting (Living Sea), and, of course, Hamilton: An American Musical.

I also try to find positive recovery-from-depression-and-suicidal-thoughts articles and posts online. This is one I go back to over and over:

Suicide Prevention: How to Help Someone who is Suicidal and Save a Life

“A suicidal person may not ask for help, but that doesn’t mean that help isn’t wanted. People who take their lives don’t want to die—they just want to stop hurting.”

When I had my first serious clinical depression in my late teens, I didn’t understand the “wanting the pain to stop” aspect and teetered really close to the edge of death.

As I got older and had some decent therapy, I was able to verbalize the inner turmoil and excruciating emotional pain that was drawing me towards dying. Understanding that I didn’t really want to die, but just to stop hurting… a pain that went so deep as to injure my soul… I was able to cling to those brief seconds of “medication will help remove the pain… hang on a little bit longer.”

Medication and therapy have not failed me yet.

Working/Not Working

Work has been nearly impossible the way I feel. I can do one call, then need 2 hours off to regroup. The calls are easy, mostly with regulars, but the energy expenditure exhausts me. Even writing this post has taken 4 days so far. Ugh. I need to be able to work!

Okay, I need to get this out to you all. It is not a cry for help, I promise. I will not hurt myself, have no plans to.  It’s just those random thoughts that flow through my mind… sometimes like heavy cinder blocks and others like wafting vapors. As long as they continue moving on the conveyor belt, I think I’m okay and headed towards healing.

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Thanks for listening

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Always reaching for help.

Bipolar Diary: New Meds for Depression

My psychiatrist, whom I adore, was great, totally understanding where I have been. I did tell him about the suicidal thoughts, said the standard line “I do not have a plan to kill myself and promise I will not” to quell any concerns he might have.

I forgot to mention in the last post that all my hallucinations have vanished. ALL of them. I cannot remember a time in 2 decades that I have not had at least one hallucination going on, usually olfactory. My world has quieted… and it is disconcertingly odd.

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Medications

I was prescribed Paxil, 20 mg a day and see the doc again in 2 weeks to see if we up it or not. I also lowered the Cymbalta from 90 mg a day to 60 mg a day for a week, then down to 30 mg after that. Interestingly, I have never taken Paxil in all these decades with Depression and Bipolar Disorder.

Dr. Google revealed that Paxil can bring on hypomania, mania, insomnia, agitation and more. I read those side effects and thought, “Bring it on!”

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It takes 2-3 weeks to really begin working in earnest and then another few weeks to settle into the system. Crossing my fingers things get better fast. I miss writing!

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Bipolar Diary: So, So Depressed

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I can barely function. Writing has become nearly impossible. I see the Psychiatrist tomorrow morning at 8am. I am hanging on tightly until then.

Despite what I write next, I will not hurt myself. I will not vanish into death. I promise.

Visions of suicide float through my mind. Romantic images of dying like Ophelia (trite, I know) wander, unbidden, throughout my day.

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artist: Simmonds

I mentally count my meds, seeing if I have enough to make me fall asleep forever.

Even as I sleep 18 hours a day, unable to work, I am still always exhausted.

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artist: Adolph von Menzel

I cannot wait to get help tomorrow.

Bipolar Diary: Zero Gravity Hallucinations

I’d thought I’d come to a place of balance. I was still having hallucinations, mostly visual, some auditory and tactile, but those not so often. Even though the hallucinations have continued, I told the Psychiatrist I did not want to take more Risperdal to try and make them go away. The short time I was on the increased amount (double what I am on now), I gained 30 (fucking) pounds in 6 weeks. As soon as we halved it, I stopped eating like an insatiable animal, and have now lost 10 of those 30 pounds. I told him I’d just suck up dealing with the hallucinations.

However, there does come a tipping point between what I can live with and seeing much of my room floating around as if I was in space.

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Balance – dance troupe, Pilobolus

What’s Going On?

I cannot pinpoint why they are getting bigger, more bizarre and more aggressive. My sleep is weird, but I am sleeping. I’m in an inordinate amount of pain, but that isn’t too new… I had my gallbladder removed on February 2 and have had a series of infection complications since. I’ve got other pain, but can usually meditate to work through it. (I have Trazadone if I need help sleeping, but have only taken that a couple of time.)

Visual

A crazy hallucination I had the other day was seeing my pillow breathing. Yes, I know… ridiculous, but I stared at it as it inhaled and exhaled for the entire 5-minutes I watched. I blinked, shook my head, told myself there was no way in hell that was real, yet the pillow kept inflating and deflating, slowly, as if it was breathing. I glance over a lot to see if it’s going for a repeat performance. Nothing so far.

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I have the usual roaches and now some flying bats, but those are pretty yawn-inspiring since they’ve been around so long now. It’s the floating toilet paper roll, the pens, my Blistex lip balm… things that are here in my room, in my real life, just appearing, mid-air… there… and then fleetingly gone again. My food shifts next to me. I “see” music coming out of the speaker. The movements around the room are near-constant. (The book next to me is shuffling the pages as I write this.)

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I try to drive infrequently and only for less than a mile or two because it is frightening to not know if that box flying through the air is an illusion or really fell off that truck up there. I am terrified when I pass bus stops because people are so close to the edge, they slide over into the road sometimes, sliding back just as I get ready to veer away from hitting them. I do everything in my power to never drive during school drop-off or pick-up, the amount of busy-ness in the roads confuse me terribly. Don’t even get me started on mailboxes.

Tactile

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I am tapped periodically. No one is here to tap me. It’s nothing. I feel things crawling on me a lot. My room is clean! There are no bugs to crawl on me. No fleas, no gnats. Nothing. Yet I could swear there was a spider crawling up my leg or on my arm. Even when I am looking right at my skin, seeing with my eyes that it isn’t there, it is there… I just cannot see it is all. (Talk about a mind fuck!)

Auditory

I have these the least at the moment. Just some occasional whispers. Nothing telling me to do anything, I don’t get those kinds. I just get ominous whispers, just out of hearing range… my name whispered a lot.

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Resolution

Klimt
artist, Gustav Klimt

Writing all that down, I see I really might need to just up the Risperdal to curb some of this extraneous activity in my brain. I am crying writing this, fearful of gaining more weight. (I gained 80 pounds in 3 months when I started the Risperdal 13 years ago.) I know there are other meds I can try, but I get Tardive Dyskinesia so easily… and have it already from the Wellbutrin… I am so wary of changing from meds I know work.

Fuck, this is confusing sometimes.

Thanks for listening.