you have to be a bit careful in perscribing these meds: a mood stabilizer and tranquilizer mean that things are really bad: but i think doctors overmedicate:
I would of started with just the mood stabilizer: why give out two meds in someone who is well enough to still right and be able to have insight into their illness: if one was hysterical and hallucinatimg, then add the mood stabilizer:
wellbutrion is a better choice then the SSRI's for a young mother.
the SSRI's are not as effective and can cause wieght gain. which is a difficult issue for a young lady post partum. I think also stopping breast feeding also changes prolactin levels and increases hormonal fluctuations: there is natural protective mechanism to breast feeding: maybe just pump and dump the milk.
i would ask the mom to add vit b complex: may try large doses of co enzyme q10 prior to antidepressant use...it sometimes works and my wife insists i should take it daily or i get "craby" i have one person successfully treated with this treatment...not much of a cohort..well...it works.
stef
mood swings means bipolar: generalized anger can be anything:
also i think something happens to the corpus callosum (my wifes theory, she's the radiologist, with obsessive compulsive disorder) again, that cross over in the frontal part of the brain misfires when ones underlining personality is under stress. Again, there are hormonal changes post partum that change the brain chemistry: maybe birthcontrol regulation with hormones for a couple of cycles would stablize things:
oh yes...stop breast feeding: i remeber persons on prolactin birth control would committ suicide...so stop the breast feeding and go on a low dose estrogen replacement.
i'm wrong about breast feeding
I guess you now have an idea of this docs glogged ideas/action/bedside manner...
Stefanos, I think it's unwise to offer medical advice to someone you've never met, based on an isolated blog entry. I'm quite sure that dooce has competent medical care, and that she and her doctor have weighed the pros and cons of her treatment pretty carefully.
yes, you are right (but dooce is smart enough to abstract from this discussion and that it is not specific to her case; people do have ability to understand a debate in the abstract): but the point is that two meds is still alot of medicine: i wonder sometimes that we doctors have less and less time to communicate: most doctors are on a timed visit: patients cannot express everything in 30 minutes in the context of an office visit: even frequent office visits: we give meds as a quick fix rather than spend the 1 and half hour to get insight and do some counsling. there are always cognitive behaviour things that can releive pressure.
now we are engaged in a discussion: how do doctors and patients recover that trust? it happens with communication and listening (or reading a glog)
a personal glog is something very facsinating to me: it does take a bit of risk taking to find out how to use this medium. Secure https glogs can be used: or the very cellphone could have the encryption key to a https from which a doctor or cousler can surf through information for the patients good. Society is not ready for this: neither the docs nor the patients. But i feel that a glog can help one monitor for adverse drug effects: i often reassure patients that the list of side effects about a medicine are not going to happen to the patient: the reality is i say that to get the patient to comply with a medication in their best interest. I always keep the communcation open for questions being that this is the best way to know as a doctor if a side effect has happened. sometimes persons do not have the insight to know when something has gone wrong: other times persons focucs on everything as a possible side effect: i guess this is where the art of medicine still lays: being able to adapt to a particular persons situation and world view to help the person in their situation.
Can the glog replace the medical record: i think a record the doctor and patient share is a radical consept: and using a glog method to record symptoms and discussions is interesting: i think it may be more applicable to persons with memory loss and be coordinated with a family or friends.
Sometimes persons have to work at being good patietns: but this required a partnership and engagement. How consumer technology will evolve is intersting: but i alway fear the insurance companies just will figure out how to cut costs and create more of a headach for patietns.
one can record their conversations with a cellphone these days and use these conversations as a method of figuring out what causes an argument: or what brings on a panic attack: the first step to cognitive therapy is to be able to identify ones inner feelings and identify fear or anger as justified, or magnified and out of proportion with the situation. Dooce has done this.
I find that sincerity is key to healing: when one is honest with oneself in a public forum, and honest to other persons, communication improves: if dooce is already doing this as reflected from her blog; i am willing to say she has a Great prognosis in getting better (this i will risk and say based upon my experience as a fellow human: i guess the risk is to be kind and supportive in a litigious society). Now the issue is this whole thing has been projected into the public: well it was place into the public domain for this very reason: to "group therapy it" and see what else can be done.
ok: when a doc decides that a medicine like celexa is the best medicine, often, remote decision makers approve or dis approve a medicine.
docs think about symptoms, side effect profile, long term plan for weaning off a med and the risk/probability that one thinks about based upon a docs experience, both educational, as well as case load and experience.
docs essentially wish to help the patient and do no harm: but the idea of remote decision making is part of cost containment with drug plans.
so instead of celexa, one may need to change to zoloft or paxil...
there is a way to pick the right ssri; or to choose alternatives: in the future, i think personal blogs/glogs will direct persons in decision making.
the whole thing about the stereotactic method or genetic profile are both systems able to be integrated into ones care plan in the near future. how will we deal with all these changes and deal with mental health.
bloging is very exhibitionary: there are many who are not so outgoing: i think that being open on a blog annonymous...
god, i just walk into the hospital and I'm being paged already...there is no hiding;-)
i hope you understand my own need to comment here: i find it a safe place and supportive place to play out some complex ideas that i think important.
Liz, are we permitted to read some optimistic twist in the tale since the past tense is used : "I've seen it [...]" that is, it is no longer, at the present moment, seen outside the window?
"May the wind take your troubles away."
-Son Volt, "Windfall"
sadness is common in life: sometimes its what helps us become aware of pain in the world: we sometimes need to reflect inwards and sometimes outwards.
we need our craziness every now and then: we need to break the standards of society and be a bit free: freedom is key to happiness.
light and sun: and time to contemplate is important for freedom.
walking is key to health as well as healthy debate: discussion and privacy with our best friend.
you have to be a bit careful in perscribing these meds: a mood stabilizer and tranquilizer mean that things are really bad: but i think doctors overmedicate:
I would of started with just the mood stabilizer: why give out two meds in someone who is well enough to still right and be able to have insight into their illness: if one was hysterical and hallucinatimg, then add the mood stabilizer:
wellbutrion is a better choice then the SSRI's for a young mother.
the SSRI's are not as effective and can cause wieght gain. which is a difficult issue for a young lady post partum. I think also stopping breast feeding also changes prolactin levels and increases hormonal fluctuations: there is natural protective mechanism to breast feeding: maybe just pump and dump the milk.
i would ask the mom to add vit b complex: may try large doses of co enzyme q10 prior to antidepressant use...it sometimes works and my wife insists i should take it daily or i get "craby" i have one person successfully treated with this treatment...not much of a cohort..well...it works.
stef
mood swings means bipolar: generalized anger can be anything:
also i think something happens to the corpus callosum (my wifes theory, she's the radiologist, with obsessive compulsive disorder) again, that cross over in the frontal part of the brain misfires when ones underlining personality is under stress. Again, there are hormonal changes post partum that change the brain chemistry: maybe birthcontrol regulation with hormones for a couple of cycles would stablize things:
oh yes...stop breast feeding: i remeber persons on prolactin birth control would committ suicide...so stop the breast feeding and go on a low dose estrogen replacement.
i'm wrong about breast feeding
I guess you now have an idea of this docs glogged ideas/action/bedside manner...
Stefanos, I think it's unwise to offer medical advice to someone you've never met, based on an isolated blog entry. I'm quite sure that dooce has competent medical care, and that she and her doctor have weighed the pros and cons of her treatment pretty carefully.
yes, you are right (but dooce is smart enough to abstract from this discussion and that it is not specific to her case; people do have ability to understand a debate in the abstract): but the point is that two meds is still alot of medicine: i wonder sometimes that we doctors have less and less time to communicate: most doctors are on a timed visit: patients cannot express everything in 30 minutes in the context of an office visit: even frequent office visits: we give meds as a quick fix rather than spend the 1 and half hour to get insight and do some counsling. there are always cognitive behaviour things that can releive pressure.
now we are engaged in a discussion: how do doctors and patients recover that trust? it happens with communication and listening (or reading a glog)
a personal glog is something very facsinating to me: it does take a bit of risk taking to find out how to use this medium. Secure https glogs can be used: or the very cellphone could have the encryption key to a https from which a doctor or cousler can surf through information for the patients good. Society is not ready for this: neither the docs nor the patients. But i feel that a glog can help one monitor for adverse drug effects: i often reassure patients that the list of side effects about a medicine are not going to happen to the patient: the reality is i say that to get the patient to comply with a medication in their best interest. I always keep the communcation open for questions being that this is the best way to know as a doctor if a side effect has happened. sometimes persons do not have the insight to know when something has gone wrong: other times persons focucs on everything as a possible side effect: i guess this is where the art of medicine still lays: being able to adapt to a particular persons situation and world view to help the person in their situation.
Can the glog replace the medical record: i think a record the doctor and patient share is a radical consept: and using a glog method to record symptoms and discussions is interesting: i think it may be more applicable to persons with memory loss and be coordinated with a family or friends.
Sometimes persons have to work at being good patietns: but this required a partnership and engagement. How consumer technology will evolve is intersting: but i alway fear the insurance companies just will figure out how to cut costs and create more of a headach for patietns.
one can record their conversations with a cellphone these days and use these conversations as a method of figuring out what causes an argument: or what brings on a panic attack: the first step to cognitive therapy is to be able to identify ones inner feelings and identify fear or anger as justified, or magnified and out of proportion with the situation. Dooce has done this.
I find that sincerity is key to healing: when one is honest with oneself in a public forum, and honest to other persons, communication improves: if dooce is already doing this as reflected from her blog; i am willing to say she has a Great prognosis in getting better (this i will risk and say based upon my experience as a fellow human: i guess the risk is to be kind and supportive in a litigious society). Now the issue is this whole thing has been projected into the public: well it was place into the public domain for this very reason: to "group therapy it" and see what else can be done.
ok: when a doc decides that a medicine like celexa is the best medicine, often, remote decision makers approve or dis approve a medicine.
docs think about symptoms, side effect profile, long term plan for weaning off a med and the risk/probability that one thinks about based upon a docs experience, both educational, as well as case load and experience.
docs essentially wish to help the patient and do no harm: but the idea of remote decision making is part of cost containment with drug plans.
so instead of celexa, one may need to change to zoloft or paxil...
there is a way to pick the right ssri; or to choose alternatives: in the future, i think personal blogs/glogs will direct persons in decision making.
the whole thing about the stereotactic method or genetic profile are both systems able to be integrated into ones care plan in the near future. how will we deal with all these changes and deal with mental health.
bloging is very exhibitionary: there are many who are not so outgoing: i think that being open on a blog annonymous...
god, i just walk into the hospital and I'm being paged already...there is no hiding;-)
i hope you understand my own need to comment here: i find it a safe place and supportive place to play out some complex ideas that i think important.
Liz, are we permitted to read some optimistic twist in the tale since the past tense is used : "I've seen it [...]" that is, it is no longer, at the present moment, seen outside the window?