Archive for psychiatric nurse practitioners

Climbing Walls and Crawling Skin: Life With Anxiety and Panic Disorders

Posted in anxiety disorders with tags , , , , , , , on May 23, 2019 by morgueticiaatoms

For a couple of weeks, anyway, I thought my generalized anxiety disorder was being kept in check by Buspar and a Xanax chaser for the panic attacks and racing, fear filled thoughts. It only took one bad appointment with an inexperienced and obtuse psych nurse practitioner and her student nurse for me to disintegrate back into a paranoid, shaky, unable to focus or beat my panic induced inertia. I am livid and feeling helpless and hopeless. Because I don’t have any options other than this woman and I simply do not think-and never did from the get- that she has the experience and expertise to treat bipolar two disorder with seasonal depression. She’s talking about stripping away my singular antidepressant therapy and that terrifies me as much as their office wide nazi like edict taking everyone’s benzo doses down to barely adequate.

The thought of facing fall without an antidepressant-or two-in place and working terrifies me. I don’t want to go down the blackened rabbit hole again.

The fact this woman would suggest it, and be serious about it, terrifies me more.

I accepted that Wellbutrin would heighten my anxiety when I asked to go back on it after a few months break. It has been the only antidepressant that truly treats my depression and inertia with any efficacy. I did not choose to go back on it lightly. It is definitely weighing the lesser evil. What I did not foresee, however, was them handing down the strict edict on my beloved Xanax. Not all of us are addicted junkies who need climbing doses. In 20 years, I have never ever gone above 3 mg a day and often, I asked to have the dose lowered when I was coping well. And when my psych center had experienced, adequate doctors, this was a non issue. They recognized that xanax is an effective drug for people with severe anxiety and panic disorders and they trusted me to ration myself and only use what I needed. Towards the end right before the edict taking me from 3mg to 1 mg daily, I was taking 0.5 twice during the day and saving the other 2 mg for the really really bad panic attacks or bad insomnia nights. I have an enormous stash of 0.5’s, 1 mg, .25 mg. I can be trusted to monitor my usage. And I am proud to say that I have learned coping mechanisms so my go to isn’t reaching for the pills.

Today, however, it was 2.5 right out of the gate because this nurse has me freaking out. I have never felt so ignored in my life, nor have I ever had a psych professional make me feel so cornered, so vulnerable, and just utterly powerless. She seems unaware of her impact and her edicts having a bad impact on me. Her goal, likely to please her supervisor, is to get me on as few meds as possible. Well, that was the goal all along through every doctor. What they all understood was that life is fluid and rapid cycling bipolar two means what your goal is and what you need to do to survive are often very different things. I miss that level of expertise, that trust they placed in me to know what was best for me and when. I no longer feel like she trusts me or even believes a word I say, for that matter. She has zero concept of how disabling my conditions are. I can’t truly open up to someone whose back is turned to me the whole appointment while she clacks on the computer and shows zero empathy. Her detachement is a bad fit for me and I haven’t experienced it since the last time they stuck me with a nurse practitioner.

I have friends who RAVE about how amazing their psych NP’s are. I was open to the possibility because some of those friends have complex diagnoses so I figured the nurses would be just as knowledgeable as a doctor. What they lack, though, is experience and the ability to let go of all the book taught stuff and LISTEN to what the individual patient needs. It is not my goal to vilify this woman, as I am sure there are others who do find her an absolute godsend. I am just one person who finds it a bad fit, like shoving my size 11 foot into a size 8 shoe and wondering why does it hurt so much and make me walk funny. This should never be cause for a patient to feel guilty or non-compliant. Finding the right fit in any doctor or counselor or even a lawyer is crucial to being able to open up and try your hardest. When someone makes you feel minimized and does not seem to grasp the severity of your personal situations, it feeds into the desire to give up because it seems so hopeless.

I am limited by insurance acceptance and geographical location in my options. Plus, I’ve been with this center 13 years, through about 9 doctors and 2 NP’s. It was always my go to place, my godsend, my miracle working center who never gave up on me and never minimized me or pushed me beyond my comfort zone to the point I needed to take a double dose of Xanax. I just don’t know how to slow my mind and heartbeat and wobbling knees any other way. I breathe, I count, I picture stop signs and recite mantras, I have aromatherapy and sound therapy. I do EVERYTHING but their counseling and that is because my insurance covers only inept people who break confidentiality. This place thinks therapy is so crucial but they won’t let me see their staff counselors due to money. If anything, it is them who make therapy seem impossible. I can’t see someone I can’t trust, I tried that and it put me off therapy for years. So I turn to my peers in the on line community who help me calm down, gain perspective, and they validate my concerns about this NP being a bad fit and they cheer me on as a strong, tough woman who has this.

What I may not have is summer vacation with a bored kid. I didn’t get the camp counselor job, and I can’t afford to send her there, so we’re conjoined twins for the next three months after 1:30 today. Talk about being under pressure and having my anxiety heightened and metastasized. Oddly, I am calmer this summer and I credit the Buspar for that. I am just going to have to get creative and try to find cheap or free stuff for her to keep busy and pray it goes by fast. Maybe her starting counseling will help, too. And it has me unwillingly pondering going to the now behavioral health place, if only for advice on how to handle how stressful this situation with the nurse practitioner is for me. But again, I got burned badly by that place and it happened twice, so…I’m gunshy and wary, to say the least.

For today even with xanax, I am climbing walls and my skin is crawling off my bones. One 20 minute psych appointment with a bad fitting nurse sent me into a tailspin. I am salty because I was starting to feel well. Then she persisted in having me talk to her back, letting the student commandeer my session, and talking about removing the very medication keeping me afloat. Enter terror and panic that has NOTHING to do with being hooked on drugs or preferring popping a pill to alternative coping skills. I should have the right to say, this isn’t working, bad fit, my needs are not being met and I feel trampled. It should not equal non compliance or addiction or being difficult.

We should all be able to take charge of our psychiatric care and have input that the professionals do not trample and quash and send us into tailspins and down rabbit holes. That is unprofessional and borderline malpractice. I just want to be treated as an individual with my own experiences and my own genetic way of processing meds. This woman told me I wouldn’t have withdrawal from Prozac and I had 3 weeks of hellish withdrawal. Because I am not a textbook case and treating me as such does a disservice to me. As a supervisor, the psychiatrist in charge should be made aware that her staff is breaking the cardinal rule in the medical field.

Do no harm.

This last appointment, great harm was done to me. I am not okay with that.

I Reported My Psych Nurse Practitioner to Her Clinic Director Today…PANIC!

Posted in anxiety disorders, depression, mental health with tags , , , , , on March 8, 2019 by morgueticiaatoms

(Sorry to flood post, scumbag brain is working doubletime today.)

If you read this blog at all, then you are aware of my months long issues with the noob psych nurse they assigned me. Initially when she saw me with my prior doctor in attendance, I thought it was going to be a good fit. She was putting on an act, apparently, because with each appointment I started to dread going in more and more. It all culminated at my last appointment which you can read about here. A person can only take so much, especially when in a vulnerable state.

I weighed my options, the consequences, the potential benefit. I railed and ranted and drove the topic into the ground in these posts. I don’t do well with confrontation which is why I am so good with writing versus staying calm during emotionally charged verbal exchanges. Except waiting to hear back on my written submission (which I emailed to the main hospital’s address asking it be forwarded to the psych center director, and he replied within 15 minutes and said it had been done.) Rather than feel any relief or even ‘spork of fortitude pride’ for getting outside my comfort zone of anti-confrontation and speaking up for myself…I just felt flooded with panic manifested in physical symptoms. Pounding heart, sweating, shaky legs, churning stomach, and just… an abject sense of terror at ‘what have I done?”

It should be simple enough to express displeasure at the doctor or nurse or therapist being a bad fit, no fault. But I talked to the receptionist twice and was told they had no doctors (well, they have a clinic director so if she was worth a damn, she’d want to see me herself to make up for this horrible breech in quality of care) so speaking up feels like shooting myself in the foot. True, the risk could have a reward but I had a terrible experience on this matter before and it did not end well for me.

I was seeing a relatively noob female doc (different psych center) who probably had wet ink on her degree and she decided to take all benzos away from all clients and replace it with low dose Seroquel for anxiety. (Fair enough, this was the popular new thinking at the time but has since been debunked ten ways from Sunday and it’s people like me who suffered because of their wishy washy mentality.) I tried to roll with it but every month, I became more strung out, more anxious, more paranoid, more panic ridden. By month 9, I was leaving the house twice a month, too terrified to leave any more often than to pay bills and get groceries. I complained to my therapist, case manager, receptionist, the nurses…I tried talking to this doctor and she would not hear me out, her word was the end of the story. So I reported her to the state professional board.

Week later they dismissed me as a client for their psych services and also deemed I no longer needed counseling or case management. It took 2 years to find a new shrink and even that I didn’t do for myself. I had no home phone or cell and I wasn’t leaving the house due to panic and terror so I begged my sister to make the calls and see if she had any luck. Low and behold, she found me what was one of my shrink’s ever and I flourished both under her med regime as well as how much she supported me in my future wishes to visit a friend in California, meet an on line friend from England, to even one day attempt to become a mother. This is how I know great doctors exist. They are pegacorns but I’ve had two of them so they exist. They just don’t want to work in Satan’s Buttcrack. (Sorry, I heard that on some youtube video and thought it was hilarious and fitting.)

Now I am 2 mg in on Xanax because I was seriously spazzing. I texted Sass and she propped me up and told me good for me and as long as I have proof of the nurse’s med mistake, I should be protected against being called a liar or non compliant. (I do fear retribution because heaven knows what these people type into your chart. Asking for a copy is nixed,too, as it’s ten cents a page and my file is a 15 year span and thick as a collegiate dictionary.) The Xanax is working slowly and I am feeling less rattled and paranoid and fearful but I am sweating buckets in spite of being cold.

I hope I did the right thing speaking up for myself. I suppose I could have been more diplomatic and not mentioned her poor bedside manner and treatment mistakes but I just felt it crucial to let the director know as she is supposed to be overseeing charts, yet she didn’t catch it, either. I meant no malice though the nurse could use some further learning in how not to treat med resistant patients. To be fair, I need to learn how to not become overwhelmed and vicious about things like lowered benzo doses because that may ultimately be the thing to bite me on the ass. “Oh, she’s just mad about our new policy and she can’t get large doses of Xanax now.” I do find it an asinine policy that punishes the responsible people with legit disorders it helps but I was learning to accept it. And I maintain had this nurse or her LPN/RN bothered with a two minute call to give me a head’s up that these changes were being made instead of springing it on me, I’d have had time to process and respond calmly. They seem to consider this basic kindness coddling, though.

Well, it may mean another 2 year hunt for another doctor (closest is 80 miles away) and dozens of “No, we won’t be taking you on as a patient” which is nothing I haven’t heard before. (Being rejected as a patient stings, man.) But in the end even if I get bounced and blacklisted at least I will know I showed courage in speaking up for myself. Feeling this dark and vulnerable, just the act of speaking up on your own behalf is a huge thing.