Smoking Cessation vs. the Clueless Psychiatrist : Smoke Coming Out of Pam's Ears

On this the sixth day of Pam's smoking cessation program, she went with a cheerful heart to meet with her unfortunately clueless psychiatrist. By the time the session was over, smoke coming out of Pam's ears was an understatement.

My wife was livid.

Why so? Just this: Dr. D had proposed two huge no-no's, those being (a) cutting down Pam's Med [X] prescription and (b) having her see a neurologist.

The following is a memo I've already written, though postdated, in an attempt to head Dr. Demento off at the pass. Will it work? Not a clue. We do know that not writing it wouldn't have accomplished much; we'll go with that.

The memo:

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Memo to: Dr. (YouKnowWhoYouAre) April 19, 2011

From: (Me), husband to Pamela B.

Re: Pamela B., Treatment Issues

1. Med [X] dosage

2. Neurologist

Dear Dr. Duh (paraphrased),

This memo is being written in hopes that it may help Pam’s comfort level in continuing with you as her psychiatrist. After her telemed session on April 11, it took the two of us these past eight days to help her completely rebalance her emotions.

What you, as her counselor, need to understand, is…why that was so. Hence, this missive.

I. Pam’s Smoking Cessation Program

To put it mildly, Pam is going through holy Hell in her war against cigarettes. Despite being a true “puffer” (not inhaling), 40 years adds up to a deeply ingrained habit with many powerful emotional triggers deeply programmed into the subconscious. She’s been doing extremely well--but this was a “worst possible time” for drama.

II. Your Interest In Cutting Down Her Med [X]

My best guess is that when you see a patient “buck” against cutting down a prescription, your first thought is: Aha! Addiction! That’s understandable, and in most cases it would even be a correct conclusion…but not in this case. Pam and I’ve been together for 15 years and counting. For nearly 13 of those years, she’s been on the same Med [X] dosage she uses today.

Regarding Pam’s prescriptions in general: She has the metabolism of a hummingbird. Monitoring her meds over the years, I’ve learned that nearly any drug (except timed release, of course) will be past the peak effect in her body within 90 minutes of ingestion. That is, a med that might knock you or me out for 6 hours is virtually processed and gone from Pam in 3 at most. She’s had surgeries where they gave her enough anesthesia to knock out a 500 lb. man…and still she woke up in the middle of it to complain, “You’re hurting me!”

Regarding Med [X] specifically, I once saw her have to get by on less. At the time, I drove long haul trucks for a living. Pam was riding with me one winter when her brand new month’s prescription spilled on the wet truck floor. Not all of them, but those that did were instant, useless mush. We counted what was left and discovered that she would have to average 2.9 pills per day, not 4, if she were to make it through to the next month.

She did it, but I deeply and truly hope I never  have to see her go through that again. Her nerves were shot. She had one of the most horrible grand mal seizures in southern Californa, nine days after cutting down to three Med [X] per day, that I’ve ever had to see her through. Her ulcer flared, not quite to the point of hospitalization, but close enough to be truly scary. She hardly slept, even with her Med [Y] at bedtime. One morning, I woke from my sleep to find the entire truck cab interior spit shined to the max; she’d not closed her eyes once during the night.

If you are simply fearful of the feds in their fierce oversight these days and feel that continuing to prescribe as before will cost you your license, please simply admit that to Pam. Despite her record of suffering at the lower level, she’ll be able to understand that.

But she knows it’s not going to help her, and I know that as well. The potential dangers of the drug “turning” on her? Yes, they exist. But those dangers are all possibilities. Cutting back on her present dosage that has worked for 13 years leads directly to known dangers, including the very real problem of experiencing one more member of the medical profession who either couldn’t understand that she knows her own body extremely well or couldn’t believe her extreme honesty with health practitioners.

II. Seeing a Neurologist

Asking Pam to go see a neurologist is a bit like asking a World War II era Jew to go see Hitler. Since I’ve known her, Pam has seen not one but three separate neurologists. In every single case, she was treated with extreme arrogance and extreme attitude on the part of the neurologist. Not one of them listened to a word she had to say; not one of them got the diagnosis right.

The last one was so bad that (a) it took Pam nearly six months, with my help of course, to get to the point where the man’s name could be mentioned without her getting terribly upset, and (b) we later read in the newspaper that he’d been censured by the State Medical Board for, apparently, treating others much the same way. He had even denied having her MRI on hand when it was later proven to have been in his office the whole time.

That said, there are things you’d like to see that Pam is extremely willing to do when we can afford the cost. For example:

1. An updated MRI. The one she had which did show clear evidence of brain demyelination was done in late 2003. They had to shoot the dye to finish the scan, and the physical aftermath was no picnic, but she’d still like to see a new one. (Interpreted by a radiologist, not a neurologist.)

2. More frequent psych sessions with you.

Sincerely,

(Me)

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Now, dear readers, we have a bit of time to see if this memo--which Pam will carry with her to her appointement in June of 2011--does any good or not. With that in mind, let's throw in a poll as a prognosticating tool, shall we?