Monday, June 9, 2014

Miami: Medical "Care"

I used scare quotes because Miami medical care is fucking scary.  Of all the reasons we're leaving Miami, this is probably the biggest, objective reason.  While we eventually learned to deal with the realities of Miami in many ways, and you can certainly choose your doctors (y'know, within the confines of your insurance plan), emergency medical care is pretty much whatever is there at the time - and with as many medical problems I've had in Miami, I simply have no faith if I get into an accident or get seriously ill that I'll get care worth having.  I am even less willing to take that risk with Adrienne.

The biggest problems I've had with mental health care.  Not surprising.  HuffPo rates Florida 48 out of 50 and Our Health Policy Matters rates it 47.  Florida clearly occupies the bottom ten percent in both occurrence (the most people with serious mental health issues) and patient care (with a shockingly tiny amount of money being spent).  My experiences bear this out in a really, really big way.

I don't currently have a psychiatrist.  This is not because my mental health issues have disappeared - though I have made considerable progress, I feel - but because all five of my psychiatrists have been incompetent morons.  I decided it was better to go it alone.  I was right.

So, the first psychiatrist I saw decided to take me off the drug combination that I was on in Ohio.  "Too much dopamine" was his entire response as he tapped away at his keyboard, not even looking at me.  I, again, feel the urge to emphasize that I am not using any artistic license.  The man barely looked at me.

At the time, I was a fucking mess.  This was during the first two months and the stresses of dealing with the corrupt, abusive and incompetent house sellers and our crook of a landlord were driving me crazy.  I was seriously depressed, suicidal ideation, I was lashing out at people with considerable emotional cruelty.  I feel bad just thinking about how bad I was and how I acted.

I didn't argue with him because, well, clearly the drugs I had in California weren't doing it for me in Miami.  Perhaps it was too much dopamine.  The psychiatrist gave me and SSRI, over my objections - admitting that due to my mental state I didn't object too loudly.  I had taken SSRIs in the past, and they hit me hard with emotional flattening.  I didn't really feel to bad, but I didn't feel much of anything at all.

These SSRIs also gave me emotional flattening.  Which, to be honest, wasn't bad in the short term.  But then I noticed something else - they were making me stupid.  They crushed my creativity and diminished my intelligence.

This caused me considerable stress.  So I scheduled another appointment but when I arrived, well, I have no idea what happened, really, because no one in the office spoke English.  I considered this a deal breaker.  I have no hostility towards Spanish-speakers, or I don't think I do, but since the doctor wasn't there and the staff couldn't tell me why, I believed that it would be impossible for me to get good service.  So I found another shrink.  Well, I think it is more accurate to say I tried because it didn't happen immediately.

What happened, instead, is I explained my situation to my primary care physician - the best doctor I've had in Miami, a Jamaican woman who I couldn't keep going to because after the first six months being here FIU changed our insurance plan and she wasn't in the new policy - who filled the scripts the previous physician had given me, including the SSRI.  I should have tried to get back on the stuff my Santa Cruz doctor was on, but I was still a giant mess and my ability to aggressively demand things of people was seriously diminished by the emotional flattening and stupid-making of the SSRIs.

During this time, I tried to get a psychiatrist and failed to do so.  The worst was I went to a group practice and the place was awful.  I didn't make it out of the waiting room.  Everyone was being rude in that way Miami has.  One person was singing a song, one was listening to music on his phone, everyone was talking over everyone else, tightly packed together in this tiny office space.  The staff ignored the incredibly unpleasant environment this created for, y'know, mental health patients.

Part of my presentation of anxiety is disliking crowds and noises.  I was in this group of rude assholes making a huge ruckus in the waiting room and realized this was no place for someone who was mentally ill.  I left, barking out that I was cancelling my appointment, went outside and had a bit of a breakdown.  Just sobbing and hands shaking, embarrassed, depressed, planning out suicide options in my head, angry at the crowd, disgusted at myself because I couldn't handle a crowd . . . like I said, I was a mess.

Eventually, we sorted out our housing situation and bought the house we are currently in.  Our current place is a couple of blocks away from a big mental health hospital.  Fine, I thought, I'll go there.  There are lots of doctors and it has the benefit of being within easy walking distance.

There, my shrink and her supervisor talked to said I was bipolar.  They changed my medication to the most common effective medication for treating bipolar, valproic acid.  It made me suicidal.  So they switched me to lithium bicarbonate . . . which has as a side effect yet more mental exhaustion.  I was still on the SSRI at this point, too, and they put me on another antidepressant, busipirone - is another serotonin effecting drug which made me even more mentally exhausted.  I was also put on clonezepam for anxiety, and that's just a straight up relaxant.

This combined to make me a fucking moron with no energy, intellectual or physical.  All the weight I'd lost in Santa Cruz (fifty pounds) I put on and more, too boot.  I can honestly say that this sequence of events has been an utter medical disaster to me from which I have still not recovered.

Anyway, the key point here is that I'm not bipolar.  More on that later, but the key point, here, is that this is a grotesque and inappropriate diagnosis, putting me on powerful drugs that - if you are not bipolar - can really, really fuck you up.  They really, really fucked me up.

The good part during this time is that we had moved into our current place.  The effects of having OUR PLACE was dramatic.  My major malfunction is anxiety - my depression is usually a reaction to anxiety.  Anxiety usually presents when triggered.  My triggers are things like authority figures, being judged, stuff like that.  Getting a house has a whole lot of authority figures who judge you, not to mention I was constantly dealing with idiots and scam artists.  However, when we moved into the house, much of that went away, not to mention the simple quality of our living area dramatically increased.  After ten months, Adrienne and I finally had enough space so we weren't always in the same room, I had a proper kitchen, stuff like that.  But the bipolar diagnosis was bullshit.

Anyway, I never got into it with that physician because I went down one day and got into a silly fucking argument with the office staff.  I came into the office and I was told that I needed to pay a twenty dollar co-pay.  I hadn't had to do that before, I said, and I didn't have the money with me.  I had an appointment today, so could I just pay the whole bill the next day, after I could get some money.

I was lectured on my responsibilities.  It didn't matter that I'd been going there months and hadn't been asked to pay.  And I wasn't trying to duck paying!  I just wanted to go to the appointment I had and I would have been happy to settle the bill next time, or even later that day.

The lack of sympathy over a superficial billing matter - I mean, my insurance was paying the other $120 bucks of the bill, so it wasn't like I was really putting a financial hurt on them by asking to come by the next day - and the hectoring tone of the asshole behind the desk made me walk away.

At that time, my primary care physician was at FIU Faculty Care.  They had just gotten a psychiatrist on the staff, so I went there.  But I was returning to life due to my improved situation.  I had also come to the conclusion that I wasn't bipolar, I had done the research to conclude that an SSRI, a serotonin agonist and a benzodiazepine (all of which had mental exhaustion and weight gain as side effects) weren't a good match for me.

So I went into this doctor's office and I said, very flatly (I still have my notes) that these three drugs weren't doing it for me.  I was mentally tired all of the time, I hated the emotional flattening, that my creativity was for shit and I would, quite frankly, prefer to be unmedicated than continue to suffer the feelings of stupidity and weight gain caused by these drugs.  His response was to increase the dosage of busipirone, one of the problem medications.

Afterward, I sat down by myself and decided to go off all of those drugs all on my own.  If he wasn't going to listen to me, I would act on my own.

I went back and told him I had gone off of those drugs because, as I said, I would prefer to be on nothing at all than to be on drugs that destroyed my emotions and made me stupid.  I also challenged the bipolar diagnosis directly.  I asked, "How do you tell the difference between manic episodes and a fat kid in a rough neighborhood doing stupid things to demonstrate his masculinity in order to avoid being bullied?"  His response was, "That's a good question."

Fuck yeah it's a good question.  I know that it's a good question because I framed it and asked it.  What I wanted was a good ANSWER.  I said to him that I was certain I was not bipolar and wouldn't take any more bipolar medication.

What I got from him was a bunch of tests that he said would help create a proper diagnosis.  What they were, however, is a bunch of tests to prove I'm bipolar.  They were the same fucking tests that got me the goddamn bipolar diagnosis in the first fucking place!  Jesus fucking Christ!

So I fired him, too.  He pushed drugs on me I said I did not want and didn't listen to me.  I have no use for such incompetence.

Since then, I have been on nothing.  It was the right call.  While Miami does make me crazy from time to time, I now have the intellectual and emotional capacity to manage it most days.  Sure, I have bad days - but no worse than when I was on all that crap, but now I have good days, too.  I decided that I would not get psychiatric care in Miami, due to the persistence of incompetence across so many doctors.

My interactions with primary care physicians have been fewer, but still poor.  My current PCP tried to tell me that I shouldn't lift weights to help with weight loss, suggesting I do some kind of magic cardio exercise.  I asked him what exercise I should do since I will not ride in Miami, my knees can't bear running and I have no access to a swimming pool.  He said I would think of something.

Fuck you.

He also suggested that I get bariatric surgery.  I'm not opposed to bariatric surgery as it is clearly the best way to lose and keep off large amounts of weight.  The more I thought about bariatric surgery, though, the more I kept wondering why this was being pushed instead of a drug-based solution, a non-surgical method.

I mean, there are several drugs out there that could help.  He never tested for a thyroid condition, for instance, though there is a very good chance I have one (a lot of extra weight creates hypothyroidism in patients).  And there is a dextroamphetamine-based weight loss pill approved by the FDA.  I'm not even talking experimental or off-brand use, here, but things the FDA and AMA have approved for weight loss.

You might be going, "Chris, amphetamines are dangerous!  Didn't you see Requiem for a Dream?"  I did and it was a good movie, but also sensationalistic.  Weight loss drugs result in a tiny hand full of deaths every year, whereas thousands (!!) die every year under the knife for bariatric surgery.  Not to mention that the side effects of any bariatric surgery are severe and awful - including stuff like severe gastric pain, severe acid reflux, malabsorption of proteins and vitamines, vomiting and explosive diarrhea.  Also, in 1 in 200 cases, death.  Just awful, terrible stuff.  It just seems to me that what we should try first is the less invasive, less side-effect ridden option.  But, no.

My last medical problem that I'll mention was with dentistry.

I had a rotten molar.  I'd lost the matching molar years ago, so it wasn't doing anything except, apparently, rotting.  So I went to a dentist to have it removed.

Well, I was there for, like, three hours, because what they would do is shoot me up with some lidocaine and then walk away while it took effect.  I've been in that situation before and generally after a couple of minutes, they come back.  Lidocaine is a very quick acting but also short lived local painkiller.  I also seem to have some resistance to it, or a lower pain threshold than I imagine.

So, they came back after AN HOUR.  By that time, the lidocaine had numbed me and then worn off so I was feeling everything, again.  They shot me up with lidocaine, again, and then left, again, for another hour.

At that point, I was, like, "It's only a pulled tooth.  It'll hurt for a couple of minutes and then be done.  Then they'll give me some hydrocone for the pain and I can get pleasantly whacked out for the afternoon, no sweat."  I told them to pull the tooth.

Without telling me, they decided to do a surgical extraction.  I didn't realize this until the drill touched the nerve.  You know how in TV shows and movies, torturers will do amateur dentistry as torture?  I can say with some experience now that it is, without a doubt, torture.  I once broke a leg and had to drag myself a hundred feet to get help - that was kiddie stuff compared to the whole drill on a nerve business.

When I choked back an agonized scream, the dentist asked me what was wrong.  I said that I wasn't numb.  She offered to shoot me up with more lidocaine and come back when it had taken effect . . .

Well, I'd been down that road before.  I didn't want to be there for an hour with an open hole in my tooth that had just been attacked by a drill.  So I told them to shoot me up with lidocaine and then keep at it.  Which they did.

It takes about five minutes for lidocaine to effect you.  It was a long five minutes.  Afterward, the counter person said I was brave.  Well, you shouldn't need fucking bravery in a dentist's office.

The actual extraction isn't very good, either.  There are bone spurs in my mouth where the tooth used to be that sometimes get bloody when I eat crispy food, like corn chips, and a couple of times when I have brushed my teeth.  It's not exposed bone, but just barely.  I'm sure that my dentist in Ohio will mention it and maybe there is something that can or should be done.

When I left, I did NOT get a prescription for any painkiller.  I was told to take some ibuprofen.  I did some research and it was probably due to the fact that practice had, at some point in the recent past, been a drug mill for painkillers - so they were acting really cautious about painkillers to avoid being shut down.  It's a big problem in Miami and the subject of crackdowns, legislation, investigative journalism expos, you name it.  We are in the midst of a crackdown, which is the probable reason they were so light on pain medication.

Which hints at the systematic problems that Miami has with medical care.  Doctors in Miami, as a group, give out so many painkillers that they're considered drug dealers.  As I said at the top of this post, the medical issues are among the firmest objective reasons that we have to leave.  This one isn't about how we feel about Miami.  It's more . . . Miami doctors are not safe.  The care here is terrible in many ways, just awful.

The effects of this mismanaged health care have been dramatic.  I look at the first two years I was here and I am still angry, very angry, at the way I was treated by psychiatrists.  I feel that two years of my life has been stolen from me.  The drugs they put me on made me sick and stupid and I still feel less mentally capable than I once did - I still feel a lack of creative energy that stymies my writing.  Not to mention the damage to my physical health - I gained seventy pounds in Miami, and I wasn't light when I arrived.  I have knee trouble that I never had before, as well.  It will take me years to get back to where I was, if I ever can.  Considering this fills me with white hot rage at the years wasted and the damage to my body, all of which I consider avoidable, all of which is a result of the malicious practices of Miami psychiatrists.

I, apparently, still have more of these in me, too.  Miami has troubled me like no other place I've lived, ever been.  I hope people continue to read these!

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