Wednesday: Trying a New Psychiatrist for First Time in 10 Years – What to expect?

Wednesday will feel just like any other day here in Costa Rica, except I will be going to the hospital used by medical tourists and visiting a new psychiatrist. The main purpose of the visit will be obtaining a holdover supply of Clonazepam. In past blogs I’ve described the rather unpleasant feelings associated with coming off Clonazepam that made me feel tired and irritable.

Due to my wonderful health insurance in the USA 😉 I can only get 30 pills per calendar month. I rely on myself to refill the prescriptions in time and on my parents to mail them to me. When there are inevitable delays shipping them to San Jose, I spend a few days feeling pissy and unable to sleep. Hopefully the doctor will take pity on me and write a prescription for 7-10 dosages that I can use while I wait for the mail to arrive. To be clear I’m not trying to doctor shop or get whacked on Clonazepam. The purpose of the visit is practical and reasonable. Luckily all the other meds I take for BPD are readily obtainable in Costa Rica WITHOUT a prescription. Yes, that’s right – WITHOUT a prescription. Costa Rica’s public health policies are much better than those in the USA.

Of course, I can’t just walk in and say, “Hi I have BPD, here’s what my USA doctor has me on, I’d like a Rx for some more Clonazepam, thanks”, and walk out the door in 10 minutes without interacting with the doctor. Every psychiatrist – especially the good ones – do their due diligence. It’s possible I may have to see this guy 3 or 4 times before I can actually get the extra meds I need.

Naturally, the real anxiety I have is dredging up my life all over again for someone else to analyze. I talked to my doctor in the USA over the Christmas holiday about seeing a different shrink and she was positive about it. She even said that if I didn’t feel like getting into the cess pool that is at the center of my BPD, I should set some boundaries that the doctor can work with. I greatly respect good doctors and the services they perform for the community. If I’m really going to get my money’s worth, it’s in my best interests to put my best foot forward and be proactive in my treatment, no matter who prescribes it.

It will be my first “get-to-know-you” session with a new Psychiatrist in 10 years, and maybe he’ll have some ideas that will help me. On the other hand, I have a few worries…

  1. Changes in medication regimen – I was referred to this new doctor after I visited a sleep clinic last summer. At the time I was concerned that I was waking up feeling as if I had lived another day in my sleep. I also suffered from overly vivid dreams and occasional night terrors. The sleep doctor analyzed my test results and concluded that I essentially needed to whip myself into shape and stop taking long naps during the day. In addition, he suggested a psychiatric consultation regarding my medications.

    What if the new doctor suggests taking another med? What if he suggests stopping one or more meds completely? Frankly I’m nervous that he’ll want to experiment with me during a crucial time in my life as I plan to move back to the USA. I’d prefer the doctor to get to the point regarding any new or tweaked medication regimens so that I don’t waste time feeling like crap. Then again, if he suggests something that makes me feel radically better, I feel it’s worth the risk to get another opinion on all the anti-depressants and mood control meds I’m on.

  2. Cultural expectations and/or differences regarding male BPD – In Latin American countries including Costa Rica, many men take on a “machista” persona. It’s basically a glorified version of the typical American macho guy with the twist of being able to have a “piece on the side” in addition to whatever woman you’re already dating or married to. Machista Latin men are also very vocal in public when they see a woman they find attractive. These guys will beep their horns, make a sexual remarks, and even whistle at women.

    BPD is primarily diagnosed in females: 2/3’s to 3/4’s of all new BPD cases involve women. What is this doctor going to think when he sees a “Joe Average” type American guy walk in his office and start to complain about his Depression and BPD? Will he think I’m effeminate? Will he give me lecture and a “man up” mantra to live by? Despite Latin America’s beneficial social health policies, there is still a stigma attached to mental illness, particularly for men. Will he even know how to talk to me? I might be his first male BPD patient in a long time! Will he understand where I’m coming from when I describe stereotypical American experiences I went through that helped contribute to my current condition?

  3. Time commitment/consistency of any potential future visits – One of the greatest benefits of being self employed is running my days according to my own plan. This is actually very helpful for therapy because I can schedule regular appointments and not have to worry about getting out of work late or be concerned the boss will give me a demerit when I have to skip a meeting to see my shrink. That said, I had to call 3 weeks in advance for my appointment this Wednesday. Does that mean I’ll only see him once a month time permitting? Would that actually be helpful or harmful? What if he wants to take me on “full time” (for lack of a better term) and require weekly visits to audit my progress with new or changed med dosages? I typically like to have a structured life. Yes, it can be boring. On the other hand, seeing a doctor for mental health treatment once a month or once a week for 3 weeks followed by a long break in between will confuse my senses. What is his standard of care and how available is he to treat my condition?
  4. I realize all of that sounds like I’m a “Nervous Nelly”. Well, check that box too on my sheet of symptoms. Anything new or unknown usually gets one response from me: “NO”. This knee-jerk reaction happens because I’m afraid of social situations involving new experiences or “adventure” style activities. For me, the thought of eating a sandwich made of portobello mushroom and duck meat is scary: I much prefer lettuce and tomato on white bread with a dash of mayonnaise.

    Sometimes in life you have to try that portobello sandwich, even if you’re 99% sure you’ll hate it. I told myself the same thing about coming to Costa Rica in 2004, and I’m still here 8 years later. Change in one form or another can be a catalyst for a better life. Seeking advice from a different doctor might be the spark I need.