I promise to provide all the details to support my allegations. As I said, I have the emails my pdoc (psychiatrist) and I exchanged, the emails between me and Dr. Amen, my pdoc's Progress Notes (from each time I spoke with him), lab slips and lab results. Everything to prove, in no uncertain terms, that the care I received nearly caused my death.
It continues, however, to stick in my craw that Dr. Amen would make so specious an argument to explain away the harm that was done me as "[Your psychiatrist] was trying to save your life." I will continue to explain what happened until nobody can be unclear on the chain of events and where the blame squarely rests. Here is the abbreviated, yet entirely accurate, version.
1. I told my pdoc I was feeling suicidal. He listened and agrees.
2. He put me on Lithium, telling me nothing about it other than it's been around a long time and is coming back into favor among pdocs.
3. While he *should* have had my serum blood level of Lithium tested within a few days of starting to take the medication, he waits more than 2 weeks.
4. He neglected to tell me to get a "trough level" test -- a test 12 hours after the evening dose but before the morning dose. That would be a "low" test during the day. Knowing no better, I had the test one or two hours after the morning dose, a "peak level" reading that (as it turns out) was THREE TIMES what the trough level result would have been.
5. Unaware he had botched the ordering of the test (and that is the *generous* interpretation -- it's possible he simply didn't *know* he should be getting and evaluating trough level readings), he sent me an email and a copy of those meaningless lab results and said, "No need to increase the dose. Everything's fine." (Again, I'll provide the exact words later.)
6. Roughly a month went by, during which I was miserable and contemplating my death every waking moment of every day. If I had access to a little money and a car, so I could exit this life with dignity, the way I wanted, I'd be dead now.
7. My pdoc and I had a regularly scheduled phone talk. He recognized my situation was dire and called the cops. They took me away to a County emergency psychiatric facility on a 72 hour involuntary hold (suicide evaluation).
8. A psychiatrist in the facility told me the lab result I quoted to him (because I had memorized it when my own pdoc sent it to me), had to be wrong. The reading was inconsistent with the low dose I was taking. It was he who explained "trough level" and "peak level" blood tests.
9. I proceeded to go (with my long-suffering wife) to several more mandatory meetings with county psychiatrists, one of whom said, "Don't wait to increase your dose. Get a new blood test LATER. Increase it!"
And so I did. And here I am. No thanks to the psychiatrist Dr. Amen employed.
I need to provide a small piece of technical information, so you'll understand the story above.
- Lithium at too high a dose is toxic, perhaps lethal.
- Lithium at loo low a dose does NOTHING AT ALL. It's as though you aren't even taking it.
- Lithium at a "therapeutic dose" is like throwing a switch. It goes from having NO effect to having efficacious effects.
The "standard of care" -- the accepted medical practice -- the protocol for prescbribing Lithium involves "therapeutic drug monitoring." Start the patient on a low dose, wait a few days for it to stabilize in the patient's system, take a trough level blood test, increase the dose if indicated. There is certainly more to it, such as evaluating the patient's other medical conditions and *asking* how the patient is doing, essentially all the other things we want doctors to do for us.
What we *don't* want is for a doctor to base his decision about whether or not to increase the dose of medication on a test he ordered wrong and the results of which are so *completely* wrong as to leave the patient absolutely without any benefit from the medication prescribed.
- If he didn't know the protocol for prescribing Lithium, he should not have done it. Negligence.
- If he had once known the protocol for prescribing Lithium but had forgotten it, he should not have done prescribed it. Negligence.
- If he simply forgot to tell me to get a trough level test -- and let me interrupt to say that he and I had mutual respect and he had always kept me fully informed about my treatment -- then that verges on criminal negligence. He didn't invest the time I took to explain to you what a "trough level" test is. What was that, 10 seconds typing slowly?
I've said I only want money damages from Dr. Amen for my pain and suffering.
Fuck that. I'm going after my pdoc's license.
Friday, April 23, 2010
Thursday, April 22, 2010
Here's what I wanted
As I said, Dr. Amen sent me 2 emails in response to those I sent to him. After (briefly) explaining what had happened, I asked him to do 4 things: (1) have a talk with my pdoc (psychiatrist), explaining the standard of care and therapeutic drug monitoring of Lithium -- so no more patients would be put at risk, (2) have the pdoc write a letter of apology to me for putting me through a life-threatening situation, (3) pay my out-of-pocket expenses (slightly more than $3,000) for the ambulance and county emergency psychiatric hospital stay I had to endure as a result of my pdoc's grossly ineffective and negligent treatment of my depression, and (4) make me an offer for what value he would place on the days out of my life I spent involuntarily confined, the days I spent subsequently going through the county's follow-on psych treatment, and (most importantly) the weeks of constant torment I experienced before and after the hospital stay until I found a new pdoc who said, 'Sure, increase your Lithium dose from 600mg to 900mg each day."
That, gentle reader, was all it took to climb out of the depths of despair and re-enter the realm of the living.
Now it wasn't as though ANY psychiatric professional (nurses, technicians) I met thought it possible that I had the blood level I told them I'd seen on 600mg. They all SCOFFED at the possibility. They assumed there must have been an error because they assumed, of course, the result I was reporting was from a trough level test -- remember, NOBODY orders anything but a trough level test. And then I met with an actual pdoc in the county facility. After he finished scoffing, he asked about the time of day I had the test. It was at that moment I learned about "trough level" and the Lithium protocol.
I had hoped Dr. Amen would have made an appropriate settlement offer. I had, after all, promised to sign a confidentiality agreement in exchange. And I appreciate that he has financial exposure here. He certainly doesn't want any admissions of culpability running around.
Perhaps it wasn't fair of me to say, "Make me an offer." Maybe I should have proposed an amount. There's an old saying in negotiation, "He who speaks first, loses." Had he been prepared to offer more than I wanted, I would have been reducing what I received. I think, as well, I wanted to see what value he placed on my life and my happiness. I haven't added up all the days, but I know it was more than TWO MONTHS of constant misery that I suffered as a direct result of his doctor mishandling my medication.
If it comes to a medical malpractice trial, I will march pdocs onto the stand until the judge and jury shout, "Enough!"
And so, what did Dr. Amen offer? He stopped communicating with me.
And now I must do 2 things: (1) look for a malpractice attorney who sees a large enough potential judgment to justify taking the case, and (2) via this blog make sure the world knows what the Amen Clinics did, such that I nearly died.
Much more to follow.
That, gentle reader, was all it took to climb out of the depths of despair and re-enter the realm of the living.
Now it wasn't as though ANY psychiatric professional (nurses, technicians) I met thought it possible that I had the blood level I told them I'd seen on 600mg. They all SCOFFED at the possibility. They assumed there must have been an error because they assumed, of course, the result I was reporting was from a trough level test -- remember, NOBODY orders anything but a trough level test. And then I met with an actual pdoc in the county facility. After he finished scoffing, he asked about the time of day I had the test. It was at that moment I learned about "trough level" and the Lithium protocol.
I had hoped Dr. Amen would have made an appropriate settlement offer. I had, after all, promised to sign a confidentiality agreement in exchange. And I appreciate that he has financial exposure here. He certainly doesn't want any admissions of culpability running around.
Perhaps it wasn't fair of me to say, "Make me an offer." Maybe I should have proposed an amount. There's an old saying in negotiation, "He who speaks first, loses." Had he been prepared to offer more than I wanted, I would have been reducing what I received. I think, as well, I wanted to see what value he placed on my life and my happiness. I haven't added up all the days, but I know it was more than TWO MONTHS of constant misery that I suffered as a direct result of his doctor mishandling my medication.
If it comes to a medical malpractice trial, I will march pdocs onto the stand until the judge and jury shout, "Enough!"
And so, what did Dr. Amen offer? He stopped communicating with me.
And now I must do 2 things: (1) look for a malpractice attorney who sees a large enough potential judgment to justify taking the case, and (2) via this blog make sure the world knows what the Amen Clinics did, such that I nearly died.
Much more to follow.
Wednesday, April 21, 2010
No good deed, etc.
They say "No good deed goes unpunished."
I've received two email responses from the esteemed Doctor Amen concerning this situation. He said (to paraphrase) "an experienced doctor can interpret results" -- which is, as I've said, complete bullshit -- because if that same experienced doctor doesn't know he's looking at peak level results instead of trough level results, he has no *clue* what he's seeing. He also said (paraphrasing again), "Your pdoc (psychiatrist) was trying to save your life."
And so he was. A kind, caring, generous man who was seeing me (with Dr. Amen's agreement) "pro bono" -- for free. A significant part of my depression was a downturn in my wife's and my finances. I won't get into that now. But I had sent emails to my pdoc saying I could no longer afford to see him. He called me out of the blue one day to tell me he'd gotten approval from Dr. Amen to see me at no charge. There's more to that part of the story, but it begs the question: Am I entitled to feel as though I was violated when the doctor was providing services for free and was seriously trying to help?
I have an unequivocal answer, "Hell yes."
Should his good intentions excuse his life-threatening negligence? I say, "Hell no."
He's a good man. A experienced, talented and caring man. A better man than I in many ways. Despite all that, he made a simple mistake. His negligent act violated the standard of care in prescribing Lithium. When I say, "I'm lucky to be alive", I'm completely serious. And any objective pdoc (psychiatrist) reviewing the history of my case would agree.
He intervened in a life and death situation and began treatment. A good thing. Unfortunately he didn't follow through with the protocol for establishing a therapeutic dose. He ended up doing no good at all (and, some would argue, made it worse).
I like him. He tried to do a good thing. He fucked up. I could be dead right now. What more can I say? In my place, how would YOU feel?
I've received two email responses from the esteemed Doctor Amen concerning this situation. He said (to paraphrase) "an experienced doctor can interpret results" -- which is, as I've said, complete bullshit -- because if that same experienced doctor doesn't know he's looking at peak level results instead of trough level results, he has no *clue* what he's seeing. He also said (paraphrasing again), "Your pdoc (psychiatrist) was trying to save your life."
And so he was. A kind, caring, generous man who was seeing me (with Dr. Amen's agreement) "pro bono" -- for free. A significant part of my depression was a downturn in my wife's and my finances. I won't get into that now. But I had sent emails to my pdoc saying I could no longer afford to see him. He called me out of the blue one day to tell me he'd gotten approval from Dr. Amen to see me at no charge. There's more to that part of the story, but it begs the question: Am I entitled to feel as though I was violated when the doctor was providing services for free and was seriously trying to help?
I have an unequivocal answer, "Hell yes."
Should his good intentions excuse his life-threatening negligence? I say, "Hell no."
He's a good man. A experienced, talented and caring man. A better man than I in many ways. Despite all that, he made a simple mistake. His negligent act violated the standard of care in prescribing Lithium. When I say, "I'm lucky to be alive", I'm completely serious. And any objective pdoc (psychiatrist) reviewing the history of my case would agree.
He intervened in a life and death situation and began treatment. A good thing. Unfortunately he didn't follow through with the protocol for establishing a therapeutic dose. He ended up doing no good at all (and, some would argue, made it worse).
I like him. He tried to do a good thing. He fucked up. I could be dead right now. What more can I say? In my place, how would YOU feel?
Take wrong test results and add water ...
OK. OK. Water wasn't involved. But wrong test results certainly were.
When my pdoc (psychiatrist) didn't specifically order a "trough level" blood test (a test done 12 hours after my evening dose of medication but before my morning dose). he could have gotten *any* blood level. The "12 hour" thing allows the body to get to its lowest level of Lithium in the system. On th other hand is what he actually got. A test run 1 to 2 hours after my morning dose. A so-called "peak level" test. The highest possible test result I woulkd ever have during the day.
Now, what I've said before is that there is no value at all to "random level" or "peak level" test results. The ONLY test results used by doctors to determine if a therapeutic level of Lithium has been reached is the "trough level" test. This isn't my *opinion*. It is accepted scientific fact. A doctor who tells you in this context that "any lithium level is significant" is a lying sack of shit. And I mean that in the nicest possible way.
What's far worse than knowingly attempting to interpret peak level test results in providing patient care is what my pdoc did. He *didn't know* he was looking at peak level readings, because he hadn't specifically ordered trough level readings. He actually thought the ".9" result the test result showed was a trough level reading -- which would have meant the dose I was taking was the correct one. As I later learned from having the correct troough level test taken on a higher dose, a trough level test WOULD have shown a result of ".3" -- a result indicating I was getting no benefit whatsoever from the dose he had prescribed.
By not ordering the right test, yet interpreting the results as though he HAD, my doctor left me dangerously undermedicated at a time when I was suicidally depressed. What he did was the equivalent of nothing. Worse than nothing, in fact, because he told me the dose I was taking was fine when every day I was walking closer and closer to death.
To sum up. While there may be more instances of medical malpractice, the two that stand out are (1) waiting too many days after beginning Lithium therapy to order the first blood test and (2) ordering it in such a way that the results were not trough level results (and, in fact, turned out to be peak level results). His misinterpretation of the results might be excused. If he truly believed he had ordered the test correctly, than his interpretation of the results would have been appropriate. Of course, he *didn't* order the test correctly, so his interpretation of the results put my life at risk.
Am I being ungrateful? Read the next post.
When my pdoc (psychiatrist) didn't specifically order a "trough level" blood test (a test done 12 hours after my evening dose of medication but before my morning dose). he could have gotten *any* blood level. The "12 hour" thing allows the body to get to its lowest level of Lithium in the system. On th other hand is what he actually got. A test run 1 to 2 hours after my morning dose. A so-called "peak level" test. The highest possible test result I woulkd ever have during the day.
Now, what I've said before is that there is no value at all to "random level" or "peak level" test results. The ONLY test results used by doctors to determine if a therapeutic level of Lithium has been reached is the "trough level" test. This isn't my *opinion*. It is accepted scientific fact. A doctor who tells you in this context that "any lithium level is significant" is a lying sack of shit. And I mean that in the nicest possible way.
What's far worse than knowingly attempting to interpret peak level test results in providing patient care is what my pdoc did. He *didn't know* he was looking at peak level readings, because he hadn't specifically ordered trough level readings. He actually thought the ".9" result the test result showed was a trough level reading -- which would have meant the dose I was taking was the correct one. As I later learned from having the correct troough level test taken on a higher dose, a trough level test WOULD have shown a result of ".3" -- a result indicating I was getting no benefit whatsoever from the dose he had prescribed.
By not ordering the right test, yet interpreting the results as though he HAD, my doctor left me dangerously undermedicated at a time when I was suicidally depressed. What he did was the equivalent of nothing. Worse than nothing, in fact, because he told me the dose I was taking was fine when every day I was walking closer and closer to death.
To sum up. While there may be more instances of medical malpractice, the two that stand out are (1) waiting too many days after beginning Lithium therapy to order the first blood test and (2) ordering it in such a way that the results were not trough level results (and, in fact, turned out to be peak level results). His misinterpretation of the results might be excused. If he truly believed he had ordered the test correctly, than his interpretation of the results would have been appropriate. Of course, he *didn't* order the test correctly, so his interpretation of the results put my life at risk.
Am I being ungrateful? Read the next post.
Tuesday, April 20, 2010
Simply wrong
I want to discuss the wrongness of what my pdoc (psychiatrist) did.
There is absolutely no question that the "standard of care", the accepted protocol for prescribing Lithium, requires testing the blood level of Lithium in order to determine when a therapeutic dose has been reached. Further, there is absolutely no question that the blood test used to make that determination is a "trough level" test -- that is, a test taken 12 hours after the evening dose, but before the morning dose. There is *no* value in evaluating a so-called "random level" or (certainly not) a "peak level" -- the result one would get one or two hours after the morning (or evening) dose.
There are *no* criteria for therapeutic drug monitoring of anything other than trough level Lithium blood tests. Somebody who says otherwise is simply spewing bullshit.
What my pdoc did was order a Lithium level blood test in the usual way, on a lib slip he sent in the US mail. It is important to note that this was my *first* Lithium test. I had no prior knowledge the timeframe during the day when the test should have been administered. He and I had exchanged emails, in which he said I needed to get the test and I requested he send the lab slip.
---------
Let me take some time from my narrative to say one thing. It shouldn't have been my job to request the lab slip. He should have known *exactly* how many days following my beginning to take Lithium that I should have gotten the test. He should have sent the slip either at the same time he sent the prescription for me to fill at the pharmacy or had his staff send it *automatically* a few days thereafter. The date I should take the test should have been written on it. As it turned out, he didn't even send the lab slip for more than twice as long as any accepted standard of care specifies. The entire point of "therapeutic drug monitoring" is to get the patient to the right dose as soon as possible.
As I will discuss in other posts, he clearly stated in his "Progress Notes" (the records he kept during and following each session) that the specific reason he was prescribing Lithium was because I was suicidal. He described prescribing Lithium as a "prophylactic against impulsive suicide." So I ask you, gentle reader, what reason, if any, was there for him to *delay* taking the necessary steps to put me on an effective dose? Every day he delayed was a day I suffered in a depression s profound that I thought of killing myself (literally) every waking moment.
I will provide the date in question later. I would encourage any pdocs out there to tell me if my pdoc acted with adequate care for my well-being. Now I understand that doctors don't like to say, "That other doctor did the wrong thing" -- or, in this case, committed gross malpractice -- so when I state my understanding of the accepted method to establish the correct Lithium dose, all I'll ask you to do is say something like, "Yes, that's how I do it, too." You don't have to say anything like, "Thay fellow was am idiot. His negligence could have killed you." I know that already. I'll keep explaining it until even a lay audience can see it.
---------
Sorry for the distraction. Where were we?
Ah, yes. The lab slip and the emails. I have copies and will produce them if you like. The significant thing about them is this: *NOWHERE* does it state to get a trough level test. *NOWHERE* does it state is simple English what I stated before, "12 hours after the evening dose, in the morning but before the morning dose." I was taking "300mg BID" -- that means one 300mg capsule twice a day. It would have been the simplest thing for the pdoc to write the instructions for when to have the test done. Literally a few seconds. But he did not.
I will probably write considerably more about this in another post, but let me cover this point here very briefly. Is it possible that, even if he absolutely should have written down the instructions somewhere so that I couldn't miss them, he told me verbally and I simply forgot? I suppose he could claim to have done so, but then he would have no honor. Let me assure you, when a doctor prescribes a medication intending it to save your life and has explained that the drug's intended purpose is to do so, the patient listens carefully to any and all instructions about how to take it.
I want to make this absolutely clear. He *NEVER* told me how to get the blood test. Whatever result he saw was completely random. I feel like I should be making a list of the instances of his negligence. Not telling me when to take the test would be at or near the top of the list. An error so egregious that, had I killed myself, I hope my wife would have specified it prominently in a wrongful death legal action.
What he *did* with those meaningless results is the topic of the next posr.
There is absolutely no question that the "standard of care", the accepted protocol for prescribing Lithium, requires testing the blood level of Lithium in order to determine when a therapeutic dose has been reached. Further, there is absolutely no question that the blood test used to make that determination is a "trough level" test -- that is, a test taken 12 hours after the evening dose, but before the morning dose. There is *no* value in evaluating a so-called "random level" or (certainly not) a "peak level" -- the result one would get one or two hours after the morning (or evening) dose.
There are *no* criteria for therapeutic drug monitoring of anything other than trough level Lithium blood tests. Somebody who says otherwise is simply spewing bullshit.
What my pdoc did was order a Lithium level blood test in the usual way, on a lib slip he sent in the US mail. It is important to note that this was my *first* Lithium test. I had no prior knowledge the timeframe during the day when the test should have been administered. He and I had exchanged emails, in which he said I needed to get the test and I requested he send the lab slip.
---------
Let me take some time from my narrative to say one thing. It shouldn't have been my job to request the lab slip. He should have known *exactly* how many days following my beginning to take Lithium that I should have gotten the test. He should have sent the slip either at the same time he sent the prescription for me to fill at the pharmacy or had his staff send it *automatically* a few days thereafter. The date I should take the test should have been written on it. As it turned out, he didn't even send the lab slip for more than twice as long as any accepted standard of care specifies. The entire point of "therapeutic drug monitoring" is to get the patient to the right dose as soon as possible.
As I will discuss in other posts, he clearly stated in his "Progress Notes" (the records he kept during and following each session) that the specific reason he was prescribing Lithium was because I was suicidal. He described prescribing Lithium as a "prophylactic against impulsive suicide." So I ask you, gentle reader, what reason, if any, was there for him to *delay* taking the necessary steps to put me on an effective dose? Every day he delayed was a day I suffered in a depression s profound that I thought of killing myself (literally) every waking moment.
I will provide the date in question later. I would encourage any pdocs out there to tell me if my pdoc acted with adequate care for my well-being. Now I understand that doctors don't like to say, "That other doctor did the wrong thing" -- or, in this case, committed gross malpractice -- so when I state my understanding of the accepted method to establish the correct Lithium dose, all I'll ask you to do is say something like, "Yes, that's how I do it, too." You don't have to say anything like, "Thay fellow was am idiot. His negligence could have killed you." I know that already. I'll keep explaining it until even a lay audience can see it.
---------
Sorry for the distraction. Where were we?
Ah, yes. The lab slip and the emails. I have copies and will produce them if you like. The significant thing about them is this: *NOWHERE* does it state to get a trough level test. *NOWHERE* does it state is simple English what I stated before, "12 hours after the evening dose, in the morning but before the morning dose." I was taking "300mg BID" -- that means one 300mg capsule twice a day. It would have been the simplest thing for the pdoc to write the instructions for when to have the test done. Literally a few seconds. But he did not.
I will probably write considerably more about this in another post, but let me cover this point here very briefly. Is it possible that, even if he absolutely should have written down the instructions somewhere so that I couldn't miss them, he told me verbally and I simply forgot? I suppose he could claim to have done so, but then he would have no honor. Let me assure you, when a doctor prescribes a medication intending it to save your life and has explained that the drug's intended purpose is to do so, the patient listens carefully to any and all instructions about how to take it.
I want to make this absolutely clear. He *NEVER* told me how to get the blood test. Whatever result he saw was completely random. I feel like I should be making a list of the instances of his negligence. Not telling me when to take the test would be at or near the top of the list. An error so egregious that, had I killed myself, I hope my wife would have specified it prominently in a wrongful death legal action.
What he *did* with those meaningless results is the topic of the next posr.
Wednesday, April 14, 2010
Bipolar Humor
A short break for levity.
When I have the money to buy gas, I'm an aspiring stand-up comedian. I started at the tender age of 59. Too soon? See rhetorich.com for links to my YouTube videos and comedy blog.
Anyway, I've written four bipolar-flavored jokes/thoughts over the years. Here they are.
1. Being bipolar is like buying a candy bar. Sometimes you feel like a nut and sometimes you just wanna f---ing kill yourself.
2. I like to pronounce it "BIP-uh-lar" (like Tripoli). Buy-PO-lar sounds too cold and clinical. BIP-uh-lar sounds more, I don't know, *perky*, doncha think?
3. One brand-name Lithium drug is called "Eskalith." It sounds like something the Inuit give to bipolar bears.
4. You can tell bipolars' moods by having them spit into a glass of water. If it sinks, they're depressed. It it floats, they're phlegm-buoyant.
When I have the money to buy gas, I'm an aspiring stand-up comedian. I started at the tender age of 59. Too soon? See rhetorich.com for links to my YouTube videos and comedy blog.
Anyway, I've written four bipolar-flavored jokes/thoughts over the years. Here they are.
1. Being bipolar is like buying a candy bar. Sometimes you feel like a nut and sometimes you just wanna f---ing kill yourself.
2. I like to pronounce it "BIP-uh-lar" (like Tripoli). Buy-PO-lar sounds too cold and clinical. BIP-uh-lar sounds more, I don't know, *perky*, doncha think?
3. One brand-name Lithium drug is called "Eskalith." It sounds like something the Inuit give to bipolar bears.
4. You can tell bipolars' moods by having them spit into a glass of water. If it sinks, they're depressed. It it floats, they're phlegm-buoyant.
The short version of the story
As I edit the reference list of words I'll use, I find myself eager to tell my story, so I'll tell you a highly abbreviated version. It will be accurate, but missing lots of details. I will omit, for now, the part before the "I almost died" event and the interactions with the pdocs afterward.
Simply put, I was suicidally depressed and my pdoc knew it. He decided to put me on the prescription medication Lithium. Lithium is what I call a "Goldilocks and the 3 Bears" drug (NOT a medical term). Take just a little less than the therapeutic dose and nothing happens. Take just a little too much and there can be serious complications, including death. The therapeutic dose is "just right."
Where the potential exists to provide no benefit to the patient, when the dose is too low, or cause harm (and possibly kill the patient), when the dose is too high, you can be sure there is a way pdocs establish that their patients are taking the right dose of the drug. The way they do it is with blood tests.
The method of testing is well established. I can point you, for instance, to hundreds, perhaps thousands of web pages that explain it. Many of those web pages are from psychiatric journals. There is no question, I repeat, no question how the pdoc should order the test be conducted and, while there is some art and some science to interpreting the results, there are guidelines for doing so.
As you will see, the way my pdoc interpreted the results of my test is not a matter of his experience or expertise. It CANNOT be described as anything other than gross incompetence and negligence. I'm lucky to be alive. I like the guy and think he should be allowed to practice medicine, but I *don't* think he should be prescribing Lithium, except under supervision.
It is critical that the blood test be conducted at a specific time during the day, a time when the level of Lithium is at its lowest. EVERY explanation of how to interpret blood levels clearly state that fact.
My pdoc didn't tell me when to get the test done, so I just happened to do it when my level was at its *highest* (a "peak level" reading). He interpreted the results as though they were from a test conducted at the right time of day (a "trough level" reading) and sent me an email saying essentially, "No need to increase your dose. Everything's fine."
Now, as you may remember, a dose just slightly too low does nothing at all. Had he ordered the test correctly, he would have seen the dose I was taking was completely insufficient to do me any good. It was like taking a placebo. Subsequent testing, at a higher dose, showed this fact.
So the situation in a nutshell is this: I was very suicidal and my pdoc knew it. He prescribed a drug to help, but botched the process of getting enough of it into my system to do any good. After weeks of complete, abject misery, spending every waking moment thinking about killing myself, I had a telephone appointment with him. He became so alarmed at my state of mind that after the call he called the cops, who came to my door and took me away for a 72-hour involuntary psychiatric hold.
That I was suicidal is not my pdoc's fault. That he intervened and prescribed medication in the first place was a good thing. That he was completely incompetent and negligent in getting the dose right was a crime -- at least it would have been, negligent homicide, if I gad killed myself. I am remarkably lucky I didn't kill myself. No thanks to him.
Not following the "standard of care" in "therapeutic drug monitoring" of Lithium is negligence. the very definition of stunning medical malpractice.
If I can find an attorney willing to take my case, I'll sue.
-------------------------------
This is from the Lithium pharmacology page on Wikipedia at
http://en.wikipedia.org/wiki/Lithium_pharmacology
Now wouldn't you expect your DOCTOR to know this?
"Lithium salts have a narrow therapeutic/toxic ratio and should therefore not be prescribed unless facilities for monitoring plasma concentrations are available. Patients should be carefully selected. Doses are adjusted to achieve plasma concentrations of 0.6 to 1.2 mmol Li+/litre (lower end of the range for maintenance therapy and elderly patients, higher end for pediatric patients) on samples taken 12 hours after the preceding dose."
The "12 hours after the preceding dose" part is the critical one. Next time I will talk about "trough levels" and "peak levels."
Simply put, I was suicidally depressed and my pdoc knew it. He decided to put me on the prescription medication Lithium. Lithium is what I call a "Goldilocks and the 3 Bears" drug (NOT a medical term). Take just a little less than the therapeutic dose and nothing happens. Take just a little too much and there can be serious complications, including death. The therapeutic dose is "just right."
Where the potential exists to provide no benefit to the patient, when the dose is too low, or cause harm (and possibly kill the patient), when the dose is too high, you can be sure there is a way pdocs establish that their patients are taking the right dose of the drug. The way they do it is with blood tests.
The method of testing is well established. I can point you, for instance, to hundreds, perhaps thousands of web pages that explain it. Many of those web pages are from psychiatric journals. There is no question, I repeat, no question how the pdoc should order the test be conducted and, while there is some art and some science to interpreting the results, there are guidelines for doing so.
As you will see, the way my pdoc interpreted the results of my test is not a matter of his experience or expertise. It CANNOT be described as anything other than gross incompetence and negligence. I'm lucky to be alive. I like the guy and think he should be allowed to practice medicine, but I *don't* think he should be prescribing Lithium, except under supervision.
It is critical that the blood test be conducted at a specific time during the day, a time when the level of Lithium is at its lowest. EVERY explanation of how to interpret blood levels clearly state that fact.
My pdoc didn't tell me when to get the test done, so I just happened to do it when my level was at its *highest* (a "peak level" reading). He interpreted the results as though they were from a test conducted at the right time of day (a "trough level" reading) and sent me an email saying essentially, "No need to increase your dose. Everything's fine."
Now, as you may remember, a dose just slightly too low does nothing at all. Had he ordered the test correctly, he would have seen the dose I was taking was completely insufficient to do me any good. It was like taking a placebo. Subsequent testing, at a higher dose, showed this fact.
So the situation in a nutshell is this: I was very suicidal and my pdoc knew it. He prescribed a drug to help, but botched the process of getting enough of it into my system to do any good. After weeks of complete, abject misery, spending every waking moment thinking about killing myself, I had a telephone appointment with him. He became so alarmed at my state of mind that after the call he called the cops, who came to my door and took me away for a 72-hour involuntary psychiatric hold.
That I was suicidal is not my pdoc's fault. That he intervened and prescribed medication in the first place was a good thing. That he was completely incompetent and negligent in getting the dose right was a crime -- at least it would have been, negligent homicide, if I gad killed myself. I am remarkably lucky I didn't kill myself. No thanks to him.
Not following the "standard of care" in "therapeutic drug monitoring" of Lithium is negligence. the very definition of stunning medical malpractice.
If I can find an attorney willing to take my case, I'll sue.
-------------------------------
This is from the Lithium pharmacology page on Wikipedia at
http://en.wikipedia.org/wiki/Lithium_pharmacology
Now wouldn't you expect your DOCTOR to know this?
"Lithium salts have a narrow therapeutic/toxic ratio and should therefore not be prescribed unless facilities for monitoring plasma concentrations are available. Patients should be carefully selected. Doses are adjusted to achieve plasma concentrations of 0.6 to 1.2 mmol Li+/litre (lower end of the range for maintenance therapy and elderly patients, higher end for pediatric patients) on samples taken 12 hours after the preceding dose."
The "12 hours after the preceding dose" part is the critical one. Next time I will talk about "trough levels" and "peak levels."
Monday, April 12, 2010
The big words first
I'm just going to type some terms, then come back and edit this post to add definitions, explanations and examples for them. Some of the details will be a bit sketchy at first, in the interest of getting something for each term quickly, but I'll try to get robust details for each term in time. If you want a fun research project in the interim, you can look up the terms yourself. You'll get many hits for each term in Google. Many have Wikipedia pages, too, that I will cite. Of course if you find something stated here you believe to be incorrect, please tell me.
pdoc - a common abbreviation on the Web for "psychiatrist"
(i.e. "psychiatric doctor"). See http://www.urbandictionary.com/define.php?term=pdoc or http://bipolar.about.com/od/glossaryp/g/pdoc.htm
my pdoc - what I'll call my psychiatrist, instead of using his name
bipolar II - See http://en.wikipedia.org/wiki/Bipolar_II_disorder
mood disorder - See http://en.wikipedia.org/wiki/Mood_disorder
borderline personality disorder - See http://en.wikipedia.org/wiki/Borderline_personality_disorder
attention deficit disorder (A.D.D.) [aka attention deficit hyperactivity disorder (A.D.H.D.)] - http://en.wikipedia.org/wiki/Attention_deficit_disorder
lamictal - See http://en.wikipedia.org/wiki/Lamictal
lithium - See http://en.wikipedia.org/wiki/Lithium
lithium pharmacology - See http://en.wikipedia.org/wiki/Lithium_pharmacology
titrate - See http://en.wikipedia.org/wiki/Titrate
standard of care - See http://en.wikipedia.org/wiki/Standard_of_care and scroll down past "Professional Standard of Care" to "Medical Standard of Care"
therapeutic drug monitoring - See http://en.wikipedia.org/wiki/Therapeutic_drug_monitoring
blood level - See http://medical-dictionary.thefreedictionary.com/blood+level
trough level - See http://en.wikipedia.org/wiki/Trough_level
peak level - See http://medical-dictionary.thefreedictionary.com/peak+level
random level
situational depression - See more at http://en.wikipedia.org/wiki/Depression_(mood)
Major depressive disorder - See http://en.wikipedia.org/wiki/Major_depressive_disorder
suicidal ideation - See http://en.wikipedia.org/wiki/Suicidal_ideation
5150 - See http://en.wikipedia.org/wiki/5150_(Involuntary_psychiatric_hold)
exit bag
"ERGO"
hemlock society
Derek Humphry
helium
Amen Clinics, Inc. - See http://en.wikipedia.org/wiki/Amen_Clinic and their home page, www.amenclinics.com.
Daniel Amen, M.D. - Director of the clinics that bear his name. He was not my pdoc; I've never met him. A living legend among many (but not all) in the A.D.D. community. See http://en.wikipedia.org/wiki/Daniel_G._Amen
By the way, as you would find watching his PBS videos, Dr. Amen's name is not pronounced as the religious word for "Let it be so" (i.e. "eh-MEN" or "ah-MEN"), but with the accent on the first syllable, "EH-men."
pdoc - a common abbreviation on the Web for "psychiatrist"
(i.e. "psychiatric doctor"). See http://www.urbandictionary.com/define.php?term=pdoc or http://bipolar.about.com/od/glossaryp/g/pdoc.htm
my pdoc - what I'll call my psychiatrist, instead of using his name
bipolar II - See http://en.wikipedia.org/wiki/Bipolar_II_disorder
mood disorder - See http://en.wikipedia.org/wiki/Mood_disorder
borderline personality disorder - See http://en.wikipedia.org/wiki/Borderline_personality_disorder
attention deficit disorder (A.D.D.) [aka attention deficit hyperactivity disorder (A.D.H.D.)] - http://en.wikipedia.org/wiki/Attention_deficit_disorder
lamictal - See http://en.wikipedia.org/wiki/Lamictal
lithium - See http://en.wikipedia.org/wiki/Lithium
lithium pharmacology - See http://en.wikipedia.org/wiki/Lithium_pharmacology
titrate - See http://en.wikipedia.org/wiki/Titrate
standard of care - See http://en.wikipedia.org/wiki/Standard_of_care and scroll down past "Professional Standard of Care" to "Medical Standard of Care"
therapeutic drug monitoring - See http://en.wikipedia.org/wiki/Therapeutic_drug_monitoring
blood level - See http://medical-dictionary.thefreedictionary.com/blood+level
trough level - See http://en.wikipedia.org/wiki/Trough_level
peak level - See http://medical-dictionary.thefreedictionary.com/peak+level
random level
situational depression - See more at http://en.wikipedia.org/wiki/Depression_(mood)
Major depressive disorder - See http://en.wikipedia.org/wiki/Major_depressive_disorder
suicidal ideation - See http://en.wikipedia.org/wiki/Suicidal_ideation
5150 - See http://en.wikipedia.org/wiki/5150_(Involuntary_psychiatric_hold)
exit bag
"ERGO"
hemlock society
Derek Humphry
helium
Amen Clinics, Inc. - See http://en.wikipedia.org/wiki/Amen_Clinic and their home page, www.amenclinics.com.
Daniel Amen, M.D. - Director of the clinics that bear his name. He was not my pdoc; I've never met him. A living legend among many (but not all) in the A.D.D. community. See http://en.wikipedia.org/wiki/Daniel_G._Amen
By the way, as you would find watching his PBS videos, Dr. Amen's name is not pronounced as the religious word for "Let it be so" (i.e. "eh-MEN" or "ah-MEN"), but with the accent on the first syllable, "EH-men."
Introduction
In January of 2010, I very nearly died as a result of negligence on the part of the psychiatrist I was seeing at the Amen Clinic in Fairfield, California. I am going to tell the entire story of that experience, in language I will strive to make easy for any lay person to understand.
I will be using my recollections, the "Progress Notes" the doctor kept during (and annotated after) each session with me, written correspondence from him, and emails he and I exchanged. I will also refer (rather extensively, I'm afraid) to medical information available in books, journals and on the Web. Again, I will define the terms I use. If you read something you don't understand, post a comment or send me an email and I will do what it takes to clarify it.
I will not name the psychiatrist publicly, until and unless I bring a medical malpractice action against him and the clinic where he works. I will refer to him by the generic abbreviation I've learned recently on the Web, "pdoc." A pdoc is a doctor of psychiatry. I will call him "my pdoc" and other psychiatrists in general, "pdocs." This usage should become clear as you raed.
The reference information I cite will all be accurate and reflect accepted current medical standards and practices.
I don't say "I nearly died" to be dramatic. This isn't hyerbole. It is, as you will see, a clearly demonstrable and incontrovertible fact.
I'm not sure my case would produce a sufficiently large judgment to make it attractive for a malpractice attorney to take to trial. I haven't explored that possibility yet. What I *do* know is that I have nothing to fear from the pdoc or clinic's lawyers. Just as at trial, in this blog I will be telling the truth, the whole truth, and nothing but the truth. I can back up everything I say.
I will be using my recollections, the "Progress Notes" the doctor kept during (and annotated after) each session with me, written correspondence from him, and emails he and I exchanged. I will also refer (rather extensively, I'm afraid) to medical information available in books, journals and on the Web. Again, I will define the terms I use. If you read something you don't understand, post a comment or send me an email and I will do what it takes to clarify it.
I will not name the psychiatrist publicly, until and unless I bring a medical malpractice action against him and the clinic where he works. I will refer to him by the generic abbreviation I've learned recently on the Web, "pdoc." A pdoc is a doctor of psychiatry. I will call him "my pdoc" and other psychiatrists in general, "pdocs." This usage should become clear as you raed.
The reference information I cite will all be accurate and reflect accepted current medical standards and practices.
I don't say "I nearly died" to be dramatic. This isn't hyerbole. It is, as you will see, a clearly demonstrable and incontrovertible fact.
I'm not sure my case would produce a sufficiently large judgment to make it attractive for a malpractice attorney to take to trial. I haven't explored that possibility yet. What I *do* know is that I have nothing to fear from the pdoc or clinic's lawyers. Just as at trial, in this blog I will be telling the truth, the whole truth, and nothing but the truth. I can back up everything I say.
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