Psych evaluation in March

What can I expect ?

[willbb]

    

  Most likely ....a psych evaluation.

Will.

[can-do-man]

My doctor never thought i needed one. It would be interesting to know though, have you asked your doctor why?

Good luck

[printze]

Funny,,,,

[printze]

My last visit in January the case nurse said all his new patients get one before tx because of the strong effects of the drugs . I never had an evaluation with a psych before , I will let you know what its like . I am curious I will call my hep doc tomorow . I have read it is good practice for new patients to see if they are capable to handle the mental sx of the drugs for depression . I don't have any of those issues , Will be interesting , another pre tx qualification .

[orphanedhawk]

I had one years ago, not for hep C.
Its simple, you go and talk to the doctor.
They ask a bunch of questions. You answer them.
Be yourself and be honest.

[suezeeque]

Never had one.  I was asked questions by the study coordinator about my 'mental stability' and I guess she took my word for it.  Mwah.

[printze]

I guess I will know if I will need to be on AD before starting tx I suppose .My specialist sure is making me do a lot of pre tx tests, I presume it's all protocol. I'm ok with that.

[flcyclist]

"I was asked questions by the study coordinator about my 'mental stability' and I guess she took my word for it."
-----------------------------------------------------------------------------------------------
It's a good thing the study coordinator wasn't tracking your cookies :o))

[crigger]

When I had one, to get AD, they just ask you about your Hx. if you every have Suicidal or homicidal thoughts any hx of mental illness hx of substance abuse   in other words are you crazy or not.  No psych test... just conversation

[printze]

It was funny opening my mail tonight and finding the appointment slip from the hospital for a psych evaluation, never had one or ever needed one before . I definetly am  not  suicidal or depressed , complete opposite , very happy easy going positive person. I think they sensed my fear of tx, of all the sx and if I can't work because I am alone , that's what I think .

[can-do-man]

It seems someone is putting the cart before the horse, why not wait until after you have the fibroscan or biopsy and be sure your even going to treat and not wait before newer drugs as you have suggested you might do?

Even so a psych now won't much matter now if treatment isn't going to start in the fall if you even decide to treat.

[pooh55811]

As Crigger said, they will ask about your history and they may also ask about your family history. Therefore, it might be a good idea to try to find out if there is any depression or psych history in your family history. They will probably ask about drug or alcohol use. They may ask about family history of alcohol use.

As OH said, just answer honestly, and more information is better than less information (don't hold back on info even if you think it may not matter).

[suezeeque]

"It's a good thing the study coordinator wasn't tracking your cookies :o)) "

HAHA!  No kidding!  I have ads for drug rehab at the bottom of my screen right now!

[kmatucson]

All I can say is be glad that they are having you do a lot of pre tx tests.. I am finding about all of the things I should have had done in this forum.  My gastro (nurse practioner) did not have me do anything..  Although I have not had any psych problems, I am now worried about my eyes, and my teeth..  Wishing I would have had baselines done..

[printze]

There is no such illnesses in my family, so that's not it;. nor do I have drug or alcohol issues, or did,  that's not it  either . Can't think of any other reason except for pre tx protocol .No I have not had biopsy, and my fibroscan is in July.I agree with can-do-man about having all this done , kinda of strange .I know he is a very good hepatologist, but seriously, since last June , I have been doing tests, and labs , I am getting fed up with all these appointments for blood work etc , and he keeps saying I have minimal fibrosis , he better be right when I do the fibroscan , a year has passed I could have tx and svr'd by now.  

[milliehepc]

Hi printze - (all) tomorrow I'm taking my second Hep A & B vacinne (took my Shingles and Pneumonia as suggest to me in this forum - - all in preparation for the dreaded tx. Thursday, I'll be going to a Hep C Conference - isn't that cool? I've learned so much here that I think I will get alot of out of it.  Sorry for digressing - you will do great on your psyche - just one more step on the HepC journey....

Millie

[1oftheclub222]

it's probably just so you can have a baseline to measure up against incase you have negative mental effects from the treatment, better safe than sorry...then you will be able to answer when the next person asks about this :).  good luck...

[virt111]

Have you ever seen, One Flew Over the Cuckoo's Nest?  Just don't go in there acting like one of them.  You'll flunk, for sure. 8~))

Okay, just a little bit of levity...

[flcyclist]

If your conversation goes like this prior to trt, you'll likely end up on AD's.... ;o)

You: Doctor, you must help me. I'm under such a lot of stress, I keep losing my temper with people.
Doctor: Tell me about your problem.
You: I JUST DID, DIDN'T I, YOU STUPID *******!!!

[orphanedhawk]

Hey my son just got over being mad at me because of an email reply of mine.
He called it, "passive/ aggressive and weird", I said, 'that's interferon tx.'
Maybe I should have done  ADs.

[pooh55811]

I am not sure where you are in treatment, but you can still have an eye exam by an opthamologist who is familar with Hep C treatment. Then you will have a baseline starting now in case anything changes.

[printze]

I have had the optomologist in January, and I am not in tx yet these are all tests I am having prior to tx. My next appointment is in July for fibroscan and discussion on tx and when I start. It seems it is taking such a long time.Like I mentioned , it is a good thing he is checking all bases before , but this dragging on since I was diagnosed by my GP last March , to me everyone else seems to have started and already finished their tx. I know he is doing the right thing because I did have lots of questions and concerns so perhaps this is all part of his assessment strategy.

[printze]

By the way on the paper it read ( PSYCH) Hepatitis.

[printze]

Forgot to add, I also had, ekg, lung x-rays, blood labs, eye exam, unsuccessful fibroscan ( equipment problem) 3 visits with hep doc specialist . Now this one.

[can-do-man]

"Forgot to add, I also had, ekg, lung x-rays, blood labs, eye exam,"

Sorry but all those tests you will need to do again right before tx starts as those will have no meaning then.

[suezeeque]

I had all those tests probably in the 3-4 weeks prior to starting treatment.  The EKG was done the day I started as well as a date with vampira.

[Advocate1955]

#1) My husband was diagnosed in March 2007, had all tests and labwork (colonoscopy, ultrasound, biopsy, vaccines, blood tests, EKG, etc.) done in March - April, and started SOC right away, April or May I think.  

#2) 2nd liver biopsy, ultrasound, blood work, and EKG done August of 2010, discovered progression from f1-f2 to f4, and started 2nd therapy (daily infergen injections/1400 mg Riba) right away Aug-Sept, 2010.

#3) Saw hepatologist in August of 2011 to talk about triple therapy, did ultrasound, lab work, and EKG, she said no need to do another liver biopsy because we already know he now has Cirrhosis from 2010 biopsy, started triple therapy on Sept. 30, 2011.  My husband has had regular eye and dental check ups and has been on an AD since Hep C diagnosis.  Hepa didn't require baseline eye exam, extra dental check, or psych eval (didn't mention it).  The baseline eye exam and extra dental check would probably have been a good idea given what I've learned here on the forum.  Perhaps she didn't feel a need for the psych eval because she treated him previously and we have the same NP as before and he's already on an AD to manage sides from previous two therapies.  Basically the timeline from meeting with the hepa to getting started with therapy each of the three times has been a few weeks for my husband.  As suezeeque said, often several things were scheduled on the same day (EKG/labs/ultrasound, etc.), which is fine for us.

Advocate1955

[willbb]

Very odd for any doctor to order "pre-treatment baseline tests" 6 months before even having a "fibroscan " to then discuss treatment options (at that time)as you mentioned??
I agree with cando .these tests will have no meaning in 6 months when you have your fibrosis assessment done(FS) and there has not even been a discussion on whether you will treat or not?
Would  not the result of the FS  have some bearing on when you would treat??
Also in all liver clinics in Canada. the fibroscan is only used in correlation with biopsy to make definitive tx desicions?.

So...what this looks like is you  are having all " HCV pretreatment tests"
done about 6 months before you even have a "non-definitive" fibrosis test done (the fibroscan,that is never used alone for diagnosis of staging) to then discuss treatment options  in aprrpx.6 months ,and if indeed tx. is warranted all the pretreatment tests will need to be repeated??

I have never heard of an odder way to proceed.  The cart is so far ahead of the horse They are not even in sight of each other?

But good luck with this...

Will

[nygirl7]

I totally agree, it's not adding up at all.  Its like going in for a broken arm and having the doc order foot x-rays in case you ever break one of them and then giving you a brain MRI and never setting your arm.

Btw never had a psych evaluation doc just said have you ever been depressed or suicidal?  Why would a doc order expensive things for no reason especially since you not even know if you need/are going to treat?

[beeblessed]

I went through more blood tests than anything, pre-tx.  I did have a lot of tests but had to repeat a couple within a month of tx.  As for the psch eval, I actually had to fill out a questionnaire.  It was to get a baseline on our "normal" behavior and responses.  I think it may also have been for data keeping purposes, as I am told we will have to do another one near the end of tx.  I agree with those above.  Just be honest with yourself and be honest during the evaluation.  These drugs can put you over the edge, and everyone has a different tolerance, so they need to be able to work in your best interest.

[printze]

I totally agree with all of you, I find it very strange to be doing all these tests and the important one fibroscan in July then to repeat all  over again, it makes no sense to me either. Now you understand why I am confused ? I have no clue whatsoever.All I can do is follow his instructions, every month or so I get another appointment for another test, I'm fed up , get on with it or not.I do not want to start all over again with finding amother specialist they are hard to get here in Montreal. I have to ride it out in the meantime, it drives me nuts.

[jules2551]

I think the fibroscan is the one you really need right now.  Then you should have a biopsy to confirm the findings.  

As for the other tests...I think you should start asking "Why"?  Why are you doing this test now when your not starting tx until such and such a date?  Sounds like one of these quack Drs that is taking the insurance company for a ride....(Just my opinion from your previous posts)!  Maybe you should take a look at possibly getting another Dr?  

From reading the posts of people in tx now....You think you are confused now?  Just wait until you start tx.  You need to have a serious sit down with your Dr and lay things on the table.

Have a great day!

Jules

[printze]

I totally agree, I was diagnosed last March, seen hep speciliast for the 1st time in June 2011. Since then tests, tests, see you in 6 mths , oh it seems you have mild fibrossis.How can he tell me that without biopsy? When I call the case nurse, oh you're ok, there's no rush.....huh ? and it seems like I'm bothering her .This waiting is playing havoc on my nerves big time.I am calling tomorrow cannot take the waiting any longer, I need to know what condition my liver is in .  

[suezeeque]

I was given the option of doing EITHER a biopsy or FibroScan.  However, it was immediately before starting treatment, not months ahead of time.

However, all the repeated, daily phone calls you made some months ago may have tipped of the doctor that there was a need for the pysch assessment.  I'm not making any assumptions about your mental health, btw.  Just offering a possible "why".

And there IS something you can do.  Ask questions.  Not of a nurse.  Ask your doctor when you are in the office, in front of him/her.  Take written questions and take the time to make notes of the answers.  If he/she doesn't want to spend that time with you, perhaps consider finding a doctor who will.

[printze]

I hear what you are saying, I have asked a lot of questions when first diagnosed like everybody does, and all  I get is  educated guesses,at the time I thought this was how its done. The psych exam is part of his protocol it is not directed to me personally . I was told that at the beginning what the tests were involved that's how he works, I 'm good with that, what I am not good with is  never being tx before and all this being new to me, I thought he was doing the same as everyone else. He's not like all of you say, 1st thing should  have been a biopsy , then all the other tests it only makes sense find out the condition of my liver first. I will put a call in tomorrow and see if I can see him in March when I get my evaluation and possibly schedule A.S.AP. either a biopsy or fibroscan instead of another dragged out 6 mths .

[suezeeque]

No person's treatment plan is the same as everyone else's.

[can-do-man]

"He's not like all of you say,"

Not sure i understand that, but if this is truly how your doctor rolls i would find a new one..... You know people get tired of being played like a fiddle.

[printze]

My typing is not the best , I meant he is not doing all the things that you say he should be doing .

[printze]

Thanks everyone for all your comments, another day in the learning process of hep.

[willbb]

You know people get tired of being played like a fiddle.
--------------------------------------------------------------------------------
Cando: Amen

[Advocate1955]

Printze, I think part of the confusion might be because you have changed your mind about the timing of treatment, if I recall correctly.  I think originally you wanted to treat in January and then later decided to wait until after summer.  Maybe the tests your doctor was scheduling were to get ready for treatment in January, but then when you decided to wait until after summer that changed the scheduling of things?  You can correct me if I'm wrong about you having changed your mind about when to treat.
Based on our experience, it's my impression that there is a certain order to the way that the doctors and nurse practitioners like to do things (e.g. blood work to diagnose Hep C and find out VL and genotype, vaccinations, ultrasound, CT scan, liver biopsy, updated blood work to clear for treatment, EKG to clear for treatment, baseline exams for eyes, possibly an updated VL for a baseline to start treatment).  I may have missed some things or added some things, and it may vary from doctor to doctor, but I think in general there is a sequence.  Then within that sequence, the treatment plan may vary from patient to patient as new information is learned through the testing.  Again, you can correct me if I'm wrong, but I get the impression that you have been indecisive and anxious about deciding which of the two triple therapies you want to do and when you want to start treatment.  This may be why your doctor doesn't have a set plan and timeline in place.  I know that being diagnosed and figuring out what to do next was overwhelming for my husband (and me), but we tried to do our research, come in with our written questions, listen to the doctor's advice, and then make a decision each time fairly quickly.  Again, I'm sure everyone is different, but we didn't want to drag out our decision making and create more stress by not deciding.  The key for us was to do our research, get medical advice, decide, and go forward as quickly as possible.  I think that helped reduce anxiety.
Advocate1955

[printze]

Thank you  for the reply, I was never the one  making any decisions, it was the nurse who gave me the wrong starting date .When I realized tx was not starting in January,( how could it start with no biopsy or fibroscan ,) it was  the doctor who rescheduled it forJuly because the October one did not take , it was then that I decided I would rather not tx in the summer because of the heat and work , this still has to be discussed .I believe that the problem with the fibroscan postponed things. That's what I think. I am still undecisive as to what PI I will do. Again I need to discuss with my specialist in July or maybe March if I can see him when I do my evaluation.

[orphanedhawk]

I'm sitting here shaking my head.
Your doctor situation makes me glad I have one who is accessible and doesn't put me off for months at a time.

If you have any ability to switch hepatologists or liver clinics, I would strongly suggest you do so.

And this is your body, your health, your input is important. Decisions ideally are made with your doctor, not by your doctor.
Its a collaboration.

[Advocate1955]

I apologize, maybe I confused you with someone else.  Best wishes as you proceed with your testing and seeking advice from your doctor.  I know that this can be an unpredictable and stressful journey.
Advocate1955

[printze]

Accessability is not there, I feel I have been pushed to the bottom of his list.I have come too far now to start this whole process all over. I agree, my health is important, very important.I am calling today and insisting to see him and sit down and talk, without  him rushing me out the door in 5 minutes and controlling the visit . I am writing down a list of questions snd keeping them in my purse. I just wsnt to get rid of this darn virus and get my health back . Thank for your comment.

[printze]

Thank you, it is very stressful I had no idea it would be like this . I am speaking for myself only. I feel like no one is listening to how I am feeling , yes the anxiety is there .  I feel like I am bothering them if I ask questions .

[jules2551]

If I were you, and I am not, I would make the phone call and ask for an hour of his/her time because you have some questions you would like to discuss with him/her.  And when you call, kill them with kindness.  I think that will get you much further and when you get in the door, have a list of questions and write down his response.  If you don't understand something ask him to stop and explain it again and in layman terms.  Ask him for a sequence of when and what needs to be done.  Then you need to figure out which PI you are gonna go with and do it.  Ask for an exact time line!  That way you can schedule all the appts accordingly.

Good luck to you!

Jules

[jules2551]

Sorry we crossed posts!  Ask you Dr for some anxiety medication.  He will probably be happy to help you out in those terms.  I am sure he realizes you are anxious and stressed to the max.  

[printze]

Thank you, that is what I am going to do . I am very nice when I see them always, I apologize for venting,  these past months are wearing on me . I will take all the advice I can from everyone , you are all very helpful and I am grateful to have you to listen to me and help me make some sense of this.

[suezeeque]

If the article many of us have read (it's in a recent thread) is true, and doctors can only reasonably start 3 patients on triple therapy a week and still provide quality care...  Then it also stands to reason that they will choose those most in need of treatment to start.

I imagine that those with still healthy livers will take a back seat to those in more immediate danger.

Might be something you want to ask about.  "Since you've said I have no liver damage, am I even being *considered* for treatment at this time?"

[printze]

I thought about that myself after reading the article. You could be right . It seems new things are being discovered about this new treatment since it became available . Perhaps the screening process has now changed .

[nygirl7]

But how can this doctor possibly have the slightest clue that you have minimal fibrosis? I had no symptoms at all and appeared perfectly healthy but biopsy showed me at stage 3. There is no way to tell without the test...how therefore can he put you t the bottom of the list?

I would want to know that! If he gives you some bs about blood work run out of there. I believe bloodwork can help determine cirrhosis...does he need to wait until you have that before giving you the proper tests?

If it takes so long to get the fibro insist on getting that bx right away, they should be able to book that pronto -why waste thousands and thousands of dollars if you don't even need to treat yet and say you are stage 3 wouldn't that help push you to the top of the list?

It makes no sense at all. Something is not right here from our experience it's all Azz backwards!

[nygirl7]

You're preaching to the choir.
Amen and amen!

[printze]

Why do always answer so nasty .

[fretboard]

"It was funny opening my mail tonight and finding the appointment slip from the hospital for a psych evaluation, never had one or ever needed one before . I definetly am  not  suicidal or depressed , complete opposite , very happy easy going positive person. I think they sensed my fear of tx, of all the sx and if I can't work because I am alone , that's what I think."

It could be the doctor sent you for a psych exam to make absolutely certain you are aware and ready for tx.  just a guess tho'

[printze]

Yes that is correct, they told me from the 1st visit they send new patients who will be on triple tx to make sure  they are able to cope with the tx and  and if they need to be put on AD before tx. It was explained to me from the beginning , that's fine. I certainly don't want any mental issues from the drugs to deal with .This triple therapy seems to be one tough tx .That is why I listen TO THOSE who are currently tx with the new drugs and those who have completed the tx. Your comments are important to me .

[jules2551]

So did you call the Dr this morning?

[printze]

I was too busy at work no time , I definetly will put a call in on Monday.I will keep you posted, thanks for the concern.

[jules2551]

that's your problem...you have spend last night and today online on this forum.  Get off line and call your Dr.

[jules2551]

And leave my wife Ny alone...we are getting as soon as Supreme Court rules in our favor

[suezeeque]

I'm hurt.  ny told me I was the only one.  :~(  I need an AD.

We'd *already* be legal in Toronto.

[jules2551]

Dammit i knew you were a problem

[can-do-man]

Don't be hurt girls, the candyman has got candy...:)

[jules2551]

what kind of candy?  lol

besides ny and i are getting married.........so enjoy

[suezeeque]

Haha!  I love this place,  Tough crowd, to be sure, but funny as heck.

[willbb]

Did I miss something ..........again.

...I thought this was a about a psych exam... now it is gay marriages In Toronto.... are there posts missing  somewhere in the middle ??  :))

[flcyclist]

Did I miss something ..........again.
------------------------------------------------------
You're not alone there.  These gals move fast. And they're on trt.  Can just imagine what they're capable of after.  Hmmm, and I used to like the fast gals.  :-)

[can-do-man]

"what kind of candy?  lol"

hershey "kisses", of course.

Will, tricylist, snooze you lose guys.

[willbb]

Hmmm, and I used to like the fast gals.  :-)
---------------------------------

That was when you were a cyclist before becoming a tricyclist   or maybe these gals given this conversation prefer a  bi-cyclist

Cando: get tested

[flcyclist]

or perhaps a tandem?

[suezeeque]

Uni cycle?