Wednesday, April 2, 2008

Adventures in Psychiatry....

Xian’s psychiatry appointment today turned out to be fairly interesting, mostly because of a turn of fate. (Sorry, no great drama to report…). There was a familiar looking woman in the waiting room---this is becoming something fairly common for us, given the huge number of medical folks Xian’s been in contact with---between the medical residents and students, nurses, specialists and so on. I always remember a face, but usually I have a hard time recalling the context, especially these days. And of course, they always recognize Xian—she was always a ‘memorable’ kid, but with her unusual case, she seems to stick with people. After a bit of a conversation while I tried to place her, I eventually figured out (she gave me a few helpful clues) that she was the neuropsychologist’s assistant, J. She was the one who tested Xian a few weeks ago. I gave her a bit of an update on what had changed since then and mentioned our appointment with the metabolic specialist, Dr. C. It turns out that Dr. C has already contacted the neuropsychologist to see if she could get any of the testing results---so she’s obviously doing her homework before our appointment. (J. said they are still putting their report together, but hopefully they had something to share). J. also said that Dr. C is a very smart doctor and that we’d be in good hands. She also gave the impression that the other doctor who has been covering the metabolics end of things here while Dr. C. was on leave hasn’t been doing a great job in terms of Xian’s case---she’s also seen Xian’s medical file and I would imagine also knows about whatever conversations the neuropsychologist managed to have with him. (Also makes some sense of a number of comments---about the doctor that was covering---that always started, “Well, he’s good at ____, but…….”) J. also made an interesting comment about parents’ observations---in neuropsych they see kids with a variety of different conditions affecting the brain---she said that most often the parents have it right in terms of their suspicions about what’s going wrong and which symptoms are important, even though the doctors don’t always listen.

It was quite interesting to see a bit of a shift when the psychiatrist, Dr. W., heard about Xian’s new symptoms. I also shared how we’d managed to get the metabolics appointment. While she did suggest that the medication Xian had been on for sleep could be increased, she didn’t argue too hard about doing that, when I reminded her that Xian’s had reactions to everything she’s taken (even antihistamines). Still, I think she would have prescribed it in a higher dose if I’d pressed….kind of makes me wonder about the current state of psychiatry in terms of treating young children! She did ask what I thought about the theory that the senior psychiatrist had suggested (the one about delayed trauma after Xian’s China trip that our pediatrician shared early in March), but it didn’t seem like Dr. W. was even buying into it much, especially when I shared some of my observations of Xian during the trip. She shared a few more details from her conversation with the senior psychiatrist, and those were more valid (mostly questions about how we are managing the ‘new’ relationships given Xian’s changed state). I did mention what I see as the more important connection between Xian’s early history and her current illness---that Xian’s patterns of response to pain/fear/strangeness have been fairly consistent. So, rather than her past history causing her current condition, what it does is influence how she responds to it, especially as she loses more of her higher levels of communication. Anyway, the plans for a psychiatric observation are now on hold (on the psychiatrist’s end). The visit was a bit useful, as she’s going to write the letter that will get Xian some funding (what they call ‘program unit funding’) to get one-to-one support in kindergarten or other programs. Who knows what will be happening in September, but I figure it’s better to get as much lined up as possible.

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