In the third and last portion of the office visit, Dr. Rookie and I went back and forth for a few minutes about his desire to test my cerebral spinal fluid by doing a lumbar puncture (LP) versus my desire for someone to find out what current, active infections I have. I did not dismiss the importance of having a LP. Dr. Rookie did a great job explaining how and why that test could be so helpful in my situation.
And then the conversation got really interesting:
DR. ROOKIE: Who prescribed the sertraline? . . . Are you still on the Vyvanse?. . . How does Wellbutrin help you? . . .Do you notice any difference when you are on these medications?
I explained to him that these medications, which I have taken for various seasons and at various dosages for over a decade, help me function. I told him, “I have OCD thoughts all the time.” I wasn’t clear to Dr. Rookie about this point, actually. I was in current season of having OCD thoughts all the time. But I did not have OCD year-round, every day.
Dr. Rookie broaches the topic of therapy for OCD.
DR. ROOKIE : What is more helpful [than medications for OCD] is Cognitive Behavioral Therapy. Talking through. Works well. You have this whole cycle where the obsessive thoughts drives you to have more obsessive thoughts . . .
And then Dr. Rookie lays it all out on the table. My sickness, in his mind, is all in my head, which is a funny dilemma. I agree that I am mentally ill. I agree that it is “in my head.” But I firmly disagree on the mechanism of the disease process. I believe I am OCD because of brain inflammation caused by underlying infections. Dr. Rookie clearly does not:
DR. ROOKIE: My suggestion is that what’s driving your not feeling well is the obsessive thoughts. And that makes you make you feel not well. And that drives [more] obsessive thoughts. This happens all the time. People can have so much anxiety that they get an ulcer in their stomach. The anxiety can eat right through the lining of your stomach. And so often people with no organic can have worsened pain, energy, appetite, all of these things go with anxiety , obsessiveness or depression. all of these can drive the physical manifestations. . . .
I insist that I feel sick and that my neck had swollen lymph nodes. He examines my neck and denies observing anything clinically significant. I ask if anyone in his medical clinic believes that OCD symptoms could have an underlying infectious cause. He affirms that possibility but continues to press his own impressions of what would make me better:
DR. ROOKIE: [Here’s]My simple holistic approach. I think that what needs to happen the most is [you need] to get a handle on how you’re feeling. That means that you probably need to learn to process the feelings better and that can be through a variety of methods, including your working with your psychiatrist. I think that ’s going to be the most important thing [learning to manage your feelings] . . . I’m just going to say this very bluntly. . . And so [you need] this combination of CBT to work through the anxiety and obsessive feelings you are having. I think what would help you with that from my stand point would be some to say, “You don’t have an infection or inflammation in the CNS. We can rule that out. We have tests for that and we can do those tests.”
Wow. Just wow.
Categories: The story continues