My Writing, Other Places

Last year I wrote here about my initial experience with the VA during my pregnancy with Austin. So many of you reached out and helped me make my voice heard online and the VA eventually heard me and decided to treat me throughout my pregnancy again. Dealing with their mental healthcare system hasn’t been easy since I gave birth a year ago. It’s been manageable, but it’s been a process that has challenged me significantly. Continue reading

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The VA Mental HealthCare System is Failing Me…and My Baby.

The pregnancy test flashed a positive sign on a Wednesday.

Two days later, a Friday, I was sitting in front of the nurse practitioner at the Cedar Park VA Outpatient Clinic, waiting patiently for the lab to confirm what EPT had already told me. When the confirmation came, there was a congratulations, a D.O.D standard “Guide to Pregnancy” book placed in my lap, and instructions from my primary care doc to stop all of my medications immediately. No Clonazepam, no Fluoxetine (Prozac) and no Lamictal. I left the clinic with these words and a promise from the nurse practitioner: “I’m going to see Dr. A once she’s done with her current patient and find out what she recommends, ok? She’ll be able to give you the proper guidance on what to do about your medications, being that she’s your psychiatrist. I’ll call you as soon as I speak with her.”

Friday afternoon came and went. No phone call.

Sunday afternoon came and I had already started to notice my mood shifting and withdrawals setting in.

Monday morning: I called and was put on hold. Left a voicemail. Called two hours later, left yet another voicemail with the nurse for the my primary care doc. Called back and tried to leave a voicemail for my psychiatrist and was unable to-the phone just rang without an answer. “She’s in the office, ma’am, how about I take the message for you?” said the vet volunteer working the front desk. Ok. Left the message. Checked my phone obsessively for the rest of the day-nothing.

Tuesday morning: Called back-left more messages. Nothing.

I spent the rest of that week freaking out from med withdrawal and anxiety over what to do. Fed up with the lack of response on the VA front, Bertski and I decided that finding outside, non-VA care was the way to go, even if we had to pay out-of-pocket until I was verified as a dependent under his insurance at work. A recommendation from a friend led me to Austin Area OBGYN and my new OB. I made an appointment, and even though it was weeks away, I was able to speak to a nurse about my medications. Within an hour I had more informed guidance: “Dr. S says you can continue to take the Prozac, but not the Clonazepam. He says that while Lamictal is relatively safe to take during pregnancy, he would prefer you to try to stay off of it until the end of your first trimester-the incident of a birth defect like cleft palate forming with Lamictal is very, very low, but he always advises staying off of it the first 12 weeks just to be even more cautious. HOWEVER if you feel yourself start to struggle and you feel you need to start taking it sooner, just let us know, and we can work with that, ok? Come in for lab work tomorrow so we can see how far along you are, ok, honey?”

I don’t think I’ve ever breathed a larger sigh of relief than I did when I hung up the phone with her. Later that day, when I checked my mailbox, there was a “CONGRATULATIONS ON YOUR PREGNANCY!” package from the Women’s VA Health Clinic in Temple. (Note: all of the VA outpatient clinics & hospitals in Central TX are all spread out-there’s one in Austin, Cedar Park, Temple, Waco and Bryan College Station.) There was nothing from my primary care doc or psych in Cedar Park, and I still had not received a phone call returning my messages as promised 7 days prior. I threw the package in the trash, completely disgusted.

That next Monday it came-an appointment card from the clinic in Cedar Park telling me I had an upcoming appointment with my psych. I laughed-it wasn’t the first time this had happened-her just scheduling an appointment instead of actually returning my messages, but I thought being pregnant would have warranted her actually making the effort to call me. (What’s faster-a phone call or the mail? The mail, OBVIOUSLY!)

I went into that appointment on March 28th ready to give her the benefit of the doubt. I left vowing to no longer allow her to be in charge of my care.

Um…why didn’t you call me back? I’ve been waiting to find out what to do.

“I did call you-I didn’t get an answer.”

Um…no you didn’t-I don’t have any voicemail from you and I’ve watched my phone like a hawk waiting to hear from you.

“Well, I called, if you didn’t get it, that’s not my problem. Anyway, in my opinion, someone in your condition getting pregnant is just irresponsible.”

What?

“I’m sorry, but you shouldn’t be on any medication-you need to give your baby the best & healthiest start possible. Taking medication in my opinion is causing your baby harm.”

What if I have an episode during the pregnancy? What about postpartum psychosis? My OB said Lamictal and Prozac are safe!

“Well, I don’t agree with that. All of the research says otherwise…these are things you should have considered before getting pregnant.”

WHAT research? Everything I’ve read and what Dr. S has told me is the complete opposite of what you’re saying. The incidence of the birth defects associated with these two meds is very low, I’ve read this myself…there are women with epilepsy who take Lamictal at much higher doses-

“So are you just going to go with what he’s saying? Fine. Do you need psychotherapy? Individual therapy isn’t available through the VA here, but I can see if the social worker here at this location is available-I doubt it though-she doesn’t do therapy.”

I left that office shaking from the anger surging within me. That was it. Bertski and I agreed that day to no longer have anything to do with her-I’d try to find a private psychiatrist or have my care transferred to a new one at the Austin clinic. Her misinformation and lack of knowledge just wasn’t acceptable, and besides-it wasn’t the first time I’d had problems with her lack of communication and dismissive attitude. It’s what played a significant role in my being hospitalized back in October. Fed up with her neglect and lack of professionalism? Yeah, understatement if there ever was one.

I’ve spent the 6 weeks since then struggling to manage my symptoms while dealing with the yuck of the first trimester, Alex’s autism and SPD diagnosis and entrance into therapy, searching for a therapist who accepts our insurance (or has an affordable self-pay option), and pushing myself to hold on until the 12 week mark, which is tomorrow. I’ve also been working with the women’s health outreach specialist to get a new psych through the VA, at the Austin clinic. They’re so backed up, she put in the consult 6 weeks ago, and it’s still pending. (She was, however able to secure the authorization necessary to have the VA cover my prenatal care and delivery so I don’t have to pay out-of-pocket or use Bertski’s insurance which only covers a certain amount-so at least that’s a win.)

I called the VA pharmacy in Waco to have my Lamictal and Prozac refilled today (since I only have a 10 day supply left of both) ONLY to find out that they’ve been discontinued thanks to Dr. A. DISCONTINUED. She discontinued my medications and did so without informing me. No correspondence, no phone call, no explanation. NOTHING.

Needless to say I’m enraged. Even more so than I was before because instead of just jeopardizing MY health, she’s jeopardizing that of the baby’s and that has me wanting to FIGHT. Fight for my right to better treatment, and fight because, well, WHO THE FUCK IS SHE TO DO THIS TO A PATIENT?! Maybe it’s just me but I don’t see how any of this is ethical.

I’ve spent the morning making phone calls to file complaints and to even try to get ahold of her and the director of the clinic to no avail. She’s not answering her phone (of course) and the director is on vacation until May 17th. The women’s health specialist is aware of what’s going on and assured me she’s going to do something to “fix” things, but honestly, I don’t even TRUST anything VA related anymore. This infuriates me because as those of you who have been reading here since 2011 know, my psych at the VA hospital in Philadelphia was AMAZING, as was the mental health clinic and psychotherapy services there.

I’m a 100% service connected disabled veteran. I’m pregnant. I have a mood disorder. I shouldn’t have to deal with this kind of treatment. I shouldn’t be scouring Austin looking for a therapist because the VA here doesn’t offer separate, individualized psychotherapy therapy for women in my situation. (Or women period-When I discharged from the hospital in October, I was told repeatedly that they just have general support groups-nothing specialized or one on one for women.) I also know that I can’t be the only woman vet in the Central TX region who has had to deal with this pathetic system and its inadequacies. But outside of reporting her, what else can I do? I don’t just want her reported, I WANT HER AND OTHER VA DOCTORS HERE INFORMED. Informed on medications and treatment for women with mood disorders during pregnancy. Trained. Educated. I want better for my fellow women vets. Since moving here I have encountered nothing but poor treatment and bureaucracy. The Central TX VA Healthcare System has done nothing but inhibit my ability to have consistent, quality, and effective mental health care.

What can I do y’all? How do I fight this so that they stop failing myself and others?

************

Update: I spoke with the women’s health outreach specialist, and she informed me that my meds were discontinued because the VA doesn’t want to assume any liability if something happens to the baby as a result of my being on psychiatric medications. Per the Chief Medical Director of the Women’s Health Clinic in Temple, TX: “The VA can’t assume responsibility for anything that may happen as a result of her staying on these medications during her pregnancy. Our psychiatrists are not experts in this area whereas a private obstetrician is. If he says these medications are safe for her to take during her pregnancy and he will write her a prescription for them, then she can bring that prescription to the VA pharmacy in Austin and we can fill them that way. If something were to happen, then this private OB is the one responsible, not the VA. Unfortunately this is what we have to do in situations such as this.”

So. There you have it. The VA has practically rid themselves of me during my pregnancy due to my having a psychiatric condition and I’m suddenly a liability concern. Question: WHY aren’t VA psychiatrists educated in reproductive psychiatry when women veterans comprise at least 10% of the veteran population and have children and are suffering from mental health issues like PTSD, Military Sexual Trauma, Depression, Anxiety, and others as a result of their fighting in combat and service?

Now what?

*************

Update #2: Several of YOU helped me flood The Department of Veteran Affairs twitter feed, sharing my angry tweets and this post with them and others like the local Fox News station here and even Rachel Maddow! At 5:29pm I received this response from their Twitter account: “@addyeB Dismayed by what happened. I’ll make sure the patient advocate in Austin hears about this.” Not sure if this will actually lead to effective action, but I’ll keep putting on the pressure until it does. If you’d like to help me apply that pressure directly to this patient advocate at the Austin clinic, comment here or email me! bconfessions at gmail dot com. Thank you for supporting me through this!

On Getting Mental Health Treatment at the VA & Your Psych Saying “It’s Time to Kick Your Bipolar in the Ass”

I really can’t complain about my psychiatrist. She’s really soft spoken but understanding, accommodating, knows her stuff, is thorough, listens to my sometimes disjointed explanations of my symptoms (this is where my mood chart helps, BIG TIME), and lets me barrage her with whatever questions pop up.

In fact, if I were to have any complaint at all, it wouldn’t really be with her. It would be with the VA hospital. I’m grateful that the Dept of Veteran Affairs has a major hospital in Philly I can go to for treatment. I just hate that it has the all too familiar “hurry up and wait” operational model like the military. It’s the epitome of bureaucracy. Their mental health clinic is fairly decent, but because they are understaffed (like much of the VA as a whole), each psych’s patient load is pretty heavy and they are always double booked. If you call and leave a message, it usually takes 2-4 days for your psych to get back to you, and their voicemails are always full.

When you come in for an appointment, the wait time can be torture, sometimes taking 2-3 hours. You arrive for your appointment, sit in the lobby with Vets from Vietnam to Iraq, listen to them argue and swap war & treatment stories, and strain your neck to see if your psych is the one walking through the double doors. Fatigued and bored, you practically leap to your feet when your name is called…if it’s your psych, you practically skip off to their office. If it’s the receptionist handing you the sheet that lists all your meds, you flop back down on your seat in disappointment. Lots of sighs and complaints punctuate the atmosphere.

While you’re waiting for your psych to come rescue you from the chaos of the waiting room, two things ALWAYS happen.

  • A fight breaks out…usually between two Vets in their 70’s. I’ve even seen two Vets in wheelchairs go at it. That one was both sad and hilarious to watch
  • A Vet with severe war trauma sits in a corner of the waiting room, quietly mumbling to himself…which doesn’t seem out of the ordinary at all until he starts hallucinating. Suddenly he’s carried off by memories of combat and everyone in the waiting room is either a comrade or an enemy. This usually throws the everyone in the waiting room into a frenzy of confusion, unease, and fear. Sometimes other Vets are triggered and this adds to the erupting chaos. “Code Red, Level 3 on Floor 7” blares over the loud speaker, security shows up, and doctors come rushing out from behind the double doors to help calm the melee.
I’m not ashamed to admit that I’m either in the hallway or the bathroom hiding when either of those two things happen, keeping an eye out for my psych.

When she does finally come to get me, escaping to her office is a welcome reprieve. She usually only gets to see me for 10-15 minutes because she has so many appointments to keep, but she does her best to take her time with me, asking about the kids, how I’m doing in school, how I’m dealing with things. Sometimes this pushes our time together to 30 minutes instead of 10, but she always reassures me it’s ok-she’d rather take the time to make sure I have everything I need than rush me out.

That is why, like I said, I can’t really complain about her. She rocks. She treats me like a person and not an object or a file number. I can tell she really cares about my well being and wants to see me get better. This is what keeps me from complaining about her taking 2-4 days to call me back when I’m struggling.

That’s why when I called and left a message on her voicemail yesterday and she called me back 10 minutes later, I was in shock.

“Hi, A’Driane. I just got your message and wanted to take some time to call you back before I see my next patient. I’ve been wondering how you’ve been doing since we talked on Friday. How are you feeling?”

As I started blurting out the answer, telling her that I’ve gone from just being depressed to being both hypomanic and depressed, having ruminating, racing thoughts, and have seen my OCD symptoms starting to dominate my behavior, she listened quietly. When I was done, she was silent for about a minute before she spoke.

“You know, A’Driane, while I think the Lamictal has been helping you some,  I don’t think it’s enough anymore. After we spoke on Friday, I took a good look at your chart and my notes…and…I think it’s time we get more aggressive in your treatment. The rapid cycling you’ve been experiencing is more difficult to treat, more complicated than I anticipated. I…I have to admit I’m going to need some help developing a more aggressive approach. We just got a team of manic depressive specialists on staff, and I think it would be a good idea to go ahead and set you up with a consult to see them. I’m also thinking some CBT will help you develop some better coping strategies, so I’m going to have you set up with one of our therapists, okay? I know it takes alot for you to get here, and you have the boys, but I think if you can get to these appointments they can help us start to really get this under control for you. I guess what I’m trying to say is that it’s time to kick your Bipolar in the ass. Let’s throw everything we can at this. I want to get you healthy. What do you think?”

Well first of all I’m shocked you just said “ass”. Kinda awesome. Sounds good to me. I’m feeling pretty desperate so I’m game for anything at this point. I just want need relief. BAD.

“And that’s what I’m going to try to get for you. So I’ll set these consults up for you, and in the meantime, let’s double your Lamictal dose now, and go up another 50mg in about 2 weeks. I’m also going to prescribe you an anti psychotic to help with the OCD and the thoughts you’re having. Let’s also try taking some Xanax to help calm you down until we get these meds to you. I’m ordering them now, you should have them before the week is out. Do you have enough to last you until then?”

Yes.

“Good. One more thing-promise me you’ll go to the ER if suicidal thoughts kick in-promise?”

Promise.

“Ok. How did the end of the semester go? How are the boys?”

And that, people is why I love her.

So…I guess it’s time to start fighting harder and kick some ass.

I’m ready.