I don't know if you are familiar with the story "The Horse Whisperer" about a man that had a very wonderful gift of being able to tame wild horses. I am writing using that theme today because the most incredible thing happened at Dr. N.'s yesterday.
Normally I don't go in to the beginning of session because I like to let the two of them talk before I come in with all of my thoughts and opinions. I like seeing if Thomas can articulate what he struggles with without me there. I want him to be in touch with his own thoughts and feelings (he struggles with doing that) and I think the best way for him to do that is to fight it out alone in session with Dr. N.. Yesterday, though, I was in there and kept my mouth shut and stared out the window but I listened intently to what went down.
Dr. N. has earned a new respect from me where Thomas is concerned. Thomas brought up his recent paranoia and Dr. N. began questioning him with the most in depth questions and then would listen and say "uh huh" and ask a follow up question. This went on like this for 15 minutes and I just listened in awe at how he was able to delve into Thomas's mind and find out information that I have never been able to get. I prided myself on being able to get Thomas to talk and now I realize that I have A LOT to learn. From all of his questioning we learned that Thomas needs a little more help than I thought. I went into this appointment personally not too keen on increasing meds and I wanted to support Thomas in what he chose to do but I soon learned that a meds increase is very much needed.
Dr. N. asked Thomas if he wanted to do anything with his meds and Thomas requested that his Buspar (for anxiety) be increased in the hopes that his anxiety would go away. Dr. N. didn't miss a beat and told Thomas that increasing the clozaril would be a wiser choice because increasing the Buspar would take a while for it to work on the anxiety and that the clozaril would start working right away. Now, I don't know if that's true or not but I felt Dr. N. went that direction because he felt Thomas needed an increase in the antipsychotic, not the anti anxiety med. After suggesting the clozaril increase, Dr. N. looked at me and asked me what I thought. I gave him "the look" and told him that I thought that was a good idea. I could tell Thomas wasn't crazy about the idea but after listening to the entire conversation I thought it was the best thing for him.
Afterwards we got in the car and Thomas was ANGRY. He started up his music and I tried to talk to him about stuff and he sat there in his seat sulking and when I asked him if he was mad he said that he was and that he "just wanted to listen to his music". The whole drive to his favorite restaurant my mind was racing trying to figure out if Thomas was going to go for the increase. After all, it's his body and mind. He said he didn't want the increase because it would make him sleepy and I tried to help him manage the increase by suggesting that he take it right before bed as opposed to with dinner earlier in the evening. My hope was that he wouldn't notice the sleepiness because he would be in bed when it hit. We drove along in silence, though, until we reached the restaurant. He ordered his food and we sat down. I really felt that I needed to explain why Dr. N. had chosen the clozaril to increase over the Buspar.
I explained to him that Buspar is for anxiety alone but the clozaril did double duty because it helps anxiety and it helps with the paranoid thoughts too. I told him that with my upcoming trip and with him already struggling with paranoia so much and having earlier admitted to me that he was worried his paranoia was going to be bad while I was gone, I thought that the clozaril increase was the best option. I asked him how he felt about what I said and he said,
"That helps me. I didn't understand why he wouldn't increase my Buspar but the increase in clozaril makes more sense now that you've explained it to me."
So, all was forgiven and we drove home two peas in a pod listening to music and talking. As the day wore on I came up with some different options for him to take his extra 50 mgs of clozaril. I told him that we should try to first take it at the normal time and see if he genuinely feels it makes him sleepier and I told him he could also try it with his morning meds and see if it wrecks his day or not. He was fine with taking it with his regular night meds and as Dan and I were going to bed I asked him how he was feeling. He says he felt more tired than usual. So tonight we will try something different.
Yesterday was quite the rollercoaster ride but in the end things turned out okay. I am hoping that the increase in clozaril will help Thomas but somehow I don't think it will. After listening to yesterday's conversation between Dr. N. and Thomas and hearing all of what Thomas is dealing with, it seems like he needs a bigger intervention than just 50mgs of clozaril. We shall see though. All we can do, yet again, is watch and wait.
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