Psych eval gone wrong......

[DawnaRose]

What's on your mind, Frandawna?

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Frandawna Graziani

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Everything is done and ready for surgery but had a not so great psych eval today. I guess I made the mistake in previous sessions of stating that I have had binges during my 'period' time as I'm pre-menopausal and it's gotten a bit more difficult over the past few years as I hit 50. The Psychiatrist expressed concern that I would not be able to control myself after the surgery during my times of hormonal changes (usually lasting a few days).

I've lost more then enough for them to be satisfied; even the dietitian said a 27 lb loss in the last 4 months is great but the psychiatrist (my last step) said he still has concerns but will talk it over with the 'team' and assess. I'm a little down right now. I don't need the surgery to happen overnight but I would like it to be started. I really regret having shared that with him in a previous session. Of the whole session talking about the almost all great days of staying on track and how I'm getting more balanced and in control, he takes notes only of this one part. I did point that out to him.

He stated that he was on my side but it was his job to show concern if I were to lose control during a hormonal episode. I responded that I hear him saying to me that he isn't really listening to everything I've been doing and reporting to him that is changing how I view food and taking control and that he isn't trusting I can understand the negative ramifications of this surgery and that it's only a tool. I am really about to just give up on this whole thing honestly. He stated I was backing up from his previous notes in saying that I can't control the binge I have when it's hormonal and I responded with the fact that he took notes on a point that was made and not the other 55 minutes of each session. At this point, I don't know where they will go from here.

 

[Badgy]

Same. Had mine this week and they have concerns that I skip breakfast and lunch often. I could just sense that he was concerned. He asked deep questions that made me cry and once I start crying I can't stop, so I looked like an emotional disaster. I'm not feeling good about this at all. Mostly because I know that he's right. Part of me has been sabotaging this whole process and I'm starting to wonder if I'm not ready for a lifetime of change.

 

[DawnaRose]

Same. Had mine this week and they have concerns that I skip breakfast and lunch often. I could just sense that he was concerned. He asked deep questions that made me cry and once I start crying I can't stop, so I looked like an emotional disaster. I'm not feeling good about this at all. Mostly because I know that he's right. Part of me has been sabotaging this whole process and I'm starting to wonder if I'm not ready for a lifetime of change.

I am so sorry. I know with psychiatrists, they are good at making you feel worse then when you started. Not a random judgement; happens a lot. I think they're going to find something to note about no matter what you say to them; there's a reason we have eating disorders. Holy cow. It's most frustrating to be working toward something and just keep getting pointed to everything you do wrong, no matter what you are doing. My family had a good heart to heart with me and I'm feeling a bit more clear about this. We just have to keep going along and trying to change to a healthy life as a way of eating. At worst right now, I know from the pscyh here, he will want to give me another month and another evaluation in a month; so it's a month longer to wait and try to lose more. I think I'm ok with that. Hopefully that helps you.

Let me know how it goes. I'm pretty sure next week I will get feedback. I have another appointment with my Dr on Monday and she's pretty tough. This evaluation is all they're waiting on to ok the surgery so I think I have to just roll with it and not disclose anything more to anyone there. I am feeling to do fine with their program as far as weight loss and hopefully that's pretty much where you are at too with just some moments of doubt put there because of the feeling to be discouraged by this but if you've started this, you are ready to get it done. Try to just take in a little each meal and show them that you can do that.

 

[3momchaos]

I’m sorry both of you are going through this. I think they’re being tough because the long term consequences of not adhering to the lifestyle change could be serious. I hope they don’t doubt you both and all your efforts. If they have concerns they need to address how they can work with you to resolve those issues rather than dismissing you. My insurance changed requirements to have 6 counseling sessions to help with behavior modifications. I felt like, even though it means more visits, that it was a good thing to do because there’s more discussion about the entire process, not just the physical aspect of surgery. This is an extremely difficult decision and process. Anyone who says this is the easy way out has no real idea what this is about. Just taking the step towards this process shows that there is a part of you ready and willing to change. Bringing that part to the light and giving it control is where a lot of us struggle, but when we want it and need it bad enough, the struggle will subside, and we do what’s best for us long term.

 

[DawnaRose]

I’m sorry both of you are going through this. I think they’re being tough because the long term consequences of not adhering to the lifestyle change could be serious. I hope they don’t doubt you both and all your efforts. If they have concerns they need to address how they can work with you to resolve those issues rather than dismissing you. My insurance changed requirements to have 6 counseling sessions to help with behavior modifications. I felt like, even though it means more visits, that it was a good thing to do because there’s more discussion about the entire process, not just the physical aspect of surgery. This is an extremely difficult decision and process. Anyone who says this is the easy way out has no real idea what this is about. Just taking the step towards this process shows that there is a part of you ready and willing to change. Bringing that part to the light and giving it control is where a lot of us struggle, but when we want it and need it bad enough, the struggle will subside, and we do what’s best for us long term.

This is the argument I had with my counselor. My husband and I were clear that we did a lot of research and discussed this. I have been modifying my behavior and the counselor could not argue that. My insurance stipulates the very same with my sessions; my entire month for the last 5 months has been nothing but back to back appointments with this same psychiatrist, dietician, trainer, medical Dr, facilitators, meetings, seminars, signing off on the lengthy discussions of the ramifications, modifications, etc, etc. I go in to get labs every other month, get weighed and bones mass checked as well as discussed every 3 weeks and have another couple months of this. Everyone has signed off without any problems. I've had three counseltations with the surgeon and two with the laison/scheduler. I've got paperwork on the liver shrink, vitamins, post liquid diets, complications, restrictions for the first years and even the threat of weight gain again. I understand all of this. I have proven I understand all of this.

I made one comment about my hormonal shifts that I had been dealing with for menopause (something you may not understand yet but it's not a simple process you go through and it lasts years). I told him in a session that I had been struggling many, many issues with this and every woman goes through it. So for you who have never hit menopause, shouldn't they ask if you will be able to handle all the hormonal issues that you won't hit for ten or twenty years after surgery and if you don't know, well then that's a valid concern to not ok a surgery? This is ridiculous. I have stated that I've lost almost 30 lbs in 4 months, my notes have indicated that I've been living a new diet and behavior modification. Can I say I won't run into more hormonal issues? Can you? Can anyone really? How many want children? Cause it's not a piece of cake for that either with eating. What we can do is assure them that we understand the changes associated with the surgery, understand as adults that it can harm us and be done. Had I known that this one statement would derail months of hard work, I simply would not have brought it up. The statement was not made specifically for binges, it was a statement about all the changes I've had to deal with entering menopause and what my body doesn't seem to be in control of. If that were an issue for me, It better well be an issue for every single female that will enter new hormonal issues. This surgery was never thought to be 'easy'. I've been in and out of the hospital for many health issues and surgeries. This was not considered anything but serious to us and it was considered carefully. There is literally nothing else I can do to prove myself in this trial.

 

[canecorso81]

What's on your mind, Frandawna?

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Frandawna Graziani

2t6fSp omnsdasouriSeSndeus
·

Everything is done and ready for surgery but had a not so great psych eval today. I guess I made the mistake in previous sessions of stating that I have had binges during my 'period' time as I'm pre-menopausal and it's gotten a bit more difficult over the past few years as I hit 50. The Psychiatrist expressed concern that I would not be able to control myself after the surgery during my times of hormonal changes (usually lasting a few days).

I've lost more then enough for them to be satisfied; even the dietitian said a 27 lb loss in the last 4 months is great but the psychiatrist (my last step) said he still has concerns but will talk it over with the 'team' and assess. I'm a little down right now. I don't need the surgery to happen overnight but I would like it to be started. I really regret having shared that with him in a previous session. Of the whole session talking about the almost all great days of staying on track and how I'm getting more balanced and in control, he takes notes only of this one part. I did point that out to him.

He stated that he was on my side but it was his job to show concern if I were to lose control during a hormonal episode. I responded that I hear him saying to me that he isn't really listening to everything I've been doing and reporting to him that is changing how I view food and taking control and that he isn't trusting I can understand the negative ramifications of this surgery and that it's only a tool. I am really about to just give up on this whole thing honestly. He stated I was backing up from his previous notes in saying that I can't control the binge I have when it's hormonal and I responded with the fact that he took notes on a point that was made and not the other 55 minutes of each session. At this point, I don't know where they will go from here.

I also did not get cleared for my psych eval. They said that I had childhood issues that needed more addressing. I cried so hard and thought my journey was over. I ended up having 6 sessions before they cleared me. I think they wanted to make sure I was able to deal with my past in other ways than eating. They do want what is best for you and I know it feels like another hoop to jump through but I actually enjoyed the sessions and learned alot. Hang in there.

 

[3momchaos]

This is the argument I had with my counselor. My husband and I were clear that we did a lot of research and discussed this. I have been modifying my behavior and the counselor could not argue that. My insurance stipulates the very same with my sessions; my entire month for the last 5 months has been nothing but back to back appointments with this same psychiatrist, dietician, trainer, medical Dr, facilitators, meetings, seminars, signing off on the lengthy discussions of the ramifications, modifications, etc, etc. I go in to get labs every other month, get weighed and bones mass checked as well as discussed every 3 weeks and have another couple months of this. Everyone has signed off without any problems. I've had three counseltations with the surgeon and two with the laison/scheduler. I've got paperwork on the liver shrink, vitamins, post liquid diets, complications, restrictions for the first years and even the threat of weight gain again. I understand all of this. I have proven I understand all of this.

I made one comment about my hormonal shifts that I had been dealing with for menopause (something you may not understand yet but it's not a simple process you go through and it lasts years). I told him in a session that I had been struggling many, many issues with this and every woman goes through it. So for you who have never hit menopause, shouldn't they ask if you will be able to handle all the hormonal issues that you won't hit for ten or twenty years after surgery and if you don't know, well then that's a valid concern to not ok a surgery? This is ridiculous. I have stated that I've lost almost 30 lbs in 4 months, my notes have indicated that I've been living a new diet and behavior modification. Can I say I won't run into more hormonal issues? Can you? Can anyone really? How many want children? Cause it's not a piece of cake for that either with eating. What we can do is assure them that we understand the changes associated with the surgery, understand as adults that it can harm us and be done. Had I known that this one statement would derail months of hard work, I simply would not have brought it up. The statement was not made specifically for binges, it was a statement about all the changes I've had to deal with entering menopause and what my body doesn't seem to be in control of. If that were an issue for me, It better well be an issue for every single female that will enter new hormonal issues. This surgery was never thought to be 'easy'. I've been in and out of the hospital for many health issues and surgeries. This was not considered anything but serious to us and it was considered carefully. There is literally nothing else I can do to prove myself in this trial.

It sounds like you’ve been doing everything right, and the one time you mention a struggle they judge the rest of your efforts based off of that. I’m not sure a female counselor would have had the same response. I mean, maybe, but I’m not sure. Rather than being unsure about your intentions, they should talk to you about vitamins your body is craving during hormone fluctuations. After I had my kids I had serious and massive cravings for chocolate. My endocrinologist dismissed it, and I so I talked to my OB about it, and he recommended I try magnesium. Totally worked. I’m not saying everyone go out and do that, but our physical needs can manifest as cravings, so they should help you reroute those mental saboteurs.

 

[dianeseattle]

There is a trick to sharing information with a psychiatrist and it is exactly the same as the trick you would use if you were testifying in court against the murderer.

Less is more.

Here's an example of what I might say in a psych evaluation if I were going for surgery today:

"My weight has been a constant source of stress and depression. I have spent most of my emotional energy on obsessive thoughts about being fat. I have tried to change multiple times but no diet or gimmick has worked. I know the surgery itself is just a tool. But I am ready to use it. I have already purchased the foods I will need for the various stages of the post-op diet. And even though I feel very nervous sharing my feelings with a psychiatrist I do not know, I hope you can see what you need to see. I am ready and not just in the concept of having surgery. I am ready for the post-surgical life. I know there are going to be a lot of changes after surgery. I might need help with some of those feelings. Fortunately, I have a great online support group. And I'm absolutely willing to use local support as well. Most importantly I know that it is essential that I follow my doctors procedures to a T."

I would also have a written letter describing the process I have gone through with gaining weight and losing weight, including membership in groups like OA or WW.

I still have my letter and list of reasons in my medical file for bariatric surgery. It is a good thing to put this kind of stuff down on paper because your mind can get so scrambled at times. Writing it down demonstrates that you know what it is, even if nerves prevent you from expressing that with any eloquence.

Your doubts may emanate from a long-standing sense of unworthiness. if that resonates with you, you might mention it to the psychiatrist. Any psychiatrist will already know this and we'll be able to see that you have the correct grasp on the situation when you reflect the in a psych evaluation.

You're not getting a psych evaluation because you're perfect or to rule you out. They just want to know who you are. Make sure your self-image matches the image you express in a psych evaluation.

 

[DawnaRose]

It sounds like you’ve been doing everything right, and the one time you mention a struggle they judge the rest of your efforts based off of that. I’m not sure a female counselor would have had the same response. I mean, maybe, but I’m not sure. Rather than being unsure about your intentions, they should talk to you about vitamins your body is craving during hormone fluctuations. After I had my kids I had serious and massive cravings for chocolate. My endocrinologist dismissed it, and I so I talked to my OB about it, and he recommended I try magnesium. Totally worked. I’m not saying everyone go out and do that, but our physical needs can manifest as cravings, so they should help you reroute those mental saboteurs.

That is my huge frustration honestly. I really feel good about what I've been doing. I've been losing and getting a frame of mind of eating in a healthy way. I'm just going to veg a bit and roll with what they have to say. My only limit right now is the timing of the surgery for my insurance as we've been paying a hefty deductible on all this testing. It will rollover after November and I'll have to start meeting it all over again and add more thousands of dollars. I don't think we can do that. I will try the vitamins and they also talked about putting me on Lexapro for those few days or just as a new medication. I think I'll find out next week. Thanks so much for trying to help out-it honestly helped some real frustration today.

 

[DawnaRose]

There is a trick to sharing information with a psychiatrist and it is exactly the same as the trick you would use if you were testifying in court against the murderer.

Less is more.

Here's an example of what I might say in a psych evaluation if I were going for surgery today:

"My weight has been a constant source of stress and depression. I have spent most of my emotional energy on obsessive thoughts about being fat. I have tried to change multiple times but no diet or gimmick has worked. I know the surgery itself is just a tool. But I am ready to use it. I have already purchased the foods I will need for the various stages of the post-op diet. And even though I feel very nervous sharing my feelings with a psychiatrist I do not know, I hope you can see what you need to see. I am ready and not just in the concept of having surgery. I am ready for the post-surgical life. I know there are going to be a lot of changes after surgery. I might need help with some of those feelings. Fortunately, I have a great online support group. And I'm absolutely willing to use local support as well. Most importantly I know that it is essential that I follow my doctors procedures to a T."

I would also have a written letter describing the process I have gone through with gaining weight and losing weight, including membership in groups like OA or WW.

I still have my letter and list of reasons in my medical file for bariatric surgery. It is a good thing to put this kind of stuff down on paper because your mind can get so scrambled at times. Writing it down demonstrates that you know what it is, even if nerves prevent you from expressing that with any eloquence.

Your doubts may emanate from a long-standing sense of unworthiness. if that resonates with you, you might mention it to the psychiatrist. I need psychiatrist will already know this and we'll be able to see that you have the correct grasp on the situation when you reflect the in a psych evaluation.

You're not getting a psych evaluation because you're perfect or to rule you out. They just want to know who you are. Make sure your self-image matches the image you express in a psych evaluation.

Thank you. I will put something in writing as you suggested. I've already told them I would welcome continued treatment and he understood that. Your first line gave me a smile for the day and thank you. I know I need to just watch how I word things when they ask questions. My weak spot these days is my blasted menopause . I think that's where it got stuck. They are getting together next week to 'discuss my case' so I'll know what to do then. I can try the letter beforehand as I have an appointment on Monday. Thanks so much for the very good advice.

 

[dianeseattle]

Dawna, I am postmenopausal. I really didn't have a lot of effects from it but how could I tell? I was on psych meds for bipolar disorder and PTSD so I was always in some kind of emotional agony. A friend of mine told me that yam derivatives would help with the symptoms of menopause. I don't know if that's true but I thought I'd just mention it. My mother went through menopause forever during my teen years and man, did I suffer. She was a physically abusive person but she had menopause on steroids and just about killed me, literally slapping me into a glass patio door that could have broken easily. I do not dismiss menopause. I know you're going through a lot. I am just going to kindly suggest to you that you look for old remedies and the treatments that are promulgated these days by new-agey people, and if that fails of course you have the option of a prescription medication for hormone replacement or a cream from your doc. You not alone in this.

 

[DawnaRose]

Dawna, I am postmenopausal. I really didn't have a lot of effects from it but how could I tell? I was on psych meds for bipolar disorder and PTSD so I was always in some kind of emotional agony. A friend of mine told me that yam derivatives would help with the symptoms of menopause. I don't know if that's true but I thought I'd just mention it. My mother went through menopause forever during my teen years and man, did I suffer. She was a physically abusive person but she had menopause on steroids and just about killed me, literally slapping me into a glass patio door that could have broken easily. I do not dismiss menopause. I know you're going through a lot. I am just going to kindly suggest to you that you look for old remedies and the treatments that are promulgated these days by new-agey people, and if that fails of course you have the option of a prescription medication for hormone replacement or a cream from your doc. You not alone in this.

Thanks much! I will try more natural supplements that can help out. I'm sorry you had so many bad years with your mom and the mix of this with steroids. I try very hard with my kids (they are 19 and 21) and they're pretty understanding. But usually I just go through migraines and cry for some days. Well the infections and cravings into binges aren't much fun either but probably the depression and crying are the worst. I can't wait to be past it lol. I was almost thinking to just get a hysterectomy and be done with it.

 

[dianeseattle]

I had a hysterectomy but they didn't take my ovaries, so my hormonal balance did not change, and for that I am grateful. When I was responding to your post I was wondering if there are any support groups you know of that support menopausal women. Menopause can go on for 15 years, though for most of us it's just a few years. If I were doing it now, I would definitely be looking around for other menopausal women.

 

[DawnaRose]

Just wanted to update here for anyone who ever encounters this. This situation was strange from the beginning and I thought about it. All my appointments were zoom until the one with my dietitian last Monday (a week ago today). When I saw my dietician, she said everything looks good, ready for insurance and I just need to see Dr. L, the psychiatrist for sign off. I said I had an appt next week (today). She looked and said, "No, just Dr Warrington." That confused me but ok. I got my appt for Thurs on zoom. The day before the appt, I looked and it said in-office. I called and asked if I need to drive out and she said, "No, all appointments were cancelled in office for a family emergency so it stays on zoom". I asked her if it was possible my appointment was scheduled for today but was cancelled and not noted and she replied that was entirely possible.

I sent my notes in for my tracking and everything to him again the night after I posted this originally (Friday) and I was told I had a message from him in my box. He also refunded my appointment the next morning and sent a message that he hadn't gotten the notes I sent me the first time so he was uninformed of how I actually had been doing the last month. I saw my Dr this morning and we addressed my hormone issue as well as the Psych write-off and she waved it away saying that the team had met Friday afternoon and discussed everything. They all felt I was a good candidate for the surgery and that Dr L also wrote off approval of going forward. She said they talked about it and decided to recommend starting Lexapro on low dosage to help with the regulation of mood swings during hormonal changes and they weren't really concerned with anything else but regulating that. It was a positive appt however and all said I was doing well.

I don't have another appt scheduled yet with Dr L but they said they will contact me next week or so for surgery date and then schedule other appts. as well as pre-surgery. She said it looks like it would be around the end of Aug at this point. Hope this helps anyone else that runs into some strange issues.

 

[gzar]

That is really frustrating, sorry you are going through this. I was terrified during my psych evaluation of saying some keyword to trigger a red flag. It ended up being an hour long session of being berated for having bad eating habits & making poor choices.

 

[3momchaos]

That is really frustrating, sorry you are going through this. I was terrified during my psych evaluation of saying some keyword to trigger a red flag. It ended up being an hour long session of being berated for having bad eating habits & making poor choices.

That’s some BS right there. I don’t recall mentioning any food choices, and you didn’t mention saying anything specific, but to be berated when we are trying to better ourselves, seeking help, most of us terrified, I know I was, of being judged by people who don’t understand, but not by the mental health specialist who’s job it is to help us. I’m sorry you went through that. There are productive ways to talk about poor health choices. Berating is generally not one of them.

 

[LDM]

I agree that less is more. I told the shrink right off the bat, that "yes, I obviously have some kind of eating disorder, otherwise I wouldn't be sitting in her office and trying to get bariatric surgery scheduled". This made her laugh. Then I immediately followed up with, " I am not depressed, I have no plan to harm myself, I don't binge and purge, I simply overeat. I have tried several diets and was successful for a while but then went back to my old ways of eating. I see this surgery not as a cure but as a tool. I know I need to change my mindset about food and I am ready to do that." She looked at me and replied, well, alright, you answered pretty much every question I was going to ask you." We both laughed and she asked a few more innocuous questions, then gave me her stamp of approval. It's sad to think that you can be nervous and say one wrong thing that might cause them to raise a red flag. I get that they want you to be successful, but to me, the fact that you have made this decision proves you have given this some thought and are ready for change. Good luck to you.

 

[DawnaRose]

I agree that less is more. I told the shrink right off the bat, that "yes, I obviously have some kind of eating disorder, otherwise I wouldn't be sitting in her office and trying to get bariatric surgery scheduled". This made her laugh. Then I immediately followed up with, " I am not depressed, I have no plan to harm myself, I don't binge and purge, I simply overeat. I have tried several diets and was successful for a while but then went back to my old ways of eating. I see this surgery not as a cure but as a tool. I know I need to change my mindset about food and I am ready to do that." She looked at me and replied, well, alright, you answered pretty much every question I was going to ask you." We both laughed and she asked a few more innocuous questions, then gave me her stamp of approval. It's sad to think that you can be nervous and say one wrong thing that might cause them to raise a red flag. I get that they want you to be successful, but to me, the fact that you have made this decision proves you have given this some thought and are ready for change. Good luck to you.

I see on my groups and everywhere that there is a psych evaluation before the surgery and then they sign off but with my program, it's different. My counselor is part of the program team and I've had a session monthly for the last 4 months. I thought it was a great idea but he used notes toward the surgery evaluation from all the sessions together. I still have him monthly and am a little deluded that I can't really have him as a counselor I can trust.

 

[Alynthia]

I'm glad that you got a stamp of approval. I wonder if asking if there was a female therapist or psychiatrist you could have talked to might have helped. I find it absolutely amazing how many male doctors don't know anything about "Female Problems".

 

[dianeseattle]

Alynthia, I completely agree with you. I have a female therapist and a female shrink and my doctor is female. The only male doctor I've had in the last 30 years was the one who performed my cataract surgery. I didn't have a choice in that one.

Oh, I forgot! my bariatric surgeon was male. I picked him because he had been on national news talking about how weight loss surgery could cure diabetes. He had also received the highest award from the AMA that you can get and he was the best bariatric surgeon in town. Funny though, he's retired now, and the head of that department is female!!!

But I feel totally strange talking with a male doctor any time I encounter one. There aren't enough female surgeons to go around oh, so the males really dominate that field. I think there are more women mental health care workers now than men.

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