Renewed

Back on my full dose of zyprexa, and with the increased daylight, my mood is working its way upwards. Out of the depth of depression, to somewhere it hasn't been in quite some time.

And then I spent my weekend at a continuing education course- one that I wasn't even sure I wanted to take- getting trained on a new stroke rehab device. And I am stoked! I am so ready to go out and start treating stroke patients again! Just when I thought I had maybe burnt out on stroke.

I have to admit, I've been looking for the "magic bullet" in stroke rehab ever since I started studying OT., and of course never finding it. I have my hope in NMES, CIMT, robotics, imagery, and now the SAEBOFLEX. They are all tools, and some of them help different people. Unfortunately robotics are still prohibitively expensive for most places.

I really think that to get the arm back after a stroke, you need to train like an athelete. It's a 9 to 5 job, at least 5 days a week. And yet, we get 2-3 hours a week of therapy with our patients. The question is, how to get them to take it home, to keep practicing. And these are all some ways to do it. To continue the therapy outside of therapy. But only for the right patient. Some don't have the time- they need to get back to their job. Some don't have the resoursces, the motivation, the concentration, the cognitive capacity.

And then there are always those for that, the stroke was too severe, the deficits are too severe, the arm just isn't going to come back in any kind of meaningful way.

But with the Saebo, I have something new to offer my patients. A new tool.

And now I can't sleep, despite an Ambien and a klonopin. And I have to get up very early!

"I still love you"

I got an e-mail last night from an old boy friend that was 4 words, "I still love you." You might think that is sweet or romantic. It has me angry and confused. It ended badly, and he owes me a big explanation, because he literally disapeared on me.

It took me a while to get over this, and to stop obsessing over what the real story was. I know I let my guard down with him and ignored too many danger signs- but I was in love and going with the feeling. I just wanted to go with it, just wanted to surrender to the experience.

In the end I don't regret it- and I miss the person that I was when I was with him. Where has she gone?

I don't think I've really been happy since I moved away from the city and took this new job. Even when I wasn't clinically depressed, I haven't felt joy. (And I've spent a good portion of it clinically depressed!).

I was miserable a lot living in NYC. But, I felt joy a lot too- well maybe not quite "a lot." But enough to make it worth it. I had enough moments when I would think to myself, I'm glad I didn't succeed in killing myself. I'm not having these moments.

Maybe I need a new job. Maybe I need a new man. Maybe I just need sex!

I've been in this really horrible depression this past week, but the past couple of days I am starting to come out of it- thanks to an increase in Zyprexa. Whatever is wrong with me, an increase in Zyprexa will usually fix it. Too bad about the side effects.

I think a return to internet dating is in my future.

Cycling

The seasons are changing, spring is coming. Plus some stress at work. And now, I'm cycling.

In the mornings I am so down, I hardly get out of bed. Then as the day progresses, I start to feel agitated and irritible, until I think I am going to jump out of my skin. The only thing that soothes me is driving- as long as there is no traffic.

At night, I don't want to go to bed. But with the help of Ambien, eventually I do. Only to start the whole thing over again the next day.

Stop being stubborn girl, raise your meds! I know what I need to do, I just don't want to do it. But I will, tonight, because this can't go on.

At least I know I don't have to do my light therapy anymore this year! I do it all winter. And then, late March or the beginning of April, my mood shifts, and I know that it is over for the year. Some years I get a few days of mild happy hypomania, but no such luck this year. I'm just miserable.

Back to Work

I'm recently back from a conference that was really good. Plus, it was really good to get away. Now the reality of getting back to work.

I had 3 days of work this week, and on 1 day we were 2 staff down. The rest of us had to cover the patients. It was a really bad day- I had two hours when I had so many patients stroke patients at the same time that no one got good care at all. That really eats me up- by the end of the day I wanted to quit.

Today was better, thankfully. And I have an interesting new patient- just about the most apraxic I have ever seen. When a patient is "interesting," it is never good for the patient. If you are a patient, you want your situation to be mild and boring.

I "only" stayed 1 hour late today- which to me felt like getting out early. We don't get any allocated time for paperwork, phonecalls, equipment orders, etc. We are expected to do this during treatment sessions, and then stay extra as necessary. But unless I have a very high level patient, I don't usually get any notes done during treatment time.

I'm in a complaining mood, so I'd better stop here. Healthcare is what it is. And I want everyone to get excellent care, and get all the care they need, and get better. And I don't want to have to put in long hours for paperwork. And I don't want to have to take a pay cut so that we can increase staffing levels or have dedicated hours for paperwork. I want the impossible.

Mostly I wish I could afford to work part time for a while. But that's not an option. Plus, I need health insurance!

Too much drama!

It was a very high drama day at work. Patients, families, fighting between patients and their families. Not good. By the end of the day, I felt like I needed a drink!

I don't like yelling or angry voices. And I can't stand meanness- although I have never figured out how to deal with it, whether it is expressed towards me or someone else. I stay calm, I say reasonable things, and I come away feeling like I was walked all over.

Assertiveness is something I am still learning. And with some people you have to be more assertive than with others!

Withdrawal or Relapse?

I'm lowering my antipsychotics a bit. I think I am having withdrawal symptoms. I hope I am not having symptoms of relapse. No paranoia, as I've had in the past. But I am not sleeping so well, I am anxious, I want to cry, and my heart feels racy. On the up side, I feel more awake and with it. This morning it was easier to get out of bed, it wasn't so much of a struggle. And I feel somehow more present. That veil that I feel is often there between me and the world is pulled back a bit.

Maybe the threat of tears, the anxiety, the insomnia, the racy heart, it is all transitory withdrawal symptoms. Or maybe some of it is here to stay. Maybe I have to take a little more bad in order to get a little more good. I'm okay with that, as long as the bad feelings are not crippling depression. But more tears, a little anxiety, I'm okay with that. Better than the numb I've been feeling recently. I just hope that the insomnia and heart pounding go away- that's no fun.

I've tried to get off of drugs before- and then got scared off by the withdrawal symptoms. But I'm doing it much more slowly this time- it seems like it is going to take forever! Then again, this strategy also means I spread out the length of time I'll be dealing with the withdrawal symptoms.

"Back in the day" before I was an occupational therapist, when I was in and out of hospitals- I used to get put in to hospital so my doctors could take me off, and then put me on, medications as fast as possible, and let me get every side effect in the book. And I would lie in my bed all day, too drugged up to attempt to go to the groups. I was a very bad patient. I always refused to go- even if it meant being locked out of my room. Until I got too bored- which meant I was feeling better. And then I would get into trouble for being too opinionated sometimes.

But now I say that I can never make another major medication change until I retire! I don't have a job where I can afford to not be functional, where I can be drugged up. What this has meant is that things have been added during breakthrough episodes, but we never want to take the risk of taking things back off. So over the 6 years I've been working, I've increased from 3 meds (an all time low), to 8. And that is just too much. So I'm taking the risk now of trying to get off of 1 or 2 things. And hopefully 3 by the end of the year. That is my plan, at least. And the best laid plans...