My first really bad day in a while

Today a lot of little things and a couple of big things, plus not too much sleep the night before conspired to put me in a terrible mood today. I actually left work 15 minutes early, as my last patient did not show up. Paperwork will be finished on the weekend.

It was the first day I really felt that bad at work. I couldn't finish my notes. I had to get away, once I no longer had my patients to distract me. I actually felt good while I was treating patients, I just couldn't deal with the down time.

I didn't really know how to make myself feel better. I ate dinner, and sat and watched the news- not recommended. I suppose this is when you have a glass of wine or a drink, but I am not in that habit. Instead I had a crumb of a klonopin, which took the edge off of what I was feeling, but didn't really make me feel good. Next time I think I'll go for the wine.

I wish I had a bathtub. Then I could take the warm bath that everyone talks about. I felt too guilty to eat ice cream or anything bad- so I just ate too much of regular food. I should have gone for ice cream.

I just feel exhausted. Physically exhausted. Like I don't want to move. I'm lying in bed right now, listening to music. And I want something more.

What did I think, that the depression was never going to show its head again? That going back to work would be a piece of cake? There are reasons why people go on disability, there are reasons why I was on disability.

But one day is just one day. As they say, tomorrow is another day. I'll try not to prejudge it. It could be awesome.

Would you die for freedom?

No, I'm not talking about a war or battle. I'm talking about healthcare.

There was a time when there wasn't much that doctors could do for you other than set a broken bone. Times have changed. For many people, modern medicine is life-saving.

There was also a time when, if you were willing to work hard, you could probably get a job with health insurance. That is increasingly not the case. And, unless you are healthy and wealthy, buying a policy privately is not possible.

So do we want the government to step in?

Republicans love to say that you can always go the nearest emergency room and get care. Well, that is only true because of federal law, which demands that all patients receive emergency care without regard to the ability to pay. If you really want the government out of health care, that safety net will be gone.

I used to think I had a libertarian streak in me- but I know that there is no way private insurance would ever offer affordable health care to the elderly and the disabled without some kind of government intervention and support. Insurance companies want to cover the well, and that is their right in a capitalistic system.

I don't know what I think of "Obamacare." In many ways, it is a terrible bill. But is it better than doing nothing? I'm not sure.

Healthcare was changing, anyway.

Health insurance companies are getting more intrusive, too.  They give you rewards and penalties.

I just got a letter in the mail today from my insurance company. I guess I have been an expensive enough patient this year that they are offering me a health coach. I am supposed to call to either accept or to turn them down. I can't imagine they have anything useful to offer.

My trip to my shrink

I saw my psychiatrist yesterday- and it was the most uneventful appointment I'd had in a long time. I really had no complaints. We did determine, however, that I have a mild tremor in my left hand (very minor), since going on the lithium. Do I care? No.

I like this guy. He is the first person who actually looks for things like tremors and tardive dyskinesia, no other doctor has. What I really think is, if I psychiatrist can't be a doctor, then let psychologist prescribe. You have to be a doctor if you are a psychiatrist. These are powerful meds you are giving people, with often terrible side effects.

I asked him my question, which I know he doesn't know the answer to: what are the odds that I can stay on 5mg of Zyprexa the rest of my life and not get tardive dyskinesia? And he hedged. He said, a lot better than with the older drugs, but that the odds obviously increase the longer I am on the drug. He said that the important thing would be to catch it early.

I am kind of at peace with my meds right now. I don't want to think about making changes, getting off of things. Other than the Effexor, I am not on a high dose of anything. Side effects are pretty manageable, and my head feels clearer than it has in years. I can concentrate. However bad the meds can be for your mind, depression is worse. I have been wanting to blame the meds for my inability to concentrate the past couple of years- even though I was pretty continually depressed during this time. I even tried coming off of things. But what gave me my mind back was actually going on lithium.

No my life is not perfect. I still really struggle with a lot of things. More that I would like. But perhaps if I didn't, I would complain that the meds made me flat.

Meds don't fix everything. DBT doesn't fix everything. But I am glad that they have fixed some things.

I did it, I shopped. And at Walmart, too.

I made it through black Friday without shopping, but then today I gave in, and went shopping. Even worse, I went to Walmart- and it was Small Business Saturday. But I needed to do some grocery shopping, plus I needed some non-food items, and a couple of little things for my niece, and I knew that I could get them all in one place if I went to Walmart.

The store was not very busy, I was very surprised. Maybe the customers had all come on Black Friday. Or people were out frequenting small businesses. I started to feel guilty.

I don't think I have ever been Christmas shopping this early before-  But I never had a niece before. That changes things.

I will be seeing her in 2 weeks, and I am so excited. I know that I have missed so much in the past few weeks, I can't wait to see how she has changed.

The fiscal cliff gets personal

I downloaded a budget spreadsheet, and I was trying to figure out how much money I was going to have this coming year to pay off my debts and replenish my savings- which were totally wiped out by going to the hospital (high deductible plan).

But I don't know what my take home pay will be. Because I don't know what the tax rates will be. How much is my pay check going to go down? It would be nice to know.

For those who believe in austerity, the fiscal cliff should be a good thing. Yes, it might shave a couple of percentages off the GDP, but it will have a long term good effect on the deficit, and reassure business and the world that we are serious about the deficit. Aren't we always telling other countries that they need to do austerity? And yet, when in comes to ourselves, we call it a fiscal cliff.

Europe hasn't done too well under austerity, but how well would it have done with continued uncontrolled spending?

I wish that economics were truly a science, and we could actually figure out what it is we should be doing, instead of just guessing. But economies are so large and complex, how can we understand them? It is like trying to predict the weather a year from now.

Realizing how bad I was

I studied today. Okay, I just read a chapter in a book. But it was, well, easy to do that. I think I must have spent weeks trying to read that chapter, in the previous months- and now I did it in an hour.

I was so cognitively impaired. I was really scared to go on lithium, scared of cognitive side effects. But really, there is nothing as bad for your mind as severe depression. And besides, I am on a pretty low dose, not like last time. My level is only 0.4.

It's funny. I have been feeling like I am not as sharp- although objectively, that is so totally not true. And then I realized, I think my brain was interpreting the state of heightened arousal, that anxious depression I was in, as mental sharpness. But it couldn't have been further from the truth. And my relative calmness now is certainly not a sign of dumbness. I just have to get used to it being different.

Did you have to go back to work?

I went to a mood disorder support meeting last week. I hadn't been in maybe 3 months. I told them that I had been in the hospital, taken a leave of absence and was back at work. And then the leader asked me "Did you have to go back to work?"

Well, yes if I don't want to be homeless. I don't think I'm quite long term disability material yet (or rather, again, as I was on it before). I would have to fail a lot more times before I give up on working.

Unfortunately, at these meetings most of the people are not working. I had my not working years too. I think that too many people give up though, once they get on social security disability. They see it as a permanent destination. I don't think it has to be for everyone. But working is definitely a stress, I will admit.

It is hard to explain, that going back to work has in some ways been easier, and in some ways harder, than I have expected. I'm glad that I didn't stay away too long- I didn't forget how to do my job. Treating patients just came right back to me.

But I have these constant apprehension- just waiting for the overwhelming depression and anxiety to return, that I had been feeling for so long when I was last at work. I am waiting for all the bad feelings to return. So far they haven't- but I can't get rid of the apprehension.

I hope as time goes on, this fear will go away.

Going too fast to slow down

I got pulled over for speeding on my way to a massage. Pretty ironic, really. It was on the road where I really have to watch my speed- because I am turning off of a 50mph road onto local 25mpr roads. If I don't watch my speed, I am going too fast. I wasn't watching my speed. I wasn't being mindful. I was going too fast.

The police officer was very sweet. And very young- I felt old! He gave me a ticket for a technical offence instead, so I am very grateful. It is too bad that driving turns civilians and cops into adversaries.

But it was a lesson in the importance of mindfulness. I could have spared myself the experience if I had been paying more attention.

I made it to my massage with a couple of minutes to spare. I'd like to say that the massage was wonderful- they used to be. But recently she has been going a lot deeper, and it isn't always as pleasant. Afterwards my body feels great, and the normal tension that I carry in my neck and shoulders just isn't there. But the experience isn't as nice.

Which makes me wonder what the purpose of a massage is, or should be. I have had so much tension in my neck and shoulders recently that I wanted her to go deep- it worked. But I do miss the sheer pleasure that I used to get. I have scheduled one again towards the end of December. I'll see what I am feeling like getting then.

I don't get it!

I don't get the Republican hatred for Obama, and all the end of the world stuff. I mean, the world was ending way before Obama, and Romney couldn't have stopped it. For some reason, Obama has just become a symbol.

Obama didn't start Medicare or Medicaid or Social Security. He didn't start CHIP. He didn't start food stamps or welfare. He didn't put us into two wars and cut taxes at the same time. He didn't introduce a new Medicare drug benefit without funding it. OK, so he shoved Obamacare down the Republican congress's throat- but it was based upon Republican ideas.

All of these trends- growing dependence upon the government, spending more than we have, out of control deficits- they were decided long before Obama took office. Perhaps it was all settled when we started Medicare/Medicaid/Social Security. What looked quite doable at the time- with changes in demographics and health care costs is now bankrupting the country.

The Republicans argue that we now have more people on government programs than ever before. Well, between an aging population and a recession with a jobless recovery, that is not surprising.

But cutting taxes would not have fixed the budget deficit- it would make it worse. If I thought that Romney could have fixed the budget deficit, I would have voted for him, despite all the things I disagree with him on. Plus, I think that Romney would be more likely to get us into additional military conflicts- again, not paid for- and which would have no good outcome.

I wish there were truth in political advertising. "Candidate A has been a disaster, but Candidate B will be more of a disaster!"

Our country is going bankrupt. I don't think it is fixable. Perhaps if Ron Paul had been elected, but it was probably too late even then. We will probably wind up inflating our way out of our debt at some point. This, of course, will make all the money I have saved for retirement worthless. But if our country is going to go bankrupt, I rather go bankrupt paying for head start and healthcare than more tax cuts.

Back at work- post Hurricane

I am back at work- I went back right after Hurricane Sandy. Perfect timing? I was scheduled to go back on a Wednesday, as I did not want to work a full week my first week back- and we were closed on Monday and Tuesday, opened again Wednesday.

Going back to work has been both harder and easier than I had feared. I think the worst part was facing up to how impaired I was right before I stopped working. Plus, I have this tension- I keep waiting to feel the overwhelmed, severe depression that I was feeling for the past few months at work. So far, it hasn't come back. But I find myself expecting it. But I am working with my therapist to not let things get so bad again before I do something. I let things go too long, trying to hang on.

Personally, I was out of power for a week. No electricity, no water, no heat. I managed, because there were other places that did have power. I could take a shower at my gym. Charge my phone at work. Etc. And I have a warm sleeping bag and hand crank radio! But I was very relieved when my power came back. Everything was so effortful when I had no power. it wore me out.

I kind of see this as a preview of peak oil. Or Mad Max! Someone pulled a gun at our local gas station! And at one point, all the gas stations in our town were closed or out of gas. Fortunately, I had topped off my tank before the storm- and felt pretty silly doing it- but I am so glad. I haven't had to buy gas yet. I think I will today. The gas situation is much better now, I think most of the stations are now open.