Monday, March 31, 2014

Today I was the patient

I went to physical therapy for my back today. Of course I had started to feel better in the afternoon, and almost felt silly going in. No, not all better- but not like I couldn't get up out of a chair like I had earlier in the day. My PT is nice, started with basic stuff, mostly I'll be doing back extensions until I see him next- something I could not have done yesterday (I tried). And actually, the first one with him still hurt, but then it got better. Every 2 hours I have to do 10 press-ups or back extensions. I just did one set- maybe one more before bed. I don't know how much longer I'll be up. I just have to get through to first one- and remember that the second one doesn't hurt so much, and by 5 there is no more pain. But that first one still really hurts.

After the session I pushed my luck by going to the drug store- and had a lot of pain there just walking down the aisles. A LOT of pain. And then I didn't feel so stupid for going to PT.

What I really want is to learn exercises that I can do so that this won't happen again (or is less likely to happen again). Because this isn't the first time I have had difficulty with my back. And I want to know when I can go back to yoga! I would guess not this week...

My other issue is the laryngitis that just won't go away and I don't know what to do about it. Just wait? Call my doctor? I saw her on Friday and she said there was nothing to do. I'm a really bad sick person, I don't have a lot of patience for it. I just want to get back to work.

My wishful thinking

I thought I would go into work today. I thought I could get myself situated on a scooter chair and not have to get up. I had a student coming in for the morning who could help me with hot packs and such. I would ask the office staff to send all patients back so I wouldn't have to get up and get them. And I didn't have any patients who needed to be transferred or on the mat today- this could work. Right. Except that I can't stand to sit for more than a couple of minutes.

I am better than yesterday, I really am. I can move around in bed much better- even getting to the edge of the bed isn't as bad. But standing up still feels impossible. I can't stand or sit for any length of time. I can't reach for anything if I have to lean my body the slightest bit.

I have to think before I make any movement. How much is this going to hurt? How can I accomplish this task with the least amount of pain? This is giving me insight into what my patients go through. I will try to see this as a learning experience.

Sunday, March 30, 2014

As they say, it never rains but it pours

I am still sick. And now my lower back has flared up again- I think this is the 5th time it has done so in my life, and the worst of my life. I can hardly move. I am saying lots of dirty words. It is really agony. I can't even do the back extension exercises that have helped me in the past- it is just too painful. So I took 3 naproxen (I wonder what my lithium level is), and a couple of klonopin (hey, it's a muscle relaxant). I tried to sleep, but I just could not today. I could not get comfortable.

I am trying to get out of bed and move my legs and such- bed rest is not a good thing for back pain- but lying down is the closest that I can get to pain free. Getting out of bed- namely standing up, is almost unbearable. Standing is not too comfortable either, but it is the transitions that are the worst. Coughing really hurts my back, and I'm still doing that occasionally too.

I am so frustrated right now. I just want to be well, I just want to be able to do things. I am used to my mood being the issue, I am not used to my body being the issue. I haven't learned patience in that area.

I think I need to go to physical therapy. But I might need to go to a chiropractor first. I wonder how soon I can get in. Do they take emergencies?

I do have one good thing to report about being sick all week: I have lost 3 pounds. Although that may also have something to do with going down on the Zyprexa.

Saturday, March 29, 2014

A night actually saved by TV

It is no fun home being sick, and then wondering if the sounds that you hear when breathing lying down mean you have pneumonia- even though the doctor listened to my lungs yesterday and declared my lungs clear. Wondering if my voice will ever come back. If I should still go in to work if I sound like this- or how much longer I can call out. Going to the doctor with a URTI is very unsatisfying these days. The last time I lost my voice and went to the doctor I got an antibiotic- and I seem to remember getter better faster. But that was a different doctor. And maybe different germs. And I was 4 years younger

So this weekend I have just been miserable. But on-demand cable came to my rescue. I got got caught up on the Colbert Report and watched 2 episodes of Helix- I am really behind. I almost decided to watch the second Hunger Games movie through pay per view, but decided to leave that for another day. Maybe tomorrow if I don't go to church. I keep saying I am going to go- I need to meet people- and now is the time- except not if I have no voice- it comes and goes throughout the day. And I need to go to the drug store if not a supermarket. And in to work to write a few notes.

Helix is really interesting. It gets weirder and weirder. I have more episodes to catch up on. It is my kind of show.

TV was just about right. I have really been too tired, still feeling to sick, to want to do any serious reading (let alone cleaning). I had thought of going for a walk- it is supposed to be good to get a little exercise when sick- but it rained all day. Being sick has just made me really lazy anyway. I just want to be better already and get back to work and yoga and life.

Friday, March 28, 2014

Being sick is a lot like being depressed

I was starting to feel some better yesterday, the trajectory was good, so I thought I'd be good for work today. And really, after getting out of a hot shower this morning, I felt pretty good. But it didn't last. I could hardly talk at work, and started coughing again. My throat hurt. And I felt tired. I didn't want to do be there or do anything. And I was afraid of getting people sick.

Coincidentally, I saw my GP after work for my 6 month appointment for my blood pressure (which was great). She said, even though this has been going on for a week, that my lungs sound fine and no antibiotics for me. It is viral. Damn. I want something with an easy fix, I don't want to just have to wait it out.

I had things to do this weekend. I think most of them won't happen. That is kind of okay, I suppose, if I feel well by Monday morning in time for work. If I don't, then I don't know what. I can't have another day in which my voice doesn't work and I am afraid to put my hands on patients.

Being physically sick is just making me see all the things I hate about myself and my life. My mood usually dives when I get sick- knowing this doesn't make it any easier. Isn't insight good for anything? Apparently not.

Thursday, March 27, 2014

Neuroplasticity- the bane of psychopharmacology

I just read another article suggesting that long term use of antipsychotic increases psychotic symptoms and worsens outcomes in schizophrenics. Now there are a lot of problems with the study- no randomization- maybe schizophrenics given more antipsychotics were "crazier" to begin with. But it is not good, not what you want to here if you are a psychopharmacologist.

As an OT, neuroplasticity is a good thing. It is how people can adjust to a nerve injury or a stroke. In psychopharmacology, it can mean that what a drug does in the first weeks or even months is the exact opposite of what it does over years of use. The brain adapts. Block dopamine receptors? The brain becomes super-sensitive to dopamine. Flood the brain with serotonin? The serotonin receptors down-regulate.

We don't need six week studies on drugs that we put people on for a life time. We need six year studies. Sixty years studies. Studies to show us if we are doing more harm than good.

A study recently came out showing that cortisone injections for tennis elbow had some limited short term efficacy but worsened long term outcomes. I wouldn't get a steroid injection for tennis elbow. But I suspect that some of the drugs we take in psychiatry are the equivalent of getting that steroid injection.

Tuesday, March 25, 2014

I have no voice

There is something about not being able to speak that I find disempowering and disturbing, even though I know my voice will soon come back. I have to be patient and let this virus work itself out of my system.

There was another time I lost my voice that was a lot more disturbing. I had overdosed- it was very bad. I had to be intubated, and on a respirator, and spent a few days in intensive care. Afterwards I could only speak in a whisper. They told me that this was an effect of the intubation, and that as my vocal tract re-epithelialized, my voice would probably come back. But they also told me that there was a small chance that I had sustained a vocal cord injury and that it wouldn't. It was a very long wait, wondering if I had destroyed my voice.

The whole episode was very traumatic. You don't just come out of a coma like it happens on TV. It happens in stages. And for a while I was very confused. I saw that I was in restraints- but the other patients in room (there were 4 of us) were not. I thought that they had succeeded in breaking out of their restraints- I thought that this was what we were supposed to do. I saw all of these monitors- I thought they were TV's. I thought it was some kind of game show- to have people break out of their restraints. So I kept trying, and then pleading for them to let me out, telling them that I give up, I lost the game, I can't do it.

I had the worst bruises on my arms and legs from where the restraints were. They eventually faded and my voice came back for which I am very grateful. They had told my parents that I might either die or have brain damage, that they would do what they could. Sometimes, when I am having trouble concentrating or remembering something- I wonder about the brain damage.

I did it to myself- and yet it was a very traumatic experience. I know it was traumatic for my family, too. I think I am glad I didn't succeed. Most days.

Sick- I hate being sick

I just got back from my conference, which was great, except that I am sick. The good thing about the conference is that I didn't have to talk much- and as of yesterday I really can't. My throat is killing, I am coughing, and now I can't talk. I got though the conference by living on cough drops- which don't work as well as I thought they would.

I am guessing that I won't be going in to work tomorrow. I really don't want to miss work, I really don't want to stay home. I didn't see patients for 2 days, I have all of these new ideas from the conference, I want to go in. And I don't want to use my PTO.

I think if I didn't work, I wouldn't mind being sick quite so much. I could just say, OK I am sick. It is just another state of being, a temporary thing. It will end. But now I want it to end right now! Or at least before tomorrow morning, when I have to decide to call out or not. I already gave my boss a head's up and told her I might not be in. We are a very small department.

I am supposed to see my primary care doctor Friday for an unrelated matter. But I wonder if I should try to get in tomorrow. They probably won't do anything for me- I don't think they give antibiotics for upper respiratory infections anymore unless you are deathly ill. How can they tell if it is bacterial or viral? I don't know.

I have to admit to feeling proud- going to this meeting this year as a CHT. I wonder how long I have in this profession before the Medicare and other regulations and paperwork get so onerous that I want out. But for now, it is a good feeling.

Thursday, March 20, 2014

No mindfulness for me

I had signed up for an 8-week mindfulness based stress reduction course. I was looking forward to it, I thought it might give me some of what I needed. But it has been cancelled due to low enrollment. I am very disappointed. Unfortunately I live out in a semi-rural area these days and there aren't a lot of groups going on. I think I really need a group.

My hospital has a depression support group- I don't know if it free or paid group- but it is in the middle of the work day, so that won't work anyway. DBSA has two groups about a half hour drive away from me that I could make- if I am able to get out of work right on the dot and have no traffic, etc. Which never happens. And I have been less than impressed with the groups. I think I was spoiled- the group I went to in the city was just so good. And there were more people there who were in a similar place as I am.

I've thought of trying to create a group on for peope with mood disorders- but I am too afraid that no one will show up and I will be left feeling depressed and lonely at whatever venue I choose. But maybe I will, eventually.

Things have been challenging recently, in part because I messed up my meds when I went out of town this weekend. I think that yesterday was the first day I started to feel like I was getting back to equilibrium. I actually left work early on Monday my headache was so bad.

But I am excited because I am going to a hand therapy conference starting on Saturday. I love going to conferences and courses. I always come back so inspired. Except for the ones that I have gone too extremely depressed when I was wiping away the tears half the time. Those were bad. But this won't be like that.

Sunday, March 16, 2014

Just what I needed

I spent the weekend out of town visiting my brother, his wife, and daughter. My niece! She is so precious. And they are just so- normal. Not in that they are ordinary- but in the absence of pathology sense. I always feel grounded after seeing them for a little bit.

How did my brother turn into this person? He has always been an amazing person- I just didn't know that fatherhood was in his future when he was younger, let alone that he would turn out to be this amazing father. It is nice to see.

I'm reading a book, "The Power of Habit" which is really good. I am starting to hope that I can change some of my habits- or create new ones- and create some order in my life- and that some things can get easier.

I've been thinking about plans for the next few months, things I want to accomplish. It is dangerous to make plans, too often depression or a spring-time hypomania will derail it all. I have paid for vacations that I never went on (I stayed home and lay in bed) because I was too depressed. But you can't stop planning. You can't give up on life. And so I plan.

Because a part of my mind also is always in denial, and thinks that I have seen my last depression. Because when you are not depressed, depression does not make sense. They are two different ways of seeing the world. When I am depressed, I cannot imagine not being depressed. And when I am not depressed, I cannot imagine being depressed again. It just doesn't make sense.

Friday, March 14, 2014

What's in a label?

I knew very early, growing up, that I was different. I was extremely shy. I couldn't stand loud noise or crowds or too much stimulation. I did very badly in school for many years due to undiagnosed learning disabilities and have a genius brother. My mother was very troubled, and my father usually absent. And I discovered that by pressing my arm against the hot water pipe I could feel better.

By the time the labels came, it was too late. I had already labeled myself as a terribly flawed person. It didn't matter when they told me that I had learning disabilities- I knew that I was stupid. And when they told me that I had: first borderline, then depression, then bipolar- I knew better. I was just weak.

There was a brief period of time in which I almost started to believe the psychopharmacologists- that someday we would find this drug cocktail that would make everything alright. It was a nice dream.

But mostly I have thought that I just need to try harder. And I don't think that is exactly wrong- but I need to be smarter about it. I keep fighting the same fights over and over again. The same things keep hurting me. I keep getting the same results.

And my moods keep doing their thing. Is it helpful to label this as bipolar? I don't know.

I am not sure how to make things better in my life right now. I think I am going to do an 8-week mindfulness course given at my hospital. Maybe it will help. At least it will give me something to do one day a week after work instead of going home to crash.

Something has to change. And I don't think it is meds.

Wednesday, March 12, 2014

I guess my weight is still a sensitive issue

I gave in to the bribe offered by my health insurance company of $100 towards my health savings account to go to a talk on healthy eating. I really didn't want to go, I shouldn't have gone.

I got so upset during the talk. First- how I was only getting a measly $100 for this- but I am spending $450 every month just on my provigil that they won't pay for, and I have thousands of dollars that I spend each year before I meet my deductibles.

But I also felt like I was being lectured about my weight. It took me so long to get used to my body after the weight I gained on Zyprexa, and so many years not to be so totally self conscious about myself. I don't need this. I am not fat because I don't know how to eat. I am fat because I am often very hungry, sometimes too depressed to cook healthy, and occasionally I eat for comfort.

But it just made me think about how much people must  judge me, as a healthcare worker being so obese. And I want to tell people- don't judge me until you have spent 15 years on Zyprexa. But I also know that not everyone gains as much as I do. I just don't like being hungry- some people don't mind it so much. I give in too easily. I gave in too easily when I was gaining in the beginning. The problem, I was so numb and depressed that first year I didn't care so much.

All of which brought up me questioning the Zyprexa, did I need it then, do I need it now, what if I had gotten off of it before I gained all that weight, etc. All in all, I went to a very bad place during the presentation, and had to run out to my car afterwards to take a half a klonopin to keep it together.

Well, the morning had been a really good morning. And by the time I got back to work in the afternoon the klonopin had started to kick in and I was able to focus on work. Until the last half hour, when I just crashed. My last patient had gone and I was making phone calls and doing notes and checking email and I thought I would collapse. But it seemed like the whole day was a high drama day- even work. And even home- my heat went out (woke up to cold and no hot water for a shower).

Now I am in my warm apartment and it is very nice. But I still feel like there is a hole inside of me when I think about the issues stirred up this afternoon. I need to find a way to reframe things so that they aren't so painful. But I haven't thought of how yet.

I have been eating healthier recently. My trip to Costco actually helped in this regard! I have such a hard time grocery shopping- buying mass quantities works for me, for everything except fresh produce. I must have a month's worth of chicken breasts in the freezer. I just cook them on the skillet and eat them with a salad or a bag of those frozen steamable vegetables. My big weakness these days is Chinese food.

Monday, March 10, 2014

An awful week- but now I am better (but whiney)

The anxiety that I had been dealing with when I last saw my psychiatrist turned into this anxious, irritable depression. And then over the weekend I couldn't sleep. I turned to yet another drug: benadryl, which helped. I finally got a good night's sleep last night and woke up feeling so much better. I didn't even take any klonopin today, I didn't feel that anxiety. It was gone.

I even managed to get two things accomplished this weekend: I took my car in for servicing and went to Costco to pick up my provigil and shop. But these things really drained me.

I confess I am having a few "when is it going to get any easier" moments. This only lasted a week, I should be grateful- but it is so disruptive. How are you supposed to figure out how to live your life when half the time you are not sure you want to live?

But I think I am not just dealing with a mood disorder- I am dealing with the collateral damage from it. I didn't spend my twenties and early thirties figuring out my social identity, finding my soul mate, establishing structure and routines in my life. I spent these years in and out of psych hospitals. There is a lot that I never learned. This makes life that much harder, even when I am not in the midst of an episode. Plus my learning disabilities- that doesn't help either.

I'm not sure how to fix that piece. I thought that therapy might- but it hasn't. I think I need more structure. But I will have to create my own, and that isn't easy.