I just finished two days at 3.75mg of Zyprexa, down from 5mg. It has gone easier than expected. I have been able to fall asleep at night (thank-you Ambien), and only woke up a couple of times during the first night, and once during the second night. Not too bad. I was a little sleepy and grumpy on Saturday, but today I was in a really good mood (but not "too good" a mood).
But I suppose that the real test will be the work week. The weekend didn't hold too many challenges for me. The real test will also be to see how long I can keep myself here, and resist the urge to go lower too fast. And I am sure that it is only by going back up on my lithium that has allowed my to lower my Zyprexa dose (especially in the spring)
But to go lower I need a different pill: a 2.5m pill, and that I'd have to get from my psychiatrist- whom I don't see until the end of May. That actually sounds like a pretty good time frame to wait.
In the past I think that I have alway gone too fast when I have tried to get off of it. This time I am going to try not to make the same mistake.
Sunday, April 27, 2014
Saturday, April 26, 2014
Why I am not so scared of mania anymore
I have been seriously off-the-wall manic. But not in a very long time. And it hit me recently that I really never had particularly hard-to-treat mania, even back then, I just had really bad psychiatric care- which really dragged things out and let my world get totally out of control.
Depakote doesn't work for me. And I had recently had lithium toxicity. So every psychiatrist I saw at the time would freak out and say there was nothing to do- or try me on some inappropriate medication. But I had been on Tegretol before, and it worked- and that was what eventually got me out of the manias in the end. It must have fallen out of favor. The one doctor I did suggest Tegretol to told me I was "drug-seeking." Well, technically yes, but what a drug to seek. I eventually got put on a baby dose by one doctor- a third of what I had taken in the past- and when he told me I was at a therapeutic level (I wasn't) and there was no point in going higher, and I wasn't responding- well, I was manic. I had no patience for idiots. I told him where he could go and stormed out.
But I now know that Tegretol works, lithium works, Zyprexa works. And for a little transient hypomania, klonopin works. I really don't need a bigger arsenal than that for keeping mania at bay. I am hoping not to to have to re-start the Tegretol anytime soon (and certainly not as long as I am taking Zyprexa- they are both anti-cholinergic), but it is there. Ideally I would like to get off of the Zyprexa- and just rely on the lithium. I hope that I can.
I just cut my Zyprexa a bit more last night after reading another article linking exposure to antipsychotics to brain volume. I've been on Zyprexa 15 years or so- perhaps most of the damage is already done. But who knows.
Depakote doesn't work for me. And I had recently had lithium toxicity. So every psychiatrist I saw at the time would freak out and say there was nothing to do- or try me on some inappropriate medication. But I had been on Tegretol before, and it worked- and that was what eventually got me out of the manias in the end. It must have fallen out of favor. The one doctor I did suggest Tegretol to told me I was "drug-seeking." Well, technically yes, but what a drug to seek. I eventually got put on a baby dose by one doctor- a third of what I had taken in the past- and when he told me I was at a therapeutic level (I wasn't) and there was no point in going higher, and I wasn't responding- well, I was manic. I had no patience for idiots. I told him where he could go and stormed out.
But I now know that Tegretol works, lithium works, Zyprexa works. And for a little transient hypomania, klonopin works. I really don't need a bigger arsenal than that for keeping mania at bay. I am hoping not to to have to re-start the Tegretol anytime soon (and certainly not as long as I am taking Zyprexa- they are both anti-cholinergic), but it is there. Ideally I would like to get off of the Zyprexa- and just rely on the lithium. I hope that I can.
I just cut my Zyprexa a bit more last night after reading another article linking exposure to antipsychotics to brain volume. I've been on Zyprexa 15 years or so- perhaps most of the damage is already done. But who knows.
Friday, April 25, 2014
Freedom
I am discharged from physical therapy today. Yea! Not that I didn't like going there, and not that I didn't like my PT, but I have other things I want to do with my evenings. And it also means that my back is better. I will have to keep doing some exercises and be careful- but I am better. Today I did not even have my morning pain that I usually wake up with.
As a therapist, it is nice to see therapy work. Especially as the patient!
I think that if this happens again I will know what to do. Hopefully it won't.
Next week I am going back to yoga. I also have to start really walking in earnest. On July 4th I am walking a 10K with some family members. I need to be in better shape for that. I did it last year with no training- but it was really cool and raining. Usually it is in the 90's and very sunny. I don't want to be one of the people who gets heat exhaustion. And my meds don't help. So I need to be in as good shape as possible.
I don't know what I am doing about seeing a rheumatologist. I called one practice- but they wanted a referral from my PCP. I made the mistake of telling them that my PCP had referred me to a hand surgeon, but I thought that I needed a rheumatologist. They said that wasn't good enough. I wanted to tell them that I am a certified hand therapist and know which I need, but I didn't.
Meanwhile all joint pain in my hands is gone. I would feel really stupid going to my PCP for "joint pain" when I don't have any.
As a therapist, it is nice to see therapy work. Especially as the patient!
I think that if this happens again I will know what to do. Hopefully it won't.
Next week I am going back to yoga. I also have to start really walking in earnest. On July 4th I am walking a 10K with some family members. I need to be in better shape for that. I did it last year with no training- but it was really cool and raining. Usually it is in the 90's and very sunny. I don't want to be one of the people who gets heat exhaustion. And my meds don't help. So I need to be in as good shape as possible.
I don't know what I am doing about seeing a rheumatologist. I called one practice- but they wanted a referral from my PCP. I made the mistake of telling them that my PCP had referred me to a hand surgeon, but I thought that I needed a rheumatologist. They said that wasn't good enough. I wanted to tell them that I am a certified hand therapist and know which I need, but I didn't.
Meanwhile all joint pain in my hands is gone. I would feel really stupid going to my PCP for "joint pain" when I don't have any.
Thursday, April 24, 2014
Compromise
I am going back up on the lithium, but not the Zyprexa. That is what I have decided. I can't take these mood swings into anxiety/irritability/depression in the afternoons anymore. I even tried not taking my afternoon Provigil, to see if that was a factor- but all that did was make me more more depressed on top of the irritability and anxiety.
I think it is the right decision. And it is better than taking klonopin every day.
Today at work a patient asked me about the scars on my arms. I really need to get better at responding to those questions- enough people have asked. I know he knew what they were. I just told him it was the past. And then he started talking about his depression. It was good.
It is the people who don't know- those are the people that I don't know what to say. Most of the people who ask do know, and it okay, and sometimes leads to a good conversation. But when someone asks me if I have a cat, I just say I used to (it is true). I haven't figured out what to tell people who ask about the scars on my arms and don't know.
My scars aren't too terrible- I have seen worse- but they are not invisible. There was a time I would not wear short sleeves, at least amongst strangers. At my first job we wore lab coats, which I loved. And then eventually I got tired of long sleeves, and I realized that I couldn't go through the rest of my life with long sleeves- I started wearing short sleeves. The first couple of years I was so self-conscious. I was always aware. No longer. I have finally gotten to the point where I really have forgotten most of the time.
So these days I am a little shocked when people ask. And really, why would you say anything? It is a little rude. Except I remember the patient who asked me if I used to cut and how I stopped. She wasn't being rude. She wanted to know how to stop.
I still do want to cut occasionally- but not all the time like I used to.. I haven't in at least a dozen years, I think it is behind me. I wish I could get rid of the scars. But I don't wish that as much as I used to. I just don't think about it very much. Job interview, first date- yes, I am in long sleeves. But not for long.
I think it is the right decision. And it is better than taking klonopin every day.
Today at work a patient asked me about the scars on my arms. I really need to get better at responding to those questions- enough people have asked. I know he knew what they were. I just told him it was the past. And then he started talking about his depression. It was good.
It is the people who don't know- those are the people that I don't know what to say. Most of the people who ask do know, and it okay, and sometimes leads to a good conversation. But when someone asks me if I have a cat, I just say I used to (it is true). I haven't figured out what to tell people who ask about the scars on my arms and don't know.
My scars aren't too terrible- I have seen worse- but they are not invisible. There was a time I would not wear short sleeves, at least amongst strangers. At my first job we wore lab coats, which I loved. And then eventually I got tired of long sleeves, and I realized that I couldn't go through the rest of my life with long sleeves- I started wearing short sleeves. The first couple of years I was so self-conscious. I was always aware. No longer. I have finally gotten to the point where I really have forgotten most of the time.
So these days I am a little shocked when people ask. And really, why would you say anything? It is a little rude. Except I remember the patient who asked me if I used to cut and how I stopped. She wasn't being rude. She wanted to know how to stop.
I still do want to cut occasionally- but not all the time like I used to.. I haven't in at least a dozen years, I think it is behind me. I wish I could get rid of the scars. But I don't wish that as much as I used to. I just don't think about it very much. Job interview, first date- yes, I am in long sleeves. But not for long.
Wednesday, April 23, 2014
Frustration
I am back to taking klonopin in the afternoon. I didn't have the same anxiety today- I didn't go out for lunch as we stayed in for a staff meeting. Instead I felt irritable and depressed. Not tolerable if I was going to finish out the work day treating patients and doing notes. Perhaps tolerable if I could have been home in bed.
A quarter of a milligram helped a lot- and I almost wished that it didn't. I don't want to be taking this stuff again. But I don't want to feel like this. I thought, momentarily, that maybe I need to go back up on my lithium or zyprexa. And then I remembered that I have lost 10 pounds in the last month without dieting- and before this I was gaining despite my best efforts- and then going back up was no longer an option.
I'll find a way to make this work.
I have mood swings that are about things- and then I have mood swings that are just biological blips. These aren't about anything- it is frustrating- there isn't anything I can do to make things better. It is just spring.
Physical therapy actually wiped me out. They added a lot more exercises. Then I did the bike twice- the second time waiting for my therapist- who never came and someone else worked on me. But my back feels really good. They were good exercises.
I think I feel ready to go back to yoga- as long as I do not do a morning class. My back is still not good in the morning- but not like it was. Interestingly, the pain in my fingers is almost gone today- and my resolution to see a rheumatologist is wavering. But I have asked my step mother to find me the name of a good rheumatologist. I hope she can find someone reasonably close. And who takes my insurance.
Tuesday, April 22, 2014
Sunshine = Anxiety?
I am loving the spring weather. But sometimes I get a little hypomanic in the spring. And sometimes my hypomania will largely take the form of anxiety. Last spring I really didn't get hypomanic. But the past two days I have eaten my lunch in my car during work- and spent the hour soaking up the sunshine, listening to the radio. And then walked back into the office feeling like I was shaking inside- I was surprised that my hands weren't visibly shaking. I was so anxious.
Time to hit the klonopin again, two afternoons in a row. Just a quarter of a milligram- but still, I thought I was done with it for a little while. I have still been a little anxious when I get home, but manage not to take anything. And at night I take enough meds that it takes care of it so I can sleep.
I can hear my psychiatrist telling me- I should wear sunglasses- that they are "like sunscreen for your eyes." But where is the joy in that? The sun makes me feel good. Except when it doesn't. I'll have to find my sun glasses.
Unrelated- I am thinking of seeing a rheumatologist again. I have had two days of really bad joint pain in my hands again. I get this periodically. I have been tested for rheumatoid and lyme and had an x-ray of my hand and everything is negative- but I can't believe that this is nothing.
I think that part of the reason I never followed this further is the bipolar thing. I don't really want to have a lot to do with medical professionals- especially if I am coming with vague complaints- as I have been dismissed in the past as it is stress or because I am overweight, etc. I think a lot of doctors don't always take mental patients as seriously.
But mostly it is the intermittent nature of this- just when I decide I am going to see a doctor, my symptoms go away, and then I decide to wait. But I have met my deductible for the year, now is a really good time to go.
I might have waited- but my primary care doctor would not do the one blood test that I really wanted- for hemochromatosis. My dad is a carrier. It can cause joint pain. But she wouldn't order the test for iron overload. Although I wasn't really forceful either. That is what I want this to be- because these is an easy fix for this that does not involve taking any drugs- they just have to take blood from me periodically to get the iron load down.
There is a website that will let you order the test for iron overload yourself- and you take it to a lab- but why should I pay when I can go to a doctor and my insurance would cover it right now? I think if I am having joint pain and my father is a known carrier then it is indicated.
Time to hit the klonopin again, two afternoons in a row. Just a quarter of a milligram- but still, I thought I was done with it for a little while. I have still been a little anxious when I get home, but manage not to take anything. And at night I take enough meds that it takes care of it so I can sleep.
I can hear my psychiatrist telling me- I should wear sunglasses- that they are "like sunscreen for your eyes." But where is the joy in that? The sun makes me feel good. Except when it doesn't. I'll have to find my sun glasses.
Unrelated- I am thinking of seeing a rheumatologist again. I have had two days of really bad joint pain in my hands again. I get this periodically. I have been tested for rheumatoid and lyme and had an x-ray of my hand and everything is negative- but I can't believe that this is nothing.
I think that part of the reason I never followed this further is the bipolar thing. I don't really want to have a lot to do with medical professionals- especially if I am coming with vague complaints- as I have been dismissed in the past as it is stress or because I am overweight, etc. I think a lot of doctors don't always take mental patients as seriously.
But mostly it is the intermittent nature of this- just when I decide I am going to see a doctor, my symptoms go away, and then I decide to wait. But I have met my deductible for the year, now is a really good time to go.
I might have waited- but my primary care doctor would not do the one blood test that I really wanted- for hemochromatosis. My dad is a carrier. It can cause joint pain. But she wouldn't order the test for iron overload. Although I wasn't really forceful either. That is what I want this to be- because these is an easy fix for this that does not involve taking any drugs- they just have to take blood from me periodically to get the iron load down.
There is a website that will let you order the test for iron overload yourself- and you take it to a lab- but why should I pay when I can go to a doctor and my insurance would cover it right now? I think if I am having joint pain and my father is a known carrier then it is indicated.
Saturday, April 19, 2014
Very tired recently
I have been very sleepy the past few weeks. Normally I am not that sleepy during the day, now I am. I wondered if I am developing sleep apnea. But then it also seems to have started when I went down on my Zyprexa. And on the higher Zyprexa I was sleeping way too much, 9 plus hours a night. Now it is closer to 8 hours a night, and perhaps my body is just not used to that yet. So I am feeling sleep deprived, even if I am waking up on my own. I hope this gets better.
Last night though, I successfully fell asleep without any klonopin- I am now off of that. I still take ambien, but I am okay with that for now. I am okay with my meds for now I think. Not forever, but for now. Although if I wind up going down any further on my lithium in the near future it will be because I have gotten tired of cutting my pills- I can't find my pill splitter.
The good news is that I have lost almost 10 pounds since going down on my Zyprexa. And I haven't really done anything differently. I am always trying to watch what I eat, but I am on no kind of diet at the moment. Yesterday at work I found myself constantly pulling up my pants because they were loose.
I have things I need to do today- but I just want to do nothing. And tomorrow is Easter, so I have to do these things today. Tomorrow I go visit my dad.
But I also have something good today, too. I am getting a massage. It will be my first since I started having this recent bout of back trouble. I hope that it helps.
Last night though, I successfully fell asleep without any klonopin- I am now off of that. I still take ambien, but I am okay with that for now. I am okay with my meds for now I think. Not forever, but for now. Although if I wind up going down any further on my lithium in the near future it will be because I have gotten tired of cutting my pills- I can't find my pill splitter.
The good news is that I have lost almost 10 pounds since going down on my Zyprexa. And I haven't really done anything differently. I am always trying to watch what I eat, but I am on no kind of diet at the moment. Yesterday at work I found myself constantly pulling up my pants because they were loose.
I have things I need to do today- but I just want to do nothing. And tomorrow is Easter, so I have to do these things today. Tomorrow I go visit my dad.
But I also have something good today, too. I am getting a massage. It will be my first since I started having this recent bout of back trouble. I hope that it helps.
Thursday, April 17, 2014
Can't concentrate
I am having trouble concentrating recently- which is really what led to me going down on my meds. The problem is, it hasn't helped as much as I hoped. Sometimes I think it is even worse- because my mind is more distractible.
This is showing up the most with my paperwork- it wasn't too bad until I got sick and hurt my back and I haven't done a very good job with it since. I just can't get back in gear. What to do? How to get back on track?
I think I will try meditating in the morning, if only for a few minutes, before I leave for work. Maybe that will get my mind focused enough by the time I get to work. And just trying to be very mindful and present while doing my paperwork. Making sure I pull all of my charts first thing in the morning, it has to be a habit. And making sure I have my favorite pen!
Meanwhile I am wondering if my back will ever be the same- and I think not- although I have had periods of time in the past when I had a lot of back pain before. I think I am overdoing my extension exercises, and that is causing new pains to crop up- so I have had to back off some. Fortunately I am tolerating the flexion exercises pretty well. Hopefully I will be discharged from PT next week.
I was thinking today that I am so glad I made the transition to becoming a hand therapist. If I was still having to transfer max assist CVA patients on a daily basis- as I did when I worked inpatient- it would not be good. But given what I do, I can be having a pretty bad day with my back and still be able to do my job- I just watch how I do certain things and stand up a lot. If I was still doing inpatient if would be a disability.
This is showing up the most with my paperwork- it wasn't too bad until I got sick and hurt my back and I haven't done a very good job with it since. I just can't get back in gear. What to do? How to get back on track?
I think I will try meditating in the morning, if only for a few minutes, before I leave for work. Maybe that will get my mind focused enough by the time I get to work. And just trying to be very mindful and present while doing my paperwork. Making sure I pull all of my charts first thing in the morning, it has to be a habit. And making sure I have my favorite pen!
Meanwhile I am wondering if my back will ever be the same- and I think not- although I have had periods of time in the past when I had a lot of back pain before. I think I am overdoing my extension exercises, and that is causing new pains to crop up- so I have had to back off some. Fortunately I am tolerating the flexion exercises pretty well. Hopefully I will be discharged from PT next week.
I was thinking today that I am so glad I made the transition to becoming a hand therapist. If I was still having to transfer max assist CVA patients on a daily basis- as I did when I worked inpatient- it would not be good. But given what I do, I can be having a pretty bad day with my back and still be able to do my job- I just watch how I do certain things and stand up a lot. If I was still doing inpatient if would be a disability.
Wednesday, April 16, 2014
Modern society is not so great
We have a new copier/fax/scanner at work. It makes great copies. It is a lousy fax machine. We therapists do most of our own faxing and I nearly lost it today. I spent my second day trying to fax out an authorization for treatment- I tried a total number of 6 times, and I cannot get it to go through.
I asked the receptionist to call the company and see if we have the right fax number- but I think maybe I was taking out my frustration on her- I suspect we have the right fax number. But what else is there to do? Put it in the mail, I suppose.
I think our old fax machine would try multiple times if it got a busy signal or such- this machine won't. And so many of my faxes just don't go through. Not just once, but repeatedly.
Anyway, I now have two patients I am trying to fax out authorizations for and I can't get them out- I just left anyway because I had physical therapy. What am I supposed to do? How many times am I supposed to try in a day? I left my eval from today for the receptionist to fax out. Maybe she will have better luck.
I am not the only one having difficulty- but I think that I do more evaluations than anyone else, so I encounter more than my share of the problem. And today I just started feeling so anxious and irritable while dealing with it. I thought it would get better after leaving work- but I couldn't let it go. I took a quarter milligram of klonopin, eventually. I think it helped.
Maybe I need a new job. Maybe I need a place with better office support. Or at least a better fax machine.
It is the fax machine on top of paperwork on top of the new Medicare codes etc. All the things that take the joy out of being an occupational therapist. That take the joy out of life.
I asked the receptionist to call the company and see if we have the right fax number- but I think maybe I was taking out my frustration on her- I suspect we have the right fax number. But what else is there to do? Put it in the mail, I suppose.
I think our old fax machine would try multiple times if it got a busy signal or such- this machine won't. And so many of my faxes just don't go through. Not just once, but repeatedly.
Anyway, I now have two patients I am trying to fax out authorizations for and I can't get them out- I just left anyway because I had physical therapy. What am I supposed to do? How many times am I supposed to try in a day? I left my eval from today for the receptionist to fax out. Maybe she will have better luck.
I am not the only one having difficulty- but I think that I do more evaluations than anyone else, so I encounter more than my share of the problem. And today I just started feeling so anxious and irritable while dealing with it. I thought it would get better after leaving work- but I couldn't let it go. I took a quarter milligram of klonopin, eventually. I think it helped.
Maybe I need a new job. Maybe I need a place with better office support. Or at least a better fax machine.
It is the fax machine on top of paperwork on top of the new Medicare codes etc. All the things that take the joy out of being an occupational therapist. That take the joy out of life.
Monday, April 14, 2014
Not sleeping well- and feeling out of it
Between cutting down on my meds and the coming of spring, I am not sleeping well. Last night I managed to fall asleep, but then woke up super early- but of course then couldn't get anything done. It just made me really tired all day- and feeling more out of it than if I had been taking more meds! I can't win.
To make matters worse, I broke down and went to Dunkin Donuts during lunch and bought an iced coffee hoping it would perk me up. It didn't. It only made me anxious- and then I took a crumb of klonopin to take the edge off of that. Now I am home, and really want to take a nap. But I can't let myself- that will only make my sleeping worse. I am wondering how early I can try to go to bed for the night. I don't think I will make it to my normal time- but that is exactly what I should be doing. Good sleep hygiene and all that.
It really makes me realize- I have to stay where I am with my meds for the moment. Maybe trying to get off of the last tiny bit of klonopin in a week or two- but otherwise I need to stop where I am for now. Especially in the spring- the chance of hypomania is just too great. Or just sleeplessness- that can really mess with your mind. And I want more energy- today I had less energy.
The good news is that my back was pretty good today. And my patients were really delightful today. Even the one who is not doing his home exercise program... There is always at least one.
To make matters worse, I broke down and went to Dunkin Donuts during lunch and bought an iced coffee hoping it would perk me up. It didn't. It only made me anxious- and then I took a crumb of klonopin to take the edge off of that. Now I am home, and really want to take a nap. But I can't let myself- that will only make my sleeping worse. I am wondering how early I can try to go to bed for the night. I don't think I will make it to my normal time- but that is exactly what I should be doing. Good sleep hygiene and all that.
It really makes me realize- I have to stay where I am with my meds for the moment. Maybe trying to get off of the last tiny bit of klonopin in a week or two- but otherwise I need to stop where I am for now. Especially in the spring- the chance of hypomania is just too great. Or just sleeplessness- that can really mess with your mind. And I want more energy- today I had less energy.
The good news is that my back was pretty good today. And my patients were really delightful today. Even the one who is not doing his home exercise program... There is always at least one.
Sunday, April 13, 2014
A quiet day
I didn't do much today- other than laundry, which I got really behind on between being sick and my back hurting. And I cooked two chicken breasts- one for today's dinner, one for tomorrow's lunch- I am going to starting bring salad with chicken for lunch again tomorrow.
My back has bothered me a little- but I don't have PT until Wednesday so hopefully it will be better enough by then that we can start flexion exercises. I really want to get back to yoga- my body really needs it. Everything except back extension seems really tight- as I have just been doing all this back extension- and my body doesn't feel balanced. I did schedule a massage for next weekend- I will
have to see how that goes, and I have some tenderness still on my back.
I have to say that I am even more of a believer in kinesio tape. With all the back exercises I managed to strain a muscle on the back of my neck, and it wasn't getting any better after 3 days- despite heating pads and attempts at self-massage. Then Friday evening I put some kinesio tape on the muscle. I could feel it improving over the course of the evening. Saturday morning I woke up to no pain. Amazing.
Unfortunately I don't think taping would help my back, because I think the problem is not muscle, but disk.
It is Sunday night and I am starting to be in a bad mood that I didn't do more this weekend, etc. Tomorrow morning I will probably have my Monday morning blues. Even though I like my job. It is just that transition to back to work that is sometimes hard.
This week I see my therapist- for the first time in a while. I am down to every other week. Then I got sick. Then she was away the next week so I couldn't reschedule. Plus I had gone to a conference. So it has been either 3 or 4 weeks, I'm not sure which.
I don't have any pressing, burning issues to discuss. I think my fear about quitting therapy is that if I start to go downhill quickly, there won't be anyone there. I have my psychiatrist- but sometimes I get too depressed to call my psychiatrist (as in- I don't want to bother them and what can anyone do for me anyway). But, I'm not sure that this is sufficient reason to stay in therapy.
Getting off of the last of my klonopin is going well- I am down to an eighth of a milligram at night. I'm sure that there are still times I may use it prn, but I will be glad not to be taking any of it- no matter how small a dose- on a regular basis. I am going to give myself one week of this dose, and then try to stop- and hopefully I will still be able to sleep.
My back has bothered me a little- but I don't have PT until Wednesday so hopefully it will be better enough by then that we can start flexion exercises. I really want to get back to yoga- my body really needs it. Everything except back extension seems really tight- as I have just been doing all this back extension- and my body doesn't feel balanced. I did schedule a massage for next weekend- I will
have to see how that goes, and I have some tenderness still on my back.
I have to say that I am even more of a believer in kinesio tape. With all the back exercises I managed to strain a muscle on the back of my neck, and it wasn't getting any better after 3 days- despite heating pads and attempts at self-massage. Then Friday evening I put some kinesio tape on the muscle. I could feel it improving over the course of the evening. Saturday morning I woke up to no pain. Amazing.
Unfortunately I don't think taping would help my back, because I think the problem is not muscle, but disk.
It is Sunday night and I am starting to be in a bad mood that I didn't do more this weekend, etc. Tomorrow morning I will probably have my Monday morning blues. Even though I like my job. It is just that transition to back to work that is sometimes hard.
This week I see my therapist- for the first time in a while. I am down to every other week. Then I got sick. Then she was away the next week so I couldn't reschedule. Plus I had gone to a conference. So it has been either 3 or 4 weeks, I'm not sure which.
I don't have any pressing, burning issues to discuss. I think my fear about quitting therapy is that if I start to go downhill quickly, there won't be anyone there. I have my psychiatrist- but sometimes I get too depressed to call my psychiatrist (as in- I don't want to bother them and what can anyone do for me anyway). But, I'm not sure that this is sufficient reason to stay in therapy.
Getting off of the last of my klonopin is going well- I am down to an eighth of a milligram at night. I'm sure that there are still times I may use it prn, but I will be glad not to be taking any of it- no matter how small a dose- on a regular basis. I am going to give myself one week of this dose, and then try to stop- and hopefully I will still be able to sleep.
Saturday, April 12, 2014
A curious thing
There is this new cardiovascular risk calculator that has been developed to tell doctors if they should put someone on a statin drug or not. From what I have been reading, age trumps just about everything else in the calculation. Just out of curiosity, I found it and tried my information.
I was told that I have less than a one percent chance of having a heart attack in the next 10 years- which is fortunately too low to be prescribed a statin. But I was a little bit stunned. No where did they ask for my BMI. Doesn't that matter? Isn't that part of why I need to lose weight- so I don't drop dead of a heart attack? But all they wanted to know were my age, gender, cholesterol numbers, and blood pressure numbers. And that I don't smoke or have diabetes.
Of course they didn't ask if I have a mood disorder- which is a huge risk factor, perhaps as big a smoking. So I think my chance is really higher. Not to mention the meds which I don't think do good things. But to not ask about weight as a predictor- that was really surprising. I wonder if they are right. Of course there are so many other ways that being overweight is bad for you- even if it doesn't give me a heart attack.
I was told that I have less than a one percent chance of having a heart attack in the next 10 years- which is fortunately too low to be prescribed a statin. But I was a little bit stunned. No where did they ask for my BMI. Doesn't that matter? Isn't that part of why I need to lose weight- so I don't drop dead of a heart attack? But all they wanted to know were my age, gender, cholesterol numbers, and blood pressure numbers. And that I don't smoke or have diabetes.
Of course they didn't ask if I have a mood disorder- which is a huge risk factor, perhaps as big a smoking. So I think my chance is really higher. Not to mention the meds which I don't think do good things. But to not ask about weight as a predictor- that was really surprising. I wonder if they are right. Of course there are so many other ways that being overweight is bad for you- even if it doesn't give me a heart attack.
Still the people pleaser, even as a patient
I am feeling like a failure because my back pain isn't all gone. I had PT yesterday, and he was talking as though I should be be doing really good this weekend, and then probably next week I will be pain free so we can be starting with flexion and then I can be discharged fairly soon.
I really do like that plan. I just hope that my back goes along with it. But today my back has not felt very good- I think worse than yesterday. And even then- the first half of the day my back is pretty sore. I don't have the sharp pain like I did in the beginning, I am not in agony, it just feels sore. I think that this soreness may take its time to go away.
By evening I usually feel pretty good- and I have PT in the evenings. When I see him I am doing well and can tolerate everything that we do. But first thing in the morning, when the disks are their largest, it hurts. Not like it did- but it hurts.
However, I don't think I have to stay in PT until the last bit of pain is gone. That might take a while! Just enough so that I can get the exercises to do on my own. My pain isn't really stopping me from doing anything at this point except going to yoga and changing the way I pick things up off the floor. I need a reacher!
When I go back to yoga, I will stick to evening classes. It will be safest for my back.
Speaking of classes, I saw something that got me really excited: a pottery studio with pottery classes. I did pottery as a kid and loved it. I'd like to do it again. I don't know what I'll do with the stuff I make- but it would be fun. Unfortunately, I just missed the beginning of classes. I think they might start up again in June.
The other thing I'd like to do eventually is to take piano lessons again. So you see, I have to finish PT, so I will have time for other things! And so my insurance company doesn't knock my off- because they are actually having to pay for this- I have met my in-network deductible and out-of-pocket maximum.
My Provigil, alas, I have to go pick up today. The price didn't drop last month. It has to drop eventually, doesn't it?
I really do like that plan. I just hope that my back goes along with it. But today my back has not felt very good- I think worse than yesterday. And even then- the first half of the day my back is pretty sore. I don't have the sharp pain like I did in the beginning, I am not in agony, it just feels sore. I think that this soreness may take its time to go away.
By evening I usually feel pretty good- and I have PT in the evenings. When I see him I am doing well and can tolerate everything that we do. But first thing in the morning, when the disks are their largest, it hurts. Not like it did- but it hurts.
However, I don't think I have to stay in PT until the last bit of pain is gone. That might take a while! Just enough so that I can get the exercises to do on my own. My pain isn't really stopping me from doing anything at this point except going to yoga and changing the way I pick things up off the floor. I need a reacher!
When I go back to yoga, I will stick to evening classes. It will be safest for my back.
Speaking of classes, I saw something that got me really excited: a pottery studio with pottery classes. I did pottery as a kid and loved it. I'd like to do it again. I don't know what I'll do with the stuff I make- but it would be fun. Unfortunately, I just missed the beginning of classes. I think they might start up again in June.
The other thing I'd like to do eventually is to take piano lessons again. So you see, I have to finish PT, so I will have time for other things! And so my insurance company doesn't knock my off- because they are actually having to pay for this- I have met my in-network deductible and out-of-pocket maximum.
My Provigil, alas, I have to go pick up today. The price didn't drop last month. It has to drop eventually, doesn't it?
Wednesday, April 9, 2014
When less is more
I cut back my lithium from 900mg to 750mg 3 days ago. I had taken 750mg for a year, and then raised it to 900mg during a mixed episode a few months ago. But I have really felt flat recently- so I went back down to 750mg, and I feel so much better.
The only problem with this is that it will drop me out of the therapeutic range- I was at 0.6 at 900mg. So if I want to stop the Zyprexa eventually, I may not be taking enough lithium to stabilize my mood. I hope I haven't shut a door. I could always go back on Tegretol, but I'd rather not. But these are future concerns. For the moment, I feel better.
I also feel better because I got my voice back today! I can talk again. It is an amazing thing. And my back is so much better- in physical therapy we started to progress things. My back still feels sore sometimes, but the sharp pain is gone. I can move. I can tie my shoes without pain.
I also had my annual performance review at work and it went really well. It was a good day- and I needed a good day. I have been feeling pretty bad recently, although I think that it has mostly been because I have been sick.
The only problem with this is that it will drop me out of the therapeutic range- I was at 0.6 at 900mg. So if I want to stop the Zyprexa eventually, I may not be taking enough lithium to stabilize my mood. I hope I haven't shut a door. I could always go back on Tegretol, but I'd rather not. But these are future concerns. For the moment, I feel better.
I also feel better because I got my voice back today! I can talk again. It is an amazing thing. And my back is so much better- in physical therapy we started to progress things. My back still feels sore sometimes, but the sharp pain is gone. I can move. I can tie my shoes without pain.
I also had my annual performance review at work and it went really well. It was a good day- and I needed a good day. I have been feeling pretty bad recently, although I think that it has mostly been because I have been sick.
Sunday, April 6, 2014
Sometimes it is better to ask for forgiveness than permission- didn't some general say that?
I have not been feeling right recently. I've lowered my zyprexa to 5mg, which hasn't fixed things the way I had hoped. (And I hoped that was the only surprise I'd have to spring on my psychiatrist). But tonight I am lowering my lithium too. Not by much- when I was taken off of lithium cold turkey in the past I got incredibly manic. And I'm not trying to get off of it all. But I think that my last increase was a mistake- and more than I needed for my depression. I was going into a mixed episode- but I could have handled that with a temporary increase in meds.
Three months between visits is a very long time to expect a patient to keep their meds the same. And I really don't want to call him unless things are really bad. And really, what can he tell me? I have to figure out on my own what works for me. It is all trial and error. Pretty sad that psychiatry can't do better than that.
But this is why I pay for an out of network psychiatrist. So I don't have to go to some clinic where I sign a paper saying I will follow my treatment plan and take my meds as prescribed. Or go to some psychiatrist on a power trip who will freak out if I cut back my lithium by half a pill. No, I go to someone sane who doesn't freak out with a patient with her own ideas- the one actually taking the pills.
Three months between visits is a very long time to expect a patient to keep their meds the same. And I really don't want to call him unless things are really bad. And really, what can he tell me? I have to figure out on my own what works for me. It is all trial and error. Pretty sad that psychiatry can't do better than that.
But this is why I pay for an out of network psychiatrist. So I don't have to go to some clinic where I sign a paper saying I will follow my treatment plan and take my meds as prescribed. Or go to some psychiatrist on a power trip who will freak out if I cut back my lithium by half a pill. No, I go to someone sane who doesn't freak out with a patient with her own ideas- the one actually taking the pills.
I don't want to do anything
I am not depressed, just feeling like I don't care, don't want to move, have no drive, etc. I hate feeling this way. I think that part of it is meds- and that is why I obsess so much about them. Maybe also it is worse recently because I have been taking naproxen for my back this past week, and that can raise lithium levels. So maybe it is even worse than usual.
And then it can't help having a very long and very bad case of laryngitis (I still can't talk very much), and add to that a bad back.
I don't want to go drive to Costco to pick up my Provigil. If I cut a couple of my pills in half, I can stretch it out until next weekend. So that is what I am doing.
And watching TV- the new opiate of the masses. My new opiate. Because I wasn't watching my serious stuff like BookTV on C-Span2. No- I was watching 3 episodes of Game of Thrones because this weekend it was free on Comcast. It is good stuff- enough to make me consider getting HBO, but I really don't want to increase my cable bill. For one person, it is hard to justify.
But while I was watching Game of Thrones, I wasn't thinking about global warming, or the effects of technology on workforce participation, or peak oil, or the next pandemic. None of which I can do anything about anyway. Watching was just pure escapism.
But that is my view of my the future: your average computer will be smarter, your average human will be dumber, technology is not going to solve our ecological problems but it sure will do a great job of keeping us entertained.
And then it can't help having a very long and very bad case of laryngitis (I still can't talk very much), and add to that a bad back.
I don't want to go drive to Costco to pick up my Provigil. If I cut a couple of my pills in half, I can stretch it out until next weekend. So that is what I am doing.
And watching TV- the new opiate of the masses. My new opiate. Because I wasn't watching my serious stuff like BookTV on C-Span2. No- I was watching 3 episodes of Game of Thrones because this weekend it was free on Comcast. It is good stuff- enough to make me consider getting HBO, but I really don't want to increase my cable bill. For one person, it is hard to justify.
But while I was watching Game of Thrones, I wasn't thinking about global warming, or the effects of technology on workforce participation, or peak oil, or the next pandemic. None of which I can do anything about anyway. Watching was just pure escapism.
But that is my view of my the future: your average computer will be smarter, your average human will be dumber, technology is not going to solve our ecological problems but it sure will do a great job of keeping us entertained.
Saturday, April 5, 2014
No energy today
Today I have just felt tired and lethargic. Maybe it is that virus that is still zapping my voice- but the world seems very gray and blah. I did manage to take my car in for new brakes, do a load of laundry, and a whole lot of back exercises. Otherwise I didn't do much. I napped and watched 3 episodes of "Helix" on demand.
That was the last three episodes of the year! OMG that was a good show, and I can't believe that I have to wait until next year to see what happens next.
So I guess I could get into something today. I also spent the morning while waiting for my car reading a sci fi book, "Lexicon," that is really good- a really interesting premise. It has been a sci fi day.
I want to go to church tomorrow, but not if I have no voice. If I have no voice, I just don't want to be around anyone. I am tired of trying to talk- and I mean TRYING to talk. As in not succeeding very well.
Tomorrow is my big shopping day- I have to go to Costco to pick up my Provigil and I will shop while I am there. And I have to get a haircut. I really have to get a haircut. My bangs are in my eyes, it just isn't good. I just wish I looked okay without bangs- because I always go too long between haircuts and then it wouldn't matter so much- but I don't think I do. And the one time I tried to cut my own bangs it didn't turn out very good.
I want to go walking tomorrow- maybe outside, maybe at the gym, I don't know. But I have to exercise. Too much sitting today. And I think that it will feel empowering to walk, too, after all the pain I have had with my back. I still do have some when I first wake up- but it goes away so much faster now. It is nice to know that exercise can fix some things. Yes, I see it in my patients- but it is nice to see it in me!
This morning I did my medicine/supplements for the week- I have this huge pill box that I put everything in. I take a lot of supplements- but I think that, for now, I am totally satisfied with what I am taking. Sometimes I think I want to take more vitamin C and E than is in my multi, but I think you can get too much anti-oxidants and I am already taking a lot of things. The only other supplement I have really thought about is DHEA, but I would only do that if I was having my levels tested- so I would have to find a doctor who would do that. And I am not sure about DHEA. But some studies have found it useful for depression.
In terms of my meds, I am not sure. I am still taking a quarter of a milligram of klonopin at night, in addition to the ambien- I'd like to stop that. I just have to have a few days when I can afford to be really tired from not sleeping well. And I can't seem to find a good time. I was thinking I wanted to stop the ambien- and I realized why- because it looks bad to be taking both ambien and provigil. Although, I was taking ambien before I ever took provigil, and I have taken stimulants before when I was not taking sleeping pills. But some doctors don't want to give you both a stimulant and a benzo or hypnotic. But my doctor is okay with it, so why am I worried? Because I have had a lot of doctors in the past who have given me problems with different things.
I still haven't figured out my Zyprexa position. Whether I am okay at 5mg or want to try to go lower and if so how long to I wait. I guess there isn't a rush to decide.
Friday, April 4, 2014
My back is getting better
I still wake up with a lot of pain- I pull on my dresser to get myself out of bed- but today the pain was mostly gone by 9am- previously it had stuck around until the afternoon. I am very diligent about doing my exercises, and they really work.
I had three PT sessions this week. I like my PT a lot. Through the mysteries of medical insurance, I am not paying anything out of pocket for my physical therapy- it is late enough in the plan year for me (which turns over in July), that I have hit my in-network deductible and out-of-pocket maximum. But I have yet to hit my out of network deductible, so I am still paying for my psychiatrist and my therapist.
I am still having laryngitis, it is really getting to me. I think my back will be fixed before my voice!
I asked about the gym- I can go back and do cardio. No weights yet, but I'm okay with that. No yoga yet- but he said soon. It's funny how now that I can't go to yoga I really want to go.
I had three PT sessions this week. I like my PT a lot. Through the mysteries of medical insurance, I am not paying anything out of pocket for my physical therapy- it is late enough in the plan year for me (which turns over in July), that I have hit my in-network deductible and out-of-pocket maximum. But I have yet to hit my out of network deductible, so I am still paying for my psychiatrist and my therapist.
I am still having laryngitis, it is really getting to me. I think my back will be fixed before my voice!
I asked about the gym- I can go back and do cardio. No weights yet, but I'm okay with that. No yoga yet- but he said soon. It's funny how now that I can't go to yoga I really want to go.
Wednesday, April 2, 2014
Maybe this is a good thing?
I feel like my current episode of back pain is a wake up call. I've had back pain before, but I've finally had enough episodes to realize that it is becoming recurrent. And that to keep it at bay I am going to have to take better care of myself physically- which means regular exercise, and also specific exercises that I hope to learn in PT. But I realize that I just have to exercise.
In PT I think I got forgotten about and was on the bike for 20 minutes. And it felt good! I need to exercise not just for my body, but for my mind. I forget that. Exercise- of the right kind- makes me feel good. Cardio tends to make me feel good. So does yoga. Weights- not so much.
So if I could do the bike in PT without too much back pain, then I can do it at the gym. I hope I am up for waking soon- I have to get in shape for July 4th when I do a 10K (I walk it of course). Last year I did it with no preparation but I'd rather prepare this year!
I just hope I get over this virus thing that I have- and I hope that I get my voice back soon. I saw my doctor again today, who prescribed me a steroid nasal spray. I can't take most cold meds because of all of the meds I take, but this should be okay. She gave me the "it's just a virus" story again. And I am sure that she is right. Half my co-workers are sick. But they can talk. I still have this really bad laryngitis.
I needed to buy gas today but decided to wait until tomorrow because it is just too hard to talk. By the end of the day I really had nothing left. This is very frustrating. I keep seeing how the behaviors of being physically sick overlap with depression. Well, depression is associated with inflammation in the body, so there are physical similarities as well.
In PT I think I got forgotten about and was on the bike for 20 minutes. And it felt good! I need to exercise not just for my body, but for my mind. I forget that. Exercise- of the right kind- makes me feel good. Cardio tends to make me feel good. So does yoga. Weights- not so much.
So if I could do the bike in PT without too much back pain, then I can do it at the gym. I hope I am up for waking soon- I have to get in shape for July 4th when I do a 10K (I walk it of course). Last year I did it with no preparation but I'd rather prepare this year!
I just hope I get over this virus thing that I have- and I hope that I get my voice back soon. I saw my doctor again today, who prescribed me a steroid nasal spray. I can't take most cold meds because of all of the meds I take, but this should be okay. She gave me the "it's just a virus" story again. And I am sure that she is right. Half my co-workers are sick. But they can talk. I still have this really bad laryngitis.
I needed to buy gas today but decided to wait until tomorrow because it is just too hard to talk. By the end of the day I really had nothing left. This is very frustrating. I keep seeing how the behaviors of being physically sick overlap with depression. Well, depression is associated with inflammation in the body, so there are physical similarities as well.
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