Tuesday, September 30, 2014

At least it's not Ebola

That's what I said to myself today when I was feeling miserable with my cold, or whatever I had. I actually said that to myself. Not imagining that this evening I would see the news that America has its first Ebola patient. I knew it would happen eventually, just not now.

I almost called out sick today- but after a long, hot shower I felt so much better I went in. But I'm not sure it was the right decision, I was feeling pretty bad by later in the day- but no coughing or sneezing on patients- I only sneezed once. I just had to keep running to the bathroom to wipe my nose or blow my nose. And of course lots of hand washing and purell. But I was really miserable.

A lot of people are sick at the hospital. And they are getting flu patients already. From what I hear, they are going to enforce the flu vaccine mandate this year. The only exceptions will be medical- per CDC- or religious- with a note from some kind of priest.

I don't really think there should be religious exemptions. It gives people with a religious objection an advantage over people with non-religious, yet deeply held objections. So if your religion tells you that you can't eat any animal products- well, there are atheist vegans too. But they would have to get the vaccine. And I don't know what other religious objections there are, unless you worship the devil. Does your religion tell you that you should get sick and infect your patients? If you think that the vaccine doesn't work or is bad for you, well, there are a lot of non-religious people who think that too. That is not a uniquely religious objection.

We might lose some staff over this. There is no good evidence showing that vaccinating the staff reduces flu in patients in long term care facilities (and you would be less likely to demonstrate the effect in the hospital because length of stay is so short that by the time the patient gets the flu, they have been discharged). But maybe it has some small effect. And it makes the hospital look good to Medicare.

I hope I feel well enough to go in to work tomorrow. So much to do. So much that didn't get done today- I just survived. Sometimes that is all that you can do.

Monday, September 29, 2014

The very worst thing I did today

Today I had to put the restraints back on an elderly lady with dementia after putting her back to bed. Supposedly she hits people. She didn't hit me. The PT and I had her up to evaluate her- she just wouldn't do anything we wanted her to do. Not her fault, it's just where she was. So we put her back to bed, instead of letting the aides do it, to see her transfers and bed mobility. And then we had to put on the restraints. And leave her- alone- in a hospital room. Although once she had the restraints on she kind of just shut down, like she knew she wasn't going anywhere. She didn't try to fight them at all.

So I guess I have no right to complain that I am having a miserable day. I woke up feeling so depressed I actually thought about calling in sick for a moment. And then I realized- I am getting sick. My throat hurts. My nose is running. I feel feverish. I made it through the day with some aleve, but I am starting to feel worse as the day goes on. I hope I am okay to go into work tomorrow. I really have to see patients. But if I am going to sneeze all over them, of course I am not going to go in.

I almost went to go get a flu shot today- they were giving them at occ health this afternoon. And then I remembered that you can't get one if you are sick.

Sunday, September 28, 2014

Just thinking about family

My grandmother is 94. Her mind is not good and my mother lives with her and takes care of her. A couple of weeks ago she broke her wrist. Then last week she was in the ER again due to severe back pain- she was sent to an orthopedist. She is scheduled for an MRI next week because they can't decide if there is a new spinal fracture or if it is old from the x-ray- and it takes a while to get MRI approval from Medicare. Meanwhile she is on codeine, lidocaine patches, and still in pain.

I started wondering if she is going to make it to 95 in May. Maybe this is her time. Maybe it should be her time- she says this herself. I don't know. My mom thinks that my grandmother is depressed. My mom thinks that my grandmother will live forever.

She won't take my advice- getting some help in the home. Start now, before grandma needs it too much, so that grandma will get used to it. But she won't get anyone, I don't think she wants anyone else in the home. And this gets me so upset that I try to stay out of it a lot. Other than moving down south, there is really nothing I can do other than listen to my mom, who is really overwhelmed.

And yet, I don't know what she will do with herself when my grandmother is gone. This is her purpose. I would like her to move up here- but she won't. She has said as much. And I am the bad daughter- I will not move to be near her even if she starts to need me. I have too much keeping me in the northeast- and don't like the area she lives in. But at least she will have some family in the area if she stays.

I hate generics

I keep getting Zyprexa that look different. I think that last week I was taking 7.5mg pills, which are smaller than the 5mg pills that I recently filled (from a different company). Granted, I should have been paying better attention to what was on the bottle and not looking at the pills to see what I was taking.

No wonder I was so tired and hungry last week. No wonder I couldn't get out of bed in the mornings. I thought it was the seasons changing. And I would come home and go to sleep early too. And I was SO HUNGRY! I thought I would pass out between meals. Just the seasons changing I told myself.

Last night I only took 5mg. And I didn't sleep that well, even after taking benadryl in addition to everything else. But my mood seems to be okay- I am not crashing or agitated or anything. Hopefully I wasn't on  the higher dose for long enough for this to destabilize my mood.

But I really never went into a deep sleep last night, or at least not for very long. I just remember being awake most of the night. I thought I would nap this morning, but I can't. Which I suppose is good. My daytime sleepiness is better. Yesterday I couldn't stop napping.

Saturday, September 27, 2014

The seasons are changing, and so is my mood

Earlier this week my mood really started to dip. I finally started doing my light therapy. But the problem is- when I feel depressed I don't want to get out of bed in the morning- so then I am late and don't have time to do it before work. But I finally have got myself to do it. I also have this alarm clock that wakes up up by slowly turning on a light. The problem is, the last time my mother was here she unplugged it to clean, and I haven't set it back up. It is a pain to program, and I keep forgetting until I am too tired and in bed.

It is a lot harder to get out of bed now that the sun is not there to wake me up. I love waking up with the sun- and the birds.

I have signed up for a yoga class on Monday, and a nature hike next weekend. So I will be doing something. Today I have felt like I am just recovering from the week. A couple of days this week I felt really feverish- I almost wondered if these were hot flashes, but I think I'm too young still plus I take the pill. And then I had chills too. One day I almost didn't make it through the day.And another day this week I had a headache so bad I wanted to cry, despite taking painkillers. So physically it wasn't a great week. And I have been pretty irritable too.

I did get some interesting patients this week- including the first case of pure anterior interosseous nerve palsy that I have ever seen. If I hadn't had to study for the CHT exam, I wouldn't have recognized it- because the doctor just put down some really vague weakness diagnosis. And I have a doctor requesting the new post-surgical Dupuytren's tension-free protocol that I have heard and read about- but never had a chance to do before.  And I have been having success treating a patient for trigger finger by immobilizing the DIP joint- something I am trying for the first time after reading about it and talking to a couple of therapists who are doing it.

We hired a new therapist, so my inpatient coverage days will come to an end, probably at the end of October. Which is good- I really don't like acute care anymore. When I did it at the hospital where I first works, we actually did comprehensive evaluations and- for selected patients- gave meaningful treatments. But we didn't see everyone. Here the OT's are really just there to write up the note saying where the person should go and what equipment they need. It is all about how many patients you can see in a day. I'm not that productive, I can't do what the last therapist used to do. So I am glad to stop doing it.

Time to go back and watch another episode of Dr. Who.

Monday, September 22, 2014

Hard to sleep last night- dragged all day

I don't know if it has anything to do with the lithium. But I am going back to 900mg, because I felt just as numb and out of it today. And I just don't want to think about meds for a while. I just want things to be set, and deal with what is. If I hadn't dropped a lithium that night, I wouldn't even be in this situation. My lithium level is not that high anyway, I'm not even in the therapeutic zone.

At work I did inpatient coverage today. The last place I did inpatient was a level 1 trauma hospital so I had a wide variety of patients. This is just a community hospital. Yes, we do get some hip fractures and joint replacements- but most of the patients are there because the are old. It really hit me today that if you are not doing pediatrics and you work in a hospital, you are doing geriatrics. In graduate school I did a subspecialty in older adults with my OT degree. But I wonder if it should be subspecialty- maybe it should be the norm.

The nice thing about outpatient is that I don't have to worry about discharge planning. Like the patient I saw today with a fracture who needs to go to rehab. But she is a caretaker, so she wants to go home. Or the older gentleman who has a little bit of cognitive decline and is probably a little bit of a fall risk but is at baseline- but if we sent everyone who is a fall risk to rehab then all of the rehabs would be overflowing.

I actually like doing inpatient- it is giving me a change. I just couldn't see the volume of patients that the regular therapist sees in a day. I'm not that fast. For us coverage therapists, they have lower expectations. I just did eval's today, no treats.

And good news on the iphone front- I may be able to get one for free. They are giving $200 rebates if you turn in your old iphone (and if it works). I think they will even take the iphone 4. That would be the price of an iphone 6 with Verizon. So I think I will get a new phone sooner than planned.

Sunday, September 21, 2014

Global stilling?

I read about a new threat to the environment today, global stilling. Apparently global warming is warming the poles faster than the equator, with the result being less wind in our future. This could affect insects, according to the article. I wonder how significant an effect it really is- probably not much yet. But what does this say for a future of wind energy? How much will it affect that?

I was reading an article today about a scientist who was predicting that we will discover life on other planets by the end of the century, and as always I thought that he was crazy and in need of a lesson in relativity. Because of the limit of the speed of light- and the unpleasant things that start to happen when you even get remotely towards that limit- we will never contact other civilizations. But then I started to think, maybe there is another reason. Maybe because by the time a species gets close to serious space travel, it has burned out its planet and gone extinct. And it might not be the greenhouse effect that gets them- all life doesn't have to be carbon based. Maybe global stilling gets them. Or some kind of effect that we can't even imagine.

I am feeling okay on the decreased lithium- just a little anxious but so far it is manageable. I haven't napped at all today, which is usually what I do a lot of on weekends. And I did two loads of laundry. Still, tonight I will go up to 750mg.

Tomorrow I am going to yoga after work tomorrow- something I haven't done in a long time. I will have an hour- or maybe even two because I am working inpatient- to kill before yoga, and I need to stop myself from going home. So I am going to the Verizon store to look at the new iphone 6. I don't think I am going to buy anything- but to look. My phone is the 4, and maybe 4 years old (ancient in the world of smart phones), but it still works. Besides the frugal aspect of me- there is the environmental part of me that says I should not upgrade my phone until this one falls apart. Although from what I have read, that may be what happens if I upgrade to the new operating system on my current phone. Planned obsolescence.

Let's face it, I do want a new phone. I just don't want to pay for one.

What do I do with this?

Last week I was thinking of going down on my lithium, but didn't. Then this morning when I was taking my meds I noticed that there was a lithium pill still in my pill box. I normally take 3 pills, so last night I only took 2. This was not on purpose. And I had noticed this morning that I felt lighter, better in some way. Before I noticed the lithium. I didn't know what to attribute it to. 

Do I keep with the lower dose? Go back up? Go up to 750 for a couple of weeks and then go back down to 600? 

Part of me feels like I should call my psychiatrist- that I don't want to be doing this behind his back- especially after last session. But I don't want to bother him with a phone call. Or have him tell me not to do it either. 

I'm not looking to get off of the lithium. It really did get me out of the horrible, very long depression that I was in. But I have sometimes wondered if I could get by with less, given that I have the Zyprexa on board for a mood stabilizer. Especially given that I struggle with numbness, lack of initiation, etc. More isn't always better. 600mg is often enough to augment antidepressants. 

But I also know- from experience, that going down too fast on lithium can be very destabilizing. 

I think I will try 750mg for a while. And see what happens. 

Just when I thought I was done with messing with my meds for a while. Except for the klonopin- I am almost off of it.

Saturday, September 20, 2014

My expensive day

I finally went to Costco to fill my Provigil prescription. I was totally out- I have been rationing this week. It is an hour drive almost each way, and I just can't get myself to go after work- and I have been away on weekends recently.

So I spent $275 on my Provigil. And $205 on groceries, toilet paper, and toothpaste. But I am pretty set for the month. I will have to go to the grocery store for milk, fresh produce (I can't eat enough to get through one of their containers before it goes bad), and a couple of items that either Costco doesn't sell or I want to buy smaller quantities of.

I expected decreasing the Provigil to make me tired and depressed- which is what it has done in the past. But yesterday I felt so numb, so unbelievable numb. I almost decreased my lithium, I thought I have to do something. But then I didn't. Today I only had half my Provigil in the morning- which was a problem- it made it hard to get out to go get more Provigil! I napped for a while and drank more coffee before I finally did it. And then, like a drug addict, immediately took my Provigil in the parking lot.

Yesterday I picked up my meds at the local hospital pharmacy. I have finally managed to get my psychiatric meds and primary care meds to refill at the same time. And I get three months of meds at a time. The bag they gave me was so big that I could have used a shopping bag!

I hate taking all of these meds. I hate that my doctor is thinking of putting me on a statin, and I am not sure about it. I think I want the blood test that tells you the particle size of your LDL. Supposedly if your triglycerides are super low, like mine, usually the LDL have large particle size, and are not so bad.

Wednesday, September 17, 2014

How I know I no longer live in the city

I hit a deer on the way to work this morning. It wasn't even a small road, and it was pretty close to the hospital. I totally didn't expect it- there was a car in front of me, I didn't see anything until the deer ran out into the road and leaped in front of my car. I slammed on the brakes- thinking it was going to be really bad- but I think that I stopped enough that the deer sort of bounced off the front of my car and to the side of the road where it staggered- and then I drove on so I don't know how bad it was hurt.

There wasn't too much of an impact on my end, but I had the weight of the car on my side. The deer probably didn't fare as well. And I found myself feeling very bad for hurting this creature, almost guilty.

But I had to get to work to treat a patient, so I really didn't totally process it. In fact, I didn't even realize at first that my car was dented- but it is. Somehow the deer managed to make sizable dents in the hood of the car. I don't understand the geometry of that. I could call my insurance company, but I am afraid of a rate increase, and I don't want to deal with it right now anyway. It is mostly cosmetic.

This afternoon, however, I crashed. I just felt really tired and exhausted and my back hurt. I left work as soon as I could, as soon as I finished with my last patient. Now I am home, snuggling under a blanket. I have to make dinner. I don't want to.

I am trying to figure out what to eat. I just had a physical, and my doctor doesn't like my cholesterol. It is a little bit unfair- if I didn't have hypertension- then an LDL under 130 would be fine. But because I do, she wants it under 100. My HDL is good. My triglycerides are good. My blood sugar is good. But my LDL is closer to 130 than 100. She doesn't know if I can get it that low without meds, she says that this is really hard- but she will give me six months to try.

I don't even know if I agree that my LDL needs to be that low- or that there is good research to support the use of statins in primary prevention in premenopausal women. I have to research this. Before I even think of going on another drug, I want to know what it would buy me in terms of preventing stroke or heart attack. Give me data.

Sunday, September 14, 2014

Good days

I have had a string of good days- which included two days at a continuing education course (it was really good, practice-changing), and two days at my brother's visiting with him, my niece and sister-in-law.

I felt more mindful, in-the-moment, than I have in a long time. My mind wasn't wandering. I was there. Although sometimes I thought I felt numb- still, I am not going to revisit changing my meds right now. I just need some peace.

I did have the sense, though, the past few days, that I felt grateful for these days, and glad to be alive for these days. Perhaps this is just a gift to prepare me for what is likely to be a very difficult week at work next week for a number of reasons- including being down a staff person until a replacement is found and rumors of a Medicare audit.

Meanwhile, my grandmother fell over the weekend and broke her wrist. The took her to the ER where she had an x-ray and was casted, she will follow up with an orthopedist next week. I wish I could be there. I asked my mom, was it just the radius that was fractured? Was it displaced? She didn't know, only that it was a wrist fracture.

Unfortunately, my grandmother already wants her cast off.

Monday, September 8, 2014

Ebola vs. ISIS vs. Russia

Which is the scariest? It is a scary world. But, perhaps because I work in healthcare, it is Ebola that has me a little obsessed. Everyone talks as though this flare up in Africa will die down, like the other outbreaks did. That it couldn't happen here. Perhaps I have watched too many movies to believe this. Not that I think we will have the same levels of disease here, but we might have cases. And I think that it will be a very long time before it goes away in Africa.

This is the proof that knowledge counts. That education counts. That you have to educate everyone, not just the rich or the boys. Ignorance is spreading the disease- ignorance just as much as lack of resources. I like to think that we are more knowledgeable in America, but I am not sure. There are people who won't let their children be vaccinated and people who don't believe in evolution (then how do you explain antibiotic resistance).  Not to mention that we have a whole political party that won't even discuss climate change. So maybe we are not that much better in the knowledge department.

I saw a talk on CSPAN by an author last week who stated that green energy was what killed the economies of Europe, and that green energy kills economy- so that if someone even wants to discuss global warming he won't even discuss it because he is in favor of people having a job. Which is totally illogical. You can say that you are going to pursue fossil fuels until the bitter end- but still want to know what it is doing to the environment, if only so to know how to prepare or mitigate it. To figure out whether we are going to be needing to do geoengineering (and how soon) if we use up all the fossil fuels available. But also, if you think that the economy cannot survive without fossil fuels- then it certainly cannot survive without energy. And you have better be planning for the end of fossil fuels if you care about your children and grandchildren. And that probably means alternative fuels.

But it is also possible that we might need to crash the economy to save the planet (or at least keep it habitable for humans)- something that even the left-wing politicians and mainstream environmentalists don't want to say. But that could be true too. But it is easier not to know that. They can't blame us if we didn't know.

I wonder if Ebola is related to climate change, or simply to deforestation.

Time to send my money to Doctors with Borders.

Sunday, September 7, 2014


I'm not really depressed, at least not in a clinical sense. Just struggling with inertia. The "a body at rest tends to stay at rest..." And having spent so much of my life depressed, I am used to not doing things, I am not in the habit of action. And on weekends this really takes over.

I have things I want to do- but then I find myself wondering why I want to do them. Because I am so used to putting things on my to do list because I "should" do them- whether it is exercise or getting out and socializing- and not because I have the desire to do them. I don't even know what I want anymore. But doing nothing isn't it either. Maybe that is just rebellion against all of the shoulds, and against all of the things that I have made myself do while so deeply depressed.

I want something to not feel like a should, but the truth is, any new thing I start is going to feel that way in the beginning, it just is. I will have to push myself to get out of this place. And the next depression will bring me back here, and then I will have to push myself to get out of it again.

I am doing laundry. I made it out of my apartment and outside and to the basement. It is pretty pathetic that this is an accomplishment. Tomorrow everyone is going to ask me, what did I do on my weekend? Do I want to tell them laundry? These questions that people ask- so personal. I hate it.

I took a shower. I did the dishes. No one would believe that these were accomplishments.

Saturday, September 6, 2014

The joys of reading

I spent the day reading. Last weekend I read the first book in a sci-fi trilogy, "Annihilation," which was really good. I then download the next installment, "Authority," which I haven't liked as much- but which kept the mystery going- I was hooked. So now I have downloaded the final book, "Acceptance." It is really good. I am 80% through (no page numbers on a kindle), but I think I have to go to bed.

It's funny- I have no idea how long these books are on the kindle. I think the last book is the longest, but that is just my feel. It doesn't tell you page numbers, just what percent you have read. And I think that it is taking me longer to read the last book, so it must be longer. Maybe the book description tells you the number of pages, or probably there is a word count feature somewhere so I could compare books based on the number of words.

But it was a good day. Not a productive day, but a good day. I am a binge-reader when it comes to fiction, I confess. I really shouldn't let myself start reading something unless I have nothing else to do. Non-fiction, or really boring fiction, I can discipline myself with- read bits of it at a time. But with good fiction- I just have to keep reading. I just want to know what will happen next. How the story will play out.

There is a part of me that wants to be a science fiction writer. But I really don't have any interesting stories to tell. Just ideas about our future to explore- and ideas without a story make for bad reading. So I am not not cut out to be a fiction writer. The only stories I write these day are why my patient needs occupational therapy treatment.

Friday, September 5, 2014

Very tired, but TGIF

I was so tired today. I didn't have the energy of yesterday- maybe that is why I wasn't bored. I just wanted to come home and collapse.

I think the past year, whenever I have a day like this- I start to think- is it my meds? Is there something I can change? But I have decided that, for the moment, no more changes. I have to stop my mind from going there, from seeing that as solution- I need to find other solutions. Eat better, exercise, start doing my light therapy, etc.

And it is not that I eat terrible- but it could be better. And the exercise definitely could be better. And I need to break down and buy a new mattress because I have back pain at night which is making it hard to get a good night's sleep. But once I am up, it is fine.

Tomorrow I am going to yoga. I really need to start making routines in my life. Saturday morning yoga needs to be one of them. It isn't until 10am, which is good- lots of time to get ready, do a load of laundry, etc. Everything I do is this momentous decision. I need to have routines. It is day X, that means I do Y. But easier said than done.

My to do list is very long as well. I need to start checking off some of those things. It had better be a productive weekend- next weekend I am out of town again.

I need to make my life less boring. I need to have more routine- but more excitement. More fun. My life wasn't always this boring. I need to do something to shake things up.

Thursday, September 4, 2014

A good paperwork day, not much else

I had some down time today at work and I was able to concentrate and get a lot of paperwork done. That was encouraging. I still have a bit to go- and a couple of really bad things I have been putting off dealing with, but I am starting to deal with the harder things. I did make progress. I could concentrate. That was good.

But good paperwork days are very uninspiring occupational therapy days. They are days when I wonder if I really like my work. Or why I bothered to learn all of the knowledge and skills that I have learned- just so that I could do notes?

I think maybe I am a little bit bored too. I did the CHT exam. What is next? I DO NOT want to do a clinical doctorate in OT- even though I could get a lot of tuition covered by my work. I think I am done with school. Do I want to become lymphedema certified? They would love it at my work if I did- but I am not sure that is what I want to do. Do I want to work at a hospital with a trauma center? With a hand center? I don't know.

Maybe it was just the day. Maybe tomorrow will be more inspiring.