Perspective

My dad needs cardiac surgery. After his stress test he was told that he needs an aortic valve repair. He is asymptomatic, but it will only get worse. So his is scheduled for a week and a half from now.

Depression is so selfish. I just focus on myself, I can't look outward. I hate that about depression. I don't mean to be selfish, it just happens. I want to be there for him. I certainly don't want to be a source of stress.

But today's phone call also made me realize that my dad is not going to be there forever. He is 83. A very fit and active 83, who only just stopped his consulting work a few months ago. But no one lives forever, and no one gets out of this alive.

I had actually had a better day today. I think the increased Zyprexa is helping. It also helped that it was my shorter day today, so that by the time the agitation started really getting to me it was time to go home and I didn't have to take any klonopin.

So I'm glad I was in this better place when he called.

I have decided that if I can't get my insurance company to pay for my Provigil (or for Nuvigil) that I will pay for it myself. It is down to $520 as of last weekend, and in a few months it will be lower. In the meantime I will put off moving to a full-sized apartment for a year, give up my monthly massages, try to pack lunches sometimes (when I am not too depressed), and will give up my therapist for an in-network therapist come January 1. I love my therapist, but I will no longer have out of network benefits, and damn it I want my insurance to pay for something.

I will keep my psychiatrist. There are hardly any psychiatrists who take insurance near me, and I like him. And I see him rarely enough that I can afford to keep him.  Plus he can see me before work so I don't have to use PTO.

I am going to get a couple of days off for my dad's surgery. That is not how I thought I'd be taking my next vacation, but such is life.

The bad thing about depression- when there is nothing that you want

There is absolutely nothing that I am looking forward to. Nothing that I want. I can't imagine what might feel good. Well, there is one exception: since the Zyprexa increase I have had a bit of a sweet tooth and food is a little bit of enjoyment- but not even one that I am supposed to give in to. So what is fair about that?

What I want is for my life not to crash, not to fall apart. I guess that is what I want. I guess that is wanting something. But maybe it is just because I don't have a plan B- I can't imagine another life, a better life. So I try to hold on to what I have. Maybe what I need is a better imagination.

The Zyprexa is helping, but making mornings hard

I wake up in a decent mood now, but really tired. So I do my light therapy, drink my coffee, take my Nuvigil- and if I have enough time I go back to bed for another hour. Then I wake up feeling okay. But on the days I go to work early, there isn't time for this.

My first 5 years as an OT I always worked the same hours every day. I think that was really good for me. My last two jobs I have had different hours on different days, and I really think it has been hard on me. It has made it that much harder to create any kind of routine in my life- between that and my changing moods. So in that respect, outpatient has not been good for me.

We might be losing an OT at one of our sites due to the flu shot mandate. She works 20 hours a week. A part of me thinks- what if  took her job? What if I went down to 20 hours/week? But I don't think I can afford that. Especially if I am not approved for Provigil. And I am only guessing that fewer hours at work would make me happier- I don't know that. Maybe I'd spend all of those extra hours in bed?

If they do let her go, there might be more pressure on me to become lymphedema certified, because that therapist is. I don't know if I want to do it. Well, definitely not now. Not until my meds and my moods are straightened out. But I don't know if I want to do it in general.

I wonder what my moods have in store for me today. I seem to be going through so many mood shirts in a day recently. I have a good moment and I think I have turned a corner- and then the next moment I can't stand to be in my own skin. It is exhausting. I just want it to settle down.

Insight

I had a patient crying in therapy today. Her surgery is not what she expected. No one told her how difficult the recovery would be (the surgeons rarely do). She thought it would be a walk in the park. I had to be the bearer of bad news- the time in the cast is often the honeymoon period, when there is very little pain. When the cast comes off, you find out what is really going on.

And it is the unexpectedness and urgency of my provigil problem that has completely thrown me. I thought I had this figured out. First when I was getting it from overseas. Then- and I had time to figure it out- from Costco. And it was generic. The price could only go down. I was already cutting down my therapy to every other week to afford my Provigil.

I was caught off guard, just like my patient. I didn't know about the massive price increase until I was down to my last few pills, not even a week's worth. I just panicked and had a tantrum and got depressed.

And I still am- panicking and tantruming and being depressed. And I really don't want to be this way, but I don't know how not to be this way. I am back to seeing my therapist once a week- this is already costing me money! I should be trying to get in with my psychiatrist a little bit sooner- but I keep waiting, thinking I will hear something. Because until I know what the decision is, I don't even know what I need to see him for. I don't know if I will need to be looking at other stimulants or not.

Right now the lowest price I can find for Provigil is $520, and it just dropped last week, so it probably won't drop again for awhile. In theory I could pay it for a while- but starting in January I have no out of network benefits and I have an out of network psychiatrist and therapist. Something would have to give.

My last two therapy sessions my therapist has asked if I had to go the the hospital. And I have to admit, the thought has crossed my mind as well. But I just don't think there is anything they can do for me there- it would just annoy me. And I just want to go to work. I think that if I were to be in the hospital twice in a little over two years- that would be too depressing to bear. So I have upped my Zyprexa, which has helped some, and am taking more klonopin than I'd like- but still not a lot (I'd rather be taking none).

I just keep thinking- if I can keep going until the weekend. I don't know what then. Crash, I guess. My last hour at work today I felt so depressed I thought I would pass out, if that makes any sense. But I keep going because it takes less effort than to reschedule patients and tell my boss I am leaving early (and why), etc. So I just keep going.

There are no gold medals for getting out of bed.

No medals for going to work when depressed. No Emmy awards for best impersonation of a sane person. Sometimes I think that there should be. 

Today was hard. It started out less hard, I think because I had more Zyprexa on board from taking extra yesterday- or maybe not. Who knows. I just know that I felt more agitated and irritable as the day went on- and then these wore me out and it turned into severe exhaustions along with the depression. I thought about leaving early- but never got the chance, patients kept coming. I thought I would run out of there at the end of the day, but people kept talking to me. And all the while, I was trying to do my best impersonation of a sane person.

I took charts home to finish- what was I thinking? I haven't touched them. The minute I got home I took half a Zyprexa and half a klonopin. I had drugs that make me feel less bad- but no drugs that make me feel good. I guess that is how it should be- you don't want to be getting your joy from drugs. But sometimes I'd just like to remember what good feels like, even if it comes from  pill. Because life isn't being very obliging. 

No news on the Provigil front. Last time I got a denial letter pretty fast from my insurance company. But so far no letter. I feel like I almost don't even care anymore. I am just tired of it all. I just feel so wounded, and I don't know how to make that feeling go away. How did I get so un-resilient? They could approve me tomorrow, and it would be too late. I am wounded, and I don't know how to heal. That is the scary thing- I really don't know how. 

I finally got out today

I had brunch with my dad and stepmom at a diner midway between us. Afterwards we went to Costco (irony of ironies), and I picked up some groceries. It was good to get out- until it wasn't. I just started feeling too bad with the gnawing in my stomach and my irritability. But at least I won't starve.

I came home and took half a klonopin and half a Zyprexa- and I am so surprised at how little effect this has had on me. OK, the klonopin I have been taking a lot of all week, maybe I am getting a tolerance- but the Zyprexa? I've only taken it a couple of times this week, and I don't really get a tolerance to it like that.

I tried watching a movie- I actually rented it from itunes, "The Zero Theorem," but it only annoyed me so I didn't get very far. A waste of money. What I really want is ice cream. Vanilla ice cream. Or even a milk shake. But not badly enough to go and get any- and I try to not keep that kind of stuff around.

I wish I knew the way out of this. Do I just have to wait it out? Take whatever meds I need to do to keep me sane until it passes? And then I read about ketamine infusions- rapid, almost instantaneous relief from depression. Not covered by insurance, of course, but what is these days? But even worse- the relief is short lived. It doesn't last. What a tease.

I guess the good news is that I do still want there to be an answer, a way out. A way to go on living. A way to have a life worth living. I just don't know if there is an answer for me.

Maybe it will start with vanilla ice cream. Maybe I will make it to the convenience store down the road. Good nutrition can wait.

Another school shooting

They say he was depressed. Two people on CNN were actually debating the wisdom of the advice "fake it 'till you make it," some of the earliest advice I was ever given when dealing with my depression. They said that in this case it failed. I'm not surprised.

A part of me can understand what he did- and that is scary. When I am severely depressed, my anger is usually not focused on any one person (although if an Aetna executive goes missing tonight I suppose I might be a suspect). But generally it is just anger at the world. The world that keeps going, and keeps expecting me to keep going, even though I am dying inside. I just want everyone to shut up. Laughter hurts. Asking me how I am doing or what I did over the weekend- when I spent it in bed- just go away. And I certainly don't want to hear all of the wonderful things that you did while I am wasting away. And I get irritable- I have no patience for anything or anyone.

But the difference is, I wouldn't do it. I'd like to think it is because I am not a violent person. But perhaps it is just because my depression stops me from acting- I shut down. I don't go and do things, certainly not anything as active as shooting people.

The day was harder than I expected. I had to take extra meds. I spent it mostly in bed- but did do one load of laundry- how many weeks has it been? I went to the mailbox, but no notice yet from my insurance company about the Provigil.

I thought I'd sleep with everything I took, but I didn't.

I have thought about cutting- and this is pretty funny. Now that I am an OT and remove sutures and do wound care, I find myself thinking that I need to sterilize the razor blades first. So maybe the whole thing isn't a good idea.

Strange but good

I have found a website that tracks the best prices on medications. Last week- even last night- the best prices for generic Provigil at 60 200 mg pills were around $750. As of this morning, multiple stores have lowered their prices by about two hundred dollars. Just like like that. Perhaps there was a delay in updating the site? Or did so many of these stores decide, en mass, that is was time to lower prices? I don't know- only that this is a good thing.

Meanwhile, Costco has removed the price for Provigil from their pharmacy website. They don't have a price for Nuvigil either. This makes me think that they want to get out of the business of prescribing controlled substances. Perhaps that was the reason, or at least a part of it, for their rate hike.

I'm not sure what I am going to do with meds if my Provigil is denied. I think maybe ritalin is worth another try- the worst side effect I can remember with it is anxiety- not psychosis or tachycardia like the other amphetamines. And on/off effects, but there are longer acting version of it. I just need to know that a $40/month option isn't going to work before I break down and spend $500/month, or whatever it winds up being.

This morning I cut my Nuvigil into quarters and only took three quarters. The whole pill felt a little strong yesterday- I normally spread out my provigil over the course of the day, so taking all 250mg of the Nuvigil felt like it was just a tiny bit too strong. So far so good. And that would help to defray costs just a little bit.

I can't decide which I like better- Nuvigil or Provigil. They feel slightly different. I think Nuvigil feels slightly more like an amphetamine. And I really like the fact that I only have to take it once a day- I am not taking medication in the middle of the day. But in the end, I will go with what I can afford.


I am looking forward to the day when this is figured out and I can think about something other than meds!

The ultimate insult

I saw a commercial today by CVS Health- which  discusses the fact that many Americans never take their prescription medications- and that they can help. I think with reminder programs.

No discussion of the fact that medications are ridiculously expensive. If your drug isn't covered, as in my case, it is really hard to take that drug, and no number of reminders will help. And even if your drug is covered- with these high deductible plans that we are increasingly pushed into- before I reach $2000 (and next year $2500), I am basically paying for my meds out of pocket. Only then do I start to pay copays.

And then of course narrow networks are in. So I, like many, am finding that next year the doctor who prescribes my meds isn't even covered. And finding another psychiatrist in my area who takes insurance can take months. If I want to change. So really, taking meds is a big financial commitment. And it means not doing other health promoting things like seeing my therapist every week and getting massages every month.

Will CVS give me a better deal with Provigil or Nuvigil?  I'd be more compliant.

I'm trying to figure out what I can afford to pay. It looks like I can get Nuvigil for a little under $500 a month, which is still less than 2 generic Provigil 200mg pills. They feel different, but I can't decide which I like better. Nuvigil goes generic in 2016, but if it is anything like Provigil its price won't fall anytime soon after that.

I feel like I've robbed a bank

Yesterday I came home with a bottle of 30 pills of 250mg of Nuvigil- that I got for free. There is a coupon that you can get from the internet that gives you a month of free Nuvigil- with a prescription, of course. And up to $50 off your subsequent prescriptions for a year.

I had enough reason left to find this website and get the coupon and call my doctor and have him call in the script. That is about all the rationality I had left. Oh- and I faxed him a pre-authorization form, because he couldn't get one from the insurance company, it was busy every time he called.

It hasn't helped that I have been cutting pills. So I couldn't tell what was situational vs. biological, but I have been pretty bad- but very confused. Slipping in and out of occupational therapist mode and crazy person mode. Who am I? I don't even know. And I was taking so much klonopin- quarter milligrams multiple times a day to get through the day. And benedryl at night.

Today I have been much better. Is it the Nuvigil? Is it the fact that I have 30 days to figure things out? Probably both. And I didn't even take any klonopin today. Not that I was fine- I really wasn't. I am still irritable. By the end of the day I couldn't stand still. But maybe that is klonopin withdrawal. But I didn't feel like I needed klonopin.

What was strange was not taking my middle of the day Provigil- I am so used to it. As I was eating lunch, I had this urge to take a pill- because normally I have to be so vigilant about it so I don't forget to take it. It felt like an itch that I couldn't scratch. But I finally got over it.

I am so tired now, I feel drained by everything that has gone on. I want to find out what is happening so that I can appeal if necessary. I think that I have a good case to make. I think that anyone who has been on over 30 psych meds plus ECT can make a good case that they need to stay on something that is working very well. The problem is I don't have dosages and dates, etc. I am 47, I have been on meds since the age of 19. Who would? Especially someone with a mental illness? But that is what they ask for.

Meanwhile the world has gone mad. CNN can hardly decide which shooting or stabbing to cover. The Ebola case in NYC is no longer major news, given everything else happening in the world today.

My therapist earned her money today

I was really a wreck today. I was not in a good place at all. My therapist helped to get me a little bit unstuck and less willful. She got me thinking more about actions I can take.

What has been intolerable has been not knowing what is going on with my authorization. I have to make phone calls tomorrow to follow up. And I will probably have to break down and buy some pills so I don't run out by Friday. That is just too soon- I don't know what is going to happen yet.

And maybe I need to make an appointment with my psychiatrist to talk about other options- but first I need to see how this plays out.

The fact that I can now even think like this- is thanks to my therapist. I was just stuck all day. I wasn't feeling like I could do anything, like I wanted to do anything. And I was sure that I wasn't going to be buying any Provigil- I just couldn't bring myself to do it- even though I have room on my credit card. I was going to let myself melt into a puddle of depression this weekend and hope that I would come out on the other side.

Maybe I won't be so calm tomorrow. Today was really hell.

Work grounded me today

I can't say that all was well today- but I didn't feel quite as crazy as I did on the weekend. I tried to be mindful and stay on task and I succeeded quite a bit- but not entirely. I did have my moments when I just wondered why I was bothering and tears would start to well up in my eyes. But then I would tell myself to stop thinking and get back to what I was doing. It kind of worked.

I stopped by the hospital pharmacy today to ask them to transfer my Provigil prescription from Costco. I called my psychiatrist to let him know that he would be contacted regarding an authorization for the Provigil- that I wanted to try again. That the price had more than tripled at Costco. And why I didn't think I was a good candidate for an amphetamine.

What more can I do? Just wait. That isn't very satisfying. I think that even if I do get authorization, damage was done, so to speak. This weekend I feel like something broke inside me. I don't know how to fix it. And of course, if I don't get authorization, then I was right. The whole world hates me and wants me dead.

It is all too much. I think I will go to sleep.

I don't want Monday morning to come

I have spent all weekend crying. I don't want to face everyone at work on Monday, and have everyone at work ask me what I did over the weekend. It isn't fair. It should be enough, if you are depressed, to get yourself to work and do your job. Having a good story about what you did over the weekend shouldn't be a part of the job requirement.

This Provigil thing has just pushed me over the edge. I can't stop crying. I do for a little bit, I pull myself together and tell myself I will do certain responsible things- and then the next minute I lose it. And I swear I will stop all my meds, etc. But I don't think stopping my meds is going very well because I have been having to take extra klonopin and Zyprexa just to make it through the moment. So much for mindfulness and DBT. What I really want to do is cut, more than I have in years. I can't believe how out of control my emotions feel, it scares me.

It is too bad it is winter. I have been thinking that I should quit my job and hike the Appalachian Trail. Clearly my life is not going well. And clearly I need to learn more life skills, like resilience. Plus- maybe by the time I came back, the price of Provigil would have dropped! But it is winter and if I quit my job I can't think of anything to do on the cheap.

I am too far behind on my paperwork- and my apartment is too much of a mess- for the ultimate out. But I have had some moments this weekend when those were the only reasons I could come up with not to.

Work will be good for me, I know that. Going to work on Monday will help to get my mind off of things. And hopefully I will get it together enough to work on the Provigil problem.

Why this provigil thing has me so upset

I know I could try an amphetamine again. It's not like I want to live forever. It is more the principle- knowing that I am taking something that gave me tachycardia before... I have already made my peace (sort of) with taking Zyprexa which has made me obese and will sooner or later give me diabetes. The lithium will probably take a toll on my kidneys. The benzodiazepines I have taken increase my chance of getting dementia. Antidepressants and anticonvulsants greatly increase the change of osteoporosis. And then- to go back on the drug that gave me asymptomatic tachycardia, which I only caught because I was playing around with the pulse ox one day at work, that is too much. My PCP already thinks I have enough cardiac risk factors to need my cholesterol numbers to be lower and probably need a statin. What will she say if my resting pulse is 114?

And then there is the fact I went psychotic on dextroamphetamine. Really seriously paranoid.

So I have my reasons not to want amphetamines.

And yet, during the period between going off of stimulants and discovering Provigil, life was really hard. I can think now. Maybe I am still not the best at paperwork- but so much better than I would be. I passed the CHT exam. I can think. I can focus much of the time. I can work. And I don't feel drugged- unless I have been taking klonopin or extra Zyprexa. If I lose that, I wouldn't want to work. I don't even know if I could work full time. And work is really all that I have going for me right now. My life is that pathetic.

Ritalin is worth looking into again, I suppose. I can't remember serious problems with that- other than anxiety and the on/off feeling it gave me. There are longer acting versions- but none that will last all day. Perhaps with the Zyprexa on board the anxiety wouldn't be so bad. Or perhaps without the Zyprexa I wouldn't need a stimulant. I can't help thinking that.

And then there is the fact that the manufacturer of Provigil paid off the generic companies to delay making generics- and that is why it is still so expensive after all this time.

And then there is what Costco did- raising the price from $276 to $900. Of course it is their right, and they were way under market- but why would you? I don't think your neighborhood drug dealer would more than triple the price of your favorite drug in a month without a good story.

Anyway, I have done very little today except cry and take the drugs that I swore I wouldn't take because I hate the fact that I take meds. I hoped this would bring me sleep, I hoped it would knock me out. It didn't.

Monday I will call my psychiatrist and have him try again to get it authorized. If it does not, I will appeal. If I lose, I don't know what I will do. I might have to take a leave of absence to figure out medication options- whether that be getting thru the withdrawal of the Provigil and seeing if I can handle life without a stimulant or trying to find a stimulant that I can both afford and tolerate. I know from the last couple of times I have run out of Provigil that it will get really bad that first week without it- and I have never lasted longer than that so I don't know what is on the other side.

Right now I have enough until next Friday, if I skip a couple doses. Then the fun begins. Unless, of course, my insurance company comes around. But I don't want to get my hopes up.

On the other hand, if they do decide to pay for my Provigil, I will even forgive them for dropping out of network coverage next year- although that is admittedly a hospital decision, not an insurance decision.

I don't know what to do again

I had phoned in my refill of Provigil to Costco-and I just got a call from the pharmacist. He wanted to know if I still wanted to fill the script- because there has been a price increase. Last month I paid $275 for it. This month it will be $900.

Well, so much for Costco- I can get it cheaper elsewhere- but not a lot cheaper. The cheapest I can find for my two 200mg pills will cost close to $800. I can't afford that. I could try Nuvigil- but the higher dose is still pretty pricy, and I think that is what I would need.

I know I should break down and try the amphetamines again. But I don't want to. My doctor is talking about putting me on a statin- why would I want to risk tachycardia again? Plus, the on/off was so dramatic that I couldn't deal with it. Plus I got psychotic on dextroamphetamine- although granted I was on a large dose and already manic.

If coffee didn't give me heartburn, I could just drink coffee all day- but it does, so I have to watch my coffee intake. I am looking at natural stimulants- but I am guessing that if any of them could really replace provigil they wouldn't be legal.

I know what would really work- but it would take so much time- and probably a leave of absence, that is wouldn't be worth it. On high dose Parnate I didn't feel the need for a stimulant. But to switch antidepressants, and to an MAOI, would be a big deal.

I was looking at the medical criteria for Provigil on my insurance site. They particularly say that use for depression is considered experimental and is not supported by peer reviewed literature. So I don't think another appeal is going to get me anywhere.

My health insurance company hates me and wants me dead. I know that is personification, but that is how I feel. They just took away my therapist and whatever small coverage they had for my psychiatrist.

I don't know what I am going to do. Maybe I can find another overseas pharmacy- but the FDA has really been cracking down on them.

It never gets better

Every job change I have had has had worse health insurance. And within each job, every time there has been a change in the insurance plan, it has been for the worse. The new plans came out for next year- we now have our choice of two options- but neither includes out of network coverage. They took that away. Neither my psychiatrist or therapist take insurance.

50% of psychiatrists do not take insurance, it is the highest percentage of all disciplines. And in my state the number of doctors-of all kinds-who do not accept insurance is very high. There are hardly any psychiatrists around who take insurance, and the waiting list for those who do is many months. But at $150 every 2-3 months, I think I will stick with my doctor. My therapist is another matter. And I am sure that there are good therapists who take insurance, but I can never seem to find them. I found one- but then she left for maternity leave. Most have been, at best useless, at worst really bad. So I think that as of December 31st, I will be done with therapy for a while. I guess they got what they wanted- they cut costs.

The high deductible option will still be there- with $500 added to the deductible and no more out of network coverage. The other option is an HMO which is no bargain either. There is still a high deductible- but is doesn't apply to doctor visits or prescriptions- there are co pays for these, and these copays are high. $60 to see a specialist (like a physical or occupational therapist, for example- imagine 2 times a week). And for the HMO I would need a referral for all care- which would annoy me, but I don't think would be too hard to get. I have a good doctor.

I think the HMO would save me money- and I wouldn't have access to any more doctors with the high deductible plan. The downside is that there is no health savings account attached to it. So when I try to figure out what is in my financial best interest, my head starts to spin. Shouldn't they teach this in schools? And I really don't like the idea of an HMO. And I feel very sorry for all of the PCP's who have to write referrals. They must have something better to do with their time.

Not a great day for medical news

America has its first Ebola case- that was contracted in the US. And it was a healthcare worker who knew the patient had Ebola and was using protective gear. This is not good. Too many healthcare workers are getting Ebola- here and abroad.

When I do inpatient I sometimes have to wear a gown and gloves. Once, when I was a student, I had to wear a mask as well because I was doing an eval on someone with TB. I was terrified. But really, if you think about it- gowns may not be enough. If someone has sneezed and there are droplets on the floor- you could get your shoes contaminated, etc. Any part of your body that is not covered with protective covering is at risk. So many ways that this could all go wrong. And apparently it has, at least for one nurse.

On a more personal level, I am wondering why the end of life has to be so hard. My grandmother broke one of her vertebrae- and things have been really bad ever since. Her pain is not under control- except when it is, and then she forgets she was in pain. The pain is making her more confused and agitated and more difficult. I don't know if they are going to be able to continue to keep her at home- but my mom has finally agreed to have someone come to the house- but they can't start until later next week.

Part of the problem is lack of continuity of care- my grandmother sees a gerontologist at a major university clinic- but the doctors keep leaving and the clinic keeps moving and reorganizing- so that there was no one they could call this weekend about pain medication because she is seeing a new doctor next week. And I'm not sure that there is anything that they could have called in, anyway, as they are all controlled substances.

I wonder if an antipsychotic would help her. I could send her some of my Zyprexa! Or maybe she will be better if her pain is managed better. Or maybe she just can't stay at home anymore. My mother really wants to take care of her mother at home- but it might be the behavioral aspect of things, rather than her declining health, that makes this not possible.

Another day of struggle

The depression was there today again. I got up late, didn't take a shower or even eat breakfast- hoping that my morning cup of coffee with a lot of milk could tide me over until lunch. I did make it to work just on time. And work did go pretty well- except that by 11am I thought that I would pass out from hunger.

Today is mental health day or week or something like that. I think I have compassion fatigue when it comes to these illness-awareness days. I was supposed to wear pink last week I think- but I didn't. Does mental illness have its own color? It ought to be black- but then everyone would just think you are from New York City.

Do we need more awareness of mental illness? Do these days really reduce stigma? I don't think they do. Not for serious and persistent mental illness. I think this manifests in two ways. Of course there is potential discrimination on the job, from dates, friends, etc. And then there are the other people who will tell you that you are not really mentally ill because you are working and living on your own.  I guess we are not supposed to get better.

What has my interest right now is the Ebola news. I don't think- for the near term- that the US is at risk of a significant outbreak. I think the biggest worry is that it will not be stopped in West Africa and will become endemic in this area, with a huge loss of life and a constant threat of infection spilling out to other areas. Because the economy will go so bad that people will migrate for work, as well as medical care. And it will become just awful in this area.

I have also been reading that India may be next in line to get Ebola, due to crowding and lack of medical infrastructure in places. I hope this doesn't happen. I really hope we get a vaccine. Before the economy crashes.

I have to admit- I have a patient who is recently back from west Africa. And I mental calculated that he had been here over 21 days before I saw him. Safe!

Hard day but a good OT moment

The depression was definitely worse today, and I couldn't be so philosophical about it. But I did have one moment at work that broke through it- getting out a golf club and balls and having a patient with a very painful arm do some putting. A good occupational therapy moment. Purposeful activity. I wonder if I can get my hands on a tennis racket.

I think I might have a UTI. Maybe that is the source of my recent fevers. I felt feverish towards the end of the day- but then I took some naproxen and I felt better- my mood felt better too. But I just couldn't get myself to the support group- I just wanted to go home. To no food- I had milk and m&m's for dinner- it was a very yummy dinner actually.

I did three eval's today and I didn't finish writing up any of them. All of the eval's had complications. The mallet finger patient with a lag- so we will try more splinting. The tendon repair patient who came in with no splint. The patient who comes in and it seems totally like something rheumatological- but the MD wants to try therapy before doing bloodwork. Sometimes I don't understand doctors.

This weekend I am going to a Bat Mitzvah for my step niece. I am kind of dreading it. But I really should go. I don't even know what I am going to wear. But I guess I have something.

I think today was a little better- but I am still down

I think my mood has taken a dive- and I am trying to ride it out. I know that if I am depressed, I need to be gentle with myself. But there is a fine line between taking it easy on myself and turning into a blob! For today, though, I let myself use dry shampoo and skip the shower. I tried to be present at work and focused on mindfulness. I just did what I could do. And I think that it helped. Or maybe it was just the truly delightful fall weather that we have outside right now.

Focus on little things. The radial nerve palsy splint I made today that came out well. The new shoes I bought- all black running shoes to wear at work- which are the most comfortable shoes I have ever worn. And try to forget that I thought about quitting when they told us that we have to fill out more checklists to make sure we have done certain things- just another step and all of these steps add up.

Tomorrow I am going to walk before work. Just a mile, but something. Because I really need that. It is my late day tomorrow to go in, so I have to do it. And for my sanity- it is going to be a really busy day. I have to make a splint, do 2 evals, and I am double booked quite a bit. My schedule has gotten really hectic because Mondays I am at inpatient, so I have to see all of my patients in 4 days.

I want to try to get myself to the support group after work tomorrow. It is a little hectic- I have to leave exactly on time and I still get there a couple minutes late (I hate being late). But I want to try it again and see if it is useful. I could use the socialization.

More than Monday morning blues

I woke up really depressed and had the hardest time getting out the door. I figured it was just Monday morning blues- some Mondays I am depressed. Not that I don't like my job, I am just bad with transitions I think. But usually I feel better as the day progresses. Today I didn't.

By lunch I realized that it wasn't going away. The darkness accompanied me the rest of the day until I could finally clock out and run home. I needed to do some grocery shopping- instead I just stopped for milk and some cookies- I needed comfort food. I'll have some lentils later. At least I had vegetables at lunch.

I know I should go for a walk or something. I just feel so tired. Maybe in the morning before work.

I have to get through this.

Sweet Friday

Friday's are always good. It is my shortest day of the week, and I know I have the weekend coming up- and I always feel so light and free at work. It was also a good day because I had a student job shadowing me to get observation hours so that she could apply to OT school- I have that a lot- but this one was really enthusiastic about what she saw, and I think she might want to go into hand therapy.

Otherwise it has been a week with a lot of discharges and a couple of really interesting patients- but if you are a patient, you don't want to be interesting. You want to be boring. These people are really involved or have unusual things that don't have clear treatment that works.

Today I have finally felt pretty much over my cold, although my throat still feels a little funny. Otherwise I am okay. Physically. I am a little anxious and my thoughts are a little loud at times- I think this is a consequence of going back down on the Zyprexa after taking too much for a week. Or maybe of starting light therapy.

My thoughts aren't exactly racing- but I just feel the weight of all of the knowledge in my head. Like I don't want to think anything, because I know that anything I think is connected to all of these other pieces of knowledge/memories, etc. which are just going to follow and it just all feels so heavy and I think I can't bear it. So this evening I took a quarter milligram of klonopin. The past couple of days I have been taking benadryl, because I have hoped it would also help with the cold symptoms. Oh, and I have been a little talkative too. For me. Probably for someone else, it would not be! But I am usually quiet.

But it hasn't been bad, I'm not too off. I think it will quiet down pretty soon.

I am supposed to go on a nature hike tomorrow, but it is also supposed to rain, so I don't know if I am going. And the last few days my left ankle is really bothering me- and I don't know why. That is not the bad ankle. I kept blaming my shoes- but it doesn't matter what I wear. I think the only thing that would help is my hiking boots. So for tonight I put on my Jimmy Copper ankle compression sleeve- that I bought for the other ankle. It seems to be helping a little bit.