I'm in a strange place (for me)

I'm doing better enough that I am actually thinking about lowering medications. I actually have already lowered my Effexor from 450mg to 300mg, and after a rough month I think I am in at least as good a mood as I was before. Should I go lower?

It is not that I don't have my down times- but there are things that meds can't help me with- except to get me through the moment. Like last weekend when I was so overwhelmed with everything I had to do I shut down and couldn't stop crying and took Zyprexa and klonopin. But the meds never really got me to be able to multi-task and prioritize and have the executive skills that most people have. They never helped my initiation. I have to work on that in other ways. DBT. Meditation. And when it gets to be too much, I run to my pills maybe- but that is better than taking higher doses all of the time and being too out of it.

I've also lowered my Provigil by half a pill. And the klonopin, which had been creeping up, is back to half a milligram a day most days- except for the days I am too wound up at the end of the day to sleep. Then I might take another quarter milligram.

I know that the key to this is doing it really slowly. I should stay where I am with the Effexor for a while. But the reason I think that maybe I should get off of it is that if I forget to take my morning meds (but I take my Provigil separately, so I usually take that one), I often feel better and have am less tired- until I start feeling withdrawal. I don't know why. Could it be the morning Effexor dose I am missing? The morning Zonegran? My blood pressure medication? I should experiment.

I also feel like I can't go off of the Zonegran unless I go off of the Effexor, or at least to a low dose of it. I once had a seizure- during a brief time when I was not on an anticonvulsant and just on lithium- and they said that it was from high levels of an antidepressant. So I am a little hesitant to take an antidepressant without an anticonvulsant, especially a high dose of one.

It is really nice to have a 3 day weekend with the holiday. Not just this week, but two weeks in a row. Plus we are closing early today, I think my last patient is at 1:30. Not too many people want to come to therapy on Christmas Eve.

Every year at Christmas patients give us food. This year must break the record. We have so much candy, chocolate, cookies, and cakes. It is unbelievable. And very sweet- in both meanings of the word.

Still moody, but at a higher level

I am doing much better. My lows aren't as low and my highs are higher. I am still moody, and my mood swings can be quite severe. Sometimes it is my fault- like the night I had wine and felt awful the next day, and then yesterday when I let myself run out of synthroid. And sometimes it is just the pressures of life that I am responding too as I am trying to get caught up from being depressed for so long and my mother and various other things. And sometimes I just don't know.

I still have trouble with initiation but it is a little better. And I still have trouble with energy but most days it is better, at least somewhat. I think those are the hardest things that I deal with.

I wish I had more weekend. Tomorrow I am going to a Handel's Messiah sing along, something I have always wanted to do. I am going with my day near where he lives. I sang it in glee club in college- well, some of it. And they will have scores there. I think it will be fun. But I am basically going to be losing the day (other than also making my monthly trip to Costco for my Provigil). I won't make it to church, I have been saying I would start going to church for advent. Last week I was at my dad's for his birthday. And now this. Not enough time.

Today I need a day at home, I really do. I had so much going on this past week- even though some of it good- I am still someone who needs to recharge. If I am really good I'll make it out for a walk. But I have mountains of laundry to do and so much cleaning to do.

My dream is to work fewer hours a week. I work 40 on paper (which is 42.5 including lunch). I have always worked 37.5 in the past, so this job is more for me. Plus I put in a lot of extra time with paperwork- and occasionally stay late to get in an urgent post-op patient in. 36 hours would still be full time, and that is what I really want to work- I think it would make a big difference in my energy and I could still afford to live on it. But it is not an options- they said that it would take hours away from the position and they don't want to do it. And really, that wouldn't mean there are less patients. We are a small department and I am the only full-time therapist at my site.

But things may change. Insurance is getting worse- I had a patient come in the other day with a $100 co-pay. She is not coming back. We may find that we are not getting enough patients to justify my hours. Especially during the slow season. And I could flex up during the winter when it seems to get crazy with all the wrist fractures from all the falls. But we also have a new hand surgeon- and although he is only at our site 1 day a week, that may be enough to keep our numbers up.


I think it takes more energy to create a life than to keep a life going. And I have no life other than work, and it has really been that way for many years. It has been hard enough to keep that going. I thought my next step would be church, but other things are getting in the way. I think that eventually I want to join a chorus- I just found out about two that are possibilities- you don't have to be wonderful singers who can sight read. And I want to take piano lessons again- but I don't think I can afford that plus therapy at the moment. I just started up therapy again with my old therapist who doesn't take insurance after two unsuccessful tries with in-network therapists. Now that I no longer have out-of-network benefits, I was hoping to find someone who took my insurance, but I don't have the patience to keep trying.

Setting the bar pretty low

I saw my psychiatrist last week and I told him how well I was doing. Afterwards I wondered if I had really meant it- I am still pretty miserable. But I realized  that I no longer want to kill myself, and haven't in the past month or so, and compared to where I was a couple of months ago, that is quite a bit of progress. So for me, not being suicidal is doing well, I guess. I hope that is not as good as it gets.

My mom is still doing reasonably well although the tumors are progressing and she is starting to have more digestive problems from not being able to absorb her food as well. She still thinks she can beat this, and is trying a lot of things. She feels overwhelmed, and I would to with all that she is doing. That is one of the reasons that I can't be there. I don't think she is going to beat this.

This week I had a mammogram. I am not even sure I believe in them with all of the recent research, but I did it. I decided, though, that if they found another thing that had to be biopsied or followed with ultrasounds that wasn't cancer that I was going to stop having them.

The violence in France is pretty awful. Extremist Islam is really scary. During the Reformation, Christians managed to kill off a third of the population of Europe using swords and bows. What will these Islamists do with access to machine guns, bombs, and weapons of mass destruction?

Back home

I spent almost a week at my mother's. My brother was there too. We had scheduled the trip because she was supposed to be having surgery this past week, but that had been cancelled after her last MRI. But we went anyway to support her and go with her for second opinions, to get her port put in for chemo, for her appointment with an alternative doctor, to organize and copy documents, etc. It was good that we went. And good to go away.

I feel like a bad daughter for saying that. But it wasn't even my mother that was the problem, it was my grandmother- who has a mean streak and I never got along with, and now that the is old and her memory is going when I get angry I can only feel guilty, I can't defend myself. And the drama in my family, between my mother, sister, and grandmother- who all live together- it just too much for me. I hate conflict.

I feel incredibly guilty that I will not be there next Thursday when she is supposed to start chemo. I don't have a lot of PTO left. I do have 12 weeks of unpaid PTO that I can take- but I don't want to take it too soon , because that is all that I can take. And if she is going to have 3 months of chemo and then surgery- I can't use it up all now.

I also have doctor and dentist appointments in September. And I am trying to save up money for unpaid leave. I have enough money for 1 month. I need two months more.

My boss asked me if I wanted to move to Atlanta. I felt like she was trying to get rid of me. I don't know if that was her intent or not. I feel like I should move there, I just don't want to. I don't like it there. Plus if I start a new job there I won't have any FML for a year.

I have to stay at my current job until January to get that little bit of a pension I will get, before they froze it and went to a 403b. I don't know if taking a FML changes that, if I would have to stay longer. I should ask HR. Also, with my implants, I think I don't get the actual teeth until March- so I will at least need to be coming back here until then.

When I have thought about moving, it has always been about moving closer to my brother and nieces. Never farther away. But for now I am staying put.

I can't imagine what my mom is going through

I am still trying to understand this. How is it that one month ago, in the hospital, they only saw the bile duct tumor- nothing in the pancreas in the MRI or other imaging. In fact things looked good enough that they thought they could wait on the Whipple surgery for her to have her knee fracture surgery first.

Then a month later another MRI finds pancreatic cancer that is so advanced that it is no longer resectable. Did it grow that fast? Was it a bad MRI in the hospital? Was it misread? I know, I know. MRI's don't show everything. I tell my patients that. But it is different when you are on the other side of that fact.

I also don't know what my mother should do. When it was bile duct cancer that hadn't spread- the surgery was a no-brainer. But now I don't know. Pancreatic cancer has pretty bad outcomes no matter what you do, do you want to spend that time getting chemo and surgery that might buy you a few months or at most a year or two if you are really lucky?

From what I am reading, there are two categories- and I'm not sure what category she is in. Borderline resectable might do okay with chemo first and then surgery. It might give her some time. But if she is in the locally advanced category, then even if they shrink the tumors enough to have the surgery- which is less likely- it won't even give her as much time.

And then mom really wants to go the alternative medicine route. And when it comes to pancreatic cancer, I am not sure I disagree. I don't think that conventional medicine has much to offer. Especially if you are not a surgical candidate.

But this is why we need a second opinion. And in the end it is her cancer, her life, and she is going to handle it the way she feels is best.

False hope

In the hospital my mother was diagnosed with bile duct cancer. They said that they caught it early and that they could take it out. Awful surgery, and no guarantee that there wouldn't be a recurrence eventually, but generally hopeful.

Now that has changed. My mother went to see the surgical oncologist and had another MRI. And she has a new diagnosis. Pancreatic cancer. And supposedly this is primary, and it spread to the bile duct. Somehow it never showed up on any of her previous MRI's, except as a shadow on the last one. But now there is a tumor. And the surgeon doesn't think he can get it all out, so there is no surgery.

He does want her to try chemotherapy and radiation, in the hopes that this will shrink the tumor enough to make it resectable. Then would do the surgery. But I don't know what the odds are that it will, or even that it will prolong her life.

I wish that I had been there. They didn't have the presence of mind to ask the right questions. It is so hard not living there.

Pancreatic cancer does not have a good prognosis. It is worse than bile duct cancer.

Yesterday I was a wreck. I left work in tears. Today I am mad. Mad that they didn't find this sooner, with all the doctors she has been to and emergency room visits for pancreatitis and pain. Mad that in the hospital they told us that this was something else- and something that they could operate on. And what I don't know is, if the MRI at the hospital was just unclear, or if her tumor has grown since then, and if she would have been a surgical candidate if they had done the surgery right away.

And I'm mad at all of the doctors who didn't want to give her pain medication over the past few months because they didn't see anything "structural" causing her pain on imaging when she really had pancreatic cancer.

Generic Zyprexa

I have been handling the higher dose of Zyprexa, 7.5mg, so much better than I have in the past. I am not as sleepy or flat or tired or even hungry. And I wonder if it is because I am on a new generic. They can vary quite a bit in their potency, up to 20% either way. Perhaps this one is not as strong. At least that is my theory. I hope they don't change generics on me again anytime soon.

The Zyprexa has helped my anxiety and agitation to the point that I am totally off of klonopin. That is a really good thing. I didn't realize how much it was affecting me, even those little bits I was taking. I still feel anxious, it is not like I don't, but I can stand it. I don't have to leave work or crawl into bed or take klonopin.

I am determined not to take anymore klonopin, but I also cannot imagine life without a prn med- which seems really pathetic to say. But having been out of control manic- there was a time I wouldn't go anywhere without klonopin in my purse. Just in case. I guess instead of klonopin I could use a little extra zyprexa if it came down to it.

The Zyprexa has helped my depression but not knocked it out- but I wouldn't expect it to. It is life. I have a lot going on. And it hasn't gotten me off of ambien either as I had hoped. At least not yet.

A part of me is still not okay with the Zyprexa increase- but I am okay with it for now. Maybe if I get to a place where I am getting a lot of regular exercise and have a lot of good things in my life I could take less- but not now. It will have to be. I will get fired if I can't get my notes done again. Curiously I am better with my paperwork on more Zyprexa.

Learning to wait

My mom's surgery isn't for another couple of weeks- for reasons that make sense, and yet- the more I read about this cancer, the more I wonder if it was the right decision to wait. And I wonder if the biliary stenting that was done to treat her jaundice was a mistake- if that could just spread the cancer as some suggest (but there isn't good data yet), and if they should have gone straight to surgery. But I don't even know if that was medically an option. Maybe her body couldn't have handled the surgery like that.

The prognosis for this type of cancer is not great, even when it is apparently resectable. But knowing a more precise prognosis will depend upon biopsies of the margins and lymph nodes. If these are clean, it is much better. There isn't a lot of published research out there on whether chemo or radiation help. Some of it is contradictory. It is just such a rare cancer.

Whatever issues I have with my mother, I just cannot imagine her not being there. There was a time when I thought that 74 was old- now it seems so young.

Hard weekend

I had a couple of upsetting things this weekend and wound up paralyzed, getting nothing done other than a load of laundry. And just now I had an upsetting conversation with my mother, and I want to turn off emotionally.

I believe in alternative medicine- I really do. But it isn't always enough. And when you need surgery, you need surgery.

My mom sort of believes in alternative medicine- but I really think it is more of a way of rebelling against conventional medicine rather than a full understanding of the alternatives. And she is rebelling right now.  I had called to tell her that curcurmin was good to take- that is has been shown to increase apoptosis of cells in bile duct tumors. Although I didn't know if she should take it now or wait until after her surgery.

And then she started going on about all the second opinions she wants- not from oncologists or surgeons but from alternative people. She is not sure about the surgery. She does not want to be pushed into this, rushed,etc. And allopathic medicine is out of date, there are better things out there that can strengthen her whole body, etc.

She doesn't know how lucky she is that this tumor is resectable. Most aren't. What is true is that, even when they take it out, more people than not will have a recurrence somewhere else. But if they don't take it out she will be jaundice again in a few weeks.

Yes I do think she should have a second opinion. This is major surgery with a long recovery. Is it needed? And is she really a candidate for it- is it really resectable?  Or has it already spread too far.

I should never have gotten my airline tickets this far in advance. I don't know if the surgery will take place as scheduled. And I just can't think about it. My mom is very stubborn and rebellious, as well as suspicious, especially when it comes to the medical establishment. I can't make her do things she doesn't want to do, she will just get more stubborn. I have to step away.

Waiting is the hardest part

My mother had her knee surgery today and it went well. Now on to the next surgery, the Whipple procedure- but that isn't until mid August. The surgeon wants my mother to get strong before the procedure and be in good shape going into the surgery. That is well and good, but I might not survive until August 17th. I just want the cancer out of her. And I want the answers that won't come until after the surgery- namely, has it spread. Is this cancer going to kill her, or will this surgery be a cure?

Meanwhile I continue to feel like I am going to collapse. I had been attributing it to stress- but now I think it is low blood sodium. It explains the headaches, the lack of concentration, nausea, the occasional muscle spasms, as well as the fatigue that makes me want to go to the ER- but takes so much energy away from me that I can't even call my doctor. I think I have been eating low sodium recently, drinking too much water between the lithium and the hot weather, plus Effexor can cause low blood sodium, and my IBS has been really bad so I have been losing fluids and possibly sodium that way.

So I dragged myself home and have been trying to eat salt. If I don't feel better soon it is probably something else.

And of course I am on the internet looking up bile duct cancer. I have to stop it. I'm no longer learning anything new. And it is so rare that there isn't even a whole lot out there. I didn't even know you could get bile duct cancer! I mean, sure, you can get it anywhere- but I had never given it a thought. I've had my breast cancer scares and I have been on my mom's case for not getting colonoscopies. But I never worried about bile duct cancer. It makes you wonder what is around the corner, and if it will be anything like what we are preparing for.

What are the odds?

The odds of a specific person having a specific rare or uncommon disease is pretty low. But I decided that there are so many rare diseases that odds are, someone you know will someday be diagnosed with something rare or at least uncommon.

Bile duct cancer is pretty uncommon. I see conflicting reports, but maybe 4,000-5,000 people a year in the US are diagnosed with it. And my mother is one of those people.

My mother was hospitalized for jaundice last week. After a number of tests and a procedure, they found a tumor in her bile duct. I was hoping there was some other explanation. And people were telling me I was being melodramatic and that she would be fine. But by the time she had the procedure I didn't know what else it could be.

The good news is that it does not seem to have spread. And she is a surgical candidate. She will be having the Whipple procedure next month. Hopefully there is no cancer anywhere else. This could be a cure. And yet, it usually isn't. When I look at 5-year survival rates, it is not encouraging.

I am so glad I was there. I was there for the other surgery, for her leg, that didn't happen. But they are going to fix her leg before the Whipple so that she will be stronger. It is a very taxing surgery.

Fortunately I think she has a really excellent surgeon. I was really impressed with the hospital.

It is hard living so far away. I am back here. And yet, I don't want to move there. I just don't. I used to think that she would move here some day- I hate to say this- but I used to think that after grandma died then we might have some good years here. And now my Grandmother might outlive my mother.

When misery is not depression

My mom is sick, really sick. I am miserable. I have not had one suicidal thought.

Pre-op testing showed that my mom had jaundice. She has had a lot of unexplained digestive issues for months, with a possible diagnosis of autoimmune pancreatitis- but that was never clear. She never had a colonoscopy because of a very long wait- it was supposed to be in a couple of weeks. I can't believe they didn't get her in sooner. Plus she has dilated pancreatic and biliary ducts- which is often seen with pancreatic cancer, only they didn't see any cancer. Still, she needs to follow up every few months because of the high risk.

So now this. I am guessing an obstruction of her bile duct. I just talked to her- the doctor said the blood work does not suggest autoimmune pancreatitis. And that was one of the better options. Now I am scared. She had an ultrasound yesterday, an MRI scheduled for today.

I have my tickets for Tuesday night- for the surgery she was supposed to have on Wednesday. It isn't going to happen. But I'll go anyway.

My dad is okay, now it is my mom

My dad is out out of the hospital and fine. Now it is my mom.

I was visiting her- I had some time off- and we were walking down town and she tripped and fell on the sidewalk. I asked her if she could get up and she couldn't- she couldn't put any weight on her leg. So I had to call 911. What did we do before cell phones?

There was an ambulance ride and a trip the the Emergency Room. It turns out she has a broken patella, and it is displaced so unlikely to mend on its own without surgery. She is on coumadin so they can't do surgery right away- she was discharged with a knee immobilizer and crutches which she couldn't use and a walker that I asked for.

I spent the next couple of days in full OT mode, trying to get her walking with the walker and transferring as best I could. It still wasn't good. And getting into and out of the house- which has steps- was a nightmare. I ordered a wheelchair ramp (from Amazon.com, of course). She lives with her mother and sister- so she doesn't live alone. I hope they can manage with her until next week. Fortunately they already had a wheelchair and raised toilet seat with bars because of my grandmother, along with a tub bench.

Wednesday she has her surgery. I am back at work, but got the time off to go back for the surgery. I have a flight late Tuesday night after I see most of my patients. Fortunately my schedule is pretty light this week- it was totally crazy not too long ago. But by late summer it gets really light. Then it picks up again in the fall.

I need a vacation from my vacation. I think I am going away in the fall- I just have to hope that no one else gets sick or hurt.

I don't want to think that my parents are old, or mortal

Pneumonia is an old man's killer, and my dad just got admitted to the ICU with pneumonia. My stepmother is there and I will go in the morning. So much for yoga I can't help thinking- I was on a roll with getting myself there... I can't help thinking this is a really bad weekend, I need to get so much done. And I can't help wondering how severe it is, and how he will do, and what this will take from him. He has had two cardiac surgeries in the past few years, and both took him a very long time to recover from and to be himself. I am worried.

Normally he is a pretty amazing 84-year old who works out with a personal trainer and is sharper than I am. But he is still 84, and no one gets out of here alive.

If I don't die an early death then I will outlive my parents. I will be an orphan. Someday. But not today.

I quit therapy

I left a message on my therapist's voicemail. I didn't think I had been seeing him long enough that I had to do it in person, and I was glad that it went to voicemail and I didn't have to actually talk to him.

I tried to be very pleasant. I guess I still have memories from the time I left an angry message on my psychiatrist's voicemail and the police and an ambulance show up at my door. I didn't want anything like that happening! I didn't even want a return phone call, and I didn't leave my phone number deliberately. He hasn't called back. I don't know what therapist etiquette is- if someone quits over the phone, are you supposed to call them back? I don't know.

I have thought a little about going back to my last therapist- but even if I had the money I just can't imagine spending $125 a session when I no longer have any out-of-network benefits. So I think I will go without for now. I don't have the patience to keep trying out therapists.

I think I was in a better mood today. Still struggling with anxiety/agitation, but not nearly as much as on the 100mg of Lamictal. I am taking little bits of klonopin- so tiny that I think half of the effect is placebo, and that is enough to take the edge off of things. I feel more awake, more alive. It is good. I am not feeling despair. I did not wish to be dead today, and that is an improvement.

Latest interest- winning the New Yorker cartoon caption contest

I wasn't going to say obsession- that is so in these days, to say something is an obsession, just because you are doing it. And I am not quite obsessed. Just determined to find something funny to say once a week no matter how difficult it seems.

My half brother is a writer and does the New Yorker cartoon caption contest. Then my brother started doing it. So I decided that I had to start doing it. I have just submitted my third entry. And it was good, except that I put an unnecessary "that" in it. I wanted to redo it but I can't. I am still impressed with myself that I managed to find something funny to say with this one, because initially I wa stumped. But as with all that I have done so far- I just pull from current events.

I wonder if, between the three of us, any of us will ever win? A lot of the winners aren't even funny- although the last winner was very good, in fact pretty perfect.

I really wish I could redo my entry. I did it so fast- not thinking I should take the time to edit a one sentence entry. But I am wordy, so I need to. It will never make it as is. I will take more time next week.

Mood swings and decisions

I decided I'm going off the Lamictal, although not all at once. I'm taking my night-time dose but didn't take the daytime one this morning. And most of the day my mood was just awful- although I did feel more alive. But then by evening my mood switched, and I started feeling good. Better than I had in days.

Yesterday I saw my therapist and it just wasn't useful- he doesn't get me, he is wrong about things. Like when I was telling him I can't do anything after work because I am so drained he thought it was low blood sugar and that I should eat an energy bar. Really, it is not that. Just like my racing thoughts are not ADD. And I am not irritable because I am feeling better and therefore expecting more of the world.

There were so many things that he didn't understand- like my trouble taking showers and grocery shopping when depressed- that I started to wonder how many depressed patients he has treated. His attitude is that you just have to make yourself do it, and eventually it will get easier. Well, I don't need a therapist to tell me that. But I beg to differ on the it will get easier part. The next depression I think that taking a shower might be just as hard.

I am going to quit therapy. I will call him tomorrow- I get out from work earlier tomorrow. I just don't think it is going to help. I don't feel understood nor do I feel like I am learning useful skills.

When you don't know whether to go up or down

I am halfway through my titration up on the Lamictal. I'm at 100mg, going to 200mg. You have to do it slow because there is a small chance of getting a very dangerous skin reaction- but this chance is lessened if you go slow.

But recently I have been miserable- and I think more miserable than I was before I went on it. But it is hard to remember. I should track my moods more often, especially when I am making med changes. I should create a program that would let me graph mood, meds, and the number of hours of daylight!

As bad as my moods have been, my sleep has been worse. I can't sleep at night- which means that all I want to do when I get home is sleep- and even if I make myself stay up I get nothing done, I have no life. If I take klonopin it is awful- klonopin on top of the higher Zyprexa dose really has me knocked out the next day.

Plus I have been really irritable- which I seem to remember being an issue with Lamictal before. Of course it could be the fact that it is the longest day of the year... my psychiatrist wants to raise my lithium, but I won't. It would just make me too numb. The dose that I am at- it isn't too bad in terms of side effects. I have been on high-dose lithium before- and that was almost enough to stop me from ever trying it again.

I did somehow make it out and to my dad's to visit with family. It wasn't easy, and taking a very necessary shower seemed like an Olympic sport.  I can't say that once I got there I felt fine and all was well- I still was really fighting with the darkness inside of me. But I'm glad I went. It was better than staying home with the darkness.

Tomorrow I see my therapist and I don't know what I am going to do. Sometimes I think I stay in therapy because it seems like I am doing something, and that to give up on therapy means to give up on me- although that isn't true.

My last therapist I felt understood me fairly well, if only because of the length of time I saw her and the need I had to tell my story at times. So my current therapist is at a disadvantage. He doesn't get what I struggle with. And I don't want to do the type of therapy that he likes the best: schema therapy. So is there any reason to stay?

I'd like to give DBT another try. I could do it with him, maybe. He does list it as something that he does on his website. I don't think I have the energy to drive an hour each way to the nearest skills group. But maybe I could do it on my own with a workbook. Aren't you ever done with therapy?

What to do about therapy?

I think I may have to break up with my therapist on the grounds that he is too mentally healthy and he is very good with his paperwork. He doesn't understand how much I struggle, and it is hard to explain. Even just the paperwork part.

I'm sure if I stayed for months he would understand more about me- but do I want to give it months?

My insurance company has messed up my deductible and I am paying full price again. I had to charge my last session- and I think that, trying to be helpful my therapist scheduled me for two week's time as I was doing better. But once I go down to every other week it never seems helpful. Or perhaps I just have more time to question why I am going.

Today my mood crashed, which is not surprising given that I got up at 3am to go into work early and do notes. Perhaps it is just as well that I didn't have therapy after work as I have been dizzy and light-headed since the afternoon. I just wanted to go home and watch the Game of Thrones finale.

It is my obsession. But I feel like it is at least one "normal thing" that I am into. Something that gets me out of myself. But now- how will I manage until the next season? Maybe I will need therapy for that! Fortunately I have the books to read.

I am not sure where my therapy is going right now. At least I felt like my last therapist knew me. I would like to do a DBT program, but there is nothing near me- it would be quite a drive, and I just don't have the energy for that with work. Plus I would have to change my work hours. And if they required me to see a therapist there it could be even more time consuming.

What I think my therapist doesn't get- because he hasn't seen me that long- it that if I have a week or two in which I get more things done- it isn't because I have had some kind of breakthrough. It is because my depression is a little less. And when the depression comes back I might just lose anything I seem to have gained and be back to square one.

Of course that doesn't mean don't try, don't fight. But it means that if I keep trying with the expectation that things will eventually get easier, I am likely to be disappointed. I try not to have that expectation, but I can't help it. I do.

Today I was so weary of life, so weary of trying. It just seemed too hard. I hope a good night's sleep fixes that.

I'm thinking of all the money I would save if I quit therapy. I could get new glasses next month- I'd have enough money in my health savings account. And I am wondering how to fight my insurance company for messing up my deductible.

Made it back to yoga

I went to yoga at a new place but with the same instructor I had previously had- she opened her own studio. I haven't done any yoga in a long time, and it was the perfect session- mostly stretching, and not too demanding. Just what I needed to ease me back into it.

And yet I came home tired and napped- but perhaps that is because I didn't sleep well last night. I tossed and turned and woke up a lot and then got up early. I also woke up grinding my teeth really hard- harder than I thought possible.

My dentist told me that I grind my teeth, and a part of me didn't believe it. I never had the sensation that I did this. But this morning I was really doing it- it is the first time I have noticed it. I wonder if that is because I am no longer taking klonopin regularly. Next I want to try to get off of the Ambien- but I'm not going to hurry that too much.

I want to ask my psychiatrist for Ativan instead of klonopin as a prn. I'm hoping I don't need it much- but if I do, I'd rather have something with a shorter half life. When I take klonopin I can feel it the next day. Then again, perhaps that is what stops me from taking more of it.

I'm down to 5mg on the Zyprexa. It is the one medication I have "permission" from my psychiatrist to titrate- although I don't think I need anyone's permission! But I realize that sometimes I will be able to get by with 5mg, and hopefully most of the time- and sometimes I will have to go up to 7.5mg. And I will probably go back and forth. When I am really depressed or agitated, I am more functional at the higher dose. But if I am not, the costs of being at the higher dose are too great. But that is what is good about Zyprexa- it can be adjusted quickly and works quickly, much faster than a conventional antidepressant.

Healthcare reform

At my job we try to be "efficient" and try to see the patient for as few visits as possible. This makes us look better with insurance companies and most patients have high co-pays these days anyway.

But there are always those patients who need more- who I keep on for a while. They might have had a CVA, RSD, a tendon repair, or just a really stiff hand because of an injury with swelling and weren't sent to therapy in a timely manner. And some hand surgeons want their patients seen more often.

Well we have a new policy at work. When a patient reaches 15 visits, 20 visits, and then 25 visits, I have to discuss their case with my supervisor. (I wonder what happens if I reach 30!) And it has me really mad.

First, I feel like my clinical judgement is not being respected. If I can convince an insurance company to let me keep a patient for 20 visits, I don't know why I should have to convince my supervisor. Secondly, I feel like we are being pressured NOT to give the harder cases what they need. And finally, what happens if my boss thinks someone should be discharged and I do not? Do I tell my patient that I am discharging them because my boss says so?

Perhaps we should tell patients up front, on the phone, when they call to schedule an appointment- if  you are going to need more than 15 visits you should look elsewhere. This seems to be the way that healthcare is going. The difficult cases require more care and make you look bad to the insurance companies and Medicare, so you can't take on too many of them. The insurance companies might cut you out of their network if you do. Medicare might audit you.

I tell myself that if healthcare becomes too awful I will become a massage therapist.

The best cognitive rehabilitation

One of the therapists where I work has started doing cognitive rehabilitation where I work. I don't think we have the best setting for it- but some people don't want to go to (or can't get to) a formal cognitive program that is further away.

Well, I have found the perfect activity, because it is really straining my brain. I am reading the "Game of Thrones" books, and I am having the hardest time keeping track of names and relationships. Who is that person? What house are they from? Who are they related to? There are just so many characters to keep track of.

But I am enjoying the books. They give a depth to the story that the TV show just doesn't have time for. I'm just reading them slow, bit by bit- which makes it all the harder to remember who is who.

Tomorrow I am signed up for a yoga basics class. I haven't gone to yoga for a long time- it will be good to get back. There was a time I was going twice a week regularly- until my next depression hit. I want to get back to that. Unfortunately the Monday class that I used to go to no longer exists. There is a later one that might be okay- except that it isn't until 7:45 and I get out of work at 4:30. Even if I stay to do notes, it is still pretty late.

The good news is that my neck is feeling better. I really worked on it two nights ago- hanging my head off the side of the bed and doing gentle mob's. Plus I had to take klonopin to sleep that night- and it is a muscle relaxant incidentally. It hasn't hurt since. But I already scheduled a massage for the weekend, I don't think I'll cancel it. Maybe that is why things got so bad, I haven't been getting my monthly massages.

Tomorrow I up my Lamictal dose. I'm still titrating up. I hope it doesn't make me too spacy.

Some good news

I had to have a follow-up mammography for my right breast today as a 6 month follow-up for my breast biopsy. It was fine. I really wasn't worried about having cancer. Instead I was very worried that they would find something- again- that would require biopsy to determine is benign. And I started wondering how many biopsies I will have in my lifetime- and remembering the patient I had who had a mastectomy due to repeated (benign) biopsies. I guess at some point you would either need to stop having mammograms or have a mastectomy if it got that bad.

Of course I could get breast cancer- but dying of heart disease is much more likely with my risk factors and family history. Unfortunately there is no law saying that you can't have both breast cancer and heart disease. Or breast cancer, heart disease, and bipolar disorder... There is a part of my mind that thinks having bipolar ought to give me a pass on having a serious medical condition, at least until I am "older." Like god/the universe wouldn't be that cruel to strike me twice. I know that this is a very irrational feeling. All the studies, in fact, show that moods disorders increase your rate of just about everything it seems- and if the mood disorder doesn't, then the meds do.

At work I was playing "Dr. House." I was diagnosing (in my head) an undiagnosed patient with neurological symptoms and it isn't good. I hope I am wrong. I'm often right about these things- and with the last patient I was right about it was ALS. If I had gone into medicine- which I considered very, very briefly for about 1 semester in college (before organic chemistry and before the psych hospital), I think I would have become a neurologist. Even though being a neurologist is pretty depressing- because the brain has limited ability for regeneration, plus many of the illnesses are progressive- there is a limit to what you can do to help your patients. But still, I thought about neurology.

Today I might be more interested in hand surgery. But I have lousy fine motor coordination, I'm lucky I can take out sutures. And I have poor spatial skills. So really, hand surgery would be a bad fit. I'll stick with neurology for my imaginary medical career.

Disability?

No, not that extreme. I just might need PT for my neck. What I really need is to do less paperwork. On my vacation, on long weekends, I have no neck pain whatsoever. The more time I spend doing notes the worse it gets- and now I am starting to get that tingling/electrical pain in the back of my neck at times- but fortunately no radiating. Or at least not yet.

My hope is that when we get to electronic medical records it will be better because we will have laptops and I will be looking up at least a little bit instead of straight down at the desk. For now I am doing my chin tucks and back extensions and cervical ROM. And I should probably go for another massage- I haven't been in a while.

I was looking at my computer at my desk today- and it is an ergonomic nightmare! There are no pull-out keyboard trays in the staff office and the monitors are just sitting on the desks- way too low. I have to bring in some books to put under my monitor. And to think that I give my patients ergonomic advice... I had better not let them into the staff office. Of course our office wasn't designed by an OT.

I see enough patients with really messed up cervical spines- I have to fix this. But I realize that it may not fully resolve until we stop doing paper notes. And I don't know what to do about PT- I'd love to go where I work (plus it would be a lot cheaper). But I don't want my co-workers knowing my medical history.

What goes up must come down...

This was a rough week and towards the end my mood really crashed. I did go to acupuncture this morning, however, and I hope that it helps. It seems to, more than last week's did. I go to a really neat acupuncture place- it is a community acupuncture place. Everyone is in one room, lying in recliners. And it is sliding fee scale, $20-$40, pay what you can. They don't ask your income, it is up to you. I have been paying $30. But it really makes acupuncture more available to more people.

Unfortunately the hours are mostly during the times I work, except for Saturday mornings. But it is good to get me out of the house on a Saturday morning, so I don't stay in all weekend. And while I am there, lying with the needles, I practice my diaphragmatic breathing- so I come out extremely relaxed.

I am so relaxed right now that I think that I have to nap. And then I have to figure out how to contact my insurance company, because they have really messed things up with my deductible. First they charged me things I didn't owe- and never got back to me when I questioned it. But they finally realized I shouldn't have paid it- and subtracted it from what I have paid towards my deductible- and they have not sent me a check for it. So I am down $1200 towards my deductible again, instead of having met my $2500- which was very nice to be just paying co-pays finally.

Tears at work

I have a patient who I have treated several times- a really nice guy- and I found out that he is in the hospital and it doesn't look good. It is sudden and very sad. But that is what happens when you work in healthcare with people who have a lot of medical issues. And some people touch you more than others, they just do.

It's funny- sometimes when I cry I feel relieved that I am crying- that all the meds I take have not made me so numb that I can no longer cry. Sometimes I wonder.

And sometimes I wonder if I drank if I would need less meds! No, I don't mean if I were an alcoholic- just if I came home to a glass of wine. I wanted one today. I had the busiest, most hectic day at work and even during lunch I had to go to an infection control inservice so I couldn't do the other things I needed to do. When I went home, I thought I'd really like a glass of wine. But I just don't like the way I feel the next day when I drink- plus with all of the meds I take I really shouldn't, if only to save my liver. So I didn't. Even though I do somehow have 3 bottles of wine. At least one was a gift from a patient.

Fortunately I do feel relaxed now- with no wine or no klonopin either. But if I had to pick wine or klonopin after a hard day at work- I'd definitely prefer wine. But I'd really prefer neither.

A very busy work week

Work is good- interesting patients, good OT therapy moments, etc. And also too busy- I'm double booked, my patients can't get times that worked for them, I can't find a moment to write my notes. It is hard. We could use another OT. Except that in a couple of months we will probably slow down when all the hand surgeons go on vacation- August and September are usually very light.

I'm feeling very American- I came home late both nights this week and wanted nothing more than to eat dinner in front of the TV. Monday night I watched Game of Thrones and tonight I watched the pilot episode of Mr. Robot- which was really good. So now I have three shows to follow- Last Week with Jon Oliver, Game of Thrones, and Mr. Robot. I haven't really been keeping up with the Daily Show recently because I find it is so hit or miss.

The past two days of rain and dreariness have taken a toll on my mood and energy. I just want to sleep. I hate how much my moods are controlled by the seasons and weather. I try to fight it, but it is really hard.

One of these days I will actually get to the gym again. Hopefully soon.

Still feeling better

I got briefly off-track at the end of the week when I decided that I would be more "efficient" if I ate lunch at work and did notes instead of walking over to the hospital cafeteria and eating there- which has been a big achievement for me. But I have had a lot of appointments recently and could not stay late/go in early as I normally do and so notes have snowballed and I got scared and stayed.

The problem is that I wasn't more efficient. And by Friday I was feeling very spacy every time I tried to do my notes. I needed to get out, get exercise, get sunshine. So I will return to going out for lunch.

Otherwise I am still feeling better. Work is incredibly busy- and I have a lot of new patients- some very interesting (in the sense that you do not want to be an interesting patient, you want to be boring). I had to get out my anatomy books. But I like interesting.

Normally I get half an hour for notes each day (not nearly enough). But I am having to treat during this time to get some eval's in recently. And double booking, etc. We are really busy. And I have a patient I need to find a way to give one-on-one time. And he needs evening hours. And I only work two evenings a week- and a lot of people need evening hours.

Management wants us to be totally booked. The problem is that, long before every slot is filled- and really, almost all of mine are- it gets to the point where patients cannot get times that they can make, and they aren't happy. And I will double book people or agree to see them less frequently, and we lose money. But management will say that we aren't at full capacity so we aren't being efficient. And because we therapists do our own scheduling, the patients aren't happy with us.

The lack of office support is the main complaint about my job that I have, the main reason I would think of leaving. 

Today I am going into work to do notes. I scheduled an acupuncture session at noon to make sure that I get out. And I will be blissful when I do my notes!

Good things can snowball too

Last week I had a much needed vacation. I have been doing acupuncture for depression- twice so far. I am staying on the higher Zyprexa, off of Klonopin, and on Lamictal. I have been going on short walks and getting sun during lunch. It is all starting to work, and the past couple of days I have really felt much better, like the depression is really getting better. I can't believe how light I feel. And not in a hypomanic way, just in a non-depressed way. 

Yesterday my therapist asked me how I managed to do something, when normally I can't- and I felt annoyed, but didn't really know why. But now I realize- I could do it because the depression was better. I wasn't suddenly a better person with more willpower. I wasn't suddenly trying harder. I just was able to do it with the normal amount of trying that I give things- and things that normally seem impossible are starting to seem like they may be possible. 

People have no idea how hard you try when you are depressed, they have no idea how hard it is to do anything- sometimes even to move. And if my therapist wants to give me credit now for getting out on the weekend it is credit that I don't deserve- because I only accomplished it because it was easier than the weekends in which it was too hard to get out of the house. 

I do still really have to push myself, but what I am pushing against feels a little bit lighter. 

Trying to get going

Between being sick and my normal inertia, depression, etc., plus seasonal allergies, I am having a really hard time doing anything this weekend. And I really can't take much for my cold symptoms with all the other meds I take. I am very tired and feel like I can't move. I am putting the Lamictal on hold, in case that is making things worse.

I am doing laundry this morning and packing. That was to have been finished yesterday but was not. I am leaving a very dirty apartment behind- so much for cleaning. And then I have to go to work and do a lot of paperwork. That was also supposed to have been at least started yesterday, but I came home to sleep instead.

I am sort of sorry I am going- I wanted to get things to a better state before I left. Cleaning, paperwork, etc. I have so much to do. I didn't count on getting sick. But I also never go anywhere- and I want to break that cycle. I a want to do something.

I normally have a problem with initiation- and I have never figured out how much of that is residual depression or habit vs meds. But then throw being sick on top of that and it is just awful. Plus being sick doesn't exactly help my mood.

I have to work on this initiation. Opposite to emotion action- DBT. Maybe I just need to make a new habit. Even if it is partially the meds- sometimes you can overcome it. Like with sex. Effexor isn't kind to that. But I can still enjoy sex- as I tell my boyfriends- it just takes a little more work.

I don't know how many hours I can bear at work today doing notes. I had meant to break it up into two days. And then I have to drive for 2 and half hours to get to Omega. I hope it is good, this workshop and this week. Because there is such a big part of me that wants to stay home. I hope I show that part of me that I was wrong, that it is better to go and do something. Even if it is difficult.

Sick and very tired

I started getting sick yesterday. Probably just a cold, but it is bad enough to make me miserable. As always, when I am getting sick- my mood plummets. Yesterday I didn't know what to do with myself I was so depressed. Today I am just mostly tired- pretty exhausted, really. I can't believe how exhausted I am. And I am going through tissues, but it isn't too bad.

I am scared that part of how I am feeling is a reaction to the 25mg of Lamictal that I am taking- but I think that is unlikely. It is more likely from being sick than from such a tiny dose. Still, it is a lousy time to be starting Lamictal.

The best laid plans... I was going to stay late at work to do notes. And do some shopping before my vacation, and laundry, and clean... I am not doing much today other than treat my patients and I managed to get a haircut. That means tomorrow and Sunday morning will be hell. I have so much to do before I leave for vacation.

But it will be really good to go on vacation. I have gone anywhere in a while. I need to get away. I decided not to go with the backpacking but to go to a workshop at the Omega Institute. And then next weekend I go to visit my brother because my niece is getting baptized.

Trying lamictal again

I saw my psychiatrist today. I talked about options, and we are going to try Lamictal again- with the aim of getting off of Zonegran eventually. However, he wants me to go on the Lamictal before I go off of the Zonegran- which has me a little nervous that I will be unable to get off the the Zonegran and wind up on two anticonvulsants.

His other suggestion was Latuda. But I told him my fear about the intractable insomnia I get whenever I have tried to stop Zyprexa or to switch to another antipsychotic. And he told me that I could take the Latuda and keep taking the Zyprexa for sleep. But I don't like the idea of taking one antipsychotic, let alone two, so no way.

I asked him what he thought about Seroquel, as that might just help with the sleep enough to get off of the Zyprexa. He didn't think it did much as an antidepressant and had a lot of side effects. So I decided not to do that one.

I'm really not sure if I am doing the right thing with the Lamictal. I was on it twice before, but never as monotherapy, so it is hard to know exactly what it was doing. But also, maybe things aren't that bad. Today was a better day. And I really think that a lot of what is going on is life, not necessarily biology. So messing with my meds might not help.

And going off of Zonegran might make me worse.

It is too bad that psychiatry is mostly trial and error.

I have made my peace with my meds (for now) this weekend

It was a bad weekend. I did a couple of things but mostly not too much. Depressed and felt like I couldn't move. Decided it might be meds- took less of one thing- and the next day even worse. I think I am going to keep things the way that they are. If I stay on the higher dose of Zyprexa, I am more likely to get off of the last bit of klonopin and the ambien, anyway. But I can't do this anymore.

The problem with being on meds- when I feel bad I don't know what needs to change. What could make it better. Could meds (or less meds) make me better?  I want to tinker. Try this, try that. But in the short term, tinkering usually makes me feel worse- and I don't stick with it long enough to see it through. I don't have that kind of time right now. So for the moment I will work with what is, and try to fix other things in my life.

First green smoothie

Since my dental surgery I have been eating horribly. I had to do something- I ordered a Ninja Pro blender. Last week I bought the ingredients for a green smoothie, and last night I prepped- cutting and measuring and putting things in freezer bags. This morning I opened my blender, and took one of the baggies out of the freezer. It was easy to blend it. But I was afraid I would hate it- I didn't, I loved it. I am a convert.

One apple, half a banana, a quarter of an avocado, 2 cups of spinach, a handful of walnuts, a small piece of ginger root and a cup of coconut water. It was really good- and the ginger root really helped. I was going to add a scoop of hemp protein powder but I forgot. It was filling enough without it- fat and fiber are really what I need to keep me full. But I'll try it next time and see how that goes.

What is next- am I going to start cooking again?

The last time I cooked regularly was a long time ago. And I was vegan at the time, so I kind of had to cook. I gave up on being vegan- even on vegetarianism- when I went on an MAOI. There were too many food restrictions on that. And I have never gone back, even though I am no longer taking an MAOI. Every now and then I still think that I should. But then I settle for trying to eat less meat.

Messing with my mind

I am watching the Game of Thrones current season plus back episodes and now I have started reading the books. And I am at a different place in the books than the TV show. It is messing with my mind- I took a nap today and dreamed about Game of Thrones- but of course the story was all messed up.

But then I also dreamed that there was this co-worker at work who wanted to go exercise with me every day after work and we did- swimming. That was the more pragmatic dream, but still a fantasy.

This morning I had a very draining phone call with my mother who is not doing well emotionally, and still has pain that they haven't figured out what it is- and they won't give her pain meds. I think that is horrible. The ER gave her 3 days worth or so but her doctor won't give her pain meds. She is in so much pain it is really affecting her emotionally. And this has been going on for so long. Yes, people can become addicted to them, but she is on Coumadin and can't take the NSAIDs. But more tests Monday, and hopefully some answers. And something to do to help the pain.

But we live very far apart, I can't really do much. The few times I have called a doctor about her it hasn't done much.

I wonder if they won't give her pain meds because she has a psych history. That would be real discrimination and undertreatment of pain. I've been really lucky with healthcare providers recently- no one has made much of my psych meds or history- but that hasn't always been true. Perhaps the fact that I am now working in healthcare buys me some credibility.

I could Fedex her the leftover pain meds I have from my dental surgery- but I think that is a felony.

My mom is someone I would worry about if she took them too long- but until they figure this out I think short term use is okay. Being in this much pain is not OK.

Beautiful weather, beautiful mood

The past couple of days the weather has been glorious, and so has my mood. Today, though, it started to go into that anxious place that it often does in the spring and I took a quarter milligram of klonopin- enough to take the edge off, but not enough to bring me down or make me sleepy. I have been having lots of trouble sleeping. I'm not really into hypomania territory, it is just how I often am in the spring.

It is probably the sunshine making me feel this good- but I don't want that to be it- because that means that it won't last. And last year I think I never really got out of the blues during the summer, not entirely. Perhaps this year I will.

Work is interesting, I have some interesting cases (but if you are a patient you don't necessarily want to be interesting, you want to be boring).  Paperwork is going somewhat better but I have to do a lot on the weekend to catch up from being so behind for so long.

I also have to do a lot of walking on the weekend to train for my 10K in July.

And I will probably watch some old Game of Thrones episodes. I have become obsessed with it now that I have HBO. I am watching the current season, even though I had only watched a few of the old episodes previously- whenever there was a free HBO week- and the I would watch youtube recaps. But now I want to watch all of the episodes so I can keep track of who is who- I might even read the books. Although the TV series isn't totally true to the books.

And I watched the last episode of Dig. I liked the series. It kind of wrapped up fast. But I loved the last scene with the calf- I just loved it. A great ending.

More lithium

Now that I have stopped taking all the Naproxen, I feel like I need more lithium. I suspect it really did raise my level, which made it easy to go down, but now that I am not taking it anymore my brain is not liking it. Time for more lithium.

Well, I am still on the lower Zonegran. I have something to hold on to. Something to confess to my psychiatrist too. And I am on the increased Zyprexa- which I think I will have to stay on until my next vacation or get fired because I can't not be good with my paperwork- and I will have a number of those days if I go down. And I haven't even decided if I am going down. I feel like I have fought that battle too many times- maybe this is where I stay. I seem to be tolerating the higher dose a lot better than I have in the past- not as spacey and I haven't even gained any weight recently.

I want to stop thinking about meds.

Don't watch Game of Thrones right before bed

And I wonder why I have insomnia. I know, I am supposed to have some soothing bedtime ritual. But I got home really late and had to eat dinner and had to watch the latest episode of Game of Thrones before people started talking about it at work. So I ate dinner in front of the TV (another no-no). And now I can't sleep.

I saw my therapist again today. We are really going back in time a lot- which I had gotten away from, but it is what he does so I will give it a try. He does something called "schema therapy" which I haven't done before.

After that I had to drive to Costco to get my Provigil. As is so often the case, due to my inertia I waited until the last possible day- I'd be out tomorrow. It is a long drive, and hard to motivate myself to go. I stocked up on a bunch of groceries and bought a stir fry pan. I think every time I go to Costco I buy different things but spend the same amount of money- it is strange.

When less is more... more or less

I am down on my lithium from 900mg to 600mg. Earlier I had lowered my Zonegran from 300mg to 200mg- after doing some research about Zonegran vs Lamictal, and reading about all the cognitive side effects from Zonegran. Well, I really had read those before, but reading them again I just had to lower it.

I feel better on the lower doses. With both decreases I had a couple of bad day- in the past I might have given in and gone back up but this time I didn't. And I feel fine now. I feel a little less paralyzed, which is what I wanted.

Unfortunately I am still up to 7.5mg of the Zyprexa. I'd rather be at 5mg. I think I will try maybe next week to do it again. This week is too soon after coming down from the lithium- coming off of lithium got me in trouble in the past- although that was being taken off of it cold turkey due to lithium toxicity. But I feel like I want to figure it out- is it 7.5mg or 5mg, before I see my psychiatrist in a week and a half. If for no other reason than to know what prescription to get.

What I want to ask him is if he thinks I could go off of Zonegran eventually- do I need to be on an anticonvulsant due to the seizure I had from meds in my 20's. I don't think that I'd be a seizure risk off of meds- but I know that Effexor can cause it- a study just came out showing that the SSRI's and SNRI's at therapeutic doses raise seizure risk. I don't know what my Provigil or Zyprexa do- they might too.

And then I wonder- if you have been on an anticonvulsant for over half of your life- does it change your brain? Could you start to need it and have seizures without it?

If I can get down to 5mg I will stay with the Zyprexa. If my mood is not good there- maybe I will think about switching to something else. I have thought about Latuda, but I think I'd have too much insomnia on it. Every time I try to go off of Zyprexa, or switch to another antipsychotic, I have intractable insomnia. I think Seroquel might be the only option because of this.

So how do I tell my psychiatrist?

I am down on my lithium. I have been wanting to try going down for a little bit- I wondered if that was contributing to the numbness. And then I had a reason to go down- I was taking a lot of Naproxen after my dental surgery, and was worried about lithium toxicity. So on the weekend I decided to take 2 pills instead of 3, which is 600mg instead of 900mg. I wasn't sure if this was a temporary measure or if I would stay with it- but so far I have felt okay. In fact, maybe even better. Like a little less paralyzed.

So I think I am staying with the lower dose. Now I just have to figure out how to tell my psychiatrist... I remember when I lowered my Zyprexa on my own he seemed so shocked. And I got the "you are paying me for my advice, so you should probably take it" lecture- said with a smile and humor, but with some seriousness too.

It would be different if I saw him more frequently. But to expect things to stay the same for 3 months at a time- with no changes- that is a long time. And unless things are sufficiently bad I don't want to go more frequently. If I had out of network benefits, it might be different.

I don't think I want to change psychiatrists, though. I do like him, I think he is good- and I have had too many bad psychiatrists to leave a good one just because of insurance. Therapy is different- I have a new therapist who takes my insurance. I have a high deductible plan, but by the time I went to him I had met my deductible- so it is so nice just to pay my 30 percent co-pay. I can afford to go every week.

Med thoughts

I will see my psychiatrist in a couple of weeks. I'm not sure what I want to do med-wise. I think give Lunesta another go- the Ambien is not working, so I am taking klonopin with it, which makes no sense. Maybe I could just take Lunesta. I think it was stronger- although when I took it, I took 3mg, which is no longer recommended by the FDA.

I wish I could take nothing to sleep- but that hasn't been the case since I went on an MAOI. They gave me insomnia, I wound up taking something to sleep, and never broke the habit. Plus, since my crazy mania's, I am scared of insomnia now, in a way that I never used to be. I used to have a lot more tolerance for it. In fact, I used to use sleep deprivation as a way to pull myself out of a really bad mood- of course it wouldn't last, just until I next went to sleep. But it was something.

My other thoughts are switching Seroquel XR for Zyprexa. Or Lamictal for Zonegran. Or just stopping the Zonegran.

I am a little scared not to be taking an anticonvulsant. The one time in my adult life when I wasn't- I was on lithium instead- I had a seizure. They told me that was because of an interaction between two antidepressants and my levels were high. I never had another. But who knows? I take a huge dose of Effexor. I don't know if other drugs I take can lower your seizure threshold. I live somewhere where I have to drive to get anywhere. I don't want to have a seizure driving. But I don't want to take a drug I don't need to take, either. Maybe I need to talk to a neurologist. Because I don't know if I still need the Zonegran now that I am on lithium- or how low I can go if I want to prevent seizures.  Should I even be worried about that.
'

If you are in a hole, keep digging

I just spent money I don't have, but I think it was well spent. After spending the weekend eating ice cream, mashed potatoes, and liverwurst (hey a body needs protein), I just ordered a nutra-ninja pro blender from Amazon. It is the cheapest of the alternatives that seems to do what I want to do: make green smoothies so I can get my veggies in without a lot of chewing. And I bet it could turn my frozen garlic steamed cauliflower into some awesome mashed garlic cauliflower.

I had heard of the Vitamix, but it is $400! Mine is under $100. I hope it works out. I read some reviews, it seems to be pretty good. The one thing I can't do is to mill nuts and grains on a dry setting into flour- but I think I can live without that- it is not like I have been doing that up to now!

The other thing I did was to sign up for HBO so that I could watch "Game of Thrones"- I just had to see it. And now I finally can- previously I have only watched it during their free weeks, and then I have binge watched it. And John Oliver's show is on HBO. That is really about it, though. Not much else. I finished watching the end of "Helix," and I wasn't crazy about the second season, but I like the way they left things at the end. I am still in the midst of watching "Dig," but I am caught up. Then there is "Orphan Black" on BBC which is really wild.

I sound like I do nothing but watch TV. Well, normally that is not true, but this weekend it was kind of true.

My mouth is scary looking. It is not just the missing teeth- it is all of the sutures he put in because of the bone grafting. The retainer I wear during the day which also has teeth for the missing ones is not comfortable. This process is going to be really long. But I think I will feel better once the sutures come out.

I just need more money

I think my computer is going. Maybe it is something simple- I should take it in to Staples and see if they can fix it. I hope so. But it is starting to shut off suddenly, for no reason. For a while it wasn't doing it too often, but now it is starting to do it very often. I am afraid that one day it won't start up. It is less than two years old, too young for this.

I don't want to have to buy I new computer. I still have to pay for my teeth. I just paid for a new car engine. I am hoping to replace my iphone 4 one of these days as it has no battery life anymore. I just need more money.

I can't believe that I was thinking of going away on vacation next month. I don't have the money. If I go anywhere it will be backpacking. I have the gear. That is probably what I will do.

I have to remember not to lean on my chin. It really hurts when I do because of the surgery. I keep forgetting. But otherwise I am just chilling- and giving myself permission to do just that. And that feels good. Maybe it is what I need. It is too bad that I have to get teeth pulled to have that.

I guess I don't have to worry about getting addicted to opioids

I had my dental surgery yesterday and it was miserable. I have fewer teeth, bone grafts for future implants, and lots of sutures. I came home with a prescription for antibiotics and a narcotic- I think oxycodone plus ibuprofen.

I am sure I have taken narcotics in the past- I must have. Maybe after getting my appendix out. I just can't remember. I was a little hesitant to take this one because I didn't know if it would mess up my moods (although they were pretty messed up already). But then as the anesthetic wore off the pain got bad and I took it. And waited to see what it would do.

Very good for pain, but no euphoria. It just made me want to go to sleep. And I didn't want to sleep because I wanted to stay upright for a while to reduce swelling and to keep using the ice pack. Really, I was a little disappointed. I thought I'd get some kind of mood boost. But it is just as well. I'd rather not know if there is a drug out there that could make me feel better than anything I take and that I can't have.

Today the pain is much better- the dentist was right, yesterday was the worst day. I have been able to manage with just Aleve today.

I have to go back to get my sutures out in two weeks. I take out sutures as an OT- but never from anyone's mouth before! So I think I will let him do it.

That is actually one of the reasons I can't go too high on the lithium. I can't afford to have a tremor when I am taking out sutures or doing wound care. Not even a tiny one.

Why do I do it?

I still read a couple of antipsychiatry websites. I have my doubts about meds- I know they don't work as well as advertised- but I have decided that I will use them, probably for the rest of my life. It is too late to stop- not unless I want to do something drastic and take a year or two off of work. And even then there are no guarantees.

So reading all this antipsychiatry stuff does nothing but make me more miserable- which indirectly leads me to take more meds, so it really isn't helpful.

One thing that bothers me about what I read is the implication that we would all be fine if we just got off of our meds. I wasn't fine before I went on meds, going off of my meds wouldn't make things all better. I think you can argue about whether meds make things better or worse in different types of people- but people who don't take meds can be really messed up. I have several family members who haven't gone the psychiatry route and I don't want their lives. Would they have better lives is they had gotten therapy and meds? I have no idea. But you can have really dysfunctional and miserable lives without these.

I have no idea how medications work, especially antidepressants. It makes no sense that a TCA, SSRI, and Wellbutrin could all be antidepressants. Although they could have some common downstream effect. But I wonder if we are wrong in thinking of this at the biological level. Depression is an intolerable mental state. These antidepressants change your mental state- subtly, and perhaps it is through different mechanisms, but perhaps that is enough over time.

All the same, I'd prefer less meds. But as long as I am taking meds- I don't want to take less than it optimal- otherwise why take them at all if I am going to be miserable despite taking them.

It isn't over until the paperwork is done

I'd like to say TGIF, but I will be going in this weekend for a lot of hours to do notes. I have so many papers on my desk and so many charts to finish and so many discharges that they don't even fit into my drawer anymore. I can't believe how many people I have discharged recently.

Still, the weather is supposed to be wonderful tomorrow, so hopefully a short hike in the morning will be possible. And I am optimistic that I will make it into work. My mood continues to be better, but not great. I predictably crash in the middle of the day and I am trying to figure out how to fix that. Yesterday I tried having an iced coffee- but it just gave me a killer headache, and I crashed anyway. I think it must be some medication going out of my system.

I am grumpy and whiney and I hate that. But at least I am not suicidal. I am on the higher dose of Zyprexa- which isn't making me as sleepy as it did last time I tried this, except in the mornings. It is impossible to get out of bed on time. 

I have a week's vacation coming up in May, right after a psychiatrist appointment. I am wondering if I should try an experiment- switching to Seroquel XR. Could I do it in a week? Would I know in a week if it was better or not? But I am adding on Benedryl to sleep- I don't want to take more klonopin- maybe the Seroquel would fix the sleep too. Maybe it would be better for the depression.

My insurance company has step therapy for Seroquel XR, and it is really practicing medicine without a license. It is not like they just say that you must have failed with two other atypical antipsychotics, they say it has to be two of the following four: Seroquel, Zyprexa, Geodon, or Latuda. Well, I've taken all but Latuda. The psychiatrist who prescribed Seroquel and Geodon is dead (he was old), so I have no documentation. They would have to take my current psychiatrist's word. 

My other thought is switching Zonegran for Lamictal. And my other thought is getting off the Effexor. Maybe going on an SSRI. 

I know this isn't all meds. I know that meds won't fix my life. But I will take any biological help that I can get. I think recently I usually say, my life is a mess, of course I feel awful, so I don't try to change my meds. But that wasn't working. I wasn't fixing my life. So maybe I need to do things differently. 

A good day, a new therapist

I was visiting my brother and his family this past weekend- and I got to meet my new niece. I had a good time, and yet the depression peeked through a lot as well. But Sunday morning we spent a lot of time outdoors at an Arboretum. It was sunny. I think the company, the walking, the sun and nature did me good. Today I felt better than I have felt in months.

I also started with my new therapist today- and with my good mood found myself wondering if I had jumped the gun going back to therapy. But I like him, and he may have something new to try. Plus, as I have met my deductible for the year- it is the least of my expenses. The main thing I am giving up is time.

I thought I might feel strange with a male therapist- especially since it really hasn't worked out with the few male therapists I have seen in the past (although I don't know to what extent it was because of gender as it hasn't worked out with a lot of female therapists too). But I felt at ease with him.

But tonight I am tired. I am not walking or cleaning or doing anything productive or even fun. I think I will go to bed early and get up early. Then clean and walk before work. At least that is the plan.

I did it

I called a therapist today and made an appointment for Monday. If he had not picked up the phone I don't know if I would have left a message, but fortunately he did. So I have one thing settled.

It was a really bad day. I left work early after my last patient cancelled. I actually thought about the hospital today, something I really haven't thought about in a very long time. But I don't have any faith that they could help me. There is no magic bullet.

And I have been experimenting with how I take my effexor recently. And I realize that I am probably taking too much- it is making me agitated when I take the double dose. I have been taking a lot of Zyprexa, which somehow isn't knocking me out the way it did last time I tried this. I felt like that was the only way I could stay alive and out of the hospital, take Zyprexa. But I did feel fuzzy on it.

I thought about asking my doctor for Abilify to add to my mix. At higher doses it gave me akasthesia, so I stopped it- but a low dose might work. But then I saw that my insurance required pre-authorization, and I just couldn't deal with thinking about that. I'm not going to go to the pharmacy and cry again when I can't fill my prescription. I've been there before.

I couldn't do Easter this year

I never know when to make plans. Do I just give up on planning because I don't want to be unreliable? But then I would have no life. I think there is no right answer.

Anyway, I couldn't get out of the house to go to my Dad's for Easter. And it was my idea to have us all do Easter dinner. I called early to give notice- but that only meant there was more time for them to try to convince me to come.

If I didn't desperately need a shower I might have made it. Or maybe not. But that was the thing that I knew I couldn't do at the moment. The next thing on my "get out of the house" list. Not that I had any idea what I was going to wear- but I hadn't come to that yet.

I felt so bad calling it off. I need the drug that will let me take a shower and get out of the house. I haven't figured out what it is. Something that won't make me too sedated or too anxious. But it there was such a drug then everyone would be taking it.

Last week I had a day so bad I wished I did (illegal) drugs. I wanted a drug that made me feel good- because I couldn't quite remember what feeling good felt like- and I needed to remember that so I could know that there was a reason to keep going with life.

Couldn't sleep

Yesterday I was very anxious- which is unusual for me for a Saturday- it usually isn't until Sunday that I start getting anxious- I think about all the things I didn't get done and about the upcoming week. Saturday I can chill out. But Saturday I was very anxious- and I even took klonopin a couple of times and still had trouble falling asleep. I took my backup, benedryl- which seems to have a shorter half life than anything else I have so it leaves me with less of a hangover the next day then klonopin would. It helped but I still took a while to fall asleep and woke up a couple of times throughout the night.

One night of bad sleep is okay, especially when it is not on a weekend. I told myself that, and it helped. Don't worry over things that haven't happened yet. I am just worried because I do know that spring time often means a lot of anxiety and trouble sleeping, even if it isn't true mania or hypomania. And really, between the Zyprexa and the lithium and the Zonegran, I don't think I could go into true mania anymore. Which is good since I don't do happy manias. Hypomanias can be happy for a little bit- but if they stick around too long they turn bad. And my true manias have been really bad. That is why, at first, I didn't believe I was manic.

But I had some good insight into my depression this past week based upon the title of a blog post on "Psych Central." The title was something like "Depression vs. Chronic Shame." And the article itself had nothing to do with me- it was about people who had been abused as kids, and needed a certain type of psychotherapy to deal with it.

But I realize that I don't give myself permission to be happy sometimes. I feel too ashamed of myself and my life. Of how far behind I am on my paperwork. Of how fat I am. Of the limited social life/ beyond work life that I have. Of how dirty my apartment is. And so on. And this shame keeps me depressed, which stops me from cleaning, from going in on the weekend to do my paperwork (because I am home in bed), from exercising, from doing activities outside of work. I am too depressed and don't have the energy.

I feel like if I fixed my life, then I could be happy. But not only that- I have to fix my life in order for it to be okay to be happy. Or at least to have some sense of progress- then I could let myself be happy, and I am missing that right now.

I have had it at various times since going back to work as an OT. First, just going back to work. Then, having a couple of boyfriends. A different job- changing to hand therapy. And passing the CHT exam. And now- things seem to be at a stand still. How do I change that?

That is what I have to work on.

A good movie if I suspend disbelief

Isn't that how it is with most movies?

I saw "Interstellar" today, and it was really good. But there were a few times that I decided that either the movie got things wrong or I don't know my relativity. But it really wasn't a movie about science, even though it used science. It was a movie about mankind's fall from greatness, about hope, betrayal, and mostly about relationships. The science was the glue, the medium. But it wasn't the story itself.

Otherwise I would spend too much time wondering how a civilization that could take itself to the stars and set up a functioning ecosystem couldn't manage to survive a "blight" of farm crops. They better make sure they don't take any of the blight to their new world.

It would have been more believable to me if the issue had been out of control climate change- but that probably would have been too political. Still, it was a good movie.

Perhaps California is going to be in the relocation business one of these days. They are calling for mandatory 25% water reductions- that is serious. Even if this drought is not primarily driven by global warming- it is proof that we are rubbing up against nature's limits. Because even before the drought they were draining aquifers and they certainly had no spare capacity for dry times.

This was supposedly one of the hottest winters on record- except for one key area: the American northeast. Which is an unfortunate area to be spared, policy-wise. People tend to be pretty egocentric and Americans are particularly known for this.

I don't have answers. I saw a talk by the head of the IMF. Or maybe it was the world bank. He thinks we can stop using fossil fuels without making lifestyle sacrifices- that we are looking for energy efficiencies rather than giving things up. I think he is wrong- but I am not giving up my car either. He wants us all to be driving Teslas. That is a rich person's solution. Not only are they expensive, they also require a place to plug in. If you are a renter and you park on the street or in a parking lot, an electric car isn't going to be a good option.

 

My moods are out of control

I knew yesterday might be bad after the Effexor fiasco. But even today I had such mood swings. I am starting to wonder if it is my meds going out of my system. I am going to change the way I take my Effexor. I have to look at some other meds too. I have to see if there is any way I can take Nuvigil instead of Provigil- it is smoother. I just can't do this anymore.

It is not that every moment is bad, but enough of them are. And every day I have some excuse for why I am having a bad day. There is always a reason. And so I just accept it and tell myself that maybe tomorrow will be better- and sometimes it is, but often it isn't.

Yes, I admit- I have been feeling sorry for myself today. I hate it when I do that. I am depressed enough to see how my life sucks, but too depressed to take any steps to fix it. It seems like nothing I could do would matter anyway.

Maybe I will go back to therapy. With someone who takes my insurance. I have hit my deductible- it is like hitting the healthcare lottery jackpot. Of course I had to spend $2500 to get here- but now that I am here, I might as well use it.

Enough complaining. I got my car back today, and that is a good thing. It was a lot of money- but less than they quoted me. And they even paid for the rental that I was driving for the past few days. So I am hoping it is good for another 5 or 6 years.

I'm not dying, it's just Effexor withdrawal

Every now and then I mess up my meds. I guess my insurance company is right. I guess I do need help taking my meds. This weekend when I did my meds for the week I forgot to put in the Effexor. By this morning I thought I was dying. Or at least I highly suspected it. I thought about leaving work to go to the ER- but that would take too much energy, and I didn't have any.

I felt exhausted, faint, light-headed, and all tingly. All of my muscles ached. My stomach hurt and I had diarrhea. I had horrible mood swings. But no tingling on the top of my head or feeling feverish- so I didn't think of the Effexor. Every time I leaned over I thought I would pass out. I thought for a while it was low blood sugar- I must have gained 10 pounds today eating.

But then, driving home- it hit me. This could be Effexor. And I was praying that it was. And then I checked my med box- and it was. I am so glad. I immediately swallowed 2 pills.

If I ever have to get off of Effexor they will have to send me to rehab. I don't know how I could ever get off of it.

I'm so glad I didn't go to the ER. That would have been really funny.

Sometimes I want to act like the mental patient that I am...

I had a bad day. And I almost wrote a nasty email to my health insurance company- I sure wanted to. I wanted to tell them that they should never send someone a health reminder to "get help taking your medication" when they have denied coverage for a medication to that person. It just adds insult to injury.

I don't know why flagged me for that message, but there it is, one of my health alerts, along with getting my vitamin D level tested and getting a living will.

I was going to go to Costco today to fill my Provigil. But then I realized that my prescription was over 30 days old, and they would fill it in my state because it is a controlled substance. So I have to call my doctor for a new prescription. I probably won't get there until next weekend- it is an hour drive with no traffic, and I just can't do it after work with rush hour. But Costco is less than half the cost of any other pharmacy.

I will run out before then- so I will split doses a couple of days. I guess I could ask my doctor to call in two day's worth to a local pharmacy, but I just don't want it to be that complicated. And I don't want to feel like that much of a drug addict. I can do this.

Last weekend I was too depressed to go. This weekend it is too late.

I actually did once email my insurance company before. That annual online health assessment that we do for $100 told me that I should eat a low sodium diet. I emailed them to tell them that they shouldn't give medical advice. I take lithium and I shouldn't change my sodium intake without discussing it with my doctor. Not surprisingly they never responded.

Recovering

I'm not as exhausted as I was yesterday, but still tired. Like a good hypochondriac I finally tracked down my blood pressure cuff and took my blood pressure this afternoon. It was 110/60, which is a little low for me, except for first thing in the morning when it is usually lower. I think it goes up with my morning cup of coffee! So maybe that is at least a part of why I am so tired. I'll have to take it tomorrow- maybe I need less of my blood pressure medicine, although I don't know why I would. But I do take a very large dose of it.

I actually cooked today- well, a co-worker gave me some Pesto sauce. So I cooked chicken, veggies, and high protein pasta and threw it all together. Enough for two or three meals. But laundry and cleaning still felt like too much. I still feel like I am mending. Tomorrow that has to change. Plus I have to make my monthly trip to Costco to fill my Provigil prescription. And then I stock up on some groceries for the month too.

Unfortunately there are some things that Costco doesn't sell- like the high protein pasta and this kale salad (full of garlic and lemon) that Shoprite makes and that I have been eating almost every day this past week. I eat it with pasta tossed with butter and parmesan cheese and some cherry tomatoes and it is really good and I am eating kale.

I am trying to make decisions about how to spend my summer- and how much money to spend on my vacations. I think I will still go on vacation, just one that is not too expensive. I will stay in a tent, not in a dorm. I will accept that my credit card balance, which has been going down, will go up for a little while- but I do hope to pay for as much of the dental surgery as possible with cash. I don't know why that is important to me. My car's new engine will be all credit card, I know. And I know that this time next year I will again be in the process of paying off my 3rd credit card (I have paid off 2 cards and my student loans so far).

Exhaustion

Today I have been so exhausted- and I hope it is just stress. It feel like something more, but it has been a pretty stressful week- including having my car break down on the highway while I was driving home. I barely got to the side safely. I will need a new engine. But that was not the most expensive thing I did that day- I discovered that my dental surgery will be much more expensive than expected, but that they hope to fix my crooked teeth too.

Anyway, work has been super crazy, with people coming at wrong times and wrong days and just really busy. But a great OT moment too- working with an older woman who told me that she had known Dr. Robert Hunter, a giant in early hand surgery and hand rehabilitation.

I decided that working on my teeth, even if very expensive, is a very life affirming thing to do. I smile without opening my mouth- I have for years- because my bottom teeth are too crooked. It is going to take months to fix that, with the implants the last step- but maybe I will smile more. Maybe I will be less depressed. Maybe I will be less self conscious. At the very least- I have to stay alive to see how it all turns out! So I will be broke for a while. I do have credit cards. But I just gave $4000 (all my savings) to one dentist- and I'd like to avoid using credit as much as possible. And of course my HSA is pretty empty.

I'm driving a rental car right now, and fortunately it isn't as expensive as I feared. And it is true, Enterprise does pick you up. I have managed the past few days better than expected- it is just the fatigue that hit me. I started to wonder if my lithium was high at work, but probably not. Probably just fatigue.

I haven't decided if I am still going on my vacation. Maybe I shouldn't spend the money. But I NEED a vacation. A "staycation" would make me more depressed. And I don't feel ready to go backpacking. I need to be in better shape.

I thought I'd fall asleep early- but I am not. Maybe I'll go watch CNN again. I am fascinated by this plane story. Fascinated that someone could just calmly set the autopilot and let it crash- and have no words, not even any disordered breathing per the voice recorder. And what irony that the fortress we created to keep danger out of the cockpit is what allowed this act.

Monday morning blues

I dragged myself into work today, the song "Just Another Manic Monday" going through my head. Except that I didn't feel manic- I felt depressed. My Monday morning blues. I should write a song about it.

The day didn't go too bad, though. I had my yearly review. With the exception of my paperwork it went very well. It is nice to get good feedback. I think I do a good job, but it is nice to hear it sometimes.

I did stay a little late to do notes, but then my brain stopped working... So I had to leave. I made it to the grocery store where I have my bribe- they have good sushi. I got sushi for dinner- I also had green beans and Jarlsberg cheese- way too much cheese- that is why I don't keep it around normally. But I did get some grocery shopping done and the sushi was good.

I've been thinking that I haven't had a proper vacation in a while. Just a day here or there. I think I am going to take a week in May to go to the Omega Institute for a workshop- and stay in my tent. It is the cheapest thing I can think of to do, other than backpacking- and I am not yet into good enough shape to go backpacking. Plus this workshop looks really good. Finally I have something to look forward to. I really haven't had anything. Mostly things I have been dreading- like my dental surgery in April.

It's not a good time to be spending the money- but I need this.

Trying to fight "the system" and it feels so depressing

My health insurance did me wrong- even by their rules. I had met my lower deductible for in-house (my hospital) providers/pharmacy.  And yet when I went to fill my prescriptions at the beginning of the month they charged me the entire price of the meds, not co-pays, as if I had not met this deductible. I have not met my general deductible, only within network. I needed the meds, I thought I had maybe miscalculated- so I paid the over $400. And then went and checked, and saw that I was right. I shouldn't have paid that money.

I e-mailed my insurance company's customer service. I got an e-mail saying I would receive a response in 10-14 days. But I have not. And I don't know what to do. All this at a time that I have to come up with $4800 for dental implants and pay state taxes from 3 years ago I didn't know I owed- I have paid them, but now they still haven't paid me the refund that I am due this year. Plus the price of Provigil isn't going down any more.

And now my computer is randomly shutting off. I don't know if it is a hardware thing or a software thing. I guess I should take it in somewhere. It is only 2 & 1/2 years old, I plan on holding on to it for a long time.

I had a vacation I wanted to take this summer. But it is too expensive. I will backpack instead. I want to backpack in the fall- when I have had the summer to get in better shape. But maybe I will also try in the spring, even though my body is not ready for it. It is better than staying home and feeling sorry for myself.

Why I hate generics (sometimes)

I have been getting a bunch of new generics recently that are really hard to split. And I splint my klonopin and now my cytomel, as my doctor raised my dosage from 1 pill to 1 and a half. But I think I am giving up on that dose.

I tried doing that dose today when I did my meds for the week. I have a new generic. I can't split the pills with my fingers- I don't have nails. And in the pill splitter they just crumble. Sometimes I can salvage a half of a pill out of it, sometimes I can't. At this rate I will run out before the end of the month. I think that after this week I will go back down to just one pill.

I'm not sure that the increase did anything. During the time it was supposed to kick in I still felt miserable. I am feeling better the past few days, but I think that is the seasons changing. I think. I'll see how it is when I go back down. If it is bad- I'll have to figure out which is cheaper- three of the 5mg pills or the non-generic 25mg pill or maybe just to get a lot of the 25 mg pills so that I can lose a lot when I split them.

I'd rather take less thyroid. My mom has osteoporosis, and I think it is from hyperthyroidism- which she had for a number of years. Until she finally got treated with radioactive iodine ablation. I don't want to get osteoporosis. I'm already at risk because of other meds I take.