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.

I always assume the worst

I saw my PCP this past week. I had bloodwork done ahead of time, and that was all fine. But while I was there she wanted a urine sample. I don't know the exact test- but every year I get tested for something to do with my kidneys.

I had completely forgotten about the test. But then Thursday I saw I had a voice message from my doctor's office. They wanted me to call to talk to me about my test results. I panicked. The message didn't sound like everything was okay- it sounded like there was something to talk about. And I started thinking- the lithium is ruining my kidneys... I was really worried. And angry at myself for ever going on the lithium.

I called. All is well, the test results are normal. So far the lithium has not killed my kidneys. But I think I will make another plea to my psychiatrist to go on instant release lithium, which I saw in one study was easier on the kidneys than the extended release. He didn't want to do that last time. I didn't push it.

But I just saw a link to a study that showed that one third of people who have been on lithium for 10-30 years had some degree of chronic renal failure. I don't like those numbers at all.

I did it

I stopped at the park on the way home and walked. Probably not quite a mile, but so much more than I have done recently. And it was good. It felt good. The miracle was was that I was able to do this when what I wanted to do was go home and crawl into bed, I was crashing. And yet I did.

It is tempting to think that this means I can do it tomorrow. I will manage to do something one day, and think I can repeat it another day- only to find that it is a different battle the next day and I give into the depression on that other day. So I never get any consistency. I never get to establish a habit. Things don't get easier.

And I wish that I could say that a walk in the sun fixed my mood- but I am still crashing.

I don't think that raising the cytomel is doing it for me. I wonder about going back on Prozac. It seemed to work well the two times I was on it- and when it stopped working, well, that was before I knew about light boxes and seasonal depression. No antidepressant works for me if I don't do light therapy in the winter. But getting off of Effexor doesn't sound like fun, even with a cross-taper.

I'm actually feeling pretty disillusioned with meds today.

I quit therapy

I had been down to every other week due to financial reasons. It was feeling increasingly less relevant. I think I kept going for a little while because it felt like I was DOING SOMETHING, even though it really wasn't. And the thought of quitting therapy felt too much like giving up on trying to make my life better. But it really isn't. It just means that I am using one less means of trying to improve my life. Hopefully this will give me more energy to put into other ways.

And in the end it came down time my energy, my limited amount of time outside of work, and money of course. I'd like to use those for other things. What this doesn't mean is that everything is better- of course it does not. It just means I want to deal with things without therapy. I want to focus on what I can do to make my life better and not have that distraction.

It actually feels kind of liberating- as if in that one evening a week I was defined by mental illness. And now that is gone. Except that I know the mood swings will continue, as they do. I guess that will have to be okay.

Do you drink more than you want to?

I heard these words spoken on a radio ad- it turns out for a study on alcoholism. But before my brain could figure out that they were talking about alcohol, I thought, "Yes, I do." I drink more than I want to- mostly water. It is a side effect of the lithium.

No drugs without side effects, unfortunately. And I am looking for some kind of relief right now. I had my conference the past few days- and every day I got more depressed. By the time I got home yesterday I couldn't stand the feel of my own thoughts in my head, I was just awful. I took klonopin and Zyprexa. I slept. Today I ate almost an entire large pizza for dinner- but I am much improved.

I think part of what did it was that the main conference room was really dark and I hardly went outside and I didn't have my light therapy. This morning I was too sleepy to do light therapy, but at least got sun driving to work. And had sun going home and through the windows.

Otherwise- good conference. I did learn some new stuff. And had dinner with some former co-workers.

I am so tired I just want to go to bed- but I am trying not to let myself. I need to get on a good schedule. But I still have the extra meds in my system from yesterday telling me to sleep (and to eat).

I see my PCP next week and I have to get weighed- I am not looking forward to it. But at least I have some good news- my LDL is down. Enough that I don't think she will try to insist I go on a statin. I got my lab results ahead of my appointment from Quest- they have an iphone app, of course. It is nice to have lab results ahead of time. If she wants me to go on a statin, I will say no- and I think my LDL is low enough for that to be okay.

My last visit when my LDL went up- that was when my A1C was the lowest it has ever been. Of course it has gone up- it is still in the normal range- but not really low like it was. Maybe there is an inverse relationship between blood sugar and cholesterol.

It's in my genes to think about these things

My mother, father, and brother were all economics majors. I went another direction- but I still find the subject of economics fascinating- seeing it as I do from the perspective of a non-economist. And it fascinates me to think that people call this a science. Well, I was a physics major. I think you have to be able to do experiments to prove or disprove things. Anyone can tell a good story.

I was listening to an economist on the news today lament the fact that last quarter's productivity had not made good gains. He said that this was the only reason that, with the GDP growth as low as it was, there was still upward force on wages. Basically, workers weren't productive enough to make themselves unnecessary. And he went on to say that if we had too many quarters of wage growth then eventually manufacturers would have to start passing on some of the costs to consumers, and we would get inflation- a bad thing.

Well, all else being equal, inflation is a bad thing. But we are not just consumers, we are workers. Inflation due to wage inflation is probably easier for workers to handle than inflation due to commodity prices skyrocketing in the absence of wage growth or devaluation of the currency. All inflation is not equal. And workers could use some wage growth.

Then last night my mother started ranting about government regulation and how it kills small business (she watches too much FOX news and gets irate about things that do not directly affect her). She said- and I have heard it many times before- that the majority of new jobs are created by small business. I wondered if it was still true in today's economy, and if so, then what is so special about small business.

So I looked up some statistics. It is true- over the last decade or so, small business contributed to 64 percent of all new jobs. So you would expect most people to work for small businesses- they don't. Only 49.2 percent of people work for small businesses. So many of these jobs don't last- just as so many small businesses don't last, I assume. So there is a lot of turnover in these jobs. I guess that is one reason why small businesses create so many new jobs.

Another might be inefficiency. While small businesses hire 49.2 of all workers, they only account for 46 percent of private sector output. So they use labor slightly less efficiently if you are looking at economic dollar output. Perhaps inefficiency results in slightly more jobs. Not really what the Small Business Bureau wants to advertise- but I am all for the inefficient use of labor.

Too much time on my hands today.

I've turned into a (snow) whimp

I have lived in both Rochester and Buffalo. I have driven in blizzards. Today I called out because of the snow- afraid that I couldn't make it out of the very long driveway that my landlord has not yet plowed. Maybe I just didn't know to be afraid in Buffalo.

And then the incentive to in to work isn't there today. It used to be that on snow days we would get caught up on our paperwork with all the cancels that we had. They were useful days. Now we have a new manager and that is frowned upon. If we have too many cancels we are supposed to be "professional" and take PTO and go home. We do have the option of helping out in inpatient for a little bit- but after that is cleared up we are supposed to go home.

I wouldn't mind doing inpatient today, but I don't feel like risking getting stuck in my unplowed driveway to see someone else's patients. And my boss told me that she is at work and there is no need for me to come in- she can see however many of my patient who manage to make it in.

It would have been nice to have a paperwork day, with only a few patients to treat. I did four eval's yesterday. I didn't finish writing them up. This means that tomorrow night I will be there late- on my own time- writing them up. Before I go to my conference.

I did bring some discharges home to write up, so I guess I will have a little bit of a paperwork day- just on my own time. We are not supposed to do that- but everyone does. There is no way to finish all of your notes at work, they just don't give us much paperwork time. No one wants to stay at work for 10 hours, so charts come home. I don't know what will happen when we go electronic.

I'm really glad to have a day off- except that it wasn't the day off that I wanted. I wanted to go get a haircut. I wanted to go the Verizon store- I wanted to get the new iphone. The conference I am going to is now all electronic- and the schedule and handouts are now on an app- there are no printouts- so I thought I should get a phone with a bigger screen since I do not have a tablet. And I have been planning the get the new phone anyway- even got some birthday money for it. I just haven't been able to break down and pay the price.

But I don't think I'll have time to get the new phone before the weekend. Hopefully I will be able to get a haircut.

I am in a pretty good mood this morning. Yesterday my mood and energy were better for the first time in a while. I started to wonder if I had turned a corner- and not sure if it is seasons changing, the increase in Cytomel kicking in, or what. I hope this lasts.  The only problem is that I am now having trouble sleeping- and have had to take Benadryl on top of the Ambien. Benadryl seems to have less after-effects the next day than klonopin- so I am trying to avoid the klonopin. But if I had known I wasn't going to work today I wouldn't even have taken the Benadryl, I would have just tried waiting it out.

Goodbye Mr. Spock

Leonard Nimoy died last week. I am sad to see him go. I watched Star Trek- the original Star Trek, growing up. My brother and I both wanted to be Vulcans. He went so far as to try taping his eyebrows up at night while he slept. I would have if I thought that would work.

Even back then I wanted what Vulcans have. I wanted to be logical, and not ruled by emotions. Sometimes I still want to be a Vulcan. Somehow Vulcans can still have curiosity and enough good motivators to keep them going. When I go numb I don't feel anything- I have no motivation to do anything- it just doesn't work for me. It would if I were a Vulcan.

But of course the real story is that the Vulcans work at their serenity. They acquire their logical abilities. They haven't bred all emotions out of themselves- they learn to control them. I missed this as a child, but it is an important lesson. Perhaps there is hope for me.

Or perhaps I am too old to become a Vulcan. Just as I am too old to become a Jedi knight...

Maybe I should settle for yoga and meditation.

Less Zyprexa and I survived

I was afraid I'd have withdrawal symptoms, but I guess 5 days on the higher dose wasn't enough to give me withdrawal. It wasn't too bad. I was depressed and anxious at times- but no more than a week ago before going up on the Zyprexa. And most importantly, none of that inner screaming inside that I had last week that had me reaching for the drug. Just normal depression.

Not that normal depression isn't bad. In fact, it gets no respect. It eats away at your life, it kills you quietly and in small pieces. And people will tell you that you seem okay, that this "isn't a bad one." "At least I am not in the hospital." Is the bar that low for my life? Talk about low expectations.

And yes, I haven't missed work. But I spent the weekend in bed. I haven't done anything else- and have let some things slide at work. I am tired of my life being judged by the ability to make it to work. I'd like to be able to do something else too for a change.

I am in the catch-22 situation. I am depressed because my life sucks. But my life sucks because I am depressed. But it is impossible to fix my life when I am depressed- I'm just holding on for dear life. So how do I get out of this cycle? I've never figured this one out, although my therapist seems to think that small changes are the answer. But I want something big.

My lost weekend

Raising the Zyprexa isn't the answer. I was felt so drugged and out of it I couldn't do anything. And I guess I gained at least a couple of pounds. I did watch some tv, was mellow- but didn't do the things I needed to do. I even slept through an appointment for a massage. I might as well be depressed.

But it has helped the depression. It really has. Maybe it will break the cycle- maybe I can go back down after my few days of more Zyprexa and the depression will be better. Maybe there will be time for the increased Cytomel to help. Otherwise I need to see my psychiatrist for some more ideas.

Or I can just try to hold out until spring. I think that is really going to help. I just have to make it until then. It is getting closer.

When I was on disability and not working, it was so much easier to make medication changes. Since I have been working is seems all I can manage is to raise things or add things- the coming off of everything and going on new things isn't possible anymore. And so I am on more and more medication.

This weekend I have been just lying around- what I really need is to exercise. I have been waiting for the nearest hiking path to be ice-free, but it hasn't been in months. I hate the gym, I hate to walk inside. I get so bored. I think that when I can walk outside I will be better. I hope.