Saturday, May 30, 2015

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!

Thursday, May 28, 2015

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. 

Sunday, May 17, 2015

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.

Friday, May 15, 2015

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.

Wednesday, May 13, 2015

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.

Sunday, May 10, 2015

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.

Saturday, May 9, 2015

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.

Friday, May 8, 2015

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.

Tuesday, May 5, 2015

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.

Monday, May 4, 2015

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.

Saturday, May 2, 2015

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.