Bipolar and the City

Perspective

2011-10-23T21:25:00.002-04:00

I have always been a bit of a doomer. Worried about peak oil, national debt, the aging population, the depletion of resources, etc. Well, this past week I have been stuck in bed due to an injury keeping me mostly off of my feet, and going on the internet. And it is much worse than I feared. There is no way that we can easily make the switch to alternatives. Yes, they could provide some of the energy that we use now, but not all of it- and it would take so much energy to build the infrastructure to start them up and get everything electrified. By the time that it make economic sense to do so, society will not have the money or energy to do so.

We are living in the petroleum age, and we think that it will last forever. All civilizations rise and fall. This one is going to fall. OK, it has happened before. Life will go on, for those who survive. Maybe we won't lose everything. And maybe some things will be gained.

But I think that a lot of people are going to die in the next 2-3 generations. And that is really awful. But I don't think that we can support this level of population without a lot of energy for farming and distribution that we just won't have- and we will have depleted our soils and deforested the environment, and old places will no longer be habitable due to global warming.

Everything is temporary. Nothing lasts.

And perhaps this insight is what is giving me some solace with my depression, despite my fears for my future and my society. I don't know how fast this is going to happen- people who predict the future tend to do so too early, so that they can be ridiculed by those who are clinging to the status quo because the sky hasn't fallen yet.

I would like the space program to continue, because that is our only hope to protect us from the next asteroid or comet that is headed towards earth. But I really don't know that is will. It is pretty damn energy intensive. But that is something that I think that we should try to save.

I wonder how many people know how bad the situation is? How many politicians? We are such optimists, especially in America, that whenever I try to bring up the subject, people just say something like solar, or wind can save us. They don't understand the scale of the problem. Geothermal can't do it either. Nuclear could do it for a while, but with a lot of start up costs. If fusion is going to save the day, it had better come fast.

You would think that we would make this another Manhattan Project. Where is our future energy going to come from? The problem is, so many people think that we already have it solved- a little solar, a little hydro, a little wind, and maybe a few nuclear reactors. If only. And we would still have to build the electrical grid to use it, and better batteries.

Some people think that private enterprise will get us there. But I think that the problems are too big, and the start up costs too high.

I think we are in big trouble.

Falling Down Again

2011-09-10T17:15:00.002-04:00

The day has progressed, I have not. I am feeling more depressed. Of course, I have not left the house. I am hoping to still make my dinner plans. Maybe I can do one thing today.

Like any good drug addict, I am already thinking of my next pharmacological escape. Which means, calling my psychiatrist and asking for a new drug. Is it time? How long do I wait? How bad do I let things get?

I'm thinking that this is my fall/winter SAD depression kicking in. All the rainy, cloudy days that we have had recently hasn't helped matters any.

I really don't want more meds, I want less meds. I think meds made me bipolar, I started out with just depression. I think my meds are making me stupid, and taking my drive away. They have certainly made me fat. But when you are lying in bed, and life is just slipping away, and death seems like a comforting thing- well, you will try anything. What is there to lose?

What I am doing today is spending hours in front of my light box- I've set it up so I can lie in bed and still use it. It's cheaper than going to Florida! Which I can't afford, in large part to all my medical spending!

I really don't want more meds. But I know if things get bad enough, I'll change my mind.

Very Strange Dream

2011-09-10T10:14:00.002-04:00

I dreamed last night that I was a part of this group of scientists that was doing experiments on rats. We were trying to teach them enlightenment by nearly drowning them over and over again, only to give them a breath or two at the last minute. I have no idea what the theory was, only that there was one.

In the dream, I was torn. My mind said that the theory works, and we will have a bunch of enlightened rats. But my heart said, what we are doing is really cruel. Look at these rats suffering!

When I was in college, I worked for two years in a lab where we routinely killed mice and rats. Not for their benefit, but ours. No enlightened rats. Only theories about the neurotransmitters in human brains.

I woke up feeling a little strange, but less depressed.

I turned on the TV while drinking my morning coffee. Of course it is all about 9/11. Until today, it has been all about the floods.

I remember where I was on 9/11, as I'm sure everyone does. I was living in Philadelphia in grad school. Someone called me up to ask me if we were going to have class that day, and I asked, why wouldn't we have class? And then they told me. I ran to the TV. It was like looking at scenes from a horror movie, I couldn't believe it was real. My dad was in NYC that day, very close by. After the first plane hit, they kept going with their meeting. After the second hit, they stopped. It took him all day long to get home to Brooklyn.

I had a NYC psychiatrist at the time. And he didn't think I was sufficiently traumatized from 9/11- but then he could never read me. He told me it was because of some medication I was taking that had been shown to protect from PTSD in some study. I can't remember which one now.

I was traumatized, but I think not like New Yorkers. And I think that was why he wasn't seeing what he expected- I was living in Philly. Also, I tend to keep my emotions inside a lot. He didn't see what was there.

OK, So I Didn't Make it to the Gym Today

2011-09-09T16:55:00.002-04:00

I am depressed today, the first day in a few days. But I'm handling it. I went out for lunch, got a fast food cheeseburger and shake, and sat in my car in the sun and listened to music on the radio. It helped, and I didn't cry.

Now I am home and just want to curl up in bed. And eat chocolate ice cream, which I don't have.

I'm trying to stay in the moment, and not wonder if I will still be depressed tomorrow, and think about potentially how long this depression could go on. Maybe this is the onset of my fall depression, despite my light box. Don't go there. Maybe this is because of going off of the Abilify- don't go there. I'll find out soon enough if this is a trend.

So the mindfulness people, and my therapist in particular, say that when you are feeling bad, it is enough to be feeling bad in that moment. Don't project into the future. But at some point, don't you have to make plans, make decisions? Like am I going to be too depressed to do the things I have planned for tomorrow? And should I make adjustments? Should I cancel anything?

Nothing is simple, not even mindfulness.

But for today, I will try to accept what is, and hope tomorrow is better.

Abilify is Not Good for Me

2011-09-04T07:21:00.002-04:00

I have been feeling like I have ADD on steroids recently- which is why I went off of Abilify the first time. I can't focus, I can't sit still, I have a lot of irrelevant and obsessive thoughts racing through my head. It is horrible. It took me a little while to realize that it was happening again.

So on Friday, I didn't take my morning 5mg dose. I have been so much better. So far, I am still taking my nighttime 5mg dose. I don't know what to do about that, only that I shouldn't go off it right away, if I do want to go off of it. Which I think I do.

I think that the Abilify does help with the depression, in some ways. But, at quite a price. If it makes me stupid- that is too high a price. Because I was starting to get depressed over how out of it I was feeling! Really depressed. Because I started feeling like I couldn't even function, and that is depressing.

Sometimes the problem is the medication.

I can't for the life of me understand why we are putting so many people on antipsychotics who are not psychotic. Now when I went on zyprexa, you could have probably made the case for it. But the Abilify was just added for depression. There were other things to do. There are other things to do. Abilify was just an easy thing to do, especially because I had a slightly agitated depression at the time, so there is always the fear of triggering mania. I had mentioned going back on wellbutrin to my doctor, but he suggested going back on abilify, and I agreed. Silly me. Next time my depression cries out for pharmacological intervention, I am going back on Wellbutrin. No more Abilify. One antipsychotic is enough.

A Little Bit Better Today

2011-08-31T21:20:00.004-04:00

I feel a little bit better today- not a lot. But enough that it makes a difference. I function a little better at work, I don't drown so much in the paperwork. When I remember, I say my "loving kindness" mantra to myself.

But it is still bad. And I come home and collapse in front of the TV, and I do nothing. I eat comfort food. I know that what my body needs is to exercise, but I don't. I am disgusting. Dishes pile up in the kitchen.

I know that it is never going to be easy to do the right thing, to do the things that I need to be doing- but today it is just too damn hard. I don't even try, beyond work. That is enough for today.

I didn't cry in my car at lunch. That was an improvement. I wanted to, but I didn't. I did yesterday.

I think I feel better physically today. The past couple of days I have felt bad physically, like I was coming down with something. I was sneezing a little, I felt chills, but it didn't get any worse than that. And getting a virus is often enough to through me into a depression. Today I feel better, just tired, and with terrible heartburn. But I had pizza and a chocolate bar for lunch, what did I expect?

I know that I have a lot to be depressed about, if I look at my life from a certain perspective. I feel like I don't have the life I want, and I feel incapable of working harder to make a better life. I feel like I am stuck.

Then again, I am alive. I have a job, and they have not fired me. I have parents who care about me. I have a brother I love who is going to have a daughter this year. I have relatively good health, especially given how much I weigh (thank-you Zyprexa), and no diabetes.

I need to find ways of making some things in my life easier, so I can do the things that really matter. Like studying hand therapy. Like doing yoga and hiking and going to the gym. Eating healthier- but making it easy. Somehow, something has to get easier.

Today when I felt so bad, I tried to think of one thing that would make me feel better, that my body was asking for, and I decided that it was a massage. Unfortunately that costs money. But I get paid this Friday. Maybe it can happen. I could get massages every week, and it would still be cheaper than my Abilify.

Depression is Back

2011-08-30T22:16:00.003-04:00

The last two days I have been very depressed. I even skipped my therapy session today because I was too depressed to go- I had to run home after work and go to bed.

I work in healthcare- basically in the service industry.Which is a hard place to work with a mental health issue, because it is not enough to do your job. You have to do it with a smile. And I understand with my patients- but with my coworkers too? I wish that I never got asked the question by a co-worker, how are you. That is a terribly personal question. I don't want to tell you the truth half the time, but I don't like to lie. So it is never a satisfactory response from my side when I feel like hell.

And that really is all too often. I am starting to wonder if I am in the wrong profession, but then I don't think that there is any right profession. I feel like I have to be so close to 100% every day to not only treat my patients right, but also to get my paperwork done, and treat my co-workers cheerfully. And I'm just not 100% everyday.

Is there a job where you don't have to be on top of your game everyday?

Is there a job these days that has no paperwork? Where you don't have to smile when you feel bad? When no one will ask you how you feel or how your weekend was, when you stayed in bed depressed all weekend? If there is, I want to know about it.

And yet, I love what I do. Just not all of the time. But I love being an occupational therapist. It is the best thing in my life right now. And the biggest burden. I guess that is normal.

When I am depressed, the one thing I have to do is work- I can let everything else go. But I have to work. So I wind up getting very angry about it, because it is so hard. But a girl has to make a living! I have been on disability, I don't want to go back there, assuming I could even get back on it. I have to make this work, no pun intended.

Today I have the running retrain "I want to be dead" going through my head, which I tried swapping out for "loving kindness." Did it help? Maybe some. But I felt bad that I was just using these words with such bad feelings, like they didn't have any meaning themselves. But I think it did help a little, and did make me feel a little more present with my patients. And I'm all about my patients when I am at work. I know I am there for them, no matter how bad I feel.

I'll feel better on Friday, when I get my next paycheck, and I can put a little more towards my new car fund and towards my credit card debt. I can't believe that it is almost the end of the month.

But for today, here I am bitching. Because in my day to day life, there is no place for this.

What Makes Us American?

2011-08-28T19:40:00.002-04:00

The storm is over, and so I have been spending my time doing laundry and watching BookTV on CSPAN. One the the authors was Christine O'Donnell who basically said that the problem with socialism is that the state decides what role you should play, but the American dream is to work as hard as we can to get a good car and a good house. Somehow this wasn't very inspiring.

In American we have a limited social safety net, so we have to work very hard. We have to fund our own retirement, and increasingly our own healthcare. This makes it all about money, whether we want it to be or not.

How does it all come down to money? It is just a human construct, it is a make-believe thing. Why is it worth more some days than other days? I have sold my soul- or at least my time- for the make-believe thing. I go to work everyday. If I won the lottery, I would want to work just enough to value my time away from work. Maybe two days a week. That would be heaven.

Maybe someday. When I am done with therapy, paid off some debts, when all my meds go generic. Maybe I can work less hours. How un-American.

It's All a Little Disappointing

2011-08-28T09:55:00.002-04:00

Yes my power did go off Saturday night- way earlier than I expected, but then it went back on by Sunday morning. I did get to test out my hand crank radio/flashlight, which is worked pretty well. But the storm itself seems not to be living up to the hype.

I don't know what I expected- Manhattan to float away? And I guess there is still the potential for a lot more flooding- now the rivers may flood. Which is more of an issue than the ocean where I live. But I think we dodged a bullet. Which is a good thing.

And yet the little kid in me says, is that it? After all that hype, is that it?

There are certainly enough people who are very effected by the storm, and for them, it is no small matter. But it seems that the buckets and pots and pans of water that I filled were filled for naught.

The Weather Channel in All Its Glory

2011-08-27T12:09:00.002-04:00

We have Hurricane Irene on our doorstep, supposed to get here tonight. I don't think it will be so bad where I live, a bit inland, I am mostly worried about power outages. And maybe trees down.

With 24-hour news channels, you never know what to believe. How bad is this going to be? They will play up anything for something to say. And I guess the answer is, when it comes to the weather, we don't know. We can't predict things with 100 percent accuracy. The storm could go a little bit this way, or a little bit that way, with tremendous consequences.

I have to get myself out and do some grocery shopping, because I really don't have much food. I was going to go last night, but I was too upset after I nearly had a melt down at the pharmacy.

I wanted to fill my Abilify prescription. And I knew that I only had less than 100 dollars left in my deductible. But they told me that when they tried to put it though, I would have to pay the whole 525 dollars. So I didn't fill it. I still have some left- but I don't know what to do. I don't know how to fight this. Maybe because I still haven't met my full deductible, I have to pay the full thing. So I just need to find something cheaper to get to my deductible, and then I can try to fill it again, and just pay my co-pay. I do not have 525 dollars in my health savings account at this time.

Every job I have had, the insurance has been worse. When you have a high deductible plan, you feel like you don't even have insurance half the time. Plus they keep finding reasons to deny things, like lab work, etc. that they say is experimental or not needed.

So anyway, I was too upset to go grocery shopping, so I have to go today. I wonder if the shelves will be bare. I have heard from my patients that bottled water is sold out.

A Good Day to Watch CNN

2011-08-21T20:49:00.003-04:00

An exciting news day. The rebels have entered the capital of Libya, it is happening faster than anyone expected. The TV is full of images of people celebrating in the streets. Joyous voices and faces.

I hope that there is a little bit more freedom coming to the middle east. I think America's star is waning, I am actually quite pessimistic about our long term future. But I hope that the freedom that has for so long been represented and protected by America will be found in other countries, whatever happens here.

Before watching CNN I was watching CSPAN, and Mark Steyn talk about the coming economic collapse of America. He was preaching to the converted- I have believed this for some time. But I don't know what to do about it.

Democracy has been a great experiment- but what happens when the electorate realizes that they can vote themselves more government benefits than they pay taxes for? What happens when our president tells us that we can go to war and not raise taxes to pay for it? We must not be teaching math is school anymore.

But I digress. The scenes in Libya are wonderful. I hope the joy is not momentary and fleeting, but that some of it can last through the hard process of trying to create a functioning government.

Today is Better

2011-08-21T11:59:00.002-04:00

I'm feeling a lot better today. I'm back up to the full dose of 10mg of Abilify- this is my 3rd day at the full dose. I've been doing the light therapy for a week. And this morning, I feel like something has shifted, I feel tremendously better. I feel at peace. I actually did dishes this morning.

I hate to admit that I need so many meds. I mean, TWO antipsychotics? Am I that crazy? Apparently so. I think t0o many people are taking too many meds.I think antipsychotics are overprescribed. I think that polypharmacy has gotten out of control. And yet- it works for me. 10 years ago I was in and out of psych hospitals, on disability. Now, while my life is still very hard, I haven't seen the inside of a psych ward for 8 years, and I am working full time. Well, actually I have seen the inside of a psych ward- but as an occupational therapist treating patients, not as a patient.

I am probably on the least sedating "cocktail" that I have been on in years, so I shouldn't complain. If I can forget the weight gain- and I am no longer gaining (just haven't lost), the side effects aren't too bad, probably the best they have been in a while. Long term effects, yes, I worry about. But lets face it- I never thought that I would live this long (or want to live this long). And I almost didn't. So I'm really living on borrowed time. Without meds, I think I would have killed myself by now.

So I need to stop messing with my meds. Yes, keep taking all of my supplements, hoping that they will mitigate the bad things that my meds do- but I need to agree that for 1 year I will not touch my medication dosages.

I Need Abilify?

2011-08-19T20:31:00.002-04:00

The past week has been the week from hell. I have been so depressed, I amazed myself by being able to get myself into work. Some days I think they should give gold medals for that- but I guess that is what a paycheck is for.

By 3 or 4pm things seem to get somewhat better, and I'm not so tearful, not so afraid that I'm going to be audibly repeating the words "I wish I were dead" that repeat constant in my head. But it is still bad. I go home and collapse.

Of course I have gone back on the Abilify. And I am doing my light therapy again, which I don't always do during the summer- but it has been so cloudy and rainy that I think I need it.

And then Tuesday I dragged myself to therapy after work. Somehow. And I am glad that I did.

I have always said that therapy does nothing for me when I am really depressed, except maybe let me vent. But my new therapist, who is big into DBT, focused on mindfulness, and that is something that I have never tried when depressed. And it helped. No, it didn't make the depression go away. But it did make it more bearable.

Depression takes so much away. When there is nothing that you want, life becomes just something that you have to push through, waiting to die. But I'm not suicidal, somehow. I guess there is still a part of me that is telling me this is probably just due to coming down on the Abilify, and that going back up on it will fix it. I hope. If not, I don't know what I am going to do.

Forever Meds?

2011-08-14T15:11:00.004-04:00

How many of my meds are forever meds? If I listened to my psychiatrists, it would be everything, and I'd never come off of anything. I would just keep adding or raising at each new crisis, and never reduce. No doctor has ever tried to get me off of anything except klonopin.

But I have successfully taken myself off of a couple of things, and reduced some other dosages. And then, sometimes I haven't been able to. Maybe I didn't go slowly enough, or maybe I really need it right then.

But after going on the Abilify for a short period, I am ready to go off of it. I am better. My life is better. And I don't want my brain to get too used to it so that I will start needing it, and then withdrawal will be harder. But I am going off of it slowly. And I know that it is there if I need it again. Which I probably will, someday. I hope not someday anytime soon. But I know that Abilify really works for my depression, and fast.

I Believe in Abilify

2011-07-11T18:09:00.003-04:00

I have upped my Abilify, and life is bearable again. The depression is not totally gone, but it is not agony anymore. And in a week, I'll be on vacation. Maybe that will pull me out even more. I'd like to think that something other than drugs can help me- especially the antipsychotics. But damn, they work so well. And the antidepressants by themselves are not enough- plus they make me manic without a good dose of my zyprexa.

The antipsychotics are the only meds I am not at peace with, that I keep trying to lower my doses of, that I don't want to be on. Between the weight gain, fear of tardive dyskinesia and other brain damage, who would want to take these drugs? Except that before I went on them, I was in and out of hospitals and had no life.

The antipsychotics are bad for your brain. But, as my psychiatrist reminded me, so is untreated depression. So I can't win. I'm going to have a damaged brain no matter what I do.

Meanwhile, I take lots of antioxidants and various supplements that I think will protect my brain. And I've started taking metformen because of the weight gain- which has helped some, but it is a little too late.

For now, I am just glad that I feel better enough to function a bit.

If only it were just bipolar...

2011-01-08T11:40:00.002-05:00

I have learning disabilities. I did 2nd grade twice. I was in special reading classes. I did badly in school for many years. In college and grad school, I finally found out enough about learning disabilities to get untimed tests, and it saved me.

I was born before everyone talked about learning disabilities. When I was a kid, you didn't really test and label people. And when I finally was, it was dyslexia, which was the learning disability that people talked about. And I did have trouble reading, reversed numbers and letters, didn't know my left from my right, etc. So it fit.

In recently years ADHD is the in diagnosis. And I am told by some that I have ADD (I'm not really hyperactive). And that fits, too. And I have had testing, of course, where they didn't give me a label, just told me what my brain does well or poorly.

The labels are just labels. So, do you want to say that I have bipolar disorder, ADD, dyslexia, etc., or do you just want to say that I have a bad brain? That is what I think.

But it all comes together to make paperwork a nightmare- and I work in healthcare. And at my new job, we are back to paper charts. And we do a lot of the tasks that had always been done by other people- like faxing out our own charts to insurance companies for authorization. And it is really a nightmare.

If I am having a bad day, I just can't do it. And even when I am having a good day- it just takes me so much more effort than it would anyone else. Even just faxing out a chart- half the time I don't get the phone number right because I have transposed the numbers right and I have to resend it.

I had some rough weeks- and I got behind. And I am trying to catch up. And I am doing it, but it is so hard, it is taking all the joy out of my job, making me wonder if I picked the right profession. But what is the right profession for someone with bipolar and ADD and dyslexia? Is there one?

I think it will be better when we go to computer charts. Which is supposed to be coming. I had an easier time with it at my other jobs. Anything is better than paper for someone with ADD, who is a disorganized disaster.

What I really need is to work fewer hours. Fewer hours- fewer patients- less paperwork. Less chance of getting 3 evals in one day.

Something I really need to think about. I think I could cut down 4 hours a week and still have full time benefits. Of course less pay. But less worry about getting fired.

I used to think I might get a second job on the weekends or evenings to make some extra money. Pay off my debts faster. Who was I kidding? I'm going in to work on the weekends to catch up, I think. That is what I need to do. I just have to accept that.

Really, I got extra time on tests in college, I have always known I need extra time with my paperwork. I guess I just hoped that someday it would get easier- but at this recent job change, the paperwork situation seems to have gotten worse. Everything else about the job I love, I really do. And for that I am grateful. You can't have it all.

Meds I Still Need: Provigil (I know for sure)

2010-12-31T20:38:00.002-05:00

I've been trying to reduce my meds, my dosages. I'm trying to see how little I can take. Of course I do it slowly, carefully. And if it doesn't work, I go back on it. So far I am off of Ambien, Abilify, and Wellbutrin. But still on quite a bit.

I've been taking 200mg of Provigil 2x/day. I wanted to go on it for my ADD- the conventional stimulants give me tachycardia, so they are now out. And I feel like the Provigil has changed my life. Plus it helps with my depression.

Of course, my insurance company would not pay for it. And, at the dose I take, it costs more than my rent. Buying it in America is not even an option, unless I want to live in my car. So I buy an unapproved generic from India. I've been doing this for a while with no problems. Well, this fall I waited until the last minute to order it- and then it never came. I waited and waited... and they said it was backorderred. And I didn't know where else to get it from.

So I got a prescription from my psychiatrist for 10 pills with a few refills, to fill here, until it came. And then I went to the hospital pharmacy to fill it, hoping that with my employee discount it wouldn't be so bad. But when they told me it would be 259 dollars for 5 days worth, I just couldn't do it. I walked away.

OK, I thought, I can do this some other way. I bought ginseng and ginko and choline and various brain-promoting nutrients. I allowed myself a second cup of coffee in the afternoon. And I have to say, these things did help some with my attention. Not like the provigil, but maybe 50 percent. But I had forgotten that Provigil also has an antidepressant effect on me. And within a week I was so depressed that I had decided that my life was over and was plotting my death.

I had just enough energy to drag myself to the pharmacy and fill the prescription. Within an hour I started feeling better. No, not all better, but some. It has taken me about 2 weeks to get reasonably back to normal.

Meanwhile, I had decided to try Nuvigil. My doctor thought it would be easier to try to get my insurance to approve this one, because the drug company is trying to get everyone on Nuvigil before Provigil goes generic, and they are giving insurance company lots of incentives. And even if I got denied, it would still be cheaper, plus hopefully I would only have to take it once a day.

Of course I got denied for Nuvigil. But then the Provigil came in the mail. I feel like ordering my next 3 months worth already, so that I will never run out again.

I got so depressed so quickly- it was really bad. Of course, I really don't know to what it extent it was a withdrawal effect, but I doubt it all was- I went off of the stimulants cold turkey a number of times without much trouble except a little fatigue and tremendous hunger for about a week.

The other drugs I know I need for my mental health are my Effexor (high dose), my thyroid hormone (and it has to be Cytomel, not Synthroid), and the birth control pill. My Zyprexa I've finally gotten down to 2.5mg, and I'm just too scared to try to go down further. I've never been manic since I started taking it. And as for my Zonegran- well, I suppose I should be on a mood stabilizer, especially if I ever want to get off of the Zyprexa. It is the one I have tolerated best, least side effects, and it even helps with appetite and depression. But if I do stay on the Zyprexa, maybe I don't need the Zonegran?

I am really the least medicated I have been in years. And having the least sedation/side effects. I am taking a ton of supplements- more about that later. So lots of pills to swallow still. But increasingly, fewer and fewer of them are conventional drugs.

A Sign of Spring

2010-04-03T19:16:00.002-04:00

Finally something to celebrate this spring other than no longer needing my light box. My first pedicure of the year! I only started getting them last year, and I went the whole winter without. But this was the first warm weekend that I was finally home, so I walked over to the nail place in my flip flops and had it done.

For 20$, nothing else feels so luxurious. I'll make up for it somehow in my spending. I don't have my homecare patient anymore, and money is very tight. Extremely tight. I really need to get a second job, I just can't stand the thought of it. Not right now.

I weighed myself this morning- over the past year I have lost 30 pounds. Some of it is due to the metformin that my doctor put me on to help with my weight- it can help with weight gain from antipsychotics. And then it has been the no time to eat diet, and now the no money to eat diet! Occasionally I actually count my calories, but I haven't been very consistant with that.

Renewed

2010-03-28T22:24:00.003-04:00

Back on my full dose of zyprexa, and with the increased daylight, my mood is working its way upwards. Out of the depth of depression, to somewhere it hasn't been in quite some time.

And then I spent my weekend at a continuing education course- one that I wasn't even sure I wanted to take- getting trained on a new stroke rehab device. And I am stoked! I am so ready to go out and start treating stroke patients again! Just when I thought I had maybe burnt out on stroke.

I have to admit, I've been looking for the "magic bullet" in stroke rehab ever since I started studying OT., and of course never finding it. I have my hope in NMES, CIMT, robotics, imagery, and now the SAEBOFLEX. They are all tools, and some of them help different people. Unfortunately robotics are still prohibitively expensive for most places.

I really think that to get the arm back after a stroke, you need to train like an athelete. It's a 9 to 5 job, at least 5 days a week. And yet, we get 2-3 hours a week of therapy with our patients. The question is, how to get them to take it home, to keep practicing. And these are all some ways to do it. To continue the therapy outside of therapy. But only for the right patient. Some don't have the time- they need to get back to their job. Some don't have the resoursces, the motivation, the concentration, the cognitive capacity.

And then there are always those for that, the stroke was too severe, the deficits are too severe, the arm just isn't going to come back in any kind of meaningful way.

But with the Saebo, I have something new to offer my patients. A new tool.

And now I can't sleep, despite an Ambien and a klonopin. And I have to get up very early!

"I still love you"

2010-03-26T21:18:00.003-04:00

I got an e-mail last night from an old boy friend that was 4 words, "I still love you." You might think that is sweet or romantic. It has me angry and confused. It ended badly, and he owes me a big explanation, because he literally disapeared on me.

It took me a while to get over this, and to stop obsessing over what the real story was. I know I let my guard down with him and ignored too many danger signs- but I was in love and going with the feeling. I just wanted to go with it, just wanted to surrender to the experience.

In the end I don't regret it- and I miss the person that I was when I was with him. Where has she gone?

I don't think I've really been happy since I moved away from the city and took this new job. Even when I wasn't clinically depressed, I haven't felt joy. (And I've spent a good portion of it clinically depressed!).

I was miserable a lot living in NYC. But, I felt joy a lot too- well maybe not quite "a lot." But enough to make it worth it. I had enough moments when I would think to myself, I'm glad I didn't succeed in killing myself. I'm not having these moments.

Maybe I need a new job. Maybe I need a new man. Maybe I just need sex!

I've been in this really horrible depression this past week, but the past couple of days I am starting to come out of it- thanks to an increase in Zyprexa. Whatever is wrong with me, an increase in Zyprexa will usually fix it. Too bad about the side effects.

I think a return to internet dating is in my future.

Cycling

2010-03-20T22:49:00.002-04:00

The seasons are changing, spring is coming. Plus some stress at work. And now, I'm cycling.

In the mornings I am so down, I hardly get out of bed. Then as the day progresses, I start to feel agitated and irritible, until I think I am going to jump out of my skin. The only thing that soothes me is driving- as long as there is no traffic.

At night, I don't want to go to bed. But with the help of Ambien, eventually I do. Only to start the whole thing over again the next day.

Stop being stubborn girl, raise your meds! I know what I need to do, I just don't want to do it. But I will, tonight, because this can't go on.

At least I know I don't have to do my light therapy anymore this year! I do it all winter. And then, late March or the beginning of April, my mood shifts, and I know that it is over for the year. Some years I get a few days of mild happy hypomania, but no such luck this year. I'm just miserable.

Back to Work

2010-03-12T21:44:00.003-05:00

I'm recently back from a conference that was really good. Plus, it was really good to get away. Now the reality of getting back to work.

I had 3 days of work this week, and on 1 day we were 2 staff down. The rest of us had to cover the patients. It was a really bad day- I had two hours when I had so many patients stroke patients at the same time that no one got good care at all. That really eats me up- by the end of the day I wanted to quit.

Today was better, thankfully. And I have an interesting new patient- just about the most apraxic I have ever seen. When a patient is "interesting," it is never good for the patient. If you are a patient, you want your situation to be mild and boring.

I "only" stayed 1 hour late today- which to me felt like getting out early. We don't get any allocated time for paperwork, phonecalls, equipment orders, etc. We are expected to do this during treatment sessions, and then stay extra as necessary. But unless I have a very high level patient, I don't usually get any notes done during treatment time.

I'm in a complaining mood, so I'd better stop here. Healthcare is what it is. And I want everyone to get excellent care, and get all the care they need, and get better. And I don't want to have to put in long hours for paperwork. And I don't want to have to take a pay cut so that we can increase staffing levels or have dedicated hours for paperwork. I want the impossible.

Mostly I wish I could afford to work part time for a while. But that's not an option. Plus, I need health insurance!

Too much drama!

2010-03-03T20:04:00.002-05:00

It was a very high drama day at work. Patients, families, fighting between patients and their families. Not good. By the end of the day, I felt like I needed a drink!

I don't like yelling or angry voices. And I can't stand meanness- although I have never figured out how to deal with it, whether it is expressed towards me or someone else. I stay calm, I say reasonable things, and I come away feeling like I was walked all over.

Assertiveness is something I am still learning. And with some people you have to be more assertive than with others!

Withdrawal or Relapse?

2010-03-01T20:57:00.003-05:00

I'm lowering my antipsychotics a bit. I think I am having withdrawal symptoms. I hope I am not having symptoms of relapse. No paranoia, as I've had in the past. But I am not sleeping so well, I am anxious, I want to cry, and my heart feels racy. On the up side, I feel more awake and with it. This morning it was easier to get out of bed, it wasn't so much of a struggle. And I feel somehow more present. That veil that I feel is often there between me and the world is pulled back a bit.

Maybe the threat of tears, the anxiety, the insomnia, the racy heart, it is all transitory withdrawal symptoms. Or maybe some of it is here to stay. Maybe I have to take a little more bad in order to get a little more good. I'm okay with that, as long as the bad feelings are not crippling depression. But more tears, a little anxiety, I'm okay with that. Better than the numb I've been feeling recently. I just hope that the insomnia and heart pounding go away- that's no fun.

I've tried to get off of drugs before- and then got scared off by the withdrawal symptoms. But I'm doing it much more slowly this time- it seems like it is going to take forever! Then again, this strategy also means I spread out the length of time I'll be dealing with the withdrawal symptoms.

"Back in the day" before I was an occupational therapist, when I was in and out of hospitals- I used to get put in to hospital so my doctors could take me off, and then put me on, medications as fast as possible, and let me get every side effect in the book. And I would lie in my bed all day, too drugged up to attempt to go to the groups. I was a very bad patient. I always refused to go- even if it meant being locked out of my room. Until I got too bored- which meant I was feeling better. And then I would get into trouble for being too opinionated sometimes.

But now I say that I can never make another major medication change until I retire! I don't have a job where I can afford to not be functional, where I can be drugged up. What this has meant is that things have been added during breakthrough episodes, but we never want to take the risk of taking things back off. So over the 6 years I've been working, I've increased from 3 meds (an all time low), to 8. And that is just too much. So I'm taking the risk now of trying to get off of 1 or 2 things. And hopefully 3 by the end of the year. That is my plan, at least. And the best laid plans...

Disapointing News

2010-02-28T09:52:00.003-05:00

There is a journal article in the February issue of the Journal of Psychiatry on rates of Tardive Dyskinesia with the Atypical Antipsychotics. And it finds that they are not much better than the older antipsychotics, as was previously thought.

I didn't read the whole article, only the summery on Medscape, so I don't know all the details. They do say at equivalent levels (presumable of D2 blockage). Perhaps the atypicals can be used at lower equivalent dosages? And did they look at Seroquel separately? There is some theoretical reason to think it might be better. I never understood why the other atypicals would be better.

We do know that the atypicals are less likely to cause short term extra-pyramidal side effects- and that was thought to indicate a decreased propensity for longer term tardive dyskinesia. But it doesn't. And, I have to say, that I had EPS side effects on Risperidal and Geodon (although not as bad as Haldol)

If this is true, we should be seeing an explosion of tardive dyskinesia among the non-schizophrenic, as the atypicals are now being used for everything from anxiety to mood disorders to insomnia. Where is it? Is it too soon for TD to have developed? Maybe these drugs haven't been on the market long enough. Or maybe this is just one study, and isn't the whole story.

The study did find that risk of TD with antipsychotic use was much more likely among the schizophrenic than the non-schizophrenic- I think previous studies had found the reverse. So I am a little confused.

But I am all the more determined to get off of my Abilify. That will still leave me with a little bit of Zyprexa. Maybe someday I'll get off it, but not soon I think. In the mean time I'll keep taking all my antioxidents and lots of vitamin E at night with my Zyprexa. I'm hoping they will prevent TD.

I wonder if this study will change prescribing patterns. I have long thought that doctors are much to quick to prescribe antipsychotics to non-psychotic people. I have met doctors who will not prescribe benzodiazapines, but they will put you on an antipsychotic for your anxiety instead- something I think is totally backwards.

It would have been nice if the atypical antipsychotics could be the new wonder drugs in psychiatry. I have not been manic since Zyprexa, it has been my wonder drug. But as time goes by, and I start to forget how bad it was to be manic, I start to wonder at what cost I take this drug.

Patients Who Break My Heart

2010-02-27T07:09:00.003-05:00

I'm having a lot of these recently. A lot of late-state Multiple Sclerosis patients. One who is clinging on to indepedent living by a thread, and I don't know how much longer he can do it. And one who is so involved I am teaching her how to use a mouth stick. At home, she spends her days in bed. And a stroke patient whose vision is so affected that, while he might be able to go back to work eventually, he'll probably never drive again. And he lives alone. Lots of changes are going to have to happen in his life.

I am biased. When someone is approximately my age, it affects me more. I remember my first ICU evaluation. It was a woman with a devastating stroke, who was exactly my age. People my age aren't even supposed to have strokes! Or so I thought, before I went into this field. I had tears in my eyes as I did the eval, and hoped no one noticed. But she did amazingly well in rehab. The arm never came back, but she is walking and back at home with her kids and out in the community.

Working in this field grounds me. I often say that if I was a wedding planner, if I worked with happy people all day, I'd have to shoot myself! Instead, I am reminded daily that I have no monopoly on sufferring or difficulty. I can't feel too sorry for myself- although I have moments when I still manage to, but not many. Everyone has their own story, their own trials, their own battles, their own joys.

And I am inspired daily to see patients who manage to have good and productive lives despite considerable disability. I am constantly amazed to see how two people with the same level of physical disability live completely different lives, have different levels of handicap. There is a concept called "resiliance" that is being talked about a lot recently. How well you adapt and respond to adversity.

I think that depression is the opposite of resiliance.

Snow Day #2

2010-02-26T08:39:00.002-05:00

OK, I wimped out. I made the mistake of watching TV news this morning, and of course they always have to play everything up. Dire warnings, don't go out unless you have to. Pictures of cars on the side of the road and accidents.

So when I called in to say I'd be late, and they told me that my first patient had cancelled, I decided I wasn't going in. Not for two patients, who might not even show up. So I gave word to cancel them, and I'm staying home. Thank God for the great office staff who actually made it in on time.

But it really doesn't look too terrible outside. Not good, but not a blizzard either. I've driven in worse. Why did I get all scaredy-cat now? Because I had many years of not driving while living in cities, I just went back to driving this past April. And I haven't done any winter driving in almost 10 years.

When I think about all the meds I was taking 10 years ago, I probably shouldn't have been driving at times- although I was very careful not to take certain meds before I drove. And then there was my manic driving, when I could not stay within the speed limit. I got 3 speeding tickets. Of course lots of people speed without the excuse of mania.

Now I am a much better driver, and much more comfortable driving. And not manic, and not taking any benzodiazapines. And I have a great little car, a Honda Civic, which I am leasing. I wouldn't want anything smaller, living in the northeast where I have to deal with snow occasionally.

So how to enjoy my snow day? I'm definately putting on my boots and getting outside. Maybe I'll walk to the chinese restaurant for lunch. And I'm going to study. I really have to study.

Snow Day

2010-02-25T20:30:00.003-05:00

Today we had snow. I've lived in upstate NY, and life there just goes on, but here people aren't so used to it. I saw all of 3 patients today, and some therapists saw less. Yes, I work in outpatient, where patients have the option of coming. The inpatient therapists had a full caseload.

It was a fun day at work, very laid back. A lot of joking and playing around. A lot of catching up on some paperwork that really needed attending to. Plus were were told to call tomorrow's patients to reschedule or cancel therm- but 3 of mine are still coming in.

Tomorrow may be worse. The snow is supposed to continue all night, and the temperature is supposed to drop- the roads will probably freeze. But I have every intention of going in to work tomorrow. I don't want to take another PTO day for a snow day. I have 3 patients to treat, and paperwork to do. But I'm going in a little late, after my parking lot has been plowed and the roads are cleared.

I wonder if we jumped the gun with cancelling tomorrow's patients. Maybe it won't be so bad. Or maybe it will. Weather is just not an exact science.

So tonight I'm relaxing with a cup of hot chocolate and watching the olympics. The wind is picking up outside, and it gives me a cozy feeling to listen to it, dry and warm. I haven't been saying this a lot in recent months- but sometimes life is good. If only for a moment. What is life but moments?

Good Day at Work

2010-02-22T19:46:00.002-05:00

I had a good day at work, a good occupational therapy day. I had enough patients, but not too many. Enough time to give my patients what they need. Good patient interactions.

I had a discharge today, one of my long-timers. Someone who has really come a long way- one of the people who reminds me why I do this. I'll miss her.

I think the day was almost all stroke patients today, which can be very intense. Plus I had one workmen's comp patient, and the case manager came today to observe therapy, which can be a little awkward. But I think it went OK.

This evening I am exhausted, but not from work. It is that time of the month, and when I get my period I always have 2-3 days when I get really severe exhaustion. I feel like I can't move. Usually it comes with depression, this time it did not. I just have the exhaustion. This is why I take the pill so I only get my pill every 3 months. I couldn't deal with this every month. I used to spend a lot of days in bed. Or, I used to get crazy every month. To say nothing about the cramps I get- but now I've discovered Aleive, and if I take it at prescription strength, I'm pretty OK.

So no, I didn't make it to the gym, or clean, or study hand therapy this evening. I just sat in front of the TV and melted into the couch. Until I finally got enough energy to get up and eat, and now to sit in front of the computer before I take meds and go to bed.

I hope I have more energy tomorrow. One of my co-workers is out, so I will have some extra patients, it is going to be a busy day. Not like today. I have a feeling I won't have so much time for giving my patients the individual attention I want to tomorrow.

When I am treating orthopedic patients, I don't mind treating more than one patient at a time. In fact, the idea of just treating 1 hand therapy patient at a time, all day long, sounds really boring to me. But most of my caseload is neurological right now, and I feel very differently about that. My neuro patients I do wish I could give one-on-one treatment for all of their sessions. Unfornately, most places don't work that way anymore.

The stroke patients coming to outpatient therapy are getting more and more involved, as patients get kicked out of inpatient rehab quicker and quicker. Many of them come to us and they can't walk, they can't transfer independently, they can't dress themselves, they can't sit unsupported- I am starting to feel like I'm doing inpatient rehab at times. And I just feel bad for the patients, because outpatient doesn't give them the intensity of therapy that they need. They need more- and we are their last stop.

Of course some patients will continue to improve on their own, after the end of therapy. These are usually the higher functioning patients. The patients who have less function, and can do less on their own, they are much less likely to make gains on their own- and more likely to decline after discharge from therapy.

Disabled?

2010-02-21T21:08:00.003-05:00

I finished my taxes today using Turbotax. And with my dad's help, too. It was a little complicated this year because I moved from one state to another and changed jobs. Plus I did some home care work as an independent contractor.

Turbotax gives you a lot of prompts and asks you a lot of questions. At one point, it asked me if I am disabled. And I kind of wanted to say yes, but I kind of didn't. It is really a very good question. Am I disabled? Prehaps the better question is, "How disabled am I?" It isn't all or nothing.

When I clicked on the "learn more" link, it didn't sound like I qualify- or if I did, that it was going to help my tax situation any. But it didn't stop me from thinking.

I have been on social security disability. But for the past 6 years I've been able to work full time- although sometimes only hanging on by a thread. Really, there are times I don't know how I have kept going. It is my patients, really. When I have a patient in front of me, I can pull it together. I can do what I have to do. Now, the paperwork may start to slide when things get bad. It is not so compelling as patient care.

I actually have two disabilities. I have my mood disorder, and I have a learning disability, of some sort. I've been told I have dyslexia, ADD, and a variety of other things. But of course I don't have all of these things- I just have one brain that we try to put labels on. I just have a bad brain! I have bad brain syndrome.

What does it mean? It means I don't always know my left from my right and my handwriting is lousy. It means I am terribly disorganized, and constantly struggling with that. And mostly, it means that I am extremely slow with my paperwork. When the paperwork is not that bad, this isn't so much of a problem. But the worse the paperwork, the more of a problem, the more of a disability it is. So, long hours, but I manage.

And to the IRS, I am not disabled. I don't have any expenses that I can deduct due to my disability- although really, I think that my meds and therapy co-pays should qualify. And unfortunately, I owe a little bit to the IRS. And I owe one state, get a refund in the other. In the end, I actually come out a bit ahead.

But money is tight- and it is going to be tight for the next year and a half. Because I am going to be studying for the CHT exam- and until then I can't do a lot of home care or take a second job. But, I am going to have to do that in the future to pay off my debt and to save more for retirement. If I can just make it until then!

And I hope that this "disabled" person can study for and pass the CHT exam while at a job that is taking 10+ hours most days because of all the paperwork.

Comfortably Numb?

2010-02-20T17:09:00.002-05:00

I read Medscape. It is a really good website geared towards doctors with the latest medical news. Recently, it referenced a recent article in the British Journal of Psychiatry, which found that people on SSRI's experienced feelings of detatchment, personality changes, and a decrease in both positive and negative emotions.

Wow. I love it when the doctors finally figure out what any patient could tell you.

But that made me think. And introspect. And in recent months, I think my level of numbness has increased- to the extent that I had really not realized because I was so numb. And I've recently added medications to deal with a depression. But the depression is over, it is time to come off these added medications.

I have no illusions that I will ever be medication-free. But I think that I really only need a subset of the meds that I now take- and I don't know which of those meds I really need. That's the problem. I can make my educated guesses, but in the end there is a certain amount of trial and error involved in seeing what I can reduce or get off of- and I need to function at a very high level to work. Therefor, there is this slow accrual of medication. Something gets added, and it stays there.

The last two medications I have added are Abilify and Provigil. I have to say that Abilify did really save me. I was having an exremely bad depression, I was about to quit my job I was so depressed. But the depression is over- and if I didn't need it in the past, I'm going to take the guess that I don't need it now. I'm feeling just too numb.

The Provigil I really hope is not contributing to the numbness. Because it is really helping with my concentration and energy. I have ADD, and can't take stimulants because they raise my pulse rate too much.

How is this numbness affecting me? First of all, I am a procrastinator. I need a certain amount of anxiety to break through this and actually get things done. I went on Effexor half way through graduate school for OT, after a suicidal depression. And after I went on it, I noticed that I was getting to class late and not getting assignments done on time- and not because I was depressed, just because I wasn't "inspired" to do things. I needed that anxiety.

I need strong emotions to function. And recently, I am not functioning at all outside of work. And it is no longer due to depression- I am not in mental anguish. Quite the opposite, I am just fine with sleeping all weekend and doing nothing. I need to not be OK with that.

So I am going off the Abilify, knowing that it is there if I need it, the next time things get bad (which they will, they always do eventually). I'm not foolish enough to do it overnight, much as a part of me wants to. I take 10mg now (5mg 2x/day), and I'm going to go off 2.5mg/week. Assuming the depression doesn't come back of course.

My depressions are so bad, they have taken away so much of my life- is it surprising that I'm willing to give up a little of myself to keep them at bay? That's the deal I made with the Effexor. The best antidepressant I've been on in some ways, but it also gave me the numbness. But not so much that feelings couldn't break through- it just took a little more.

But now I feel like nothing is breaking through. So I need to do something.

You may ask, did I talk to my psychiatrist about this, no. I'll tell him at the next visit which isn't for a couple of months. But he is very good about this type of thing. As long as I'm being responsible, he doesn't mind me adjusting my own meds. Warning: not all psychiatrists are like this! Some are real control freaks. And if you are not stable, or don't know what you are doing, adjusting meds on your own without talking to your doctor is a really bad idea.