Jumping to conclusions

I sometimes hear people say that getting old is not for sissies. Well, Parkinson's Disease is no walk in the park. And it may have been a walk that Robin Williams did not want to take- and that may have been the main reason for his death. The early reports all jumped on his history of mood and substance abuse disorder.

I often hear it said that suicide is never a rational choice. But I think it can be- even for someone with severe, recurrent, treatment-refractory depression. Maybe you just don't want to deal with that kind of life anymore. Most of our actions are not 100% rational, anyway.

For someone as expressive and emotive as Robin Williams, Parkinson's seems like a particularly cruel fate. And yet, I have many patients with Parkinson's disease with good lives. The medical therapies are getting better and there are some new rehabilitation techniques as well. But in its later stages, it is a savage disease.

I don't know what I would do if I got the diagnosis. To have to deal with that on top of the depression- that would be a lot. My biggest fear is dementia, as a result of both my illness and my meds. Along with tardive dyskinesia- although my doctor thinks we could spot this early.

A death, amongst many

People are dying of Ebola. In skirmishes  between resistance fighters and the army in Ukraine. From ethnic cleansing in Iraq.

And Robin Williams killed himself. Surprisingly, that doesn't touch me very much. My step mother called to ask me how it affected me. She said that some of her friends with depression were affected- or felt validation- that this showed the world how bad depression can be, and how hard it can be to hang on.

I think I put Robin Williams in the "celebrity realm" and it doesn't touch me. They inhabit a separate world in my mind. And I am not a part of that world. What celebrities do- it never seems real. Even this. If my neighbor did this, I would be terribly affected. But an actor/comedian? It doesn't seem real. Which is probably not being fair to celebrities. I'm sure their lives seem very real to them.

And I was never sure I liked Robin Williams. I liked a couple of his movies- but most of them seemed too tame, not him. And yet his standup comedy was both genius and uncomfortable to watch at times. He went too far into that strange place. Too far for me.

I'm sorry things were so bad for him. He must have been in a lot of pain.

Fortunately my thoughts have not been that dark recently. In fact, I did something life- affirming today. I gave blood. I used to- but after I moved several years ago I got out of the habit. It turns out that none of the drugs that I take are contra-indicated for blood donation.

I always have this image in my mind when I give blood: A depressed person is in a car accident, needs emergency surgery, and gets a transfusion of my blood (with all my meds in it). And then the person wakes up feeling better than they have felt in years!

It is funny- I am normally fine with blood. I do wound care, change dressings, watch surgeries, etc. But when I give blood, I cannot watch the blood going out of my arm into the tube and into the pouch. I feel like it is my soul that is leaving my body. So I just don't look.

A good weekend

My mom and I went to visit my brother, sister-in-law, and niece this weekend. It was great. In my recent visits I really haven't felt that great- I felt better this time. Maybe the med changes are good.

Or maybe it was the good news. They are having another baby. Yea! Niece does not not yet- it will be a shock. She is so used to being the focus of their attention. But I hope she will step up to the role of the big sister.

All of which made me think of moving closer. As I often do, I looked at the job ads on the two websites for hand therapists- and saw an ad for a job at a neighboring city. It is at a very prestigious hospital and hand center, and might even involve work with the hand transplantation team.

And I don't know. Is that just too much pressure? Or is that what I need? I don't know. Sometimes I want more of a challenge. But not yet. I need to get my meds settled first- then maybe figure it out. Plus, my pension- what little of it there is before they froze it- isn't vested for another year. Maybe another 14 months, because I took 8 weeks off for disability. So it is too soon to be going anywhere.

And I couldn't quit now anyway- I think we might be losing one of our therapists who just had a baby. If I left now- I couldn't do that to my boss. But I am not ready to leave. If I even want to leave. I don't know. I have it pretty good where I am now.

I just know that I have a very delightful niece. And I have an amazing brother who came out shockingly normal in some ways. I think that marriage and fatherhood have been good for him.

Rough day

Yesterday I felt so depressed that today I am back up to 300mg of Effexor. I don't even care what my dosage is- I just want to feel not depressed but not so numb that I lose my motivation and ability to act. I don't know how to get there. 

Today I had taken the day off- I thought I would go tubing on the river with my mother who is still here. She opted out due to concerns about her osteoporosis. I would up doing pretty much nothing today, and feeling in a terrible mood. I think we keep clashing in small ways, over and over again. We are such different people with different lives, and there is too much history between us. If I am not in a good mood to begin with, I cannot handle her. 

She also has to talk constantly. I need quiet. When I walk out of the room for some quiet- she follows me. There is no subtlety with her. She doesn't get hints. How can I be related to someone who talks so much? And yet, I think my mood problems come from her side of the family. There is a big component of her in me.

Tomorrow we go to visit my brother and family. I am looking forward to that. It will be something good. I get to see my niece!

Still in a strange place

I am feeling better in some ways, but very sad too- and like I am on the verge of tears much of the time. I'm not sure it is a bad thing. It will be if I get stuck here, but not if I can pass through it eventually.

This week I am desperately trying to get caught up on paperwork, but there are only so many hours I can stay at work. I did get some big things done but I am still behind. I think it is getting better. No, it is getting better. But it is taking so much of me that there isn't time for anything else- yet. When I get caught up- and I will- I think it will get better.

My IBS continues to be to be better- just some stomach pain occasionally, but no diarrhea. I am continuing to eat the modified diet. It is a pain sometimes- not so much when I cook but when I just want to grab something to eat out of the house- but it is doable.

My obsession right now is the Ebola virus and the Americans who have been brought back to the US and given the experimental serum. Will they live? Was this the right thing to do? Will we learn anything from this? You are supposed to do clinical trials with any new drug- you want to know how effective it is- and the only way to determine that is to give it to some and not to others. You need a control group. If we decide that the serum is helpful- no one will ever agree to be in a control group. You will never be able to do a clinical trial. If you believe in clinical trials- this should be very worrisome. And yet, it is very understandable what was done.

Supposedly the serum cannot be mass produced. Neither could penicillium, initially. If it works, they will they will eventually find a way to make larger quantities- if there is a financial incentive. A big if. The satire magazine "The Onion" had a great headline: Scientists Estimate Ebola Vaccine 50 White People Away.

Living on the edge

It has been good to cut back on the Zyprexa and the Effexor. I feel more alive, I don't struggle quite so much with initiation- it is easier to act. It is even easier to do my paperwork. And yet, I can see the specter of depression starting to appear at times- although nothing very serious yet. I just know it is there, waiting. And I think that if I go lower on meds, at least for the moment, I will go into that depressed place.

And then I think, maybe it is not depression- maybe it is just sadness. I have a lot to be sad about. Maybe decreasing my meds is just letting me feel that sadness, and that is not a bad thing. Maybe I have to go through that place.

But mostly I am just tired. I am tired of trying to get caught up on paperwork at work from the times I couldn't do things- and didn't know what was wrong with me. I am tired of this messy house that I have been too apathetic to clean- and I am trying to fix that. I have so many things I am behind on- and I just want a clean slate. I want to start my life over again. I wish I could be my pre-Zyprexa weight again. Now if I ever get there I will need a tummy tuck or such.

And when I came home late from work tonight, I wish that my mom had cooked dinner. But that would be expecting too much. I should have brought food home. I was disappointed. I continue to expect things of her and I shouldn't, I just get disappointed.

I remind myself that I am going to see my brother, and my niece, this weekend. That will be good. And I have Friday off- even if I go in to do notes in the morning. Maybe I will get a pedicure. My last one was in January. And then mom and I will go river tubing- it is a 3 hour trip. Life will be good- I think if I can get through the next couple of months, life will be good. But it is going to be hard.

If I could handle today without klonopin, I should have it made!

I spent the day with my mom here, and it has been stressful. I am not sure this visit was a good idea. I feel like she sucks the air out of the room- but I know that I am just very sensitive to her. Plus this apartment is way too small for company. I can get any distance.

But, I managed the day without klonopin. I can't say I didn't have a minute or two when I thought about it, but it really didn't get so bad that I felt that I had to have it, so I didn't.

I am still taking my quarter of a milligram at night to help with sleep in addition to the ambien. That is next on my list- after the Effexor. To get off of that. But not too many changes at once.

Tomorrow it is back to work, and we are meeting with some kind of efficiency expert tomorrow. The word is that the higher ups want us to see more patients per hour. But the irony is- that doesn't mean that we will make more money- because we see a lot of Medicare patients and Medicare doesn't let you double bill- if you are seeing multiple patients and one of them is a medicare patient, you have to split the billable time between them. So if I were seeing three patients per hour instead of two, it would be even more likely that one of my patients that hour would be a Medicare patient, and I would have to splint the billable minutes three ways instead of two.

I have treated three patients an hour before- it is doable in hand therapy- except for some of the really complex patients- but the billing becomes really complicated. I really hope we don't go that route. It is also going to make our patients unhappy. We are really able to give a lot of personalized attention right now. And the paperwork will be worse- and I can't imagine that they will give us more non-patient care time to do notes.