I'm glad I stuck it out

I made a couple of minor med changes over the past two days. Yesterday I was still feeling very numb- and thinking that this is not acceptable and I can't risk another day of this and getting nothing done. But I was still hoping it was temporary, and possibly because I had messed up my Effexor (it didn't feel like Zyprexa numbness), so I kept at it- and today I feel good. The numbness is better. My mood is pretty good.

I am at the higher dose of Zyprexa- and I realize that when I started going to yoga and doing things it was at the higher dose, and that when I went back down to 5mg I stopped going to yoga. So I am back at 7.5mg. The only way I can do this is to take all of my Provigil at once in the morning, instead of breaking it up- but it seems to be lasting enough of the day that it is okay. And I am not taking any klonopin, except for that quarter of a milligram at night to help me to sleep. I think klonopin is destabilizing for me- I get rebound effects. I hope that I can get off of that last little bit of klonopin.

I don't even want to be taking Zyprexa- but if I am going to be taking it, I want to take enough of it to really make me better. Otherwise, why bother? I'd love to take no meds- but I think I will die of old age before I could wean myself off of all of them, so I am stuck with them. I am going to use them.

I have a lot to do today. I am doing laundry. I have to do dishes. I have to go visit my dad- and it is over an hour's drive each way. I have to go in to do paperwork. I have to work on my inservice. And I have to write my Provigil appeal.

The price has dropped into the 200's again at Costco- but it is still much higher in the other stores, and I don't want to be at the mercy of market forces. It would be so nice to have the Provigil covered. Especially as the deductible for my health insurance is going up by $500 next year and my psychiatrist fees won't count towards it. And I still haven't decided if I will continue with therapy- my therapist will not be covered and I hate switching. I hate trying to find someone good. And trying to explain my life to someone new.

Hard days

I have been overly emotional about some things. And just had some really hard days. I am thinking about what my psychiatrist said in jest- that meds can fix everything- and wondering if meds could do more than they are doing. And wondering what there is to do for the things that meds cannot touch.

I think some of my trouble is anxiety as well as depression. But klonopin does not seem to be a good answer these days- it makes me too sleepy. If they could make a klonopin that wasn't sedating, I would be a willing addict. Two nights ago I couldn't sleep and in the morning I was so anxious that I took klonopin early in the day- and just a smidge- but got so tired I thought I'd have to go home sick. But a second cup of coffee seemed to work to get me through it, and then I was functional.

And that was good- because I had a very interesting patient in the afternoon- a stage II tendon Hunter Rod tendon reconstruction patient 2 days out from surgery. So I had to take off the surgical dressing, clean things up and do some dressing changes, and make a splint. And get him started in his home exercise program.

The weekend is going to be a lot of paperwork and preparing for an inservice. I an giving an inservice on screening our patients for cervical problems that might be causing the distal symptoms that they present with- so that we can refer to the PT's. And leading a discussion on a journal article on the treatment of compression neuropathies.

I am also spending money! I am giving in to the black Friday sales (although I have not set foot into any store). I have most of my Christmas/birthday shopping done. Our family has a lot of December birthdays. I also bought a few work tops for myself and a set of hypnosis CD''s on procrastination. It came bundled with one on "mental toughness" so I am getting that too.

I am glad it is the weekend. So much to do.

Sad

I am feeling sad today. I am trying to keep it in the moment, and not to project into the future. I have reasons to be sad. A lot of reasons. And I am lonely. I really need to get out more.

I don't know why this makes me feel sad- but I am going to visit my dad in rehab tomorrow. I am planning to bring Thanksgiving food. But my step-mother, and now my dad, keep telling me not to bring food, he will have turkey for his dinner there. But what about me? What will I eat? And what about having a shared meal? I thought that was the point. Now I don't even want to go. I'm not going to bring food just for myself.

Plus I am under orders from my step-mother not to bring up the impending breast biopsy. Not that he's the best person to talk to about it- she actually is, she has had breast cancer. I can't talk to my mother about it- she told me not to do it and to read Suzanne Summer's book on alternative treatments. Plus she is so overwhelmed with taking care of her mother right now- that she really can't focus on anything else.

I'm not afraid I'm dying. If there is anything there, which is unlikely, it is extremely early. I am afraid of the treatment if there is anything there. I want to keep my breasts. I don't want radiation or chemo. And- I just thought of this today- afraid that I will have to stop my birth control pill and not be able to go on HRT after menopause. Afraid of what that will do to my mental stability.

I do happen to know that Suzanne Summers is taking bio-identical hormone replacement therapy. But she also had a mastectomy. So she didn't just do alternative stuff.

It is the waiting that is the hard part. But at least at work today I forgot. I saw all of my patients by 2pm, at least the ones who didn't cancel because of the snow. I am really hoping that I can get my car out of the driveway tomorrow morning for the local Turkey Trot. It all depends upon when my landlord plows, or if it all melts overnight.

I also decided today that I am going to change my hours at work a little in the interests of patient care. I will have to see if that opens me up to different evening activities or support groups. And I am going to make that change soon- because I will be looking for a new therapist very soon and will need to know my hours.

But medication can fix everything!

I know that my psychiatrist was making a joke, but he smiled so brightly when he said this that for a moment I thought he was serious. And I think he thinks this more than I do. Meds don't give you a life- at best they make it possible to do the things to have a life. But if you have been sick for many years, if you lost the life you had- or if you got sick very young and never had a great life to get back to- then meds are not going to fix this. If you have forgotten how to be a human being, or never learned key skills growing up, meds are not going to fix this.

My psychiatrist might say I'm dysthymic. He was really pushing to see if I needed any med adjustments. And I'm glad he did- sometimes when I am telling myself that this has nothing to do with meds it is me falling into depression and justifying to myself why I feel so miserable. But I know that it is impossible to medicate away this dysthymia for any length of time, if that is what it is, and I'm not sure that it is.

Anyway, things will stay the same for the next three months. At least that's the plan. That is what my prescriptions are written for and that is when I see him next. But a lot can happen in three months.

Today I am totally exhausted. I got up early to see my psychiatrist and then had my late day at work. Only to find that I wanted to be on the internet looking up breast calcifications and biopsies on google. There is also a possibility that I will get in to see the surgeon tomorrow- if anyone cancels due to the snow they will call me. Otherwise I have to wait until December 9th. It is a long wait.

It was only a matter of time...

I knew these mammograms were a mistake. Even the research can't tell me if I should be getting them. I only started getting them to appease my PCP. I knew the false positives would start coming- I just didn't realize how soon.

At my first they found nodules in my left breast which meant every six months I had to get a follow up mammogram and ultrasound. I thought my right breast was doing okay. Today it let me down. They found calcifications in it- and they want me to have it biopsied. Even though it is most likely benign. Most likely but not guaranteed.

So ironic- I was feeling so good today. Finally back on Provigil (and realizing it is the drug for me). You would think that at least this could hit while I was a little more ambivalent about life. But I am not really worried, I don't think it is anything. I just have to do this because- well, that is what you do I guess.

And then I started reading about the procedure, and thinking, my poor breast! It is not exactly like when I had the mole on my back biopsied.

So the imaging center had a patient care navigator- who was in the room with the radiologist- and made the appointment for me with the surgeon. I don't have an appointment for a consult until December 9th, so either they are very busy or they aren't too worried. The biopsy isn't even scheduled.

I forgot to ask if I am done with the ultrasounds on my left breast- they said last time I probably would be if things continued to stay the same, and per the ultrasound tech they stayed the same.

And tomorrow I see my psychiatrist.

I'm just bankrupting the healthcare system. No, wait- I've got a high deductible plan. It is bankrupting me.

.

The trade-off

It is my second day of the lowered Zyprexa, I am down to 5mg from 7.5mg. I woke up and felt awake before my morning coffee. My head feels clearer. Even my depression feels better. The only thing that isn't better is my anxiety- that is a little worse. But that is the trade-off. I realize that there is no good way to medicate my anxiety without substantial trade-offs. The sedation, mental dulling, cognitive side-effects, etc. For now my anxiety is small enough that I can deal with it without more meds. That may not always be true- I am sure I will continue to have my times when I need my klonopin or more Zyprexa.

I'm trying to figure out what to do re Nuvigil or Provigil and which to stay on. Maybe a smaller amount of Nuvigil would work. I really liked the once a day dosing and fewer mood swings- but I think 250mg was too much and made me irritable (although I also needed that much on the higher Zyprexa dose). Half a pill doesn't seem like quite enough, though. But then Provigil, at the moment, is cheaper. I think. But for how long?

Next weekend I am going to write my appeal for Provigil- I have 60 days. I am guessing that they won't care what I say, but I have to do it anyway. If Provigil gets approved, I will obviously go with Provigil. I have had too much going on with my dad to do it sooner.

I wonder if there is anything that this "health coach" that my insurance company is offering me could do to help me with my appeal. "Health coach" is really misleading. They only want you to be healthy in ways that make you cheap to insure. If it helps your health to take an off label drug or to get a medical test more often than their guidelines say, you are out of luck.

I always wish weekends were three days long. Yesterday I was visiting my dad. Today I am doing laundry and I have to drive to go buy my Provigil. I also have to go into work to do notes- but I wish that could be tomorrow. Only it can't be, because tomorrow is Monday, and I will have new notes to do.

My dad's in rehab

Yesterday my dad got transferred to a rehab hospital. I visited him today. He is still very tired, but doing much better. The OT in me observed him transferring from the wheelchair to his bed for a nap- with an aide of course- but he really didn't need much help. He is going to be okay.

I may be spending Thanksgiving with him- I think my step mom wants to spend it with the rest of her family who is all coming here. I mentioned that I could bring catered food. She didn't think that was necessary, as they would probably be giving my dad something turkey for dinner. Well, what about me? Plus, hospital food is not the same. But she is not a foodie.

I am still figuring out meds- isn't that the story of my life? I have been just so irritable- even on the higher Zyprexa- and I can't take it anymore. I think it is the nuvigil. Plus I am down to my last pill. I have to go to the pharmacy to pick up Provigil- but didn't make it there today because I was so wiped out from all the driving to see my dad. Anyway, I went down on the Zyprexa last night hoping that if I did I could get by on half a Nuvigil today. But I was really sleepy, and only survived on lots of coffee. It wasn't enough. Now my mood is bad and I don't know if it is the Zyprexa or Nuvigil.

I have half a Nuvigil left for tomorrow morning- then I really have to get my Provigil. It is a drive. But the price I was quoted is not too bad. I swear, this is like watching the stock market. I am going to try to stay down on the 5 mg of Zyprexa. If I stay at the higher dose I am going to wind up 300 pounds.

I did one good thing today- I registered for our local Turkey Trot. Well, I do the walk, no the trotting. But still, it is better than doing nothing but driving and eating on Thanksgiving day.