Saw My Psychiatrist a Couple Days Ago

I saw my psychiatrist a couple days ago.  I called and was able to get in sooner than scheduled, which was fortunate because I'd been feeling pretty bad.

The appointment went all right.  He recommended increasing my Cymbalta.  I'd been on 90 mg and it was my understanding that 90 mg is the highest dose studies have found to be effective.  While  higher doses are safe, studies haven't found them to be beneficial.  So I had though increasing it wouldn't help.  However, what I wasn't thinking of is that sometimes higher doses might be helpful for someone, even if statistically studies haven't found that to be the case usually. 

I was on a very high dose of Effexor for several years, 450 mg, when most people are on 300 mg or less of that.  And it caused me to develop super high blood pressure, but it did help my depression, when a lower dose hadn't.

While I'm not sure a higher dose of Cymbalta will help, it does seem reasonable to try that before switching to a new antidepressant.  Plus it might help my pain, too.  I mean, Cymbalta does help my pain, that's one reason I am hesitant to switch to a different antidepressant.  I just mean maybe the higher dose might help even more.  I was worried that changing to a different med would cause a significant increase in pain.

He also prescribed Trazadone for sleep, which I've been on before.  Trazadone is actually an antidepressant, but for it to help much with depression, you need a big dose.  But it's very sedating, so it's seldom used for that purpose these days.  We have better antidepressants now that have fewer side effects.  But it's often used for sleep in smaller doses because it is so sedating.

Well, when I took it before, it seemed like if I was on a high enough dose to make me sleep, it made me really groggy and hung over the next day, which I did not like.  But at this point I'm willing to try it.  He prescribed 100 mg but I plan to start with 25 mg (I will chop the pill into quarters) and increase it after a few days.  I am desperate enough for some relief that I'm willing to deal with some grogginess in the morning if I have to, but I want to minimize the side effects as much as I can.

My psychiatrist also recommended I find a therapist for CBT, or cognitive behavioral therapy.  I've done CBT before and I know it works for most people but I really did not find it helpful.  If I wanted to do therapy, that's not what I would want to do.  But I don't really want to do therapy.  I reminded him I have not been in therapy for almost three years, not since my horrible experience at the ER and in the psych ward.  I pointed out that I don't trust mental health care providers anymore.

He sort of laughed at that.  I sort of laughed, too.  I was like, "I don't really trust you very much, either."  I trust him enough to see him, but if I didn't have to see him in order to get my meds, I wouldn't.  But my PCP won't prescribe my psych meds.  And I wouldn't feel very comfortable having my PCP adjust my psych meds, either.  I believe my psychiatrist is more knowledgeable and better able to do that safely and well.  But that doesn't mean I trust him a whole lot.

He tried to talk me into CBT.  I don't think he understood what I was saying about it not being helpful for me.

I did think about it afterward.  I did a little DBT, or dialectical behavioral therapy, when I was in the hospital up in Michigan many years ago, the hospital that specializes in treating PTSD and trauma-related disorders.  I'd be willing to consider doing that again, if I could find someone that does it nearby.  It's often done in a group therapy setting and I might feel safer in that setting than one-on-one.  But I have no intention of doing CBT.

* The hospital I was at in Michigan is Forest View Hospital in Grand Rapids.  I highly recommend it for anyone needing inpatient care for PTSD or DID.

The Busiest Week Ever

I have had the busiest week ever.  Well, OK, not ever.  I've had busier weeks in the past.  But like, a really long time in the past.  Back when I was a social worker, I often worked 50 hours a week.  But that was, what?  Twelve years ago?  A little more than 12 years ago.

But the last four days have been super busy for me.  Monday and Tuesday and Wednesday, I left the house by 10 am and didn't make it home until dinner time or later.  So eight hour days or something like that, and then I came home and had some data entry stuff to do for my mystery shopping jobs. Today was a little less busy but still pretty busy.  I took Whiskers to the vet and did two mystery shopping gigs after that.

Plus I took Isaac to the park for a while first.  Which may have been a bad idea, because he managed to roll in something stinky, and even though I cleaned him up the best I could, he was a bit smelly the rest of the day.  But we have had a lot of rain here all week, plus I've been so busy, and that means he has not had much exercise.  I was able to let him run around at a park for about 20 minutes yesterday, between thunder showers, but he still really needed to run and let off some steam today.

I needed to be outside today, too.  I wasn't feeling very well, had a headache and felt kind of achy and nauseous, so I didn't want to walk very far, especially since it was hot and extremely humid.  But I stood under some trees in the shade while Isaac ran around and took a dip in the lake and rolled in stink.

I think both Isaac and I have handled our busy week well, but I also think I need to take care not to over schedule myself in the future.  I know I do best when I get enough rest and enough time to hike and be outdoors.  And I haven't done that this week.

I had a minor anxiety attack Tuesday, when I was already exhausted and then this indicator light came on in my van.  You know, the lights on the dash that tell you something's wrong?  And I had no clue what this light meant.  When I bought my van, it did not have an owner's manual with it, so I didn't have that to look it up in.  The light sort of looked like a light bulb, except it was not bulb-shaped, it was round.  It also sort of looked like a bomb, and I really hoped it did not mean my van was about to blow up.

It turns out it was supposed to be a light bulb and it was telling me that one of my turn signals, the rear left one, to be exact, is burnt out.  But why not actually make it bulb-shaped?

I figured it out by stopping at Auto Zone and asking the guy working there if he knew what it meant.  He came out to the van and looked at it and he was not sure, either, at first, but he was able to figure it out.  I was pretty pleased with myself for thinking of stopping at Auto Zone and asking, plus I was really relieved to find out it wasn't something serious, so that helped the anxiety.  That, and 50 mg of vistaril.

Week after next, Isaac and I are going to Michigan for a few days to visit a friend.  I'm looking forward to a little vacation!

Stress is Not Good for Me

This is not news, of course.  But I am reminded of how much an effect stress has on my fibromyalgia.  I have been in more pain yesterday and now this morning than I have been in a long time.  And I know it's stress.  And it's a reminder that trying to work a lot more and cut back on acupuncture and stuff would not work for me.  Except if I end up without a car, I won't be going to acupuncture anyway, because I won't have a way to get there.

I see my acupuncturist later today and I hope to take a nice long walk with Isaac, and hopefully those things will help.

Limitations

Sometimes I get so frustrated by my disability.

No, that's not quite accurate. By my limitations. By the things I can't do and want to do or even need to do.

I have been having a lot of trouble with my car and I have to get a new car. Well, a used car, but new to me. I live in the middle of no where, there is no public transportation, I cannot be stuck here without a car. It is a mile to the nearest store, and while I could walk a mile there and back, at least most days, with my back problems I could carry very little home in the way of groceries. And all my doctors are far away. I have to have a car.

Well, I do not have much money for a car, so my options are very limited. It is becoming apparent to me I am not going to be able to find anything in any kind of decent condition for what I can spend. And it is using up a lot of spoons looking. So my first thought was, well, I need to work more to make more money, and I also need to spend less money, so I should cut back on my acupuncture appointments.

And then I thought about that for a minute. That would have worked, maybe 12 years ago. But now? Work more and do the only thing that helps me manage my pain less? That sounds like a sure recipe for disaster. I can't do that.

But that is the only way I am going to be able to get a car and I need a car. And I want to be able to do it. I want to be able to work hard and then get what I need. I want to be able to do it and I just know I can't.

3 am and I'm Wide Awake

It's about 3 am and I'm wide awake. 

I have my dental work this afternoon.  About 11 hours from now, in fact.  And I'm anxious about it.

I'm doing all I can to prepare. 

I moved my regular tutoring session from Tuesday to  Monday so I don't have to go tutor after getting my tooth pulled.  The student's mom assured me that it would be OK to cancel Thursday, too, if I'm not feeling well by then.  I was like, "Oh, I better be feeling OK by then!"  Good grief, I don't wanna be in pain for three days!

It was kinda funny.  The little girl I'm tutoring is 10 years old but she has pretty significant learning disabilities, so she's more like a six-year-old, I'd say, socially.  She wanted to see my loose tooth and wanted to know if she could wiggle it.  So I let her.  First I got her to tell me what letter "tooth" starts with.  Sneak some learning in there whenever I can, you know!  Then she informed me she thought it was going to hurt a lot when they pull it.  I told her to shush and get back to her homework.

Anyway. 

I have protein shakes, yogurt, soup, homemade applesauce, lots of yummy soft and liquid stuff in case it hurts to eat.  I have my anxiety meds in my purse - I'll take one right before I get to the dentist's office so it should be kicking in by the time it's time for the procedure.  And I have my anxiety meds and Tylenol by the couch for when I get home.  I have Orajel by the couch, too.  I have my heating pad on the couch and I'm going to put my weighted blanket out here before I leave for the appointment.  I have an ice pack in the freezer.  My dishes are washed, my house tidied up.  I have some music I like on my MP3 player to listen to in the car.  I've got movies to watch on Netflix when I get home, while I lie on the couch.

I finished up the custom cloth menstrual pads a friend ordered and will stop by the post office to mail them before I go to the dentist.  I have some articles to write but those were just requested yesterday and I told my client I probably wouldn't be able to start on them until Wednesday or Thursday.  So there is no pressing work I have to do.  All I have to do is rest and recover until it's time to go tutor on Thursday.  And I have my tutoring materials ready for that session already.

A friend offered to come over after I get home from the dentist and spend the evening with me.  It's someone I'm sort of dating.  We haven't known each other real long and I wasn't sure I wanted him to see me when I was feeling anxious and unwell, but I like him and I trust him and he really seemed to want to be here for me.  So I said OK.

Mike was going to stop by when he gets off work but I told him he doesn't need to since my other friend is coming over.  But Mike said I could call him if I changed my mind,  he'll be available.

My other friend will probably actually be more helpful, though.  He will do stuff like take Isaac out to pee for me if I don't feel like getting up and taking him out.  When I had the biopsy of my gum done a few months ago, I remember I ended up taking a double dose of my anxiety meds, which pretty much zonked me out for a few hours, because that was the only thing I could think of to do to cope with the pain.  I may end up doing that again, but I'd feel better about doing it with someone else here with me to take Isaac out and stuff.

I think I've done all I can do to prepare but I still feel really anxious.

Dental Work Scheduled for Next Week

Tuesday I am going to have my loose tooth pulled and get a temporary bridge put in.  Then they will schedule a date to put a crown on the tooth that will support the one end of my new bridge, but my mouth will need a week or two to heal before that.  I am hoping the extraction goes easily.  It is being done by my regular dentist, I don't have to go to an oral surgeon for it.  I'm anxious, though.

This kind of thing really triggers my PTSD.  I'm worried about how much pain I might have afterward. Also, I stopped taking my turmeric in preparation for the procedure, because it can lead to excessive bleeding.  So I'll be turmeric-free for several days before the procedure, which will probably make my back pain and arthritis and stuff worse.

I am glad it will be getting done, because this tooth is really bothering me.  But I just hate to deal with the PTSD and anxiety and pain.

Well, That Scared Me

Saying it scared me is putting it mildly, really.

Yesterday I took Isaac to the park near my home, where we go all the time.  All summer long, I've been letting him run off leash there.

Please don't tell me that was unwise, because I realize that now.  I felt it was OK because A) the park sits way back from the road and the trails are away from any roads B) we are almost always the only ones at the park when we go during the week so there is no risk of him bothering anyone else or of encountering any aggressive dogs C) his recall is pretty good, though it is not perfect (and we ARE going to be working on it!). 

What Isaac usually does is run a short ways ahead of me, then run back to where I am, then head off the trail a short ways, then come back to where I am, etc.  He often seems to be checking in with me to make sure I don't get lost.  He rarely goes out of my sight and when he does, I can usually hear him because he likes to go crashing through the brush.  If I don't see or hear him, I call him and he comes back to me.  Not always instantly, but within a minute or two.  So we've been doing this all summer and it's been fine.

Today, we were going down this steep hill.  Isaac went ahead of me and reached the bottom first.  I saw him down there, rolling in some leaves.  Then I took my eyes off him so I could watch where I was putting my feet because it was very steep and I didn't want to fall.  When I got to the bottom of the hill, I did not see Isaac.  There was a little bend in the trail and I went around that bend, thinking I'd see him there.  There is a creek there that he likes to play in.  I did not see him, so I called him.  He did not come.

After about 20 minutes of calling, and still no Isaac, I was starting to panic.  I didn't know what to do because if I tried to go look for him, I wasn't sure which way to go.  The trail went in a couple different directions shortly after going around that bend, and I didn't know which why he'd gone, or if he was even on a trail, and I was afraid I'd pick the wrong direction and end up going further away from him.

I called a friend who works nearby and he came over to help me look for Isaac.  It was about 30 minutes before he could get there, though.  By then, I was hoarse from yelling for Isaac.  My throat hurt, I was thirsty, I was panicking.  My anxiety meds were back at the car but I was afraid to go back to the car because it was at least a mile from where I was and I was afraid to leave the area where I'd last seen Isaac.  I was terrified something had happened to him and thinking what a terrible dog owner I was.

I don't know how to convey the level of panic I was feeling.  I think the anxiety, the worry that something might have happened to him, was pretty reasonable, fairly rational.  But then my thinking started going really crazy.  Really illogical, irrational.  Which it does.  Which is one of the reasons it's so important to take my anxiety meds at the beginning of an anxiety attack, and which is why Isaac is trained to bring me those meds at the beginning of an anxiety attack.

But they were back at the car.  I have thought about that and decided I need to carry some with me on hikes from now on.

But anyway, my thinking was going in all sorts of crazy directions.  I was thinking that Isaac was hurt, that he would be dead, and that then I would have to kill myself.  I was thinking that I never should have gotten a dog because I should have known something bad would happen so it would be all my fault when it did.  Because I wasn't supposed to have anyone that loved me.  I was really thirsty and thought I was probably getting dehydrated (which was rational, because I'd been crying and yelling for Isaac for more than half an hour and we'd walked a ways before that so it had been a long time since I had anything to drink) and I knew I needed my meds but thought that I wasn't supposed to go back to the car to get them because I was supposed to suffer because I was being punished for being such a bad person.

Finally my friend got there.  He pulled into the little parking area and called me on my cell phone.  Isaac was lying there by my car.  He was by the back door on the side where he usually gets in.  He recognized my friend's car and got up and looked happy to see him.  My friend said he looked like he was fine.

I got back to the car as fast as I could.  Isaac did indeed seem fine.  I think that for some reason he got too far away from me and ended up just finding his way back to the car and waited for me there.  I think it was really smart of him to find the car and wait for me there.  But I was so, so scared when I couldn't find him.

It will be a while before Isaac gets to be off leash anywhere besides a fenced in dog park, I think.  I am going to hire a local trainer to help me work on his recall.  Like I said, I think his recall is pretty good but it is clearly not perfect and it is apparently not good enough to be off leash anywhere that is not fenced in.

Ready for Surgery Tomorrow

As ready as I'll get, I guess, anyway.

My kitchen is stocked with easy-to-prepare and easy-to-eat foods, including yogurt, soups, protein shake supplies, and supplies for making smoothies.  I've got my meds and lip balm and hand cream and all that good stuff on the coffee table in easy reach of the couch.  I've got my weighted blanket and anxiety meds ready to take with me.  I even cleaned up the house a bit.

The dog walker is coming to take Isaac for a run later in the afternoon after my surgery, so that's good.  If I'm not feeling well, I won't need to worry about taking him out as much.  I also have one of his favorite peanut butter-filled bones in the cupboard, so he'll have something fun to do that won't require me taking him outside or playing with him.

I feel less anxious than I felt about my oral surgery last fall.  Oh, I'm still anxious, I'm still wishing I had someone to go with me or something to be with me at home afterwards.  I do remember what a hard time I had after the surgery last fall.  The surgery itself was quick and easy but that night, alone in my apartment, I had flashbacks and anxiety attacks and nightmares and cried a lot.  I remember.  I'm hoping that won't be the case this time, but I know there is a good chance it will.

But it is what it is.  I did ask friends if anyone was available to go with me to the appointment or spend some time with me at home afterward, but I didn't expect anyone to volunteer, and no one did.  Last time I ended up feeling really sorry for myself because I had to go through all that alone, but this time I feel more... accepting of it.  It is what it is.  Sure, I wish it was different, but it's not, and maybe it never will be.

And I got through it last time.  So I can get through it this time, too, right?

I Have to Have Oral Surgery

I have to have oral surgery next week on my gum.

I've been dealing with a problem area in the gum behind one of the crowns that was put in for my bridge last fall for a couple of months now.  Since early to mid May, I guess.  I tried ignoring it for a while and when it didn't get better, finally gave in and went to my dentist.

I really like my dentist.  I had having to go to the dentist, any dentist, but I do like mine.

He tried a couple things and couldn't figure out what was causing the problem, so I had to go see a periodontist.  Which of course Medicaid will not pay for.  Apparently I have some sort of weird infection and a lot of inflammation and I have to have surgery to clean out the infection and also he is going to do a biopsy just to make sure nothing more serious is going on.  Of course neither Medicaid nor Medicare will pay for the surgery, but Medicare will pay for the pathologist to examine the tissue specimen taken from the biopsy.  Isn't that nice of them?

I am stressed.  I am more stressed about the idea of having to have surgery than about the money, which tells you how much this sort of thing triggers my anxiety and PTSD, since it is going to cost me $950.  $950 which of course I do not have.  I had to borrow it from a friend.  I have no clue how or when I will be able to pay him back.

And it's bad timing because there is all sorts of financial stress going on already, which I haven't written too much about.  I did mention that I had to start paying my Medicare premiums, which are $105 a month, and that this extra expense should cause my rent to go down a bit.  Well, I am still waiting for that to go into effect.  The reduced rent, I mean.  Paying the Medicare premiums started in July.  But my rent did not go down yet.  But on top of that, my freelance writing income has decreased and when I reported the changes to the state welfare department, they did something goofy and decreased my food stamps and increased my  Medicaid spend down, which is the opposite of what should have happened.  It will be fixed but it is a huge pain and is taking a while to fix.  So financially, things suck right now.

But surgery.  On my mouth.  It's triggering and I am stressed.

He's Throwing Up Again

You may remember that last Friday, Isaac threw up.  Well, he threw up again today.  It was just after  noon and we'd just headed out for a walk.  It looked like the remains of his breakfast.  It worried me a bit because, although he only threw up once last Friday and has seemed fine since then, it is unusual for him to throw up.  But I hoped it would be a one-time barf, like last week.

But it wasn't.  I took him back inside and called the dog walker to cancel his afternoon run because I figured running wasn't a good idea with an upset stomach.  And then he threw up again.  Just liquid that time.  And again.

After the third time, I called the vet.  I asked if it might be a reaction to the injection he had for allergies yesterday but the vet really didn't think so. 

I am absolutely certain he didn't eat anything harmful so I didn't know what else it might be. 

The vet suggested I take his temperature.  Don't you love it when vets suggest stuff like that?

Did I post about trying to take Cayenne's temperature several months ago?  I'm pretty sure I did.  It did not work.  And after that, I threw out my thermometer because, well, although I never actually got a temp, it did at least sort of go in her butt.  I just couldn't keep it there long enough to get a reading.  It was not a good thermometer for rectal use, anyway.  It had this flexible tip, which is good for taking oral temps, I guess, it's not real hard and won't hurt your teeth if you bite it... but it's not good for sticking in tight places, if you know what I mean.

I know, ick, right?

But I went to Rite Aid to buy a new thermometer.  I am pretty sure they actually make thermometers for pets but Rite Aid does not carry these.  I got a digital one with a tip that is not flexible.  It is supposed to get a reading in 10 seconds.  I doubt I could hold Cayenne still for 10 seconds, but I figured I could probably get Isaac to cooperate for that long. 

I also bought some of those little plastic sleeves you put over the thermometer.  When I tried to take Cayenne's temp, I didn't have any of those.  I ended up cutting a finger off a latex glove and using that as a sleeve for the thermometer.

When I got home, I discovered Isaac had thrown up again. 

I did manage to take his temperature and it was normal.  He didn't seem to mind that much, really.  He didn't look thrilled about it but honestly, he looks much sadder about taking a bath.

The vet thought it would be OK to watch him through the night and call back in the morning if he's still vomiting then.

It's almost 10 pm now and he had thrown up 15 times so far.  I was getting worried about the possibility of dehydration but he has had something to drink a couple times.  And it's stayed down a while, too, but then he's ended up throwing up again.

Twice I've taken him out to potty and the second time, he not only peed but also pooped and that looked normal.  He seemed interested in going out.  He's been mostly lying down but he has followed me into the bathroom and kitchen several times, like he normally does.  Twice he's brought me his Kong, wanting me to put a treat in it, which I did not do, of course.  He certainly isn't acting normal but he is still showing some signs of interest in his usual activities.

I feel so bad for him.  He looks so sad after he throws up and I feel sad.  Several times I've sat on the floor beside him and cried.

And I feel so anxious.  I need him to be OK.  It's not like I think he's not going to be OK, he'll probably be fine... but I need him to be OK.  I need him.

I'm also tired of scrubbing my carpet, but honestly, I am a lot more concerned about Isaac feeling bad than I am about all the cleaning.

The Lack of Logic Goes On

Since my medical expenses have suddenly increased by $105 per month, I contacted my landlord to ask about whether this might allow my rent to be reduced.  My rent is based in part on my income but also in part on my medical expenses.  He said yes, it should be cause for a reduction in rent, though he couldn't say offhand by how much.

So this morning I took the letter from Social Security over to the rental office.  And was informed that, in addition to a copy of that letter, I would need to provide about 15,483 other documents because they would have to totally recalculate my rent.  Even though they just did that a few months ago.  Apparently there is no way they can just add the $105 Medicare premium into their prior calculations.

So, in order to find out if my rent can be reduced and by how much, I need to provide a current bank statement (which is more trouble than it sounds since I do not get a paper bank statement, I have to print it out from the internet, but I have no printer because I am poor, so printing anything is a big hassle); a list of every doctor, hospital, pharmacist and other health care provider I've seen in the last year (complete with names, addresses and phone numbers); receipts documenting every medical expense I've had over the past year; a signed letter from Isaac's dog walker verifying how often he walks Isaac and what he charges (the one he signed in December not being recent enough, apparently); a written prescription from my doctor for all the non-prescription vitamins I take, verifying those are medically necessary (the one he wrote in December also not being recent enough); and probably a few other things I'm not thinking of at the moment.

And then, after several weeks, I'll find out by how much my rent will be reduced.  The change might go into effect in August.  Maybe.  Because the people in charge of calculating everything do not rush.  The fact that I am panicking over how I'm going to survive on $105 less per month does not constitute an emergency for them.  And I get that.  Kind of.

That does not change the fact that I wanted to smack the lady in the rental office when she kept rattling off item after item that they would need from me.

It's not reasonable.  It's not logical.  It's probably doable, but it's not easy and it's not simple and it's not fair.  Like anything ever is, right?

I spent a lot of the day sleeping.  Because I'm not panicking when I'm asleep.  My stomach doesn't hurt then and I don't feel like I'm going to throw up.

Panic and Depression. And a Lack of Logic.

Lately, I feel like I've been coping pretty well.

Yesterday, I found out why.  Because nothing stressful has been going on, really.  Duh.

And then, something stressful happened, and I am back to being a mess.

I got a letter from Social Security yesterday informing me that the state of Ohio will no longer be paying my Medicare premiums.  Instead, $105 will be deducted from my monthly SSDI payment.

Of course, the letter did not explain why.  It's possible it is an error, logically one might assume it has to be, since my income has not changed.  But one would only assume that if one was naive enough to think the system was logical.  Like if one had never been on any type of public assistance.  In reality, the reason is most likely either that the formula the state uses to determine whether they will pay one's Medicare premiums has changed and I no longer qualify according to the new formula or my recent increase in food stamps (I used to get $15 a month and now get a whopping $32) and decrease in my Medicaid spend down (which is like a monthly deductible I must meet in order to receive my Medicaid card) means I am now too wealthy to qualify.  Of course it is ridiculous that getting an additional $17 in food stamps would mean I can afford to pay $105 for Medicare.  But I learned long ago that you'll make yourself crazy if you expect the system to make sense.

I decided to call Social Security to ask why the change.  If you've never had the pleasure of calling  Social Security, well, consider yourself lucky.  After finding my way through an extremely long and convoluted phone tree and holding for a long time while enjoying some elevator music, I finally got to speak to a real live person.  Who informed me I needed to call the state Medicaid department to ask why the change.  Silly  me, I figured since the letter was sent by Social Security and the telephone number printed on the letter was that of Social Security, that was who I should call.

I did not have the energy to call the Medicaid people yesterday.  In fact, I have not summoned the energy yet.

If you have had the pleasure of calling Social Security, well, let me tell you that trying to call the Department of Job and Family Services (the welfare people in my state, where you apply for things like Medicaid and food stamps) is like that experience multiplied by at least five.  Maybe seven.

Last week I had a dentist appointment and I had a question about whether or not I could get a gas voucher from JFS for that appointment.  Seems like a simple question, yes?  So I looked up the number for the JFS office in my county and called to ask my question.  After listening to a very long message which informed me, amount other things, of the hours of my local JFS office, what number to call if I wanted to report child abuse or neglect, what number to call if I wanted to talk to someone about child support, and various other bits of info I did not care about, I was given an 800 number I could call if I had questions about benefits.  And that was it.  No way to reach an actual person.

So I called the 800 number.  Which is a state-wide number, not my local county office.  After holding a while, I was able to speak to an actual person, who informed me that she couldn't answer any questions about gas vouchers because those are administered by the county office, not the state office.  I would need to call my county office.

I told her I had done that first and was unable to speak to a real person but the recorded message said to call the 800 number.  I asked if she had a number for the county office that would reach an actual person.

She didn't.

I asked how I could get an answer to my question.

She offered to give me a fax number.

I have no idea if they would respond to a question via fax (I somehow doubt it) but it doesn't matter because, surprise, I do not own a fax machine.  I pointed out that probably most people that are poor enough to be on Medicaid and need gas vouches probably can't afford fax machines.

Silence.

I asked how I could get an answer to my question.

She suggested I go into my local JFS office to ask.  Yes, that's right.  Drive to the JFS office, using gas, to ask if I can get a gas voucher, which I might or might not actually be able to get.

There's logic for you.

So anyway.  I have not called yet to ask them why they will no longer be paying my Medicare premiums.  I simply have not had the energy.  And... I keep crying.  I'd prefer to call when I am able to complete the call without bursting into tears.

Plus, who knows if they will be able to give me an answer on the phone?  Maybe I'll need to fax them my question, on my non-existent fax machine.  Or maybe I'll have to drive there and sit in an uncomfortable lobby for a long time to ask my question.  I guess the benefit to that, if you want to call it that, is that occasionally if you burst into tears and look like a crazy person in a place like that, they actually try to help you, either out of pity or fear or just to get you out there as quickly as possible.  Of course, they might also respond by calling security, so that's the change you take, I guess.  It's a situation I prefer to avoid, if I can.

I will call.  When I feel in control of my emotions enough.

Right now, I feel panicky and depressed.  I've cried a lot.  I know $105 probably does not sound like much to most people.  But it is almost half my rent.  It is a lot to me.  Plus apparently I don't cope well with unexpected news like this.

More on Yesterday

I realize that in my post last night, I probably sounded like a lunatic.  I was sort of crazy but maybe not in the way I sounded in my post.  I was not really throwing my groceries around the kitchen, not exactly.  It was more like slamming things down on the counter, slamming cabinet doors, stuff like that.  I did throw a package of hotdogs into the freezer, but since I was standing right in front of the freezer, it wasn't much of a throw.  I was stomping my feet and being loud, though.  And that is not at all typical of my behavior.

I do think it frightened Isaac some.  Cayenne was sitting on the couch the whole time, not looking fazed at all.  I'm  not sure, but I think Isaac was bothered because he knew I was wanting him to do something but for some reason that I don't quite understand, he didn't understand what it was that I wanted.  And then I was getting mad and of course that didn't help him figure out what it was that I wanted.

After I finished putting the groceries away and stomping around, I sat down on the couch and cried.  Isaac came over to me, crept over, like he was a little unsure it was the right thing to do.  He put his head on my knees and I put my arms around him and hugged him and then he was fine.  He sat there with me for several minutes, then went and found a toy and brought that to me, which is typical Isaac behavior.

I realize my thinking last night was really irrational.  What I was thinking was something along the lines of, no one is helping me, I need help and no one will help, the rheumatologist won't help, my other doctor won't help, there is no one to help me, and now Isaac won't even help me.  Of course it's not true that no one will help, but it was true that there was no one around last night to help me.  And it is true that I don't always have help when I need it.  But I tend to get stuck in black and white thinking at times like that, where it's all or nothing.  No help at that moment means no help ever, period.

And of course it's not true that Isaac won't help me or was refusing to help me or didn't want to help me.  Isaac, for reasons I am unsure of, didn't know what was expected of him last night when I was having a major meltdown.  That is not the same as refusing to help.  Isaac very  much wants to help but he is a dog, not a computer or robot or mind reader, and sometimes he gets mixed up or doesn't understand.  And usually, it's because I am not communicating things to him clearly.  Which is my fault, not his.

Today Isaac and I practiced doing the lights and getting the meds a few times.  We are going to practice those things a lot in the next few days.  One of the problems may have been that I was standing in the doorway asking him to get the lights and we have not practiced that command from there very often.  The light he gets the most often for me is the living room light and most of the time I am on the couch when I give him that command.  He can turn on the lights in the kitchen, bathroom and bedroom, and we practice all of those occasionally, but probably not enough. 

I was wanting him to turn on the kitchen light last night, but maybe he wasn't sure which light he was supposed to get.  Really, it would have been OK with me if he turned on the living room light instead, but if he was confused about which light, it makes sense he didn't turn on any of them.  He needs to be given clear instructions and it's my job to be clear with him.

In addition to practicing the other lights more, we are going to practice getting the meds.  Isaac and I have practiced that extensively, with me giving the command from all rooms in my apartment, and with me sitting on the floor, standing up, lying on the bed, etc.  But we haven't practiced it with me given the command in different tones of voice.  Either I say, "Get the meds," in a calm voice, or we also practice it with me sitting and rocking back and forth, which is something I do when I'm very anxious, and he knows that means to get the meds without being told to get them.  But by the time I told him to get them last night, I was upset because he hadn't turned on the light and because of everything else that was going on, and I think I was loud and angry-sounding.  So we're going to practice it with me saying it in different tones of voice.

Seeing the Rheumatologist Tomorrow

I see the rheumatologist tomorrow.  I'm anxious about it.  I'm worried she's not going to listen to me (and I found numerous reviews of her online, where prior patients complained that she doesn't listen) and that she won't want to prescribe adequate pain medication.  My primary care physician doesn't want to keep treating my pain, but right now I don't even have a diagnosis, so who knows if it's something the rheumatologist would treat.  I mean, if she thinks it's fibromyalgia then she would treat that, but what if that's not the diagnosis? 

And what about my back?  I don't think my back problems are caused by fibromyalgia, even if I do have fibro.  The back pain is due to degenerative disk disease and/or a herniated disk, depending on which back specialist you think is right, and that's not the kind of thing rheumatologists treat. 

So I'm worried that I'm not going to get adequate pain medication.  The medication I have currently is just barely adequate.  But I will run out of it over the coming weekend and if the rheumatologist doesn't prescribe more, I'm not sure how I'm going to cope.  I'm trying not to panic about it now, to wait and see what happens, because anxiety only  makes the pain worse and there's no sense making it worse now when I don't even know that's going to happen.  But it's hard not to worry.

So I Panicked

It was an all around bad day.

I had a plan.  Pick up meds at the pharmacy, get gas, pick up milk and tomato soup at the dollar store, then go to the food pantry to get produce. 

The local food pantry I go to has produce once a month.  Last month I got about a hundred organic bananas.  Well, OK, it was just a dozen or so.  But that's a lot for one person.  I also got corn on the cob, oranges, yogurt and cottage cheese.  I know, yogurt and cottage cheese are not produce.  But I got yogurt last month and the month before and I was hoping to get more today.  I was also hoping for apples.

So I went to the pharmacy, where I found my doctor had failed to call in refills for my Tramadol and Flexeril, and where the pharmacy tech tried to charge me a copay for my Miralax, when I think Medicaid should have paid that copay for me.  I asked the pharmacy tech why Medicaid didn't pay it and she said they paid for more of the cost.  I said no, that would have been Medicare that paid for most of it.  Medicare is my primary, Medicaid is my secondary.  Shouldn't she know that Medicare and Medicaid are not the same things?  Surely she has many other customers that have Medicare and Medicaid.  So she said she'd bill Medicaid and I said I'd call my doctor's office and come back later.

On the way to the gas station, I called the doctor's office.  I spoke with his medical assistant who said, "I think he's working on those refills today."  What does that mean?  I have no clue what that means.  What is there to work on?  It's a phone call to the pharmacy.  Might take 90 seconds.  So I asked her what that meant and pointed out that I will be out of those meds at the end of the day.

Now, I called about those refills on Wednesday, two days before I would run out.  I thought two days seemed like ample time for someone at the doctor's office to find 90 seconds to make a quick phone call.  I didn't call sooner than that because I figured they would not want to call in refills if I still have a lot of pills left.  Plus, I figured my insurance wouldn't pay for the refills if I tried to get them too soon.

The MA seemed annoyed and said she would call me back.

And then I panicked.  What if they didn't call in the refills?  I started thinking of how much pain I'd be in all weekend.  My right arm started hurting more just thinking about it.  I recognized that, I realized that my anxiety was going to make the pain worse.  I cried a little bit.  I took some anxiety meds.  I reminded myself that the anticipation of pain makes pain worse.  I reminded myself that the pain wasn't too bad right then so I needed to focus on that, not on how much it might hurt later.

The panic receded and I went on to the dollar store.

Then I went to the food pantry and found they were closed.  There was a sign on the gate that said, "Sorry we are closed today."  I have no clue why.  I was there Monday for my regular groceries and the woman at the desk reminded me that Friday was produce day.  I was really disappointed.  I had been really looking forward to the yogurt I hoped I would get. 

And I was counting on that food.  Before I set out to do my errands I had carefully planned what to get at the dollar store and how much gas to put into my car, because money is that tight right now.  You know, I was working out, well, I have $7 available on my credit card and $12 in my checking account and $9 left on this gift card, so I can use the credit card for the gas and with the gift card I can buy two gallons of milk and two cans of tomato soup and a package of dog treats for Isaac, like that.  No produce at the food pantry totally messed up my plan.

I'm gonna call them Monday and see if maybe they will be doing produce on a different day.

Shortly after I got home, the MA from the doctor's office called and said the refills would be called in by the end of the day.  I plan to go back to the pharmacy tomorrow.  Hopefully it's all been taken care of.  It was a rotten day.

Doctor Appointment Tomorrow

I have an appointment with my primary care physician tomorrow to talk about my increased pain and what to do about it.  I feel incredibly anxious about it.  Part of the anxiety is the fear that he won't believe I'm in this much pain and won't want to do anything about it.  Part of it is that I don't know what I want to do about it.  I like going to the doctor with a plan.  Which is maybe sort of silly, but I usually have an idea of what's wrong with me and what I want to do about it.  You know, if I have a very sore throat and a fever, I want a strep test and, if it's positive, an antibiotic.  Or I have a list of blood tests I want, and then if my B12 level is low, I want a script for B12 shots.  But I don't know what I want now.

I spent some time looking online for pain management specialists.  I read lists of treatments they offered, like epidural steroid injections and nerve blocks.  I've tried those things and they provided some temporary relief but it didn't really last long enough.  But also, those things aren't really options for me now because they sedate you for the procedures and you have to have someone to drive you home.  For some of the procedures, you're supposed to take it easy for a day or two afterward.  I don't have anyone to drive me and I can't take it any easier than I already do, because there is no one else to do things for me that need to be done.

But then I thought, if I go in there and start saying oh no, I can't do this and I can't do that, they are going to think I am being difficult and that I just want drugs.  Which isn't true.  I mean, I'd love a pill that made the pain go away.  But I don't want to become addicted to pain meds and I also don't want meds that make me too drowsy.  I can't take a pill that knocks me out all day.  I have to take the dog out and feed the cat and stuff.

Most of the pain management specialists seem to require a referral from your primary care doctor, but I don't even know if I want a referral.  I don't know if I want to see a pain management specialist.  I don't know what I want.  I just want the pain to stop.

I'm really anxious about the appointment tomorrow.

Little Victories

I know I write a lot about problems I'm having but I want to try to focus on positive things more and there have been a few positives in the last week or two.

• I know I've mentioned how much I hate asking for help.  Well, about a week ago, I needed to do a load of laundry and I had enough quarters for the washing machine but was one quarter short of  having enough for the dryer.  I spent some time searching for one more quarter, in the bottom of my purse, under the seats in my car, everywhere I could think to look, but could not find one.  I thought of going out in the bad weather to an ATM machine, withdrawing $10 (and paying a fee for using an ATM at a bank where I did not have an account), and going to the grocery store to see if they would give me some quarters.  I thought of just washing my stuff and hanging it up all over my apartment to dry.  I also thought of asking one of my  neighbors if they had a quarter (I had nickles and dimes, just no quarters), but that seems a lot like asking for help, and I didn't want to.  But I finally did.  And of course, she gave me a quarter.  And it was so much easier than going to the ATM and then to the grocery store, so much easier than having wet laundry hung up all over the place to dry. 
• And tonight, I asked a friend if he could stop on his way home from work and bring me a gallon of milk.  I hated asking for that.  But it is freezing out, it's snowy, the roads are kind of icy still, and my back hurts.  To go out to the store, I would have had to scrape ice off my car windows, which is hard on my back.  The cold makes my joints hurt.  I just really, really didn't want to go out.  I need some stuff from the store, but I figured if I just had someone to bring me some milk, I could have a protein shake for dinner and another for breakfast in the morning and I can figure out getting to the store in another day or two.  So I asked.   And I got milk.
• About a week ago, I was in the kitchen making my morning protein shake.  I poured a glass of milk, added calcium citrate powder and Miralax, and was getting ready to add the vanilla protein powder - and I knocked over the glass.  Spilled milk all over the counter.  Luckily it didn't get on the floor, so it wasn't too hard to clean it up.  What's notable about this is that I didn't get too upset about spilling the milk.  Normally, a little thing like this sets off this whole downward spiral for me.  I get angry at myself.  I start thinking about how I always mess things up.  I would feel guilty about wasting the milk, and also the calcium citrate powder and the  Miralax, because I can't afford to waste stuff like that.  I would think about how stupid and clumsy I am.  These kinds of thoughts would just spiral out of control and the whole day would be ruined.  And this time, that just didn't happen.  I cleaned up the milk.  I made another protein shake.  I took some anxiety medication and I got on with my day.  This probably sounds like a silly little thing, but it really was a victory.

The Root of Fear

I've been thinking the last couple days about how frightened I got thinking about winter and the risk of falling on the ice.  I think the reason for my fear, the root of it, is the feeling that I can't take care of myself, can't protect myself, and that no one else is take care of me or protect me, either.  It's strange how threads connect in our minds, isn't it?  You wouldn't think the experience of being sexually abused as a child would have much in common with the experience of falling on an ice walkway, but there are little pieces of both pictures that are the same.  There are emotions and thoughts that go with both experiences that are the same, and when those connect, other emotions and thoughts start to occur, not based on the real experience but on the emotions and thoughts from the other, seemingly unrelated, experience.  Am I making sense there?

I don't think those fears are unrealistic, really.  Maybe the intensity of them is out of proportion.  But the truth is, if I fall on the ice, if it happens late at night, I really could be lying there until morning.  One of my neighbors has a home health aide that arrives around 7:00 am.  I could be lying on the ground from 11:00 pm until she arrives at 7:00 am. 

And if I was injured, if I needed help at home for a while, there is no one that could help me.  I might talk Mike into going to the store for me one time to pick up just a few things.  Maybe.  There is no one else I could even ask to go to the store for me.  There is no one that could do laundry for me or other things around the house.  I could ask Isaac's dog walker if, instead of taking Isaac for his hour long run, he would be willing to come to the house two or three times a day to take him for short walks to pee.  He might do that, but he couldn't do it every day, because he goes to school and has a job.  So he might be able to help with taking Isaac out but he couldn't do it all the time and there is no one else that could help me with Isaac.

Is it likely that I will fall this winter and hurt myself badly?  I don't know.  I fell twice last winter.   Both times I was able to get back up.  Once a friend was with me, but I didn't need much help getting up.  The other time I was alone and it took me a minute, but I got up and walked back to my house.  So I fell, and I survived it, and I had some bruises, but it wasn't that bad.  I was not left lying on the ground for hours and I didn't need help doing basic stuff at home afterward.  I wasn't injured badly.  Probably, if I fall this winter, I'll be OK.

But it's possible I won't.  And I'm afraid.

Rethinking the Day

I had plans for a busy day today.  I need to go to the Medicaid office, which is always fun.  I was going to do some cleaning and maybe a load of laundry.  I also need to pick up some things at the grocery store.

But then I woke up.  I woke up in a lot of pain.  Not just my back, but my elbows and knees hurt.  My knees.  I have arthritis in both knees but they have not hurt since I lost a bunch of weight several years ago.  But they hurt today.  Especially the right one.

So I had to rethink my plans.  No laundry, for sure.  To much lifting and bending involved, even with Isaac to unload the dryer.  No cleaning, because I can living with a messy house for one more day.  The trip to the Medicaid office and a trip to the store, but a shorter grocery list.  Some stuff I can live without for a few more days.

I'm trying not to be frustrated that I can't get done the things I want to get done, the things I feel like I need to get done.  I'm trying not to panic about being in pain and alone.

More Winter Worries

I just took Isaac out for his usual pre-bedtime poop and something else occurred to me.

When I pick up after Isaac, I dispose of the poop in the dumpster that is at the far end of my parking lot.  There is a trash can right outside the front door of the building but the property manager asked me not to dispose of poop there because it might smell.  Well, I can walk on the grass almost all the way to the dumpster, but then I have to walk a short way on the pavement.  This evening, all the ice is gone and it was not slippery at all.  But I'm sure it would have been slippery this morning.  I'm sure it will be slippery at times this winter.

So what do I do with Isaac's poop?  Risk walking on the icy pavement to throw it away?  Seriously, if I fall out there by the dumpster at 11:00 at night, I could be out there on the ground all night long.  But what else can I do with the poop?  Take it back inside with me, keep it in my apartment until the ice melts later on and I can safely dispose of it?  That's... rather gross.  Although I guess I'd go for gross over lying on the cold ground all night long.

Not only is this frightening to me, it's very frustrating and it's also embarrassing.  There is some shame involved with not being able to do things independently that most people can do easily.  There is some embarrassment in saying, "I don't know how I will dispose of my dog's poop."