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.

Feeling Depressed

I have been feeling pretty depressed the last few days.  I dunno why.

I feel lonely.  Last night I was thinking, Isaac is such a good companion, he's a really good friend, but... well, sometimes I wish I had someone to talk to.  Because talking to myself in my head, or here on my blog, I mean.  I was thinking about it, and in the last time I had a conversation with someone, beyond the hello/how are you/it sure is cold out/thank you/goodbye kind of conversation with the checkout person at the grocery store was over a week ago, I think.  I had lunch at Subway with a friend.  Today I saw my massage therapist and we talked about the weather and that was the longest conversation since the lunch at Subway over a week ago.

I was supposed to get together with a friend yesterday.  We'd planned it two weeks ago.  Then she backed out of the plans.  So I called another friend and asked if he wanted to go for a walk with me and Isaac.  He said yes but he was busy, he would call me back in half an hour.  He didn't.  Well, he did call, but not in half an hour.  After 50 minutes, I decided Isaac and I were going to the park by ourselves.  He called a little while after we'd gotten there and were already hiking.

So I spent the day along.  Well, with Isaac.  I love Isaac.  He's a good listener.  But sometimes I would like to have a conversation with someone that talks back.  Just sometimes.

So I feel lonely.  And depressed.  I am doing all the things I know to do to deal with it.  I went to the park with Isaac yesterday even though no one was available to go with me.  We walked for almost an hour.  Later that night, we took another walk down the road, about 20 minutes.  I came home, took a long hot bath.  Lit some incense.  Today I had an appointment with my massage therapist, so I had a massage.  Nice nurturing stuff that is supposed to make me feel better.

But I don't, not much.  I feel lonely and depressed.

I cleaned my kitchen.  Worked on some training with Isaac.  Doing something, anything, sometimes helps.  It's better than sitting on the couch thinking about how lonely and depressed I am.

But I still don't feel much better.

Again with the "Suicide is Selfish"

It shouldn't surprise me that after the death of Robin Williams by suicide, people are making the same old ignorant comments about "suicide is selfish" and "cowardly."  And maybe I'm not so much surprised.  But I'm angry.  And I'm hurt.

He died of depression.  It's sad.  It's tragic.  But it's not selfish.  It's no more selfish than if he'd died of a heart attack or cancer or a stroke.  And it's no more cowardly.

Mental illness is an illness.  It's not a choice, it's not a character flaw, it's not a moral failing, it's not a weakness, it's not an act of cowardice or selfishness.  It's an illness.  Why is it so hard for people to get that?  Why do people refuse to acknowledge and accept that?

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.

Electroconvulsive Therapy

Did you know electroconvulsive therapy (ECT), what used to be referred to as "shock treatment," is still used today?

I think many people imagine it as a thing of the past.  It's much more humanely-done today than it was in the past.  Patients are fully sedated for the procedure, they aren't awake, they don't experience any pain, and they are given muscle relaxers so they don't actually convulse.  In the past, patients sometimes suffered broken bones or bit through their tongues, stuff like that, from convulsing so hard.

But it is still used today.

You can read about it here: Electroconvulsive Therapy

I underwent ECT in the spring of 2010.  It's one of the things I don't talk about much.  I'm not embarrassed or ashamed of it, but the idea seems to scare a lot of people.  And maybe I'm worried it makes me look really crazy.  I mean, it seems so extreme.  Only the really crazy people would have to have shock therapy, right?

Also, though, there's a lot I don't remember about that experience.  One of the side effects of ECT is memory loss.  I remember having it done, I remember the hospital, I remember the anesthesiologist and a couple of the nurses, I vaguely remember the doctor.  I had it done on an outpatient basis.  Mike drove me, we were there for a few hours, then he drove me home.  I wasn't allowed to eat anything in the morning before the procedure and we would stop for lunch on the way home.  I vaguely remember that.  I do remember being given crackers and diet soda in the recovery room when I woke up after the procedure.

I remember this woman that was always in the waiting room.  She drove a friend there for ECT and she would wait in the waiting room and she brought this big container of markers and a sketch pad and did these elaborate doodles while she waited.  Mike and I called her "the coloring lady."

I know I went three times a week for five or six weeks, although I didn't actually remember how many treatments I had altogether.  I had to ask Mike.  I also didn't remember whether I'd had unilateral or bilateral ECT, so I asked Mike about that, too.  He told me they started out with unilateral, which is what they usually do because it tends to cause less memory loss, but at some point switched to bilateral, because it wasn't working as well as we'd hoped it would.

I did have a lot of memory loss.  More than I'd been led to expect, more than I've been told is "normal."

I had ECT shortly after Cayenne was first diagnosed with, and treated for, cancer.  And I completely forgot that she'd even had cancer.  Many  months later, my sister said something to me about Cayenne's cancer.  And I was like, what?  And as she talked about it, I started to remember.  But I had totally forgotten it.

I read a lot of books during the time I was having ECT.  I would take a book to the hospital and read while I waited for my turn to have the procedure done.  Afterwards, though, I couldn't remember anything I'd read.  I had a whole shelf of books that I reread a few months later, after I'd finished the ECT, because although I knew I'd read them, I didn't remember the stories at all.

I forgot how to get to places that I'd been going for years.  For instance, I'd been seeing the same psychiatrist, in the same office, for six years.  I could not remember how to get to his office or what street it was on or anything.  I could not remember how to get to the grocery store.  I could not remember where things were in the grocery store, either.  It was very frustrating for me.

ECT did not have the drastic effect on my depression that I'd hoped for.  I think it helped a little, but certainly not a lot.  For a long time afterward, I felt it hadn't helped and maybe actually made things worse because of how debilitating the memory loss was for me. 

Now, though, looking back, I think in some ways it did help a little.  I was severely, severely depressed when I chose to have ECT.  I was suicidal.  It was a last resort for me.  And I had at least a little hope that it would help and that gave me something to hang on to.  I didn't kill myself because I thought maybe this treatment that I'd never tried before would help.  It gave me a reason not to kill myself yet.  And while it didn't get rid of the depression, certainly not entirely, I wasn't suicidal when I was done with it.

A Year after the Hospital

I've made it through Thanksgiving.  I was a little worried about how I would do since last Thanksgiving ended up so bad for me.  Last year, I ended up in the hospital.

Tonight I was reading the posts I wrote about my experience in the hospital last year.  Actually, the posts about it were written in March; I wasn't able to talk much about it until four months after the fact.  I was too traumatized to talk much about it for a while.

I was reading the post in which I explained how I left the hospital in significantly worse shape than I was in when I was admitted.  I was still in worse shape in March, four months later.

I am better now, a full year later, than I was in March.  But you know, I am still worse now, a whole year later, than I was when I was admitted.

Honestly.  Seriously.  The damage done in that hospital in just five days was that severe.

Prior to that hospitalization, I was having nightmares three or four times a month.  Four months after the hospitalization, I was having nightmares four or five times a week.  Now, a whole year later, I still have them at least three times a week.  Often, the nightmares are about being hospitalized, although some are about my childhood or other things.

I am sleeping better now than I was in March.  I've always had a lot of trouble sleeping, but that is probably back to how it was before the hospitalization.

I have flashbacks to the ER doc putting staples in my arms without any pain meds.  I don't have them as often now as I did back in March, but I still have them occasionally.  I hadn't had any flashbacks of the childhood abuse in a long time prior to the hospitalization.

I'm a lot less anxious than I was in March, but still have more anxiety and have to take more medication for it than I did before the hospitalization.  I take a medication for Vistaril as needed for anxiety and used to take 25 mg when I needed it, which was usually a couple times a week.  That was before the hospitalization.  After the hospitalization, I was taking Vistaril two or three times a day, usually.  Now I'm down to taking it four or five times a week, usually, but I'm also on a higher dose.  I now have to take 50 mg, twice the amount I used to take.

My pain is significantly worse.  I don't know how much of that can be attributed to the hospitalization, but I think the increase in stress and anxiety has made the pain worse.  Also, before the hospitalization, I was receiving treatment for my back pain from a specialist at the Cleveland Clinic and I was taking Vicodin as needed for the pain.  Since the hospitalization, I've had a very difficult time seeking medical care for anything.  I haven't seen the specialist since then and I ran out of Vicodin about a month after the hospitalization and am now on Tramadol, which does not seem to work as well.

I also have "phantom pains," what some people refer to as "body memories," where I feel like my arms are being staples or like the staples are still there, even though those wounds have long since healed.  I don't have those pains as often now as I did back in March, but I still have them.

I am more comfortable seeking some types of medical care now than I was back in March, but I had no problem seeking care when I needed it before the hospitalization.  Over the past few months, I've been able to see my primary care physician for a urinary tract infection and for strep throat.  I even went to the dentist, which is something that's always been difficult for me.

However, when I cut my finger about six months ago while chopping an onion, I did not feel safe going to the emergency room even though I was sure I needed a couple stitches.  My finger bled for 15 hours.  I am not exaggerating when I say I would have preferred to bleed to death in my bed than go to the ER.  I still feel that way now.  And prior to that horrible experience in the ER a year ago, I would not have hesitating to go get stitches if I accidentally cut my finger while chopping veggies.

Despite my increased pain, I do not feel comfortable seeking help for that.  I am afraid no one will believe me that I am in a lot of pain.  I feel too vulnerable to go see anyone about it.

I haven't been in therapy since a couple months after the hospitalization.  I did go back to therapy for a little while afterwards, but it didn't really feel safe.  I think it would only be safe to go if I was very, very careful about what I said and if I avoided some topics completely.  And I don't see the point of that.  Why bother going to therapy if you can't talk freely about things?  It would be too stressful, trying to make sure I didn't say the wrong things.  It would be too dangerous.

I did finally go back to see my psychiatrist and now see him every three months.  I am very guarded about what I tell him, though.  This is going to make me sound really paranoid, but I'll admit it anyway.  I have not given him my new address.  I never told him that I moved.  If I am in his office and he starts talking about hospitalizing me for any reason, I plan to get the hell out of there fast.  He wouldn't be able to send police or anyone to get me because he doesn't have my address.

That sounds really paranoid, doesn't it?  I don't think I was ever paranoid like this before the hospitalization.  But you know, just because you're paranoid, that doesn't mean they aren't out to get you.  I have a story about that.   Maybe I'll tell it another day.

Anyway.  While I am able to get some kinds of medical care now, I still have a lot of trouble with that, and I never had that issue before the hospitalization.

I also don't trust people as much.  Not that I was ever a person that trusted easily.  But a friend was with me in that emergency room, someone I trusted to take care of me, and he sat right there and did nothing while that doctor put staples in my arms with no pain medication.   Our friendship has not been the same since and I don't think it ever will be.  We are still friends, but I don't trust him much.  Not with things that really matter.

But I don't trust other people much, either.  I don't trust anyone to be there for me, to help me, to do things for me if I really need something.  I don't trust anyone to take care of me or protect me.  There weren't many people I trusted to do that before, but now there is no one.

So things are slowly getting better, but I am still worse now than I was before that hospitalization.  Worse, a whole year later.

Feeling Overwhelmed

Feeling overwhelmed is a pretty common symptom of my depression and PTSD.  Mostly I deal with it by carefully scheduling my days so that I don't have too much to do on any one day.  I mostly know how much I can easily tolerate and how much is pushing things a bit too hard.  Of course, sometimes things happen that are out of my control and I have more to do than I'd like, more than I can easily handle.

I get frustrated because things that are too much for me seem to be easy for most people.  I get tired easily.  I get worn out, physically and mentally, faster than most people seem to.  I have fewer spoons than most people.  Sometimes I forget that.  Sometimes I ignore that fact because I don't want it to be true, because I think I should be able to do more, because I feel guilty for not being able to do more... and then I regret it.

One of the things I miss about being in a relationship with Mike is that, when we were together, whenever I felt overwhelmed and had too much to do, I would just ask him what things I should do and what things I shouldn't.  He would look at my daily "to do" list and tell me,"We really need some groceries so go to the store.  The laundry can wait until tomorrow or the next day. Take a nap instead." 

Somehow, having him tell me that made me feel OK about it.  I can look at my own list of things to do and try to pick out what things are most important and what things can wait, but I have a hard time with it.  I have a hard time putting "take a nap" on my list.

Right now, I feel tired and overwhelmed.  I'm stressed out about how much Cayenne's visit to the vet cost and how much I have to pay Wednesday for my bridge.  I need to get a lot done in the next few days.  Too bad Isaac can't fix my "to do" list for me.

Feeling Like I Always Mess Something Up

I wrote earlier about the Halloween party and how Isaac knocked over a dish of candy corn by wagging his big happy tail.  But I didn't really explain how much that upset me.

I want to make it clear that I'm not upset with Isaac.  Isaac was so good at that party.  I'd been a bit worried because he is used to being in the common area of that building when he's not working, not in his vest, and he is used to seeing our neighbors when he is not working, not in his vest.  In fact, many of our neighbors have never seen Isaac in his vest.  I think a couple of them saw him the day I came to look at the apartment for the first time, and Isaac was with me, and in his vest then.  But he doesn't wear the vest in our building, normally.  Most of the time, I keep it in the car.  Since Isaac is used to being off duty when he sees those people, and is used to running up to great some of them quite enthusiastically, I was a bit worried he'd want to act like that when he saw them at the party.

But he didn't.  He gave them his big goofy doggie smile, and his happy tail was wagging like crazy, but he didn't try to climb in one single person's lap.  He did not try to nuzzle anyone's ears.  I could see he was happy and excited to see people he likes, but he stayed calm and professional.  He was even good when the person sitting next to me tried to feed him a bite of a cookie and I told her not to and she took it away at the last second.  Oh, he looked a bit disappointed, and he gave her the sad puppy eyes to try to make her change her mind, but he didn't whine, he didn't beg, he didn't stick his head in her lap and get up to try to sniff at what was on the table.  He was so good.

And it's not his fault he knocked the candy dish off the table.  That was my fault.  I should have been paying more attention.  I should have moved the candy dish or else had Isaac move so that his tail was safely away from things he could knock over.

But I was so embarrassed.  I was so mad at myself.  I'd worked really hard to have things go well for the party.  I put so much thought and effort into Isaac's custom, and I know it looks like a really simple costume, and it was simple to make.  But I thought really hard about how to make a costume that would be cute but also be comfortable for  him to move in.  I wanted it to feel to him like wearing his service dog vest so that he would be in "work mode" when he was wearing it.  I didn't want anything that would feel awkward or uncomfortable to him, because I didn't want him to act weird because he felt weird in his costume.  I tried it on him several times, made alterations, tried it on again.  Yesterday I cut his toenails and brushed him so he'd be nicely groomed for the party.

And things were off to such a great start.  We went in, found a place to put our cookies on the snack table, greeted a few people, found someone to snap a picture of us.  Isaac was behaving beautifully.  And then I messed up by not noticing the dish of candy.

I feel like things never go right because I always end up making stupid mistakes.

The fact that I worked so hard to make things go well is probably pathetic because it should not be that hard to prepare for a stupid Halloween party.  But it did take a lot of work for me.  And even with all that work, I couldn't get through the first 15 minutes without messing something up.

I am anxious and depressed.  I just took some more anxiety meds and I'm going to try a hot bath and then go to bed.  I had some writing to get done tonight but I don't think that is going to happen.  I'm too anxious and depressed to concentrate.

Happy Birthday to Me

Today is my birthday.

Yesterday I baked myself a cake.  I had decided, since I would be spending my birthday alone (well, with Isaac and Cayenne, but otherwise alone), that I would make myself a cake.  It was a huge baking fail. 

First, I had decided I wanted a lemon cake but it is impossible to find sugar free lemon cake mix, so I bought a sugar free yellow cake mix and some lemon extract.  I bought lemon frosting.  When I was baking the cake, though, right after I'd added the extract, I realize I had somehow picked up orange extract, not lemon.  So I thought, OK, I'd have orange cake with lemon frosting.  That would probably taste OK, still, right?

Then the cake stuck to the pans.  I used non-stick cake pans AND I remembered to spray them with non-stick cooking spray, but somehow they managed to stick anyway.  And I mean, they stuck bad.  So, OK, my cake was not going to be very pretty.  It would still taste the same, right?  Yeah, I guess.

It depressed me.  It was a typical over-reaction, which I have sometimes due to my anxiety and depression and stuff.  All I wanted for my birthday was a stupid lemon cake and that wouldn't even turn out right.  I sat down on the floor and cried for a while.  Isaac came over and lay beside me and insisted on a belly rub.  I felt better, got up, and cut the cake up into cubes.  I put some in a dish, put a spoonful of frosting on top of it, and a scoop of no sugar added vanilla ice cream on top of that, and ate it.  It tasted all right.

Birthdays are  hard when you're alone.  I mean, I'm not totally alone, I have friends... but not a lot of close friends.  And a couple of my good friends live far away.  So I am here, in my apartment, alone on my birthday.  I made myself a cake because  no one else was going to make me one.  I thought about buying myself a gift, but since I still owe the dentist $1,195 for my bridge, I decided new teeth would count as my birthday gift to myself.  But no one else is giving me anything.  No one has sent a birthday card.  It's easy to get depressed and think no one cares that it's my birthday and it wouldn't matter if I had never been born.  But I don't want to go there.

Concentration.... or Lack Thereof

Difficulty concentrating is a common symptom of depression.  At times when my depression is most severe, I can't watch a movie or even an hour-long television show, because I just can't focus that long.  Half-hour sit coms, maybe, but then you don't really have to pay much attention to those in order to get the humor.  I can't read books when my depression is most severe, either, because by the time I get to the end of a chapter, I've already forgotten what happened at the beginning of the chapter.

Post-traumatic stress disorder can make concentration difficult, too.  There is the hypervigilence, startling at the smallest sound, things most people would just tune out.  There are the intrusive thoughts and memories.  Of course, sleep deprivation makes it hard to concentrate, too, and I am always sleep deprived.

I am on Social Security disability but I also supplement my disability check by doing some work as a freelance writer.  I get paid by the article, not by the hour.  No one would pay me by the hour to write because it takes me much longer than it would take most people to complete a 500-word article.  Most of the articles I do are about 500 words and I should be able to complete one in about an hour.  On a good day, a really good day, I can do that.  But I hardly ever have really good days.

Most days, I am really lucky to get two articles done.  Often I can complete one in an entire day.  Some days I can't even finish one.  See, you have to be able to concentrate to get an article done, especially to get one done in an hour.  And I don't concentrate well at all.

It frustrates me sometimes.  Mostly I'm used to it and I've adapted to it and I can deal with it since I work from home and usually don't have strict deadlines... but sometimes it frustrates me.

Unfortunately, there isn't much Isaac can do to help me with my lack of concentration.   Sometimes it makes it worse, because sometimes he wants to play when I want to work or needs to go out to pee when I am in the middle of writing something.  He's good company, though, and I'm willing to put up with him interrupting me sometimes.  Too bad there's not a task he can learn to do to help me focus, though.



 

So Tired of People That Say Suicide is Selfish

Don't get me wrong.  I don't think suicide is a good thing.  I've discouraged suicidal friends from doing it.  I once called an ambulance for a good friend that was swallowing a bottle of pills while on the phone with me.  When I was a social worker, I once put a teenager and his mom into a cab, which I paid for out of my pocket, to go to the emergency room because he was suicidal and mom didn't drive and I wasn't about to send her and a suicidal kid out to catch a bus to the hospital.

But my friend wasn't selfish when she called me on the phone and told me she was taking a bottle of pills.  She was severely depressed and suffering from post-traumatic stress disorder.

The teenager that sat in my office and told me he had a stockpile of pills hidden in his bedroom wasn't selfish.  He was severely depressed.

They were both sick.  They didn't get sick on purpose.  They didn't want to be sick.  It isn't selfish to get sick.

When my grandmother got breast cancer, she wasn't being selfish.  When my grandfather develop Alzheimer's disease, he was not being selfish.  When Mike's father developed congestive heart failure and died from it, he was not being selfish.  They were sick.  Sick does not equal selfish.

Most people that commit suicide are mentally ill.  They are very sick.  Mentally ill does not equal selfish. 

Someone that is suffering from severe depression or another serious mental illness can't just stop being sick, anymore than my grandmother or grandfather or Mike's dad could just decide not to be sick.  That doesn't mean they are selfish.

And I am so tired of all the ignorant people that think it does.

Saw My Psychiatrist

This was actually a couple weeks ago.  I just didn't get around to writing about it until now.

I decided to go for two reasons.  One, I was close to running out of my medication for anxiety, and I thought that would be a pretty bad situation.  I thought I was doing OK without my antidepressants and wasn't interested in getting back on them, but I was worried about dealing with the anxiety with no meds.  I haven't been taking my anxiety meds as often lately because I haven't had such severe anxiety, which is good, but I still didn't like the idea of being out of the meds altogether.

And two, I am on SSDI (Social Security Disability Insurance).  Social Security periodically reviews disability claims, to make sure a person is still disabled and unable to work.  They don't exactly do it on a schedule, so you don't know exactly when they will review yours, but you know they will at some point.  It had been a few years since they reviewed mine so I figured I had a review coming up at some point.  I figured that if my case was reviewed and I had to say I wasn't in treatment at all, no therapist, no psychiatrist, Social Security might question whether I am still disabled.  Beyond that, they ask for the name and address of your current treatment providers, and they can contact them to verify that you are still disabled.  I figured it might turn out bad for me if I didn't have a doctor that would confirm my disability if asked.

And it turns out I was wise to consider the fact that my disability claim might be reviewed soon, because right after that appointment, what do you think I got in the mail?  Paperwork from Social Security, including forms for me to fill out, regarding my review.  I was really relieved that I'd just seen my psychiatrist when I opened that envelope, let me tell you.

So anyway, I saw my psychiatrist.  I explained why it had been seven months since I'd seen him.  I told him how the emergency room doctor had stapled my arms with no anesthesia and no pain medication, and he looked all confused, and said, "But wasn't that painful?"  I said, "Yes!  Of course it was painful.  That's why I'm so upset about it."  At least he confirmed for me that the doctor should have used lidocaine and that yes, the procedure would have been painful.  I mean, I know it hurt, but when I complained to the director of the ER, she kept telling me staples aren't that painful.

Of course, my psychiatrist told me that I should not avoid seeking medical because of that one negative experience.  He made some goofy analogy about how everyone had different fingerprints so somehow that means not everyone will respond to me in the same way.  I understand that most health care professionals will not respond the way they did at that emergency room, but the problem is, they can respond that way.  He just didn't seem to get that part.  He started explaining my rights to me, including the right to refuse treatment, and I know what my rights are.  I also know that, when dealing with a patient that has been deemed mentally ill, health care professionals don't always respect their legal rights.

I am a writer by profession, I know how to research.  I did my research.  I spoke to not one, but two different attorneys.  What happened in that ER was wrong, it shouldn't have happened, but unfortunately it's not that unusual.  And what's worse, and scarier, is that there is no way to protect yourself to make sure it doesn't happen again.  The best you can do is hope you have better luck next time.

Seriously.  I mean, you can also have a psychiatrist you trust and hope he's not out of town when you have a crisis.  I had a psychiatrist I trust, but unfortunately, he had a death in the family and had to go out of town for a funeral at the time I had a crisis.  It's not like you can schedule your breakdown for a time your doctor will not be out of town.  It's not like he can schedule the deaths of family members to make sure he's available when I need him.

And you can have someone you trust go with you to the ER to help advocate for you.  I did that, too.  See how well that turned out for me?  I'm still angry that Mike wasn't more help, but I really don't think there is anything he could have done to change things.  It's just that I would feel better if he'd tried.  I wouldn't feel abandoned and betrayed by him.  But I don't think he could have done anything to prevent the doctor from stapling my arms without any pain medication. 

Maybe if you are rich, you could keep an attorney on retainer and have your attorney accompany you to the ER in a crisis.  Alas, I am not rich and my SSDI is not quite enough to cover that.

Anyway.  My psychiatrist talked me into trying Cymbalta.  Cymbalta is an antidepressant, but it's also used to help with chronic pain, including back pain.  That's how he convinced me to try it.  I decided I would give it a try and see if it helped my back.  And I think it is.  I don't know if I feel less depressed, but I am in less pain.  I think I feel less anxious, too.  Maybe that's just because I'm not in so much pain all the time.  I still have pain, it's just more tolerable now.

He also told me I looked stressed.  You think?  He said I should take a vacation.  Think I can get Medicare to pay for that?  I bet he'd write it on a prescription pad for me, if I asked him to.

Have a Hippo, You'll Feel Better

Today I got upset about something and started to cry.  I sat down on the floor and called Isaac over to me.  He put his head on my shoulder and sat there sweetly with me for about a minute, then abruptly got up, trotted off, and returned with his favorite stuffed hippo, which he dropped on my head.  It was like he was saying, "OK, enough crying.  Have a hippo, it'll help you feel better."

So I squeezed the hippo's butt to make it squeak, and Isaac picked up his tiger, whose butt also squeaks, and we began a game of what an online friend of mine refers to as "co-squeaking."  I squeak the hippo, Isaac squeaks the tiger, repeat, repeat, repeat.  Only Isaac couldn't decide which toy he wanted to squeak and which toy he wanted to let me squeak.  Every time I squeaked the hippo, Isaac decided he wanted the hippo and snatched it out of my hand.  Then I would squeak the tiger, and he would decide he wanted that, and drop the hippo in order to snatch the tiger away from me.  He's like a little kid that thinks whatever toy someone else has must be the best one.

He was right, though.  After ten minutes or so of co-squeaking the hippo, I did feel a bit better.

Some Thoughts on Abortion

I know, this has nothing to do with service dogs.  It is somewhat related to my disability, though.  And I see so much discussion on this topic on Facebook and in the news and everywhere these days.  I just wanted to take the opportunity to put some of my own thoughts into words.

I guess I should start by saying I am pro-choice.  That doesn’t mean that I think abortion is something that should be chosen lightly, and I don’t think many women do make the choice lightly.  I can think of three women I’ve personally known that had abortions (there are probably more but it’s something most people don’t share with everyone they know) and I know all three of them put a lot of thought into making that decision.  I know two of them considered themselves pro-life or at least never thought they would choose to have an abortion, until they found themselves in circumstances in which they could not see another solution.  I know one of them got pregnant while using condoms and one of them got pregnant while taking birth control pills; the third was not using any form of birth control because she was not sexually active when she was raped and became pregnant.  I know one of them would have loved to have another child but it just did not seem feasible at that time, in those circumstances.  None of them was relying on abortion as a form of birth control.

I’ll also say that while I am pro-choice, abortion is not necessarily the choice I would make if I found myself facing an unexpected pregnancy.  I actually got pregnant when I was 16, and both my parents and the father’s parents encouraged us to either place the child for adoption or have an abortion.  I chose not to have an abortion.  I gave birth at age 17; my daughter was mostly raised by her father.  I see abortion as a last resort type of thing.  It’s what I would choose if I felt I was unable to carry a pregnancy to term for some reason.  If I felt I could carry a pregnancy to term but not raise a child myself, then I would place the child for adoption.

So what does all this have to do with being disabled?  Well, to begin with, being disabled affects my access to contraception.  I’m on Medicare, and I would like to have a tubal ligation because I definitely do not want to become pregnant, ever again.  However, Medicare will  not pay for a tubal ligation.  My primary care provider recommends I avoid birth control pills because I have a family history of breast cancer and the pills increase one’s risk of breast cancer.  She and I agree that it is best that I avoid all hormonal forms of birth control, since side effects can include depression and I already have a history of very severe depression.  That doesn’t leave me with many options, but Medicare will not cover a tubal ligation.  Unfortunately, I don’t have the $5,000 the surgeon told me it would cost to pay for it myself.

So because I am disabled, I don’t have access to real effective birth control.  I can use condoms, and I do, but they are not nearly as effective as a tubal ligation.  Am I just supposed to be celibate to make sure I don’t become pregnant if I don’t want to be?  I’ve been on Medicare since I was in my mid-30’s.  Do our legislators just assume disabled people aren’t interested in having sex?  And none of the pro-life folks have offered to pay for my tubal ligation in order to prevent an unwanted pregnancy, either.

At this point in my life, if I did become pregnant, I believe I would have to abort.  I don’t want to have to do that, so I am super careful about birth control (which at this point means condoms and vaginal contraceptive film).  But what if my birth control failed?  Even a tubal ligation can fail, although it’s very rare.  I asked the surgeon I spoke to how that could possibly happen, and it said that in some cases the tubes simply grow back together, or grow around an obstruction.  How bizarre is that?  It’s kind of cool, too, if you think about it, the body’s remarkable ability to heal and repair itself.  But it wouldn’t be so cool for a woman that had a tubal ligation and then found herself pregnant.

And let’s not forget that fact that some women that are abstinent become pregnant after being raped.  And women with disabilities of any kind are more likely to be raped than women without disabilities, although of course it can happen to anyone.

Anyway, if I became pregnant at this point in my life, I think I would have no choice but to abort.  I don’t see how I could possibly get through a pregnancy.  And that’s because of my disability.

For a moment, let’s just forget about my fear of doctors and hospitals.  I’d have to have a home birth, with a midwife, but that’s what I would have wanted before developing this fear, anyway.

I have severe depression, which is sort of stable at the moment, but the physical and emotional stress associated with pregnancy could wreak havoc on my psyche.  The hormonal upheaval scares the crap out of me.  Looking back on my life, I think I was depressed from a very young age, but it was not diagnosed until I was pregnant the first time.  And in the postpartum period, my depression was very severe; that’s when I attempted suicide for the first time.  Perhaps a second pregnancy would be easier than my first, but I don’t believe it would.  I believe there is a very good chance my depression would get significantly worse.  I believe I would be at risk for killing myself.

How does a severely depressed, suicidal person get through nine months of pregnancy?  Even if I  wanted to spend nine months on a locked psych ward (and I don’t), that wouldn’t happen.  Who would pay for it?  You’d be looking at about $1,000 a day, maybe more; that’s about $30,000 a month.  Medicare isn’t going to cover that; I think my co-pay for inpatient hospitalization is something like $450 per day right now, because I’ve already used up a lot of my inpatient days on my Medicare Part A plan.  As far as I’m aware, none of the prolife organizations offer to pay for inpatient psychiatric care for suicidal pregnant women, either.

Then there is the issue of quality of life.  Who would want to spend nine months on a locked psych ward, even if that was an option?  Who would want to spend nine months suffering from severe depression, from self-hatred, from feelings of guilt and hopelessness and despair?  

Medication wouldn’t be an option, since most psychotropic drugs have not been proven safe during pregnancy and many are now known to cause serious birth defects.  There are currently some class action lawsuits in the works for women that were given antidepressant drugs while pregnant and told the drugs were safe.

The bottom line is that I do not believe I would live through a pregnancy.  Now, many prolife folks, though not all, believe abortion is OK if a woman’s life is at risk.  Not all do, though.  And even if it is legal to have an abortion if my life is at risk, who gets to decide whether my life is at risk or if the risk is great enough?  Do I have to convince a doctor that my depression is that severe?  We all know how well doctors listen, right?  Who is in a better position to decide whether or not I really need to have an abortion than me?

Poem: Prozac in the Water

It seems like a poetry kind of day.

Prozac in the Water

They should just put Prozac in the water supply,

you say, but I shake my head.

The water would be so bitter.

It would taste like the insides of mental institutions,

like Belleview, McLean,

like ECT and strait jackets and quiet rooms.

It would taste like walls painted hospital-green,

like paper slippers and gowns that open in the back.

Cold sheet packs and insulin shock and trans-orbital lobotomies.

The city couldn’t swallow it, I say.

Saw the Surgeon... Sigh, I am Depressed

I actually like the surgeon.  I'll start with the positive.  I told him I have PTSD and that doctors and hospitals make me very anxious.  He seemed understanding and in fact told me that he also has PTSD, as a result of  having been a combat surgeon in Iraq.  He added that he realizes his PTSD is not as severe as mine is, but said he understands the anxiety one can have with the condition.  So that was nice.

The doula showed up late, which made me even more anxious and also made me angry.  I'm still angry about it.  She had agreed to meet me there 15 minutes before my scheduled appointment and ten minutes after she was supposed to be there, she called me and said she was sorry she was running late and that she was almost there and would be there in just a few minutes.  By that time, I was thinking she just wasn't going to show and I was anxious and trying not to cry and also feeling sorry for myself because apparently I cannot even pay someone to care enough to be there for me at a time like this.

She finally did show up, about 25 minutes after my scheduled appointment time, about 40 minutes after she was supposed to be there, half an hour after she called to say she would be there in a few minutes.  I had not seen the surgeon yet, but I was in the exam room, dressed in a hospital gown, had already had vital signs taken, already talked to the medical assistant, etc.  The appointment was half over; we were out of the office about half an hour later.  By the time she got there, I was anxious, angry, depressed, and trying not to cry.  I was also shut down, dissociating; I had turned off the feelings as much as I could and was just trying to get through the moment.

She apologized several times and told me she is never late.  Well, apparently that's not true, because she was late today.  I did tell her that I was extremely anxious and that her being so late did not help and that I had been thinking that I can't even pay someone to care enough to be there for me.  She apologized again.  I didn't really care.  Her apologies didn't make me feel any better.  I thought I'd explained pretty well how anxious I was and how important it was to me to have support for the appointment, but she didn't make sure she was there on time.  And it wasn't like there was a horrible accident that shut down the highway or something.  She was just late.

Because she was late and I was angry and everything, I didn't really trust her.  Having her there didn't make me feel better.  In fact, I almost asked her to just leave.  Looking back on it now, I kind of wish I had.

After my appointment, she told me to call her if I needed her to go with me for the biopsy, which will be done in a couple weeks.  Yeah, right.  Why would I want her to do that, when I can't count on her to show up on time?  I gave her the check I'd made out for her services and said goodbye and left.  Now I'm sorry I paid her.  At least, I wish I'd told her I only wanted to pay half the fee, since she was only there for half the appointment.  Maybe I'll email her and tell her I want a partial refund.  I don't know.  I didn't want to do anything like that out of anger, and I was very angry, but I don't have a lot of money and it was difficult to come up with the cash to pay her and then she didn't even show up on  time.  I feel like she should have offered to reduce the fee, really.  I shouldn't have to ask.

Anyway.  Moving on.

I need a biopsy, which I already knew.  The surgeon said it should be done at the hospital so they can do it under fluoroscopy, a special kind of x-ray to guide the needle.  If I understood him correctly, he was recommending I be sedated for the procedure, but I don't think that is mandatory.  I think he just felt it would be better in terms of managing the pain and anxiety and PTSD and stuff.  That sounded good to me.  I talked to him about pain management and he said there would be some pain afterwards but that he would prescribe pain medication.

That all sounded good to me but here is the problem.  If I am sedated for the procedure, I cannot drive myself home afterward.  I'm not sure yet when the procedure will be; it will be either May 1 or May 15.  They are supposed to call me tomorrow to let me know.  Well, a friend had told me she would go with me for the biopsy, but now she can't get off work if it's on May 1.  I am trying not to complain, because I know people have to work and they need their jobs and they can't just drop everything because I need a ride.  But it's not like I chose for this to happen now and it's not like I have a lot of choice about when the procedure will be.  When you need surgery, you have to do it when the surgeon is available and when an OR is available.  That's just how it works.

I don't trust the doula to do it, even if I could come up with the money for her to go with me.  I'm trying to think of other options and I'm coming up pretty blank.  People are saying things like oh, they would love to help if only they lived closer or if only they could get off work, etc.  Well, I understand why they can't do it.  I really do.  But... well, this is important.  I mean, I need a surgical procedure to find out if I have cancer.  I think it's sad that there is no one in my life that sees it as so important they would just drop everything in order to be there.  I understand why they can't, I really do.  But shouldn't there be someone?  At least one person, in this whole wide world?

I was thinking of taking a cab, if the hospital would release me to a cab instead of a friend or family member.  But the hospital is a 20 minute drive from where I live now and about a 45 minute drive from my new apartment, where I will be living when it's time for the biopsy.  That would be a really expensive cab ride.  And I'd have to take a cab there, too, because if I drove myself there and then took a cab home, my car would still be at the hospital and I'd have no way to get it back.

Then I thought, maybe I could stay in a hotel near the hospital.  I could probably find a cheap place and then it would only be a couple miles.  The cost of a hotel plus a cab for a short distance would probably be cheaper than a cab from my apartment.  I don't know how comfortable I would be at a hotel.  But it might work.

Then I thought, maybe I can just be awake for the procedure.  I think being sedated was optional, I think the surgeon just thought that would be easier.  But if I was awake, they would use a local anesthetic so it probably wouldn't be that painful.  Then I could drive myself home.  I don't know how much pain I will be in afterward but probably not too much pain to drive.  I could take my pain meds as soon as I got home.  I'm sure being awake for the procedure would make me anxious but at least then I wouldn't have to worry about a ride and I wouldn't have to feel guilty about inconveniencing everyone.

I'm depressed, though.  I just don't have the energy for this right now.  I want to use my energy focusing on my health, on getting through this with as little emotional trauma as possible.  Instead, I feel like I have to worry about everyone else and how to make things as easy as possible for them. 

One More Poem: On Insanity

Insanity

When you’re crazy

you get to tell the truth,

which is itself a blessing.

If you’re lucky,

you’re crazy enough

not to care or understand

when people tell you the truth,

which is an even better blessing.

Unfortunately, I have

only a mild case of insanity,

and I have seldom been blessed.