Where Have I Been?

I haven't blogged much lately.  I'm not really sure why.  I've been busy and I've had a sinus infection that just won't go away.  And I've had some stress.  Really, being sick is almost always stressful for me, but I've had other stress, too.  Like, Isaac was bitten by another dog at a dog park.  That's a whole separate post, but it was really stressful for me.  More stressful for me than for him, I'm pretty sure.

This sinus infection has been going on for a good month now and I'm just beginning to feel better.  It really triggered my PTSD and I ended up very emotional and not sleeping much.  At one point I was prescribed prednisone for the inflammation and it was higher dose than I've been on in the past and I had horrible side effects from it.  After only two doses, I was crying frequently and having flashbacks and nightmares and my anxiety was through the roof.  After the third dose, it finally occurred to me that what was happening might possible be related to the meds I was on for the sinus infection.  So the prednisone was discontinued and I'm feeling less emotional but still not quite back to normal.

Also, when I saw my rheumatologist back in March, she increased my gabapentin.  I think it is just now finally starting to decrease my pain, but it is causing a lot of blurred vision and that is really driving me nuts.  I am thinking I am not going to be able to stay on the higher dose.  I just don't think I can tolerate this blurriness. 

But I do want to get back to blogging and I have things I want to blog about, so hopefully I'm back now.

Leaving It

A few months ago, Isaac and I did a lot of work on his leave it because two times he's tried to eat food on the floor in a restaurant. Since then we've seen food on the floor in a restaurant and he ignored it nicely.

Well, today I dropped a bottle of medication on the floor and asked Isaac to pick it up for me. When he started to pick it up, the top popped off (I have to get the non-childproof tops because with my arthritis, I can't open the safety caps). About a million pills spilled out all over the floor and I instantly said "Leave it! Leave it!" and Isaac instantly dropped the bottle and sat down and looked at me to see what I wanted him to do.

I will add that I only ask Isaac to pick up medication bottles if I am sitting right there. When he brings me meds, those are in their bottles inside another contain, a bag that he cannot open, so there is no risk of him getting the pills. But he will pick up pill bottles if I drop them and ask him to.

Just another example of why a SD needs a really good leave it. Isaac got a nice treat and an ear rub and I picked up the pills.

Had a Tooth Pulled Today

I had a tooth pulled today and I got the dentist to prescribe me some Tylenol with codeine. I'm not sure why I have been having such good luck with doctors lately. Usually around here it is extremely difficult to get any type of pain meds. But a few days ago I got a muscle relaxer and now I have Tylenol 3.

And it is working wonderfully. Unlike last time I had a tooth pulled, I am having no pain at all. I'm sleepy and getting ready to lie down for another nap. Whiskers is pleased with all day napping. But my mouth does not hurt one bit.

Isaac was great during the appointment.  I had to have an x-ray taken and he did a perfect down stay in the hall outside the door (which was left open), even though there were people walking around in the hallway.

It was a lovely day today and I am sure Isaac would have enjoyed a walk.  But I gave him a new beef knuckle bone to entertain him.  Whiskers finds napping on the couch with me entertainment enough.

Managing My Meds.

I am currently on a ton of meds.  I've been on a lot for a long time, if you count all my vitamins, which I am counting.  I take a lot of vitamins because I had gastric bypass surgery about six years ago and that affects your ability to absorb vitamins and minerals.  So if you count those, I am on a ton of meds.

Here are all my meds for one day, Mondays to be exact.  There are a few vitamins I only take a few times a week, like vitamin A is only on Mondays, Wednesdays and Fridays.  But vitamin D3 is only on Saturdays and Sundays and zinc is only on Tuesdays and Thursdays, so it works out to about the same number of pills.

This is not counting any PRN meds, like meds for anxiety or migraines.

I used to take my meds in three separate doses, the first at breakfast, the second either at lunch or dinner, and the third at bedtime.  Between the new med for vertigo, which has to be taken every eight hours, and the antibiotic for my UTI (which fortunately I only have to take for one week), I had to change my medication routine.  I now take meds five times a day, on a pretty tight schedule.  I have the alarm on my cell phone set to make sure I don't forget when to take them.

Just one of the things many people with chronic illnesses deal with on a daily basis.

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.

Coordination of Care

My readers with multiple health issues will probably understand this. Those without multiple health issues or complex conditions may not have experienced this personally.

People with multiple health issues or complex conditions typically have multiple physicians.  Health care is so specialized these days.

I personally have a primary care physician, a rheumatologist, a psychiatrist and an acupuncturist (yes, she is a physician) that I see regularly.  Each treat different things.  None communicate much, if at all (my PCP referred me to the rheumatologist, so I think there was a little communication there in the beginning, at least a few records faxed back and forth).  Three of them prescribe medications and they are only aware of what the other prescribes because I tell them.  My pharmacist and I look out for possible medication interactions. I also take lab reports about blood work or other labs ordered by one physician to the others so they all have copies.

So I've been feeling lousy lately, feeling like something is off and maybe I need some meds changed for something. But here is when having multiple doctors is a problem.

If I'm feeling more anxious and depressed, I should probably see my psychiatrist, right? But depression can sometimes, though apparently not often, be a side effect of the medication I take for fibromyalgia. Which was just increased recently. So should I see my rheumatologist instead? And if my psychiatrist wants to try a different antidepressant, that will probably mean stopping the one I'm on first, but in addition to being an antidepressant it is used to treat pain, so if I stop taking it my fibro pain may get worse, so should I discuss that with my rheumatologist first? 

Ideally my psychiatrist and rheumatologist would have a discussion about these things, but do you know how hard it is to get two doctors that do not work for the same practice to have a conversation? Sigh.

Medication Change

I saw my rheumatologist yesterday and together we agreed to increase my dose of gabapentin.  It was something I'd been thinking about for a good month, considering the potential benefits and the risk of increased side effects.  When I started taking this medication, I was on a very low dose.  We increased it two other times, and both times, I felt tired and nauseous and just icky for about a week.  I figured that would probably happen this time, too.

So yesterday I took the higher dose and felt fine.  I felt fine until this afternoon, when I suddenly crashed.  I am not nauseous, although I don't have much appetite, but I am tired.  Like, exhausted.

I hate dealing with this. I hate that I have to.  I hate having to weigh the risks and benefits of meds and I hate having to decide to deal with the side effects because I need the benefits.

And I hate know I'll feel lousy for a week or so, especially because I have stuff I need to do and also stuff I want to do.  Like, I am supposed to get together with an old friend Tuesday and I am really hoping I have the energy to do it.

Update on New Med

I posted last week about being on a new med that was causing my blood pressure to drop significantly.

I finally called my doctor, and it took a long time and multiple phone calls before the office manager checked with him about the med, which really pissed me off because this is serious stuff and how hard is it to give a message to the doc?  But anyway, I had decided on my own to discontinue the med, since I couldn't get in touch with my doctor for advice, but then the day after I stopped taking it, when I was already feeling better, I called his office yet again and was finally told he recommended stopping it.

I asked the office manager if he wanted to prescribe something else and she said "He didn't say."  Well, um, when I spoke with her the day before I specifically asked about that so why didn't she pass on that part of my message?  Grrr.  She sucks at her job, seriously.

So I spent a week feeling crappy and now I'm back to square one.

New Med

Monday I saw my psychiatrist and he was concerned about how poorly I sleep.  I also mentioned feeling increasingly anxious and somewhat distracted lately.  I've been more forgetful and confused and stuff.  He wanted to prescribe a new med and I agreed to try it.

I don't agree to try new meds easily.  Even when I left his office and went home with the prescription, I was not certain I was going to take it.  I went home and researched it more.

But I decided to give it a try.

I am sleeping better.  Despite the fact that it is almost 2:00 am and I am awake, overall I am sleeping better.

I've been tired a lot during the day, but less tired  yesterday than the day before.  I think I am adjusting.

The main side effect I am experiencing is low blood pressure.  My BP tends to run low anyway.  90/60 is about normal for me.  If you don't know, 120/80 is considered the norm.  My psychiatrist checked my blood pressure when I was in his office and he was concerned then because it was only 105/89.  I was like, um, that's high for me.  It was only that high because I was at his office, which makes me anxious.

So he opted not to prescribe one med he was considering, because it causes low blood pressure and he was concerned it would make mine drop too low.  I am on the one that is less likely to cause seriously low blood pressure.

Thursday my BP was 79/45.  Yesterday it was 86/56.

No wonder I am dizzy and tired.  Half the time, I feel like I can barely stand up.  Like I might just fall over.  Or sink to the ground.

I'm hoping I'll adjust to it over a couple of weeks.  If not, I may end up not being able to take it.  Wouldn't be the first time.

Isaac is a big  help.  Bending over is not good when I'm already dizzy.  Yesterday I was cleaning up the living room and he picked up his toys for me.  I dropped some mail outside and he picked that up for me.  He's picked up lots of things.  I need to do laundry this weekend and he will be a big help with that, too.

Retrieving Meds

One of Isaac's tasks is retrieving meds for me.  I have a pouch that I have certain "as  need" meds in, like anxiety and pain meds.

The meds are in plastic bottles inside the pouch.  The reason they are in the pouch is because it's easier to find than a small bottle and because it makes it harder for a dog to chew through (Isaac never chews stuff like medication bottles but you never know with dogs).

Isaac is trained to bring the  pouch when I tell him to "get the meds" and he is also trained to bring it if he sees signs that I am getting anxious.  For instance, I start to rock back and forth when I am anxious, and Isaac knows that means to bring the meds.

I know I've posted about this task before but I just wanted to post about it again, including a pic of the med pouch, because it's a question I get asked from time to time, like what I keep the meds in that Isaac brings to me.

Oh. That's Why I'm So Tired. Duh.

I saw my rheumatologist Friday and she increased my gabapentin to 300 mg twice a day.  I'd been on 200 mg twice a day.  We discussed it and decided to increase it because I think the pain is going to get worse with the cold weather.  Actually, it has already started getting worse.  It's still quite tolerable, quite manageable, but I remember how horrible and nearly unbearable it was last winter.  So, hoping to head that off, we decided to try increasing the gabapentin.

I think I forgot to mention the med increase when I posted about the visit because I was too busy talking about how I dealt with the issue of her being scared of my service dog.

And today, I was struggling with this overwhelming fatigue and thinking it was just part of the fibromyalgia, which, you know, it is a symptom of that, but then suddenly as I was lying on the couch, too tired to sit up, it occurred to me.  Maybe fatigue is a side effect of gabapentin.  I couldn't remember if it was or not, though, and I was too tired to sit up and reach for my laptop and Google it.  A couple hours later, after Isaac convinced me to get up and take him out to pee, I did look it up and sure enough, it's a very common side effect. 

Did it make me this tired when I first started taking it?  Or when she increased it from 100 mg to 200 mg?  I can't remember.

She prescribed the higher dose Friday but I didn't actually start taking it until last night, after I picked it up at the pharmacy and put the new pills in my medi-set.  So I guess that explains why I am so exhausted.  And hopefully in a couple days I will adjust to the increase and this fatigue will pass.

Accessibility at the Pharmacy (or Lack Thereof)

I picked up three prescriptions at CVS today. When I called for refills, I specifically asked for caps that were NOT child resistant and explained that it's very difficult for me to open child resistant caps due to arthritis in my hands.

I got home and opened the bag and only one of the three has a cap I can easily open. So I called back to complain.

The pharmacy tech explained that on the paper they look at to fill a script, there is tiny N that means non-child resistant cap and it's so tiny sometimes they don't see it. I suggested they make the N bigger, then, since it is important someone with a disability be able to actually open their medication. She said she can't make it bigger. 

I said I did not believe there was no possible way to improve the system to make sure customers get medication they can actually open. I don't know the best way to do it because I don't know what their current system is - but surely there is somewhat to put a  note on the script.  Or how about writing it on a big post it note and sticking it to the pharmacist's forehead, if necessary?  Come on, surely someone there can figure it out.

She suggested I drive back to the store - a 35 minute drive one way from where I live - and they would put the medication in other bottles for me. Um, yeah, that's not a good solution. 

They need to pay attention when they fill scripts. I do not believe there is no way that can be done. They just don't care about doing it.

And understand: This is what the pharmacy staff is thinking/saying when they don't care about making reasonable accommodations like this.

"Most of our customers are able to open bottles.  If a few of our customers are defective in some way and can't do simple tasks like that, well, that's not really our problem.  If it's convenient for us and if we think about it, we will do them a favor and put the special caps on for them.  But if it's too much trouble or we just forget, well, they should understand.  We are used to selling prescriptions to normal people that can open bottles.  And it's not like we have a lot of customers that can't open a normal bottle.  Their business isn't that important to us, anyway."

Vicodin and Me

I probably sound a bit like an addict lately, going on and on about how I want some Vicodin.

I know I've said it before but I'm gonna say it again.  I used to have a high pain tolerance.  I had a natural childbirth when I was 17.  Nineteen hours of labor, and yes, it hurt, but not so much I needed pain meds.  When I had my gall bladder removed a few years ago, I took one dose of pain meds (Vicodin, by the way) at the hospital before I left for home.  I took one more dose that night before bed.  The next morning, I felt fine and was back to my usual activities.  I've never been one to want  lots of pain meds.

I very rarely drink alcohol.  I have had a total of four drinks since I had my gastric bypass surgery more than five years ago.  Two glasses of wine and one two occasions, I shared a frozen margarita with a friend.

I've never done illegal drugs.  Never smoked pot.  Been around people smoking it a couple times but never smoked any myself.  I've never even seen cocaine, crack, meth, heroin, etc.

I've had prescriptions for sedatives, things like valium, ativan, klonopin, xanax, for years.  When I was in high school and other kids were stealing xanax from their mommies' medicine cabinet, I had my own xanax, prescribed by my psychiatrist.  And I took it as directed.  And not very often.  I also did not share with my friends.  Not that any of my friends had serious substance abuse problems, but some of them did take pain pills or sedatives or smoke pot occasionally.  But I never did, except for the meds prescribed to me by my doctor.  And I never took those things for the purpose of getting high.

I'm trying to remember if I've ever taken meds prescribed for someone else, other than the Vicodin my friend gave me recently.  I guess I have, a couple times.  A friend once gave me some omeprazole, which is an acid reducer, available both over the counter and by prescription.  It's expensive stuff and I was having some heartburn and had taken some bought over the counter and a friend that used to take it by prescription has some left over and gave them to me.  I know technically you're not supposed to do that, but it was the same med available without a prescription, and nobody is getting high on omeprazole.

I have refused to take, or to continue taking, prescribed meds that made me feel drugged or hungover.  I don't like that feeling.

About an hour ago, I took another Vicodin.  Just one. 

I was having pain in my right elbow, which is not at all unusual, but it was particularly bad.  It's hard to describe the pain, but it sort of felt like someone was poking needles into the area around my elbow while also burning my skin.  From the elbow down, my arm felt sort of numb and tingling, like when your arm or leg "falls asleep."  Every 10 or 15 seconds or so, a sharp pain would shoot down my arm.

I was trying to write an article about home remedies for warts.  I kept stopping, moving my arm around, shaking it, rubbing the elbow, trying to get some relief.  I couldn't focus on my article.  Plus, it's hard to type when you are shaking your arm and rubbing your elbow.

Finally, I took a Vicodin.  Just one.

I wouldn't say my arm feels good, but the shooting pains are gone and I am able to type.

Why is that too much to ask for?

Update on My Pain

Thursday when I saw my doctor, he instructed me to increase my Flexeril to three times a day and my Tramadol to four times a day, instead of just taking it as needed.  When I was taking it as needed, I didn't take it every time I felt pain because I have pain all the time.  I took the Tramadol when the pain was really bad.  I took the Flexeril when I had a lot of muscle spasm.  I filled a script for 60 Flexeril last February and still have four of them left when I saw my doctor.  That's how often I took it.  And on a really bad day, I might have taken the Tramadol three times, but most days I only took it once or maybe twice.  I worried about running out, about not having enough, about being without pain meds when the pain got really bad.  So I tried not to take the meds unless I really, really had to.

Well, yesterday I realized I was having far fewer muscle spasms than I had been having.  I think I had spasms just two times yesterday.  I haven't had any so far today.  And today I notice I'm not in as much pain.  I still hurt, but not nearly as bad.

I've been sleeping a lot.  I think the amount of meds is making me drowsy.  I don't care, though.  I'm just glad to have some relief from the pain.

Storing Medications

I recently heard a sad story about a woman whose service dog got a bottle of prescription medication off the kitchen counter, managed to open it, and ate about 90 pills.  I'm not sure what the medication was, but 90 pills were not good for the dog.  The dog's owner rushed him to the vet and after several days of veterinary care, and several thousand dollars, I'm sure, the dog is recovering at home and will probably make a full recovery.  He may have some lifelong kidney problems, they aren't sure yet.

This dog had never gotten anything off the counter before.  He'd retrieved prescription medication bottles for his handler but never chewed on them or shown any interest in doing so.  She doesn't have any idea why he decided to get this bottle off the counter and chew it open and eat the pills.

This story worried me.  I keep medications in a few different places.  Most of my medications, including prescriptions, over-the-counter meds, vitamins, and herbal stuff, are in my linen closet.  I have a small supply of meds to be taken as needed in my purse, which is normally on my kitchen counter.  There are some pain meds and anxiety meds in a small vinyl bag on top of an end table in my living room, which is what Isaac fetches for me when I need him to do that.  Then there is about a one-week supply of meds and vitamins sorted into one of those weekly pill containers that have little boxes for each day of the week, which I'd been keeping on my coffee table.  The meds on the coffee table are what I worried about when I heard the story of the service dog that ate the prescription meds off the kitchen counter.

I'd been keeping them on the coffee table because I take pills from that container three or four times a day.  It needs to be within easy reach so I don't put off taking them or forget to take them.  When I first got Isaac almost a year ago, I was careful to keep meds out of his reach.  But he never bothers them.  Isaac never counter surfs.  He never chews anything that is not a toy meant to be chewed by him.  He's never chewed a single shoe.  If I drop a bottle of pills, he picks it up for me and gives it to me with no interest in playing with it or chewing it.  Sometimes if he picks up something like a sock, he gives it a playful little shake, but not pill bottles.  Never, not in a whole year.

That's what the owner of the service dog that ate the pills thought, though.  She thought her pills were OK on the kitchen counter.  Then her dog almost died.

I decided I cannot keep pills on the coffee table anymore.  I have a plastic container, about the size and shape of a picnic basket, that holds craft supplies.  I keep whatever craft I am currently working on in it and keep it beside the couch.  I put the pills in that container.  I imagine Isaac could knock the lid off the container and get to the pills if he tried hard enough, but I think they are safe enough in there.  It's not like when they were just sitting on the coffee table where he could grab them, or knock them off wagging his big tail, and then decided to snack on them.

Those of you that have dogs, do you store medications out of their reach?

I Am Medicated

My back has been pretty bad lately.  I've been putting off certain tasks, like cleaning my kitchen floor, because my back just hurts too much.  But today I moved the mattress and box spring on my bed, because these two screws had fallen out of my bed frame, and I was worried that the bed frame was going to fall apart when I flopped down on it or something.  The mattress and box spring had to be moved so I could reach the place where the screws went.  I was going to have Mike come over and help me but then I decided that I know how to use a screwdriver and I am not weak or incompetent and I just wanted to fix it myself.  So I did.  It wasn't even that hard.  But now my back hurts a lot.  So I took some pain meds.

I've also been super anxious the last couple of days.  I have to go to the dentist tomorrow to get my teeth cleaned and figure out what I'm going to do about this crown and getting a bridge and everything.  The dentist makes me anxious and worrying about how I'm going to pay for a bridge makes me anxious.  I am also worried about Isaac and his ankle.  And today I got the oil changed in my car and was advised that the serpentine belt, whatever the heck that is, is badly cracked and needs to be replaced very soon.  If it breaks, my car will be dead on the side of the road.  The garage I normally go to cannot fix it until next Wednesday, but I have to go to the dentist tomorrow.  There is a garage near my dentist that can fix it tomorrow morning, before my dentist appointment, but they charge $30 more for it than my regular garage does.  Plus I have to be there at 8:00 am, plus that is right before I go to the dentist.  It is all too much to deal with, but what choice do I have?  So I took some anxiety meds.


The meds are not helping enough.  I want chocolate.  Like a big old slab of chocolate cake.  With ice cream.  Alas, I have no chocolate, no cake, and no ice cream in the house, and am afraid to drive the car.  I guess I will have some lovely yogurt later.  Blah.

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.

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.

Training Update - Getting the Meds

Not long ago, I wrote about some training goals I have with Isaac.  We've been working on getting my meds, with me giving the command from different rooms of the house.  I typically keep them in the living room, on a table next to the couch.  The further away I was from my meds, though, the more likely he was to get confused about what I was asking for.  I could sit or stand in the dining room and tell him to get the meds and he had no problem.  When I started moving down the hallway, though, he knew I wanted him to do something but wasn't quite sure what, so he would turn on the dining room light, run into the kitchen and open the fridge, and then bring me anything nearby in case that was what I wanted.

I started sitting in the dining room right by the hallway and sending him to get the meds, rewarding him with treats and lots of praise when he brought them to me.  Then I moved about a foot down the hallway and repeated.  And then I did it again.  Over the course of two days, practicing for about five minutes at a time several times a day, I moved all the way down the hallway and into bedroom.  I sat on the end of the bed and told him to get the meds.  First he ran into the bathroom and turned on the light, but then he ran out to the living room and got my medication.  He got several treats and was very proud of himself.

After three days of work, Isaac will now go get my meds from the living room if I am in the bedroom or the bathroom.  I've told him he's the smartest dog ever.

Chronic Pain and Social Withdrawal

I've been having more back pain lately.  I don't really know why.  For a while, I was pretty close to pain free.  At least, the pain had lessened so much, I barely even thought about it, except to be amazed occasionally at how easy it was to turn over in bed at night or get out of my car or get up from the couch.

The pain is still less than it used to be.  There have been times in the past when it was so bad, I literally could not get up.  Once I drove home and could not get out of my car.  Just could not.  The pain was so excruciating when I tried that I could not force myself to do it.  I ended up having to call Mike, who was at work, to come home and help me.  I had to sit there and wait for him to get home, then he went into the house and got me some Vicodin, then waiting in the car with me until it kicked in so I could stand up.

That hasn't happened in a long time.  Several months.  I think having Isaac has helped immensely, as I do much less bending and lifting now.  I've also been taking tumeric, which is an  herb that has anti-inflammatory properties.  I suspect that has helped, too.  I've been doing some energy work, and I think that has helped.

But for the past week or two, it's been bothering me more.  It occasionally wakes me up at night.  It's not really keeping me from doing things I need to do, at least not yet.  But it wears on me.

I think I have a high pain tolerance, at least most of the time.  When I had surgery to remove my gall bladder, an outpatient procedure, I took exactly one dose of pain medication after I got home from the hospital.  Didn't need anymore.  I had a natural childbirth when I was 17.  Didn't feel the need for any kind of pain medication during my 17 hour labor.

But I do sometimes feel the need for pain medication for my back.

Unfortunately, I've been out of pain medication for about a month now.  And with my new, emergency room-induced fear of doctors, I can't go see my back specialist to get more.

A friend was kind enough to call the back specialist yesterday for me, to ask for refills on my Vicodin and Flexeril.  He agreed to refill the Flexeril but not the Vicodin.  Flexeril is a muscle relaxer and I use it when I have muscles spasms in my back, which I have occasionally but not very often these days.  If I had to choose one, I'd much rather have the Vicodin.  And it's not like I was taking it often.  I got 45 tablets in October and am just now requesting a refill.  That means I took about 11 pills per month.  I'm not drug seeking.

But he says I have to make an appointment and go see him before he will refill the Vicodin.  And I can't do that.  I just can't.

Living with chronic pain is different than living with temporary pain.  If you have surgery or injure yourself or something, you know it's going to hurt, but only for a while.  When it's a chronic condition, when you know it's probably going to hurt forever, that's much harder to cope with.  The coping skills that help with temporary pain don't work so well with chronic pain.  It's depressing, but it also engenders great fear in me sometimes.  I wonder how I'm going to live with this for the rest of my life.

And I tend to withdraw, socially speaking.  Dealing with the pain takes a lot of energy.  I don't have much energy left for socializing, for hanging out with friends, even for talking with friends online or on the phone.  I'm preoccupied with my pain, but I don't want to bore or annoy people by talking about it all the time.

And the last week or so, I've been sleeping a bit more than usual because, when the pain was gotten really bad, I've been taking a sedative.  I'm out of pain meds, but I have plenty of sedatives and sleeping pills.  Yes, I know those aren't supposed to be used for pain.  But if I really need some relief from the pain, then I take one of those and I sleep for a couple hours.  Of course, sleeping half the day messes up one's social life, as well.