I am now working full-time, making quite a bit of money, and my medical expenses are far less. I'm only getting labs 2-3 times per year, my labs are minus depakote levels, which are expensive, and I only have to see Dr. Body when I'm sick or for 2 check-ups each year for thyroid and diabetes insipidus follow-up. The last few years I've seen Dr. Kidney as well; I refuse to see him again so hopefully that will be one less visit per year, although Dr. Body may want me to see someone else. In that case I'll probably see a Dr. Kidney that Dr. Brain works with who is used to psych patients' needs, rather than the former Dr. Kidney who came across as totally clueless this year and then tried to put me on a low potassium diet even though my potassium was fine because he thought it was high (it was at the high end of normal, which is completely in line with the fact that most of the foods I eat are high potassium). I'll still have big expenses, and if I have to change antidepressants I'll be paying more for that. But realistically my meds are so cheap now that another small increase is still better than it used to be. At one point I was paying $250 or more for meds each month. Now it is about $90, plus about $15 of over-the-counter meds for bowel issues.
All this is to say that I'm suddenly a lot better of financially than I have been since I first got sick. I've been able to save money. And so this morning I was able to wake up, realize how much my bed hurts, and I bought a new one. I've been preparing to do this for the last few weeks. I knew what I wanted and that I was going to do it this weekend. I just didn't really know if I could make myself do it. I did, and in a week or so I will have a new bed that isn't totally worn out.
In a few minutes I'll be leaving for my montly appointment with Dr. Brain. It's a big one; see below. But on the way I get to stop and do something I normally hate with a passion: buy jeans. This year though I'm excited because the reason I'm doing that today is that I do not have a single pair of jeans that is not 3-4 sizes too big. I have to exchange some shirts I bought because they are way too big as well. I have just now gone down a shirt size and it caught me off guard. I also need to start changing out my pants to the next size down. The ones I have now still kind of fit, but I keep a lot of stuff in my pockets at work and they slide off my hips.
The appointment with Dr. Brain is a big deal because it's time to make a big decision. I want her to make it. The antidepressant I'm on now has worked for me for a long time. However it has a big limitation in that I have a very narrow range of dosage that is effective but doesn't cause mania. That range is 70-80 mg. I was on 90 for a few months this summer when I was pretty depressed and I had to come down because I got manic eventually. At this point I'm ok on 80. I'm not depressed although I am dealing with a lot of anxiety. But 80 is causing the great constipation battle of 2009 and it is not going to be a battle I can continue indefinitely (why do I always misspell that word?). So, I need to go back to 70. Seventy has worked fine for many years. The trick is that right now is the beginning of the 4 months per year that I am highly vulnerable to depression thanks to SAD. Ideally we wouldn't be lowering my antidepressant now. But because of my limitations with dose, I need to be back to 70 even if I could tolerate 80 to give me leeway for increases with SAD, which happen most years. However, I am not really willing to go back up to 80 because it just isn't worth the discomfort and reliance on bowel meds that are unpredictably useful. (ie sometimes I need all the regular meds for this plus one dose of Miralax, sometimes 2 doses of Miralax, and sometimes Miralax is too much. There's no predicting, and to make it worse Miralax really needs consistent use to work right.)
So, that leaves me in a predicament. If she thinks I can make it through the winter on 70, I'll start weaning to it now. That at least lets us know if that works in the next few weeks. If she thinks there's a good chance 70 won't get me through the winter then I want to discuss changing to Emsam, which is a MAOI patch. The reason I'm not just doing that is that the switch includes a week of no antidepressant at all, which scares me silly. But there are distinct benefits to the switch, particularly the part where it shouldn't cause constipation. And the removal of 8 pills per day from my life. So if it is likely that this switch may happen I want to stay on 80 for the next 5 weeks, which gets me to the end of this contract. At that time I can easily take a week off work to make the change, allowing me to feel bad in peace and to be hospitalized without drama if that is needed. If I make this change I want to know that hospitalization is a ready option if I start feeling very bad. If it's going to cause me to feel seriously crummy I want to know from the start there's a safe place.
And that leaves me with a decision that is going to be made on the basis of Dr. Brain's guessing. I trust her, she has known me for nearly this entire journey and has known of me (she supervised my therapist) since I was first diagnosed. Since that therapist didn't have much experience with this Dr. Brain has actually been pretty involved since the very beginning. She has tended to be pretty accurate with her guesses, so I'm comfortable making this decision based on a guess. It also helps a lot that I know that this has a good chance of happening, and if it does I'd very much rather do it without disrupting my work and having to explain anything to my company or someone I'm contracted with. The problem with telling someone "I can't work because I'm going to be in the hospital" is that they are sure to ask if you're ok, what's wrong, etc. And if I lie through that they may want to visit or send flowers or whatever, and I obviously won't want them knowing where I am. Avoiding that would be a good thing.
It just doesn't make me feel very calm about this visit.....