Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth." Genesis 9:13

Friday, April 30, 2010


I finally, finally, finally had a good day. Yesterday I had a few better hours. Today several good things happened and while I had a long, stressful day with enough anxiety to give me an aching face from toothgrinding, I also finally don't want to curl up in a ball and not move ever again, if only the anxiety would allow me to hold still.

Good thing number one: I have a new placement. I'm excited because it's home health. I did home health years ago, and back then didn't really like it, mainly because I didn't feel I had any right to tell people how to live in their own homes. Now that I'm not 25 and just out of school I have confidence in my ability to help people in that environment, and I'm kind of anxious to get to see the "what happens next?" chapter. In nursing homes we get people when they are really ill and get them well enough to make it at home. In home health they get to go back to their real lives. That's extremely meaningful to me for obvious reasons, so I'm happy to try this. Plus, I've been doing the same specialty although with some variation during the psych years, for almost a decade now. A patient recently asked me how long I'd worked where she is. I told her about 9 months. She asked if I'd learned a lot. I explained that I'd been doing this for over 9 years, so mostly it was pretty routine. She couldn't believe I was old enough, and has told me now twice that I look 18. yeah, well, double that and subtract 18 months......But it's true. I have an absolute routine that I go through doing evals, and I write variations of the same goals depending on the one of about 5 options that are possible at the time of discharge, and I can guess pretty accurately what a person is going to be like very early on. In a new setting things are going to be new, yet I'll still mainly work with the elderly.

There are distinct downsides. I'll be driving a LOT. They cover a pretty big area, and they are far away (the town I worked in last year). I'll be staying there at least one night per week and will miss my kitties terribly as well as my house and my sewing and peacefulness. But I do get paid mileage during the day, and I get paid to stay down there, and my understanding is that there will be a distinct financial benefit to this. And as I keep saying, it's only 13 weeks. Even if I hate home health (I won't) and even if the drive is intense, it's only 13 weeks. Plus the contract includes my getting done at noon on the day I see Dr. Mind, so I'll actually have plenty of time to get up to see him and not have it be horrid.

I don't have my contract yet, which I was hoping for, so I know few details beyond that. Mainly though the knowledge that this particular burden is lifted is huge. I think that the anxiety started when I first admitted to myself I'd had it with my current contract and I think a nice sized chunk was related to "what next?" before I even had spoken the words "had enough". I also think I was being honest with myself a long time before I was ready to talk about it to others.

I also had a podiatrist appointment and got mainly good news. The orthotic/brace combination is working very well for my bad ankle and he finally said he thinks I will avoid surgery at least for the time being. Years from now, or if I sprain it again, that may change, but apparently tolerating the correct position from the orthotic and having pain when the orthotic isn't used is what they want to see. I told him that I'd seen a picture of myself where I saw for the first time how badly I was turning that ankle even when just standing and that it horrified me. He smiled and agreed. No wonder the day I came in with right foot pain he was so focused on my left ankle, particuarly after watching me walk. I was practically walking on the inside of my leg. The bad news we're hoping for now isn't too bad. I'm still having pain in my right foot. I already had a diagnosis of plantar fascitis in it, which is basically tendonitis or in my case he believes a small tear. However, further testing today indicates that I have basically carpal (it's tarsal 'cause it's the foot) tunnel syndrome, a nerve that has gotten trapped by my bad position of my foot and from bearing so much extra weight while I was healing. The plantar fascitis will heal, although somehow slower because at this point normally I'd be getting cortisone shots or possibly taking oral anti-infammatories and I can't have those with the MAOI and/or lithium. One reason I like Dr. Ankle so much is that he is totally aware and comfortable with my restrictions without my saying anything or arguing or insisting he look anything up. He really knows this stuff, and that's rare. MAOIs are so rarely used that I'm generally my doctors' only patient on one and there are so many rules that I've not memorized them all. If the problem is the nerve there's little to do. So for now he prescribed this high dosage cortisone cream mixed with lidocaine and it had to be specially made for me and mailed to me, so next week I'll start using it. They tried it today and it did help.

So the podiatrist was kind of a mixed bag, but the worst problem is under control and that's the main thing. I really suspect that more time without strain on that foot from the other one being so messed up will do a lot of good.

There's probably more, but I'm insanely sleepy. I worked late because I had to take a long break for my phone interview, and I had to make up time lost earlier in the week to lack of patients, and then I had to go to the pharmacy and gas station and figured I might as well run through the grocery since that's fast now that I only eat a few things. So I did that too.

So, good night.


Jean Grey said...

Re the "tarsal tunnel syndrome," I developed really severe CTS on nardil. I actually asked my psychiatrist at the time if there could be a correlation, and she laughed at me. However, I was into reading psychiatry texts at the time and in an older one it said that the MAOI's, especially Nardil, can cause serious B6 deficiency. And B6 deficiency is related to CTS. The recommendation: 200mg of B6 if a deficiency was found. I started taking it and my CTS went away within a month. I don't know if Ensalm does the same thing or not, or if this could be a possible contribution. I know there is a lot more going on with the foot.

Just Me said...

Thank you! I'll have to check on that. The funny thing is that I have a B deficiency skin issue called cheliosis that I developed after vomiting for months from lithium toxicity. It's these sores on the sides of my mouth. I haven't had one in a long time. So I'm going to dig out the B supplement; can't hurt anyway. And while the foot has reasons for hurting, it also seems like it shouldn't feel worse than the truly screwed up one. (We won't go into how frustrating it is to apply a brace and 2 orthotics daily and know that the braced leg is going to hurt much less than the other one.