In a heartbeat

Today was just not going overly smoothly. I'm tired and people weren't available when I wanted them, and I'm tired of paperwork. I had 2 patients in the last week go home before being treated, which means I waste about an hour of my life, minimum.

I have one patient I'm close to, who has been getting a minimum of an hour a day since right after I started from me. We've gotten close. I really care a lot about her.

Tonight she choked at dinner. Not just a "that was scary" choke, a 6 of us working on her and thinking "she's going to die and I can't do anything more than I am right now" choke. 911 time. The kind of thing where adrenaline gave me strength to hold her upright with one arm after she passed out while the nurse did the Heimlich and I used the other arm to stimulate her. She's not small and there is no way my normal strength could have supported her dead weight with one arm. When we finally had her breathing a little and could move her onto her bed to hope she would cough or vomit up the rest while laying safely on her side (and I also learned that one of the weird things is that you're so focused on what's happening that you find yourself thinking "vomit, vomit, vomit, hit me with vomit" because you're in front of her and so desperately want her to clear it) 4 or 5 of us lifted her to bed; again it was like lifting air and she was dead weight and totally unconscious.

At one point her roommate who was trapped on the other side of the room was panicking and I pulled the curtain. The patient's husband was there and I told him he could look or not but it might get ugly for a while. But I never can take away what he did see. I can't even describe the color of his wife's face before the heimlich started to work a little and some air got in. The color is when I thought she'd die. Or the scary limpness of her upper body.

And the sound....She was fighting with all she had. And I know that when I was around someone who choked to death she made no sounds because she never was moving air. I know the sound was just the air moving around a large object. But oh. That is something I'll never forget. And it makes me understand how terrible the death of a patient who choked alone a number of years ago probably was. I pray that she passed out quickly.

I'm talking about it tonight but trying to not do so in a way that is upsetting to others. I know I'm well hardened with these things and it got to me. But tomorrow is going to be a hard therapy visit because someone has to hear the whole story and I think it has to be someone outside the ones of us there.

I need sleep. I hope some comes.

Too sensitive?

People where I work are not careful about how they say things. I have heard the word "retard" more in the last 3 months than in the last 3 years. Until I got pushy about it there also was "psycho" and varities of t hat as well. That still happens too, but a bit less.

I've told people I'm bipolar. They have no clue how bad my situation is; they seem to think it's minor, or that because it's controlled with meds it can't be bad enough to make me as sick as what they consider "crazy" people.

We've had a lady lately who has been really having some issues and is getting a lot of Haldol. I keep hearing jokes about how "oh, *I* need some of that to deal with my husband". It makes me so, so angry. I know that being defensive about taking an antipsychotic helps nothing, but it feels so insensitive, like comparing a frustrating husband to my psychotic symptoms. Which is comparing a single mosquito bite to sitting on a 2 foot tall fire ant hill.

I just take deep breaths and move on. I'm not sure I can do that forever though.

Am I being sensitive?

Notes to Self

- Flaxseed oil capsules may be really fun to squeeze, but maybe not so hard.

-Losing weight won't make pants fit in the belly if the belly is still big.

-Knowing patients can be really rude sometimes doesn't make getting called fat to your face all the time any fun.

-It may be true that it's not fair to have to take meds that cause tons of weight gain, but nobody else cares, to them fat is fat.

-Taking antihistamines for anxiety management doesn't mean no spring allergies.

-Praise God every day that sometimes there are safeties built in that prevent things like being forced to pay for every medical expense in March due to not paying COBRA on time.

-Praise God also for living in an area too rural to have a dentist covered by my plan so that I get awesome coverage and no network.

-Learning to gently lead my least-experienced therapist is frustrating.

Too much practice

You know you've been having severe issues swallowing meds for far too long when you swallow a mouthful of pills, gag, realize you can't control it, and manage to throw up everything directly into your t-shirt, wrap up the shirt, pull it over your head and finish the med routine all without making any mess.

Go me!

Politically incorrect, again

I believe that I look at people equally.  I try very hard in my work to not define people with a particular diagnosis as having a group trait that is not there based on solid research or my own observation of a large number of people with that disease.  For example, patients with MS tend to have certain personality characteristics and can be hard to deal with.  I've noted this in personal dealings with MS (it runs it my family, plus my SIL has it) as well as clinically.  The patient who tried my patience more than any other the thousands I have seen had MS along with other issues, and I had to constantly monitor myself because I did not want  to be affected by that part of him.
 
Politically, I've been all over the map.  I grew up assuming I'd be a democrat because EVERYONE is where I grew up.  In college I became much more solidly Republican.  I'm not necessarily proud I voted for George Bush, but at least I voted, and I worked hard to do it since I spent 3 hours in line and I live in a state that was fairly important that time.  This time around I'm less certain.  I voted Democrat in the primary because the Republican was sealed and I had strong feelings about which Democrat I preferred.  My political feelings are also affected by how a given candidate is going to affect my personal life with healthcare revisions.  And of course, mental law is of great interest, and sometimes the Democratic way seems more in line with what I want professionally and as a patient.
 
But  political correctness stumps me.  I've written before (can't link it b/c I'm on someone else's laptop and don't want to open my page; that's also why it's mistyped in places-the computer is sending the cursor to the middle of the 2nd line over and over for some reason.  I do not want to be called a consumer.  I am generally irritated by being called a client.  This  is a healthcare issue and when we are treated for health issues we are patients.  Dr. Mind is treating me as much as Dr. Brain is, after all and he is a doctor as well, albeit not the physical kind.  I call my patients patients.  If I am not treating them I call them "resident", but if they are on my caseload they are patients because I'm a healthcare professional and I'm trained to treat patients.  I don't know why I am so bothered by client, but somehow it makes me remember my realtor.  I was hiring him to do work for me.  Someone who is treating me is working WITH me. 
 
I call myself bipolar.  I use it ale l sorts of politically incorrect ways to describe myself and I don't feel bad about it.  It's my way of recognizing how pervasively bipolar has infiltrated my life.  I don't want others to think of me that way first, but I am aware many do.  I do get frustrated because it's impossible to explain to people how very ill I have been and could be again when I seem so well, but there are worse problems to have.  Mainly I just want people to understand that what I deal with is way, way worse than "yeah, I wonder if I'm like that", or "my friends' brother's sister's daughters 1st cousin" has that but needs to take meds.  I talk about med allergies, but never about being seriously sick enough to require so very mucch medication.
 
Today I got a dose of reality and a reminder how much we will separate things from ourselves.  I saw a news article referencing "mentally disabled" adults.  I thought it would be about mental retardation.  It absolutely never occurred to me thata it would be about bipolar and schizophrenic adults (ie severely mentally ill adults). 
 
So now we're making it evenif  more confusing, is my thinking.  First it was shameful or worse to be mentally ill.  Then somehow we started try to pretty it up (ie why are we called bipolar when everyone in the real world only knows manic-depressive?).  Then it was a big thing to announce mental illness.  That extended to finding more pretty words to make the whole thing remote from the real world.  And now it seems we're mushing mental retardation and mentally ill together into this "mentally disabled" thing.
 
Does mental illness cause mental disability?  Sure. I have plenty and I hate every second.  But the two are not the same. 
 
The only thing I'm sure of is that this policital correctness stuff now has me so confused that I'll well, I'll forget my sentence and fall half asleep.  But really, it's time someone figured out where one begins, another ends, and preferably someone takes into account that psychiatric care is MEDICAL.  I just found out that my new insurance, which I was so excited about last week because I had covereage for 20 counseling sessions will count my 12 visits with my psychiatrist.  Which means I will have little counseling coverage after all.  I'm also concerned that  I'll have to pay huge amounts for most psychiatrist visits because the visits will get used on counseling, which is much cheaper.
 
I'll probably have little contact the next few days.  Back soon. 

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Spell a grand slam in this game where word skill meets World Series. Get in the game.

The good and the bad

The good is that I'm handling what I have to do well. I let the anger burn off first and I have planned a calm way to handle it tomorrow.

The bad part is that it's something really hard for me.

One of my assistants has a few years of experience. She doesn't go forth into new territory often. She wants rid of hard patients.

I of course can't let that happen. I try to generally balance out hard people among the 5 of us. Two of us (the manager and I) are supposed to have reduced caseloads; we both enjoy hard people. She likes neuro treatments and I like patients who need a lot of trust. Medicare changed some things making me have to do administrative paperwork more rapidly; this is changing my caseload to only a few hours per day. I think. So among the other 3 I try to spread out the challenging people. We've had a lot of those lately. And because I see this person not always taking big steps to help her patients I've been keeping the distribution the same but giving her a few really challenging people.

One person I treated myself for a bit and had no trouble with is not doing well with this therapist. And I wouldn't stop her treatment today, so the therapist wrote a note that could cause an automatic (and founded based on wording) denial and get me in trouble for signing it and continuing to treat.

Generally I don't read every word that crosses my desk. I've told everyone that. I will now be reading every word from this woman.

I know how to approach this. I know how badly I've done it in the past. I know how important it is, and that she HAS to learn how to function with harder patients.

But she's going to be really mad. And this is going to be worsened because the 2 people above me are out of the office tomorrow and I don't work Thursday, so she'll have a lot of time to complain before I'm there again.

It's the first time I've really dug my heels in at this job, and won't be the last. Tomorrow in some ways is good because a number of people are off and she'll have less support. Nonetheless, it stinks in some ways.

This is better than graduation day

This is my 500th post. It feels like it came suddenly; writing in this thing is so much part of my life now. It seems like forever ago I finally got it really started. I had set up the account and played with it 3 months before I wrote a word. And now I've had 500 posts, readers from every continent but Antartica, and I've learned a lot from what I've written.

It is absolutely perfect that I get to celebrate something huge with this post. First, to explain the title, you have to understand how much I hated grad school. It was miserable, I didn't get along with most of the professors, only one professor even seemed to think I could even do this, I even was dissuaded from doing a thesis over a research project (less strenuous) because it was "too much work". The thing was that to get a PhD you often need to have done a thesis, I loved research and the type of precision a thesis required was right up my alley, and I had won a scholarship that covered living expenses and a bit more so that for the first time in my educational history I didn't have to work. I wound up babysitting so I got out of the house, and I actually made more money that way, but that was fun. My thesis was done well before most people's research projects. Grad school was also the beginning of the long slide into bipolar. I have an email that I wrote from about this time in 2000 and I wrote about how I was feeling so "weird", depressed some days and fine others, and like things were partially propelling me forward out of control. The thing was that looking back maybe we should have seen I needed a good psychiatrist, but as happened so often then, it seemed easily explained: I was heading into my full-time clinicals which is of course scary, I was exhausted from months of thesis writing, etc. And then the psychiatrist at the college that I'd seen for 2 years died in a way that left a lot of questions, and he wasn't replaced for months. His replacement immediately thought I was bipolar and I walked out on her.

Anyway, the first semester was so hard I thought I'd fail and that would be the end of that. After that semester I did fine, sometimes really well, but there was so much unpleasantness. I had gone to a tiny Christian college and this was the polar opposite. At the college I went to we were only allowed to have men in our rooms one night/week and the door had to remain open. I was once told I had to put my feet on the floor to comply with the rules when I was merely sitting with my legs underneath me beside my boyfriend. The school I went to for OT had a grad dorm I initially lived in. I moved out after finding a man in the women's restroom in the middle of the night wearing only his underwear.

At some point during the first year and a half I made a friend a countdown book to graduation. We counted down from something like 500 days. And I mean that literally, I always knew how long until graduation day, Dec. 9, 2000. (Strangely we actually had to finish one more week of clinicals after that, so for my last week as a student my technical credentials were MS, OTS (OT student). We missed much of that week as a result of a blizzard though.

Every picture from that graduation shows the happiest I've ever been. I was so sure everything would be great now. I'd move back to my home state, find a job in one of the 2 states I called home, and study for my license. Soon I'd be done with the test and on my own. This was finally my LIFE.

We all know (unless you're just joining us) that this wasn't true. I became very symptomatic very rapidly. Trying to study for my boards induced horrible panic attacks. I'd take computer tests and fail, over and over. I soon was involved in the mess of med changes that have been tried to get me relatively stable since 2001.

In all that time I've been on and off many meds. Last month, for the first time ever, I was told that I could reduce the frequency of one of them (a more minor one) because I was doing so well. I really had no difference with that change, so as of last night I'm on an approved slight taper of my Seroquel. I have been taking 3 1/4 pills, or 650 mg. This isn't a dose commonly used, we just tried to get the lowest possible dose I was ok at because the lower I'm ok at the more wiggle room there is when things change. So, yesterday I got official permission to cut one pill into approximate 8ths, take those pieces from largest to smallest to taper off, and go back to 600. I can also try 625 if needed but the more we back off in the spring the less manic I'm likely to be in summer, and the more we can work with in the fall.

So, I made real, honest-to-goodness progress.

And I didn't have to wear a stupid hat.

Perfect

This works perfectly. I've been hoping for my 500th post to be special, and I have special news. Very special news. News I've hoped for. But you must all wonder a bit longer, because this is #499 and I have something else on my mind.

April is Occupational Therapy month. I always make sure some kind of fuss is made about it, and our company bought us (ugly) shirts and a cake.

Apparently April is also the month for something else near to my heart: child abuse. I do not and will not write very specifically about the abuse I lived through as a child, but there was a lot. I lived with a molestor and a family member who cared for my while my parents worked was also a molestor. My father was also physically and verbally abusive, gradually worsening as I got older.

Everyone knew in the town I grew up in; everyone knew everything. Once at a sporting event the coach had to physically intervene when my father was going after me for some stupid infraction of a stupid rule. I literally was locked in the school alone for some time. I don't know what happened and I don't care, but I will never forget the big, strong coach who threatened my father into leaving me alone that night. Reports were made, protective services provided counseling, but nobody changed the main problem.

When I dealt with the abuse in counseling that was the most difficult part, that people didn't help me. I was a child and I was given choices I wasn't qualified to make. I was allowed to choose for no physical intervention to be made; I thought I would be removed from the home, not that my father would have been.

Apparently someone decided the best way to draw attention to child abuse would be to place pinwheels prominently in communities, showing the number of substantiated claims in the last year. I saw a display today, and it struck me that this truly irritates me.

Child abuse can potentially ruin a life. I'm so fortunate to have had the help I did to not be snared in it forever, but even so I have plenty of not normal parts of my life, parts that are forevermore damaged from how I grew up. Among many things, I have no doubt that I wouldn't have as severe bipolar if I'd had a stable life the first 22 years.

Child abuse isn't fanciful like a pinwheel. I realize the symbolism, but children don't. And my own memories of my past aren't symbolic, they are real, and horrifying. Child abuse displays need to show that child abuse hurts, and there is nothing lovingly spinning in the breeze. In fact, a more accurate depiction would be one of those enormous windchime things from the movie Twister with Helen Hunt, blowing completely out of control, loudly.

Solution at Last

For months now I've been (hesitantly but trying to maintain my usual level of openness) posting about the horrible constipation that has caused much pain and frustration over the months since I started Seroquel. Ultimately the untreatable constipation plus my signs of dehydration were what led the doctor to question the possiblity of diabetes insipidus.

We've treated the diabetes insipidus successfully for a few months now. My labs are good and I'm peeing normally most days. But the constipation continued and if anything worsened. The meds simply weren't effective.

Last week I had my CT scan. I had to drink barium and someone warned me that this can make you constipated. I was worried about that given my usual situation. When I was in target I grabbed a bottle of flaxseed oil caplets since my doctor has approved that in the past for depression.

I'm taking only 1 per day instead of the recommended 2-3. Already I'm able to say it is definetely helping, a lot. I may even get to try reducing the stool softener I'm taking huge amounts of if I can increase again.

I hope this is the last on this topic.

I hate being right

A few days ago I wrote about someone who I was pretty certain would die very soon. He wasn't ready. He did die although it took about a day longer than I thought.

In other news I finished my taxes. I topped $10,000 in medical expenses. My return is, as usual, huge. I did learn that I managed to decrease my therapy visits from about 70 (I think 72) in 2006 to 55. Much better.

I also have learned I may be ready to take wobbly steps into not seeing Dr. Mind every single week, but I'm not ready for a major decrease. Last week I had to miss thanks to my CT scan and it's showing in little ways. For the first time in a long time I'm really anxious to see him. I think it needs to remain a monthly thing and be decided by how I'm doing around the target time. The goal is to mainly work on letting me have Thursdays off on the week I see Dr. Brain to let me make up the rest my marathon trip to the Big City requires.

Anyway, I suddenly got very, very sleepy and I am not fighting with that.