Going back to work was hard

I didn't want to go to work today. I didn't want to be at work. I felt lazy. I felt irritable. I know that I was just feeling the effects of having been off of work for several days- and transitioning back to work. I tried to remind myself of this- that it is not the end of the world. It was still hard.

It also seemed very unfair to me that I had to stay at work past sundown- there had been such beautiful sunshine earlier in the day. There ought to be a law against it. Give me my sunshine. Well, I did go out for lunch and ate in my car- I didn't want to come back in knowing that this was the last I would see of the sun for the day.

Tomorrow is a late day, and I plan to get some walking in before work. But I always plan. It is the implementation that is hard. I'll have to see what happens.

I had a good Christmas

I spent Christmas with my brother and family. Normally they go to my sister-in-law's parents but this year she was too close to her due date to fly, so they stayed home. It was really nice to spend time with them, and to spend Christmas with a 3-year old.

How did my brother become so normal? And I mean that in a good way- I actually think that he is a really extraordinary person. But of me and my cousins, he is the only one "making it"- living the life with a wife and kids and house and now a car and high powered job. Plus he has hiked the entire Appalachian Trail, served in the Peace Corps, lived and worked overseas in several very dangerous countries. Oh yes, and he has run several marathons.

I think my brother has a combination of a strong will yet resilience and adaptability. The strong will sometimes got him into conflict growing up- but due to his resilience and adaptability it didn't seem to hurt him long term. And his strong will has definitely been an asset in accomplishing what he has.

My niece seems to have his strong will at times- but mostly she is just amazing and delightful. She has such an imagination. And- she will do the same activity over and over again (with shrieks of delight), reminding me of how we need repetition to learn- and relearn (for my stroke patients).

It is amazing how advanced her language it. How is it that she was born just 3 years ago, and is talking so well now? And how could people have every thought that Skinner was right about language learning or development- that it is all reward and reinforcement? There has to be something preprogrammed into the brain, guiding language development. But this goes back to my graduate school days in research psychology- when I wanted to have two cats, one named Skinner and one named Chomsky. If I ever have cats again- they are all going to be named after scientists. That is what I decided.

The next time I go to visit I will have 2 nieces. That will be really exciting.

I'm still on the higher Zyprexa. I think that, when things are good, 5mg is okay. But things aren't good all that much. I have more resilience on 7.5mg. Maybe after I finish the DBT group I will have enough stability that I can try going down on it again. I really don't want to hit 50 on the higher dose- it is post-menopausal women who have the greatest chance of getting tardive dyskinesia. But at least until I finish the group, I will take the higher dose. I need some stability in my life.

Finally some good news

It is benign. I had my follow up appointment with the breast surgeon this morning, and it was benign. I am so relieved. The past couple of days I had started to obsess, and I was actually reading about DCIS- which is what it probably would have been if it wasn't benign. And while my surgeon had said that it wasn't that serious, very easy to treat... they typically do a lumpectomy and radiation for that. Not something I would want.

Today my mood was better- but it has been pretty bad at times recently- but then I had the insight that some of it might be low blood sugar. I need to eat carbs in the morning- sometimes I don't, like yesterday- and I just didn't think I could go on living by noon. And I take 1000mg of metformin twice a day (because of the Zyprexa, not diabetes) and my A1C is 5.1, the lowest it has ever been. I need to have more than a protein shake with 2 grams of carbs for breakfast. But that has been my lazy breakfast recently.

Last night something weird happened. I woke up in the middle of the night, feeling extremely anxious and my heart pounding. I felt fine when I went to sleep. I took a klonopin- a whole half milligram- and went back to sleep. That doesn't usually happen to me. But it had me a little foggy today.

I am watching Syfy's Ascension mini-series on demand. I just finished the second episode. I think it could have been a lot better. I think even the premise could have been a lot better. They keep saying, "Ascension is the lifeboat for humanity." Well, I thought that perhaps maybe the whole ship and crew were all simulations on a computer, and because humans had destroyed the environment, this was all that was left for humanity- to be simulations on a computer. Or maybe a plague has made the earth inhospitable- so they are living in the life boat. But by the end of the second episode, I still can't really figure out what their purpose is.

The show has way too much sex- and not enough science. Aren't there supposed to be a lot of smart, intelligent scientists on this ship?

I have one more episode to watch. And then I have to watch the finale of the Colbert Report. I will really miss him. I wonder what he will do with the late show. It will be interesting to see him "out of character."

I finally looked

My incision is bigger than I thought. It it more triangular than a straight line. I guess that is why no sutures- they let it heal on its own with just steri strips. Thankfully it spares the nipple, but it is pretty close. All in all- it is a little worse than I thought it would be, but I can live with it. Well, I'll have to anyway. I think I'll buy some good scar stuff to put on it. Assuming of course that this is it- that this is a false alarm. And that I don't have another surgery in my future.

I have enough scars on me already- arms, legs, even a few on my stomach. Even my appendectomy scar. Somehow this one is different- or maybe it is different because I don't cut anymore. And because I want to have sex again someday. There, I said it. I do want that.

Except that most of today I didn't want that- I didn't want to be alive. It was a rough day. I am tired of these bad days. I was tired of the fight today. If I didn't have moments when things weren't a fight- then maybe I would have an easier time accepting that life is just a struggle and get over it. But I have moments when it isn't, and then I think that is how it should be- and then I hate the struggle even more.

Thankfully I saw my therapist today. It gave me some perspective, made me realize some steps I need to take- although how to take those steps remains the challenge.

Had my biopsy, wasn't so bad

The hardest part was being still. There is this table that looks deceivingly like a massage table, only it is bigger and has a hole for your breast to stick through when you lie down on your stomach. Then they can do what they need to do. It was a stereotactic core needle biopsy. Afterwards I had to go next door and get another mammogram to make sure they got the right spot- they leave a metal clip in afterwards so that it will always show up on my mammograms where I have had my biopsy.

Everyone was very nice. But now I just have to wait until Friday. That is when I go for my follow up.

What is nice about this (if you can say that anything is nice about this)- is that it is all paid for. They are all take insurance and are in-network. I have met my in-network deductible, and almost all of my in-network out of pocket maximum. Very different than my mental health care.

Although it isn't just mental health care. We have a neurosurgical group that operates out of our hospital that doesn't take insurance. As of January 1st, we can't even use our hospital insurance towards payment to see them, if we needed that kind of care.

But for the moment I will be glad that my breast care is covered- and hope that Friday I will get the news that I don't needed more care. And not just because of the money.I really hope this was much ado about nothing.

No salvation in a self-help book

I am halfway through my book on Acceptance and Commitment Theory and I am giving it the thumbs down. Maybe it is better in person- by book it is too cognitive, yet too simplistic. But what self-help book isn't simplistic? What self-help book doesn't assume that your life isn't really terrible screwed up and you just have to change your emotions and thoughts?

I love when it asks me to write the story of my suffering- and gives me one and a  half pages. Where do I even start? And what does that even mean? What is suffering? It is not all unitary, not all of the same source. And then it tells me to keep the facts- but write the story in a different way. No need. I do that all the time in my head. I am all too often in "problem solving mode" as my therapist would say. I try to figure things out a lot.

That has always been my problem with cognitive therapies- either my mind is numb and blank, and I don't know what I am thinking- or it is so full of thoughts that there isn't any one in particular that is giving me most of my pain. Plus, when I am seriously depressed, if you point out to me that my thoughts aren't logical, I usually won't care. I will think that somehow the thought is still true in my case.

Meanwhile I am battling terrible anxiety today- and I think it might just be partially biological. The IBS has been really bad- maybe not getting full effects of meds. Plus I think I have been drinking gallons of water over the weekend. It is just really dry in my apartment and at work and my lips get so dry that they crack and bleed, so I have just been drinking water. So maybe my lithium is low. That, plus I wanted to go into work for paperwork (won't). Plus breast biopsy tomorrow.

Instead I took extra klonopin and even a little Zyprexa- I am still anxious. This sucks. I want to to be late enough to go to bed. Just to go to bed.

I'm not worried about the biopsy- just the waiting part. I can't believe I am doing this. There are times- and fairly recently- when all I wanted was some fatal illness. The only reason I started doing mammograms was because I was being hounded by my PCP.

I haven't felt that suicidal recently, but I have wished for death. I just want to stop the fight, I want to stop trying. I can't say that it hasn't gotten easier- sometimes it is- but it is clearly still a fight. And even the damn ACT book is depressing, emphasizing that it is still a fight. OK, you feel lousy you don't want to do anything. Ignore that  (sorry- accept that). Do stuff anyway. Can you live your whole life that way?

If the paperwork doesn't get any easier, I have decided that I can't work 40 hours a week anymore. But it might be easier when we go electronic. No- I know a lot of the electronic documentation is worse- but I won't be drowning under stacks of paper, losing scripts, and I will be forced to do my notes in a timely manner. I am hoping that saves me. Otherwise I have to cut my hours or go somewhere where I can work fewer hours. Fewer hours means fewer patients means fewer charts to document.

I'm tired of fighting paperwork. My anxiety and depression. My weight. My fatigue. Sometimes I just want to give in to everything. But I know how that ends, and it is not good. So I keep fighting.

I guess I just can't drink at all

I'm not much of a drinker, never was. I know that it tends to make me depressed- I learned that early. Believe me, if alcohol was an antidepressant for me, I'd be an alcoholic.  But I do like a good glass of wine every now and then or a good ale. I'm a social drinker, but I'm not very social- so I don't drink very often!

Last night we had our work holiday party and I had a small- very small- glass of white wine. This morning I got up and then couldn't figure out why I was so sleepy and tired after sleeping so long and went back to bed for 3 hours. I'm finally better- but this is the problem with me and alcohol- not what it does to me when at the time, but the after effects the next day. I just don't feel good.

I know that my meds, especially the effexor, delay metabolism of alcohol, so it probably sticks around longer. I can live without alcohol- I just wish I could have the occasional glass of wine. Still- I'd rather give up wine than coffee! Although I am cutting back on the coffee because of heartburn... it sucks to get old. Coffee is my favorite drug, and it really has an antidepressant effect for me.

Now that I am up I am trying to do home things- marathon laundry, some cleaning, etc. I gave up on walking today because it will be dark before I am done with laundry. Maybe I can do some dumbbell exercises at home. And I did my meds/vitamins for the week.

Last week I didn't take my supplements because a lot of them increase bleeding and I have the biopsy on Monday. But I shouldn't have stopped my fiber supplements- my IBS is getting bad again. I started taking them again today, and it seemed to have helped some already I think. It isn't what you would expect- that fiber would help with diarrhea. Meanwhile I am trying to figure out what to eat- I had been able to get away with not following the FODMAPS diet too closely for a while, so I don't have a lot of safe foods in the pantry. I was going to eat broccoli and cauliflower with cheddar cheese for one meal today, but that is probably one of the worst meals I could eat.

Does torture work and does that question matter?

There are two separate questions- does torture work, and should we torture. And they may not be all that related. Because if you think torture is wrong- then if even if it works, we shouldn't do it. And if you think torture is a necessary show of force- then it doesn't matter if it works either. Admittedly for some people there is a gray area- it is okay if it works, not okay if it doesn't work.

Today the Obama administration came out with its report on our bad behavior regarding treatment of prisoners. I'm not sure it was necessary. I don't know how much was new, what we learned- and the cost is inflaming the enemy. But it is what it is. I am hardly following the news these day- other than listening to NPR in my car. It is just too depressing and there is nothing to do about it and some of the really serious stuff affecting our future no one talks about or gets really wrong.

It was a really slow work day today- I had a lot of cancels for various reasons- which meant it was a very good paperwork day. But I went home with a stiff, aching neck. And I felt like I had been at work for much longer than I was. I went home brain dead.

I am signed up for a DBT group in my town starting next month that I found on Psychology Today. I am really glad there is something local now- other groups are an hour's drive away- something I don't have the energy to do at the end of a work day.

I am so mad about the changes to my insurance and no out of network benefits next year. I can't believe they would do that. It is really hard for mental health, because so many providers do not take insurance. Psychiatry has the highest rate- 50% of all doctors who do not take insurance. Of course my hospital does have a clinic- and I'm sure they would want me to go there- but I have not heard good things about it. And they have a long waiting list anyway.

I am using the breast surgeon at my hospital- they have a good program. Somehow I thought she would have access to my records from my PCP- because I see one at the hospital. But no, they had to have all my meds faxed over. So much for electronic medical records.

I wonder who I would use for carpal tunnel surgery? I am having more symptoms recently- although today was better. I think I just have to get back to using my braces at night. But sometimes I wake up in the morning and they are off- I must have taken them off during the night.

Once I had a patient who told me that his splint kept falling off. I kept adding straps- until I realized that he must just be taking it off during the night and not remembering. I think that is what I do, especially when I am hot- and my bedroom is hot. My living room is freezing and my bedroom is hot- there is no way to set the thermostat to have a cool bedroom and a living room that I don't need a winter coat in. Sometimes I just give up and open the window.

I saw the surgeon today

She was great- really down to earth. This is nothing to worry about. It was a very small area of calcification. It probably isn't cancer, but if it is it is in the earliest stages and we can take care of it. So next Monday I am scheduled for a breast biopsy. Now all I have to do is move my patients. 

There is a part of me that thinks God wouldn't give me both bipolar and breast cancer. I know that is not rational- but there is that feeling. And then there is the thought that I could never have anything as trendy as breast cancer. If Sheryl Crow and Angelina Jolie have it, I probably don't. I know, not rational. They say bipolar is in these days, but no one is going around wearing ribbons for bipolar. I wonder what color they would be?

It is really a testament to the movement that breast cancer is so out there. Two taboo topics- breasts and cancer- and now people can't stop talking about it. Colon cancer doesn't seem to be doing as well in the PR department- even though it kills a lot of people too- maybe even more, I can't remember. And the evidence for colonoscopies is better than the evidence for mammograms.

My mom has offered to come up for the biopsy. But I don't know how she would manage it with my grandmother, even with the help they have. And I think I would just be reassuring my mom the whole time.She didn't even want me having this biopsy- she wants me to go the alternative route. So I said no. They said I can drive myself. But that I should stay home for the rest of the day. I had better go grocery shopping before hand.

Where is the dialectic?

I am about a third through my book on Acceptance and Commitment Theory. Some of it is useful- but it seems a little all or nothing. There seems to be even more acceptance involved than in DBT. And, taken to its logical conclusion (and I take everything to its logical conclusion), it seems to be incompatible with the use of mediation- because that is a form of trying to run away from your pain- at least if you have depression, anxiety, or dysphoric manias. If you are medicating euphoric mania, I'm not sure where that fits.

So I'm looking for the dialectic. If I can take medication, get physical activity, regulate my sleep, eat healthy, etc., because I know that this will result in less mental pain- isn't that a good thing? And can't that be integrated into a theory that also involves acceptance- and getting on with life in the face of this pain? Maybe this happens later in the book.

What I am taking away from it right now is the emphasis on not over-identifying with internal states and not over-interpreting thoughts as real. There was a term for the latter, but I can't remember it. So anyway, this afternoon, when I felt my mood start to dip- I told myself that I am experiencing feelings of depression and having discouraging thoughts. Did it help? I don't know. I also had a piece of carrot cake- I probably would not have had that if I was feeling better. But a couple of hours later I did feel some better.

Feeling paralyzed

I have things to do and I feel like I can't move. I just can't get myself going. It doesn't help that it is dark and rainy out- I need my sunshine. I just want to sleep, or at least do nothing. But I have said that I would make it to my dad's by dinner. And I have two errands to do before then. And my apartment is a complete wreck. And I have to pack my overnight bag because I am staying overnight.

I guess that is a muscle that I have to build- acting when I feel paralyzed. It is no use wishing that I didn't feel this way- or worse, thinking about the kind of life I could have had if I didn't have to so frequently fight just to act.

The problem is, my old weapon used to be cutting, and I really haven't found a new weapon- other than sheer force of will or telling myself all of the bad things that will happen if I don't act. Those can work, but there is only so much I can use them before I just start to feel like life is too much bother.

I haven't quite figured it out. I haven't read very far into Acceptance and Commitment Therapy, but I think that they are going to say to ignore- no accept- how you feel, but do your life anyway. Which is very hard when you feel like you physically cannot move.

But at least there may be a physical reason for this, which is the lack of synthroid last week. I'm back on it, but maybe it takes a while to get back to normal.

My own personal energy crisis

I have been really tired- not sleepy tired but physically tired and light headed, starting in early afternoon and lasting the rest of the day. I dont know what to make of it- I can only hope that it is the effect of running out of synthroid (which I finally got today), or from now taking all of my Provigil in the morning instead of breaking it up to twice a day.

But it makes me good for nothing later in the day, and it makes me worry. Not so much about my health, but rather the effect this has on my ability to have any kind of life. It is only in the mornings that I can be productive and do notes, etc. The latter half of the day is awful. The days I work evenings are truly awful. Yesterday my last patient did not show and I left early.

I suppose I have to give the synthroid some time to get back into my system. And them maybe try to splint my Provigil dose if that doesn't do anything. And then, if that doesn't work, go to the doctor. But I don't want to go to the doctor while I am still dealing with the breast biopsy stuff- one thing at a time.

And then I tell myself maybe I just need to exercise and lose weight- maybe that is catching up with me. Or maybe I just take too many meds.

Anyway, I am a year older. Google Chrome knows it is my birthday- and that is scary. I recently read a study which said that happiness in Americans is at its lowest level at the age of 47, and then it climbs back up. So in theory I have just had the most miserable year of my life and things can only get better.

I am currently reading a book on Acceptance and Commitment Theory. I need something. Maybe that- or to get back to DBT seriously. I need something. I need to change my life.

I've become a klonopin wimp

When I was first put on klonopin, way back when, I was taking 10mg a day. These days I take a quarter to a half milligram a day. Yesterday turned out to be a really bad day, and I was tired of bad days- and realizing that Zyprexa was not doing it for me. I decided to take klonopin until the screaming inside my head stopped. I think I took all of 1.5mg.

It worked. The screaming stopped. Although I was holding on to furniture to go to the bathroom and realized that I couldn't drive to the nearest store to get food. I was an impaired driver. Eventually I slept. And woke up- feeling okay. Not drugged. But I fully expected a hit of anxiety or panic to hit me today at work as the rebound effect kicked in. Surprisingly, I didn't have any anxiety. Instead, around lunch time, I got very tired and lightheaded. Now, I get that a lot- but this was really bad. Like I knew there was no point in going home sick because I couldn't drive. Like I wondered if I should go to the Emergency Room. And then, magically, it started to lift a couple of hours later. Just in time for my rush of afternoon patients. Still not an easy day, but I didn't collapse.

But I didn't make it to the pharmacy at work to fill my Synthroid. I have been out for 2 days. Not good. They have such limited hours that I have to go during lunch, and during lunch I could barely stand up.

I am still feeling tired and weak and a little light headed, but not anything like I was. Hopefully tomorrow I'll be back to normal- physically, at least.

I'm glad I stuck it out

I made a couple of minor med changes over the past two days. Yesterday I was still feeling very numb- and thinking that this is not acceptable and I can't risk another day of this and getting nothing done. But I was still hoping it was temporary, and possibly because I had messed up my Effexor (it didn't feel like Zyprexa numbness), so I kept at it- and today I feel good. The numbness is better. My mood is pretty good.

I am at the higher dose of Zyprexa- and I realize that when I started going to yoga and doing things it was at the higher dose, and that when I went back down to 5mg I stopped going to yoga. So I am back at 7.5mg. The only way I can do this is to take all of my Provigil at once in the morning, instead of breaking it up- but it seems to be lasting enough of the day that it is okay. And I am not taking any klonopin, except for that quarter of a milligram at night to help me to sleep. I think klonopin is destabilizing for me- I get rebound effects. I hope that I can get off of that last little bit of klonopin.

I don't even want to be taking Zyprexa- but if I am going to be taking it, I want to take enough of it to really make me better. Otherwise, why bother? I'd love to take no meds- but I think I will die of old age before I could wean myself off of all of them, so I am stuck with them. I am going to use them.

I have a lot to do today. I am doing laundry. I have to do dishes. I have to go visit my dad- and it is over an hour's drive each way. I have to go in to do paperwork. I have to work on my inservice. And I have to write my Provigil appeal.

The price has dropped into the 200's again at Costco- but it is still much higher in the other stores, and I don't want to be at the mercy of market forces. It would be so nice to have the Provigil covered. Especially as the deductible for my health insurance is going up by $500 next year and my psychiatrist fees won't count towards it. And I still haven't decided if I will continue with therapy- my therapist will not be covered and I hate switching. I hate trying to find someone good. And trying to explain my life to someone new.

Hard days

I have been overly emotional about some things. And just had some really hard days. I am thinking about what my psychiatrist said in jest- that meds can fix everything- and wondering if meds could do more than they are doing. And wondering what there is to do for the things that meds cannot touch.

I think some of my trouble is anxiety as well as depression. But klonopin does not seem to be a good answer these days- it makes me too sleepy. If they could make a klonopin that wasn't sedating, I would be a willing addict. Two nights ago I couldn't sleep and in the morning I was so anxious that I took klonopin early in the day- and just a smidge- but got so tired I thought I'd have to go home sick. But a second cup of coffee seemed to work to get me through it, and then I was functional.

And that was good- because I had a very interesting patient in the afternoon- a stage II tendon Hunter Rod tendon reconstruction patient 2 days out from surgery. So I had to take off the surgical dressing, clean things up and do some dressing changes, and make a splint. And get him started in his home exercise program.

The weekend is going to be a lot of paperwork and preparing for an inservice. I an giving an inservice on screening our patients for cervical problems that might be causing the distal symptoms that they present with- so that we can refer to the PT's. And leading a discussion on a journal article on the treatment of compression neuropathies.

I am also spending money! I am giving in to the black Friday sales (although I have not set foot into any store). I have most of my Christmas/birthday shopping done. Our family has a lot of December birthdays. I also bought a few work tops for myself and a set of hypnosis CD''s on procrastination. It came bundled with one on "mental toughness" so I am getting that too.

I am glad it is the weekend. So much to do.

Sad

I am feeling sad today. I am trying to keep it in the moment, and not to project into the future. I have reasons to be sad. A lot of reasons. And I am lonely. I really need to get out more.

I don't know why this makes me feel sad- but I am going to visit my dad in rehab tomorrow. I am planning to bring Thanksgiving food. But my step-mother, and now my dad, keep telling me not to bring food, he will have turkey for his dinner there. But what about me? What will I eat? And what about having a shared meal? I thought that was the point. Now I don't even want to go. I'm not going to bring food just for myself.

Plus I am under orders from my step-mother not to bring up the impending breast biopsy. Not that he's the best person to talk to about it- she actually is, she has had breast cancer. I can't talk to my mother about it- she told me not to do it and to read Suzanne Summer's book on alternative treatments. Plus she is so overwhelmed with taking care of her mother right now- that she really can't focus on anything else.

I'm not afraid I'm dying. If there is anything there, which is unlikely, it is extremely early. I am afraid of the treatment if there is anything there. I want to keep my breasts. I don't want radiation or chemo. And- I just thought of this today- afraid that I will have to stop my birth control pill and not be able to go on HRT after menopause. Afraid of what that will do to my mental stability.

I do happen to know that Suzanne Summers is taking bio-identical hormone replacement therapy. But she also had a mastectomy. So she didn't just do alternative stuff.

It is the waiting that is the hard part. But at least at work today I forgot. I saw all of my patients by 2pm, at least the ones who didn't cancel because of the snow. I am really hoping that I can get my car out of the driveway tomorrow morning for the local Turkey Trot. It all depends upon when my landlord plows, or if it all melts overnight.

I also decided today that I am going to change my hours at work a little in the interests of patient care. I will have to see if that opens me up to different evening activities or support groups. And I am going to make that change soon- because I will be looking for a new therapist very soon and will need to know my hours.

But medication can fix everything!

I know that my psychiatrist was making a joke, but he smiled so brightly when he said this that for a moment I thought he was serious. And I think he thinks this more than I do. Meds don't give you a life- at best they make it possible to do the things to have a life. But if you have been sick for many years, if you lost the life you had- or if you got sick very young and never had a great life to get back to- then meds are not going to fix this. If you have forgotten how to be a human being, or never learned key skills growing up, meds are not going to fix this.

My psychiatrist might say I'm dysthymic. He was really pushing to see if I needed any med adjustments. And I'm glad he did- sometimes when I am telling myself that this has nothing to do with meds it is me falling into depression and justifying to myself why I feel so miserable. But I know that it is impossible to medicate away this dysthymia for any length of time, if that is what it is, and I'm not sure that it is.

Anyway, things will stay the same for the next three months. At least that's the plan. That is what my prescriptions are written for and that is when I see him next. But a lot can happen in three months.

Today I am totally exhausted. I got up early to see my psychiatrist and then had my late day at work. Only to find that I wanted to be on the internet looking up breast calcifications and biopsies on google. There is also a possibility that I will get in to see the surgeon tomorrow- if anyone cancels due to the snow they will call me. Otherwise I have to wait until December 9th. It is a long wait.

It was only a matter of time...

I knew these mammograms were a mistake. Even the research can't tell me if I should be getting them. I only started getting them to appease my PCP. I knew the false positives would start coming- I just didn't realize how soon.

At my first they found nodules in my left breast which meant every six months I had to get a follow up mammogram and ultrasound. I thought my right breast was doing okay. Today it let me down. They found calcifications in it- and they want me to have it biopsied. Even though it is most likely benign. Most likely but not guaranteed.

So ironic- I was feeling so good today. Finally back on Provigil (and realizing it is the drug for me). You would think that at least this could hit while I was a little more ambivalent about life. But I am not really worried, I don't think it is anything. I just have to do this because- well, that is what you do I guess.

And then I started reading about the procedure, and thinking, my poor breast! It is not exactly like when I had the mole on my back biopsied.

So the imaging center had a patient care navigator- who was in the room with the radiologist- and made the appointment for me with the surgeon. I don't have an appointment for a consult until December 9th, so either they are very busy or they aren't too worried. The biopsy isn't even scheduled.

I forgot to ask if I am done with the ultrasounds on my left breast- they said last time I probably would be if things continued to stay the same, and per the ultrasound tech they stayed the same.

And tomorrow I see my psychiatrist.

I'm just bankrupting the healthcare system. No, wait- I've got a high deductible plan. It is bankrupting me.

.

The trade-off

It is my second day of the lowered Zyprexa, I am down to 5mg from 7.5mg. I woke up and felt awake before my morning coffee. My head feels clearer. Even my depression feels better. The only thing that isn't better is my anxiety- that is a little worse. But that is the trade-off. I realize that there is no good way to medicate my anxiety without substantial trade-offs. The sedation, mental dulling, cognitive side-effects, etc. For now my anxiety is small enough that I can deal with it without more meds. That may not always be true- I am sure I will continue to have my times when I need my klonopin or more Zyprexa.

I'm trying to figure out what to do re Nuvigil or Provigil and which to stay on. Maybe a smaller amount of Nuvigil would work. I really liked the once a day dosing and fewer mood swings- but I think 250mg was too much and made me irritable (although I also needed that much on the higher Zyprexa dose). Half a pill doesn't seem like quite enough, though. But then Provigil, at the moment, is cheaper. I think. But for how long?

Next weekend I am going to write my appeal for Provigil- I have 60 days. I am guessing that they won't care what I say, but I have to do it anyway. If Provigil gets approved, I will obviously go with Provigil. I have had too much going on with my dad to do it sooner.

I wonder if there is anything that this "health coach" that my insurance company is offering me could do to help me with my appeal. "Health coach" is really misleading. They only want you to be healthy in ways that make you cheap to insure. If it helps your health to take an off label drug or to get a medical test more often than their guidelines say, you are out of luck.

I always wish weekends were three days long. Yesterday I was visiting my dad. Today I am doing laundry and I have to drive to go buy my Provigil. I also have to go into work to do notes- but I wish that could be tomorrow. Only it can't be, because tomorrow is Monday, and I will have new notes to do.

My dad's in rehab

Yesterday my dad got transferred to a rehab hospital. I visited him today. He is still very tired, but doing much better. The OT in me observed him transferring from the wheelchair to his bed for a nap- with an aide of course- but he really didn't need much help. He is going to be okay.

I may be spending Thanksgiving with him- I think my step mom wants to spend it with the rest of her family who is all coming here. I mentioned that I could bring catered food. She didn't think that was necessary, as they would probably be giving my dad something turkey for dinner. Well, what about me? Plus, hospital food is not the same. But she is not a foodie.

I am still figuring out meds- isn't that the story of my life? I have been just so irritable- even on the higher Zyprexa- and I can't take it anymore. I think it is the nuvigil. Plus I am down to my last pill. I have to go to the pharmacy to pick up Provigil- but didn't make it there today because I was so wiped out from all the driving to see my dad. Anyway, I went down on the Zyprexa last night hoping that if I did I could get by on half a Nuvigil today. But I was really sleepy, and only survived on lots of coffee. It wasn't enough. Now my mood is bad and I don't know if it is the Zyprexa or Nuvigil.

I have half a Nuvigil left for tomorrow morning- then I really have to get my Provigil. It is a drive. But the price I was quoted is not too bad. I swear, this is like watching the stock market. I am going to try to stay down on the 5 mg of Zyprexa. If I stay at the higher dose I am going to wind up 300 pounds.

I did one good thing today- I registered for our local Turkey Trot. Well, I do the walk, no the trotting. But still, it is better than doing nothing but driving and eating on Thanksgiving day.

Back at work, it feels strange

I spent most of the past 5 days in the hospital with my dad except for Saturday. He had his surgery in the city so this involved staying in a hotel two nights and commuting the other days. It was very draining. He is still in the hospital, I went back to work today.

His heartbeat never came back enough after the open heart surgery, so after 5 days on an external pacemaker, he had a pacemaker placed today. The surgery went well. He could finally get out of bed today- they had been keeping him in bed. Hopefully he will get out of the ICU tomorrow and to a step-down unit. 

I was with my dad yesterday when the electrophysiology resident came by. My dad made a funny joke. He said, "I knew I needed a plumber. I didn't know I needed an electrician."

Meanwhile, I just feel so exhausted today. It is both physical and emotional. I just came home and ate- that is another thing I am doing- I just want to eat- and I don't know if it is the increased Zyprexa, the situation, the change in seasons (and no light therapy for the past week). I have been craving macaroni and cheese- which is something that I hardly ever let myself eat. Pure comfort food. Of course I didn't eat it- I didn't have any and didn't want to stop. And wanted to eat something healthier anyway. The problem is, I ate a few healthier things. 

To add insult to injury- I got a letter from my insurance company today offering me a "health coach." They say it is based upon claims data and diagnoses that are reported. I got a similar letter last year. Unless my health coach can tell me how to get provigil or nuvigil paid for, I am really not interested. My insurance company is not interested in my health, they really are not. They only care about their bottom line. I really think it is a conflict of interest to have an insurance company giving health advice.

Just like it is wrong to have a computer program giving medical advice. To get $100 added to my HSA each year I do this annual online health assessment. Only to be told that I should be on a low sodium diet. Which I really shouldn't. The effexor puts me at significant risk for low blood sodium. And a low sodium diet puts me at risk for lithium toxicity. Plus my blood pressure is well-controlled. One year I actually e-mailed them, but got no response. 

I am just writing because I am hoping that if I wait long enough the food that I ate will tell my brain not to be hungry anymore- but it is not working. 

Catching my breath

I spent the last three days at the hospital with my dad. He is still in the cardiac intensive care unit, and probably will be there until Monday. The surgery went well, but then there was some drama the next day when his external pacemaker shorted out- once very briefly, and the second time big time. Both times I was standing at the bed (maybe I am bad luck?) and saw his eyes roll back and then go unconscious. It was pretty awful. But he was hooked up to a backup pacemaker which they were able to get going pretty quickly.

So far his heart is not beating without the external pacemaker- and it can take 3 days for the swelling from the surgery to go down and know if it is going to come back. But so far it looks like he will need a pacemaker, and they will probably do it Monday. I'll be back at work then.

Today I am just trying to recover and do some things that need doing- like laundry, a haircut, etc. And sleep- I am so tired. Tomorrow I will go to the hospital again. This is my first day home. Wednesday night I spent the night in a hotel in the city with my step mother, and Thursday I stayed in a very cheap hotel by myself so that I could be there early on Friday- and she could do later in the day. And last night I spent at my dad and step mother's. I was too tired by the time I got there to drive home. Today she will go and be with him, and tomorrow I will go so she can have a break.

My dad is just incredibly tired and weak. They didn't want him out of bed yesterday but they wanted him to move- so I tried to get him doing some heel slides and some punches at shoulder level- but he was too tired. I think he is going to need to go to rehab. I know the good acute rehab places around here, but I don't know the good STR places- and I don't know if he can do 3 hours of therapy, plus medicare doesn't consider cardiac to be a rehab diagnosis so it is always hard to get those patients into acute rehab.

I have to find a good STR place for cardiac rehab.

A better Monday

It was a good Monday. I also think that the combination of 7.5mg of Zyprexa and 250mg of Nuvigil is good. I can't help but wonder if I took 5mg of Zyprexa if I could take less Nuvigil (and cut my pills), but I don't know if I want to experiment right now. I have been so bad so recently.

This puts my in a bind. Do I appeal the Provigil denial? I think the Nuvigil is more even and I don't have the ups and downs I had with Provigil- and I am very sensitive to changes in blood levels of  meds. Plus I am falling asleep better- some days I would take my 2nd Provigil late enough that it would make it hard to sleep.

I think I will try to stay with Nuvigil. Maybe when I see my doctor we can try for authorization. Maybe I will just pay out of pocket. My fear is that they are going to jack up the price before it goes generic in a year and a half. Often they do that with drugs. I wonder if there is a way to stockpile Nuvigil?

Meanwhile, I just want to stop thinking about meds.

My dad's surgery is coming up very soon- Wednesday. Which leaves me with all of tomorrow to get caught up with my notes at work. Such is life. But paperwork went better today. I hope it will continue to do so.

Nuvigil + Coffee = Anxiety (for me)

I think I am going to have to give up coffee if I stay on Nuvigil- or at least switch to decaf. Coffee is one of my favorite things in the world, and it usually has more of an antidepressant effect for me than an anxiety-producing effect (unless I really overdo it). But it really seems apparent that my anxiety kicks up a notch, and I find myself reaching for the klonopin, after I have my coffee. And I drink it twice a day.

It wasn't as bad on the provigil- perhaps because I space out the doses. Nuvigil does feel a little bit stronger. Although on the higher dose of Zyprexa, I kind of need that in the mornings to get me going. I am hoping that higher dose isn't for too long- but I am still too vulnerable to go down I decided this week. When I was doing my meds this week, I was trying to figure out what dose of Zyprexa to put into my pill box.

I still haven't called about the appeal for my Provigil- I have been wondering if Nuvigil is better. But mostly I don't know when to call as I am at work during the day and don't think that there is anyone to talk to outside of work hours. At least anyone with the authority to do anything. I still don't know anything about the process or if I have any chance of getting approved.

I am looking to find a new therapist, one who takes my insurance. I don't really know how to find one, other than the psychology today website. I think it is probably in bad form to ask my current therapist for a recommendation. But I am totally not changing because of her, I am changing because of changes to my insurances. I suspect that she may have other clients who may leave too, as my hospital is a big employer.

I want a therapist who has some experience in DBT or ACT or some kind of mindfulness-based therapy. I want a therapist who has experience working with people with serious mental illness and won't freak out when I say how bad things are.

I got a notice in the mail about getting my mammogram. And I want to skip it. I can't imagine doing as something life-affirming as looking for cancer and maybe treating it so that I could live longer. But if I don't get it, my PCP will just hound me, and I really don't want to explain all of this- so maybe I will just go.

I really don't understand drug pricing

Last week the price of generic Provigil had fallen at several pharmacies (after skyrocketing the week before at Costco). My two pills were now about the same price as one Nuvigil- all would be well I thought as the price could only go down in a few months. It's generic, right?

Well today I go on my website- and the price of generic Provigil is up again. And by quite a bit. Nuvigil is now the much better deal, at $520 plus a $50 off coupon- but I was hoping not to have to pay this much. I think this weekend I will try cutting pills and see if I can make do with less. Although a part of me tells me that this is not a good idea.

Nuvigil generics could be on the market as early as June 2016, but I am not holding my breath. The company paid off the generic makers to delay the Provigil generics. And I am not expecting the price to come down anytime soon. I am just hoping that they don't jack up the price of Nuvigil as it gets near the end of its exclusivity, like they did with Provigil.

I actually like Nuvigil- I love the fact that I don't have to take it twice a day. There is nothing that makes me feel more like a drug addict than taking out my pill bottle at lunch and downing a pill. Plus I can too easily forget. But if Provigil were to get cheap, I think I'd go back to that- at least until Nuvigil falls in price (which will be a long time from now).

The two big things I will have to give up are moving to a full-size apartment- and being able to have a cat. And my therapist. I might have had to give up my therapist anyway with the change in insurance. But I can't afford to pay it all out of pocket, especially now. I will still have a high deductible plan, but at least my therapy sessions will count towards my deductible if I see someone in network.

I never thought that I could make as much money as I do and still feel- no, not poor, but struggling. But I live in a very expensive area. Hospitals probably pay the lowest OT salaries. I have a high deductible health insurance plan. I have medication I have to pay for myself that isn't even covered. My therapist and psychiatrist don't take insurance. I am still paying off debts.

For a Monday, it could have been worse

I had a so-so day. I was in a bad mood in the morning but felt a lot better in the afternoon- just very tired. A lot better than yesterday. For a Monday, and given what my mood has been recently and all that is going on, I can't complain. It helped that I had a pretty manageable caseload.

With the time change I am ready to go to bed already. I brought notes home, but I will do them in the morning. Tomorrow is my late day- I don't go in until 10. And I have to do a load of laundry and go walking before work. Maybe I will vote. Usually I do. This year, I just can't get into it. I really haven't followed my state politics at all- I haven't been following politics very much (for me). It just turns me off too much.

This morning, when my depression was worse- I was feeling guilty about being depressed. Because of my dad and his upcoming surgery. I felt guilty for not being sure I wanted to be alive- when other people are sick and want to live. And that is really why I can't do lymphedema therapy. I can't be working with cancer patients when I am half suicidal half the time myself.

I put in my PTO for next week- I am taking 3 days off. The surgery is on a Wednesday. I won't see much of my dad that day- he will be out of it. Initially he goes to cardiac intensive care, then to a step down unit as his condition allows.

It was not too much more than 2 years ago when I was taking time off for my dad's aortic aneurysm repair surgery. And my gift to him was keeping myself together through the surgery and for a couple of weeks afterwards- I was deeply depressed. Two weeks later, I think, I was admitted to the hospital. I really hope this isn't a repeat.

Denial

I thought I was expecting it, so I thought it wouldn't hurt so much. I was wrong. I got the denial letter in the mail today about the Provigil, and it seems I am not as strong as I thought. I still feel like it is a personal rejection, like the universe wanting me dead. I still find myself thinking I will never pay that much for a pill- even though I had decided that I would.

The letter talks about an appeal, and I don't even understand that. It talks about whether your insurance allows for level 1 or level 2 appeals (I have no idea). It gives a deadline for written appeals- but also a number to call- is that instead of or in addition to? And it doesn't mention what kind of documentation they might want.

I can't decide if it will make me too crazy to try to appeal. Or if I will feel even more depressed if I don't. I'm not optimistic about this- all the denial letter did was lay out their coverage criteria based on sleep apnea and fatigue that isn't resolved after faithful compliance with a CPAP machine.

I took some extra Zyprexa. I am trying to read a book on my kindle, 2084, which doesn't talk at all about health insurance. Just global warming. I was trying to find a movie that was a little more light-hearted on itunes that I wanted to watch, but couldn't really decide on anything.

My insurance paid for my Abilify when it was over $1000. But they won't pay for a $520 medication that is already generic and will be going down. Because of that FDA approval thing. But in psychiatry, so many meds are used off label. Even tegretol is not FDA approved for bipolar. And klonopin is approved as an anticonvulsant.

Interstellar

Perhaps this means I am insufficiently depressed- that I can focus on something other than myself. In this case, I have been watching sci-fi movie trailers, and I can now pick apart a movie before it has even come out.

The thing is, "Interstellar" used to be the kind of movie I lived for. If I was a teenager again, I'd love it. Being a physics major kind of cured me of my love of these kinds of movies. I ask too many questions.

From what I can tell from the trailers, the earth isn't doing very well, at one point someone tells the main character that his daughter is the last generation that will live on the earth. Scenes of fires and barren farm land. But then, I think, faster than light drive is discovered, and a ship is built. Astronauts are sent to look for habitable planets. I will assume that they find them.

But then what? The trailers don't tell me. I don't see how a sizable number of people could be evacuated from the earth. That would just be too energy and resource intensive. And what would you take? What plants? What animals? What microbes? Could we even set up a functioning ecosystem on another planet from scratch and not crash it pretty fast if we don't know what we are doing? And if we knew how to do that, we could probably manage our own a lot better. There are some geoengineering techniques that have been proposed to deal with climate change that are pretty low-tech compared with interstellar space ships.

So I am sure that I will see the movie- but I already have my reservations about the premise.

Perspective

My dad needs cardiac surgery. After his stress test he was told that he needs an aortic valve repair. He is asymptomatic, but it will only get worse. So his is scheduled for a week and a half from now.

Depression is so selfish. I just focus on myself, I can't look outward. I hate that about depression. I don't mean to be selfish, it just happens. I want to be there for him. I certainly don't want to be a source of stress.

But today's phone call also made me realize that my dad is not going to be there forever. He is 83. A very fit and active 83, who only just stopped his consulting work a few months ago. But no one lives forever, and no one gets out of this alive.

I had actually had a better day today. I think the increased Zyprexa is helping. It also helped that it was my shorter day today, so that by the time the agitation started really getting to me it was time to go home and I didn't have to take any klonopin.

So I'm glad I was in this better place when he called.

I have decided that if I can't get my insurance company to pay for my Provigil (or for Nuvigil) that I will pay for it myself. It is down to $520 as of last weekend, and in a few months it will be lower. In the meantime I will put off moving to a full-sized apartment for a year, give up my monthly massages, try to pack lunches sometimes (when I am not too depressed), and will give up my therapist for an in-network therapist come January 1. I love my therapist, but I will no longer have out of network benefits, and damn it I want my insurance to pay for something.

I will keep my psychiatrist. There are hardly any psychiatrists who take insurance near me, and I like him. And I see him rarely enough that I can afford to keep him.  Plus he can see me before work so I don't have to use PTO.

I am going to get a couple of days off for my dad's surgery. That is not how I thought I'd be taking my next vacation, but such is life.

The bad thing about depression- when there is nothing that you want

There is absolutely nothing that I am looking forward to. Nothing that I want. I can't imagine what might feel good. Well, there is one exception: since the Zyprexa increase I have had a bit of a sweet tooth and food is a little bit of enjoyment- but not even one that I am supposed to give in to. So what is fair about that?

What I want is for my life not to crash, not to fall apart. I guess that is what I want. I guess that is wanting something. But maybe it is just because I don't have a plan B- I can't imagine another life, a better life. So I try to hold on to what I have. Maybe what I need is a better imagination.

The Zyprexa is helping, but making mornings hard

I wake up in a decent mood now, but really tired. So I do my light therapy, drink my coffee, take my Nuvigil- and if I have enough time I go back to bed for another hour. Then I wake up feeling okay. But on the days I go to work early, there isn't time for this.

My first 5 years as an OT I always worked the same hours every day. I think that was really good for me. My last two jobs I have had different hours on different days, and I really think it has been hard on me. It has made it that much harder to create any kind of routine in my life- between that and my changing moods. So in that respect, outpatient has not been good for me.

We might be losing an OT at one of our sites due to the flu shot mandate. She works 20 hours a week. A part of me thinks- what if  took her job? What if I went down to 20 hours/week? But I don't think I can afford that. Especially if I am not approved for Provigil. And I am only guessing that fewer hours at work would make me happier- I don't know that. Maybe I'd spend all of those extra hours in bed?

If they do let her go, there might be more pressure on me to become lymphedema certified, because that therapist is. I don't know if I want to do it. Well, definitely not now. Not until my meds and my moods are straightened out. But I don't know if I want to do it in general.

I wonder what my moods have in store for me today. I seem to be going through so many mood shirts in a day recently. I have a good moment and I think I have turned a corner- and then the next moment I can't stand to be in my own skin. It is exhausting. I just want it to settle down.

Insight

I had a patient crying in therapy today. Her surgery is not what she expected. No one told her how difficult the recovery would be (the surgeons rarely do). She thought it would be a walk in the park. I had to be the bearer of bad news- the time in the cast is often the honeymoon period, when there is very little pain. When the cast comes off, you find out what is really going on.

And it is the unexpectedness and urgency of my provigil problem that has completely thrown me. I thought I had this figured out. First when I was getting it from overseas. Then- and I had time to figure it out- from Costco. And it was generic. The price could only go down. I was already cutting down my therapy to every other week to afford my Provigil.

I was caught off guard, just like my patient. I didn't know about the massive price increase until I was down to my last few pills, not even a week's worth. I just panicked and had a tantrum and got depressed.

And I still am- panicking and tantruming and being depressed. And I really don't want to be this way, but I don't know how not to be this way. I am back to seeing my therapist once a week- this is already costing me money! I should be trying to get in with my psychiatrist a little bit sooner- but I keep waiting, thinking I will hear something. Because until I know what the decision is, I don't even know what I need to see him for. I don't know if I will need to be looking at other stimulants or not.

Right now the lowest price I can find for Provigil is $520, and it just dropped last week, so it probably won't drop again for awhile. In theory I could pay it for a while- but starting in January I have no out of network benefits and I have an out of network psychiatrist and therapist. Something would have to give.

My last two therapy sessions my therapist has asked if I had to go the the hospital. And I have to admit, the thought has crossed my mind as well. But I just don't think there is anything they can do for me there- it would just annoy me. And I just want to go to work. I think that if I were to be in the hospital twice in a little over two years- that would be too depressing to bear. So I have upped my Zyprexa, which has helped some, and am taking more klonopin than I'd like- but still not a lot (I'd rather be taking none).

I just keep thinking- if I can keep going until the weekend. I don't know what then. Crash, I guess. My last hour at work today I felt so depressed I thought I would pass out, if that makes any sense. But I keep going because it takes less effort than to reschedule patients and tell my boss I am leaving early (and why), etc. So I just keep going.

There are no gold medals for getting out of bed.

No medals for going to work when depressed. No Emmy awards for best impersonation of a sane person. Sometimes I think that there should be. 

Today was hard. It started out less hard, I think because I had more Zyprexa on board from taking extra yesterday- or maybe not. Who knows. I just know that I felt more agitated and irritable as the day went on- and then these wore me out and it turned into severe exhaustions along with the depression. I thought about leaving early- but never got the chance, patients kept coming. I thought I would run out of there at the end of the day, but people kept talking to me. And all the while, I was trying to do my best impersonation of a sane person.

I took charts home to finish- what was I thinking? I haven't touched them. The minute I got home I took half a Zyprexa and half a klonopin. I had drugs that make me feel less bad- but no drugs that make me feel good. I guess that is how it should be- you don't want to be getting your joy from drugs. But sometimes I'd just like to remember what good feels like, even if it comes from  pill. Because life isn't being very obliging. 

No news on the Provigil front. Last time I got a denial letter pretty fast from my insurance company. But so far no letter. I feel like I almost don't even care anymore. I am just tired of it all. I just feel so wounded, and I don't know how to make that feeling go away. How did I get so un-resilient? They could approve me tomorrow, and it would be too late. I am wounded, and I don't know how to heal. That is the scary thing- I really don't know how. 

I finally got out today

I had brunch with my dad and stepmom at a diner midway between us. Afterwards we went to Costco (irony of ironies), and I picked up some groceries. It was good to get out- until it wasn't. I just started feeling too bad with the gnawing in my stomach and my irritability. But at least I won't starve.

I came home and took half a klonopin and half a Zyprexa- and I am so surprised at how little effect this has had on me. OK, the klonopin I have been taking a lot of all week, maybe I am getting a tolerance- but the Zyprexa? I've only taken it a couple of times this week, and I don't really get a tolerance to it like that.

I tried watching a movie- I actually rented it from itunes, "The Zero Theorem," but it only annoyed me so I didn't get very far. A waste of money. What I really want is ice cream. Vanilla ice cream. Or even a milk shake. But not badly enough to go and get any- and I try to not keep that kind of stuff around.

I wish I knew the way out of this. Do I just have to wait it out? Take whatever meds I need to do to keep me sane until it passes? And then I read about ketamine infusions- rapid, almost instantaneous relief from depression. Not covered by insurance, of course, but what is these days? But even worse- the relief is short lived. It doesn't last. What a tease.

I guess the good news is that I do still want there to be an answer, a way out. A way to go on living. A way to have a life worth living. I just don't know if there is an answer for me.

Maybe it will start with vanilla ice cream. Maybe I will make it to the convenience store down the road. Good nutrition can wait.

Another school shooting

They say he was depressed. Two people on CNN were actually debating the wisdom of the advice "fake it 'till you make it," some of the earliest advice I was ever given when dealing with my depression. They said that in this case it failed. I'm not surprised.

A part of me can understand what he did- and that is scary. When I am severely depressed, my anger is usually not focused on any one person (although if an Aetna executive goes missing tonight I suppose I might be a suspect). But generally it is just anger at the world. The world that keeps going, and keeps expecting me to keep going, even though I am dying inside. I just want everyone to shut up. Laughter hurts. Asking me how I am doing or what I did over the weekend- when I spent it in bed- just go away. And I certainly don't want to hear all of the wonderful things that you did while I am wasting away. And I get irritable- I have no patience for anything or anyone.

But the difference is, I wouldn't do it. I'd like to think it is because I am not a violent person. But perhaps it is just because my depression stops me from acting- I shut down. I don't go and do things, certainly not anything as active as shooting people.

The day was harder than I expected. I had to take extra meds. I spent it mostly in bed- but did do one load of laundry- how many weeks has it been? I went to the mailbox, but no notice yet from my insurance company about the Provigil.

I thought I'd sleep with everything I took, but I didn't.

I have thought about cutting- and this is pretty funny. Now that I am an OT and remove sutures and do wound care, I find myself thinking that I need to sterilize the razor blades first. So maybe the whole thing isn't a good idea.

Strange but good

I have found a website that tracks the best prices on medications. Last week- even last night- the best prices for generic Provigil at 60 200 mg pills were around $750. As of this morning, multiple stores have lowered their prices by about two hundred dollars. Just like like that. Perhaps there was a delay in updating the site? Or did so many of these stores decide, en mass, that is was time to lower prices? I don't know- only that this is a good thing.

Meanwhile, Costco has removed the price for Provigil from their pharmacy website. They don't have a price for Nuvigil either. This makes me think that they want to get out of the business of prescribing controlled substances. Perhaps that was the reason, or at least a part of it, for their rate hike.

I'm not sure what I am going to do with meds if my Provigil is denied. I think maybe ritalin is worth another try- the worst side effect I can remember with it is anxiety- not psychosis or tachycardia like the other amphetamines. And on/off effects, but there are longer acting version of it. I just need to know that a $40/month option isn't going to work before I break down and spend $500/month, or whatever it winds up being.

This morning I cut my Nuvigil into quarters and only took three quarters. The whole pill felt a little strong yesterday- I normally spread out my provigil over the course of the day, so taking all 250mg of the Nuvigil felt like it was just a tiny bit too strong. So far so good. And that would help to defray costs just a little bit.

I can't decide which I like better- Nuvigil or Provigil. They feel slightly different. I think Nuvigil feels slightly more like an amphetamine. And I really like the fact that I only have to take it once a day- I am not taking medication in the middle of the day. But in the end, I will go with what I can afford.


I am looking forward to the day when this is figured out and I can think about something other than meds!

The ultimate insult

I saw a commercial today by CVS Health- which  discusses the fact that many Americans never take their prescription medications- and that they can help. I think with reminder programs.

No discussion of the fact that medications are ridiculously expensive. If your drug isn't covered, as in my case, it is really hard to take that drug, and no number of reminders will help. And even if your drug is covered- with these high deductible plans that we are increasingly pushed into- before I reach $2000 (and next year $2500), I am basically paying for my meds out of pocket. Only then do I start to pay copays.

And then of course narrow networks are in. So I, like many, am finding that next year the doctor who prescribes my meds isn't even covered. And finding another psychiatrist in my area who takes insurance can take months. If I want to change. So really, taking meds is a big financial commitment. And it means not doing other health promoting things like seeing my therapist every week and getting massages every month.

Will CVS give me a better deal with Provigil or Nuvigil?  I'd be more compliant.

I'm trying to figure out what I can afford to pay. It looks like I can get Nuvigil for a little under $500 a month, which is still less than 2 generic Provigil 200mg pills. They feel different, but I can't decide which I like better. Nuvigil goes generic in 2016, but if it is anything like Provigil its price won't fall anytime soon after that.

I feel like I've robbed a bank

Yesterday I came home with a bottle of 30 pills of 250mg of Nuvigil- that I got for free. There is a coupon that you can get from the internet that gives you a month of free Nuvigil- with a prescription, of course. And up to $50 off your subsequent prescriptions for a year.

I had enough reason left to find this website and get the coupon and call my doctor and have him call in the script. That is about all the rationality I had left. Oh- and I faxed him a pre-authorization form, because he couldn't get one from the insurance company, it was busy every time he called.

It hasn't helped that I have been cutting pills. So I couldn't tell what was situational vs. biological, but I have been pretty bad- but very confused. Slipping in and out of occupational therapist mode and crazy person mode. Who am I? I don't even know. And I was taking so much klonopin- quarter milligrams multiple times a day to get through the day. And benedryl at night.

Today I have been much better. Is it the Nuvigil? Is it the fact that I have 30 days to figure things out? Probably both. And I didn't even take any klonopin today. Not that I was fine- I really wasn't. I am still irritable. By the end of the day I couldn't stand still. But maybe that is klonopin withdrawal. But I didn't feel like I needed klonopin.

What was strange was not taking my middle of the day Provigil- I am so used to it. As I was eating lunch, I had this urge to take a pill- because normally I have to be so vigilant about it so I don't forget to take it. It felt like an itch that I couldn't scratch. But I finally got over it.

I am so tired now, I feel drained by everything that has gone on. I want to find out what is happening so that I can appeal if necessary. I think that I have a good case to make. I think that anyone who has been on over 30 psych meds plus ECT can make a good case that they need to stay on something that is working very well. The problem is I don't have dosages and dates, etc. I am 47, I have been on meds since the age of 19. Who would? Especially someone with a mental illness? But that is what they ask for.

Meanwhile the world has gone mad. CNN can hardly decide which shooting or stabbing to cover. The Ebola case in NYC is no longer major news, given everything else happening in the world today.

My therapist earned her money today

I was really a wreck today. I was not in a good place at all. My therapist helped to get me a little bit unstuck and less willful. She got me thinking more about actions I can take.

What has been intolerable has been not knowing what is going on with my authorization. I have to make phone calls tomorrow to follow up. And I will probably have to break down and buy some pills so I don't run out by Friday. That is just too soon- I don't know what is going to happen yet.

And maybe I need to make an appointment with my psychiatrist to talk about other options- but first I need to see how this plays out.

The fact that I can now even think like this- is thanks to my therapist. I was just stuck all day. I wasn't feeling like I could do anything, like I wanted to do anything. And I was sure that I wasn't going to be buying any Provigil- I just couldn't bring myself to do it- even though I have room on my credit card. I was going to let myself melt into a puddle of depression this weekend and hope that I would come out on the other side.

Maybe I won't be so calm tomorrow. Today was really hell.

Work grounded me today

I can't say that all was well today- but I didn't feel quite as crazy as I did on the weekend. I tried to be mindful and stay on task and I succeeded quite a bit- but not entirely. I did have my moments when I just wondered why I was bothering and tears would start to well up in my eyes. But then I would tell myself to stop thinking and get back to what I was doing. It kind of worked.

I stopped by the hospital pharmacy today to ask them to transfer my Provigil prescription from Costco. I called my psychiatrist to let him know that he would be contacted regarding an authorization for the Provigil- that I wanted to try again. That the price had more than tripled at Costco. And why I didn't think I was a good candidate for an amphetamine.

What more can I do? Just wait. That isn't very satisfying. I think that even if I do get authorization, damage was done, so to speak. This weekend I feel like something broke inside me. I don't know how to fix it. And of course, if I don't get authorization, then I was right. The whole world hates me and wants me dead.

It is all too much. I think I will go to sleep.

I don't want Monday morning to come

I have spent all weekend crying. I don't want to face everyone at work on Monday, and have everyone at work ask me what I did over the weekend. It isn't fair. It should be enough, if you are depressed, to get yourself to work and do your job. Having a good story about what you did over the weekend shouldn't be a part of the job requirement.

This Provigil thing has just pushed me over the edge. I can't stop crying. I do for a little bit, I pull myself together and tell myself I will do certain responsible things- and then the next minute I lose it. And I swear I will stop all my meds, etc. But I don't think stopping my meds is going very well because I have been having to take extra klonopin and Zyprexa just to make it through the moment. So much for mindfulness and DBT. What I really want to do is cut, more than I have in years. I can't believe how out of control my emotions feel, it scares me.

It is too bad it is winter. I have been thinking that I should quit my job and hike the Appalachian Trail. Clearly my life is not going well. And clearly I need to learn more life skills, like resilience. Plus- maybe by the time I came back, the price of Provigil would have dropped! But it is winter and if I quit my job I can't think of anything to do on the cheap.

I am too far behind on my paperwork- and my apartment is too much of a mess- for the ultimate out. But I have had some moments this weekend when those were the only reasons I could come up with not to.

Work will be good for me, I know that. Going to work on Monday will help to get my mind off of things. And hopefully I will get it together enough to work on the Provigil problem.

Why this provigil thing has me so upset

I know I could try an amphetamine again. It's not like I want to live forever. It is more the principle- knowing that I am taking something that gave me tachycardia before... I have already made my peace (sort of) with taking Zyprexa which has made me obese and will sooner or later give me diabetes. The lithium will probably take a toll on my kidneys. The benzodiazepines I have taken increase my chance of getting dementia. Antidepressants and anticonvulsants greatly increase the change of osteoporosis. And then- to go back on the drug that gave me asymptomatic tachycardia, which I only caught because I was playing around with the pulse ox one day at work, that is too much. My PCP already thinks I have enough cardiac risk factors to need my cholesterol numbers to be lower and probably need a statin. What will she say if my resting pulse is 114?

And then there is the fact I went psychotic on dextroamphetamine. Really seriously paranoid.

So I have my reasons not to want amphetamines.

And yet, during the period between going off of stimulants and discovering Provigil, life was really hard. I can think now. Maybe I am still not the best at paperwork- but so much better than I would be. I passed the CHT exam. I can think. I can focus much of the time. I can work. And I don't feel drugged- unless I have been taking klonopin or extra Zyprexa. If I lose that, I wouldn't want to work. I don't even know if I could work full time. And work is really all that I have going for me right now. My life is that pathetic.

Ritalin is worth looking into again, I suppose. I can't remember serious problems with that- other than anxiety and the on/off feeling it gave me. There are longer acting versions- but none that will last all day. Perhaps with the Zyprexa on board the anxiety wouldn't be so bad. Or perhaps without the Zyprexa I wouldn't need a stimulant. I can't help thinking that.

And then there is the fact that the manufacturer of Provigil paid off the generic companies to delay making generics- and that is why it is still so expensive after all this time.

And then there is what Costco did- raising the price from $276 to $900. Of course it is their right, and they were way under market- but why would you? I don't think your neighborhood drug dealer would more than triple the price of your favorite drug in a month without a good story.

Anyway, I have done very little today except cry and take the drugs that I swore I wouldn't take because I hate the fact that I take meds. I hoped this would bring me sleep, I hoped it would knock me out. It didn't.

Monday I will call my psychiatrist and have him try again to get it authorized. If it does not, I will appeal. If I lose, I don't know what I will do. I might have to take a leave of absence to figure out medication options- whether that be getting thru the withdrawal of the Provigil and seeing if I can handle life without a stimulant or trying to find a stimulant that I can both afford and tolerate. I know from the last couple of times I have run out of Provigil that it will get really bad that first week without it- and I have never lasted longer than that so I don't know what is on the other side.

Right now I have enough until next Friday, if I skip a couple doses. Then the fun begins. Unless, of course, my insurance company comes around. But I don't want to get my hopes up.

On the other hand, if they do decide to pay for my Provigil, I will even forgive them for dropping out of network coverage next year- although that is admittedly a hospital decision, not an insurance decision.

I don't know what to do again

I had phoned in my refill of Provigil to Costco-and I just got a call from the pharmacist. He wanted to know if I still wanted to fill the script- because there has been a price increase. Last month I paid $275 for it. This month it will be $900.

Well, so much for Costco- I can get it cheaper elsewhere- but not a lot cheaper. The cheapest I can find for my two 200mg pills will cost close to $800. I can't afford that. I could try Nuvigil- but the higher dose is still pretty pricy, and I think that is what I would need.

I know I should break down and try the amphetamines again. But I don't want to. My doctor is talking about putting me on a statin- why would I want to risk tachycardia again? Plus, the on/off was so dramatic that I couldn't deal with it. Plus I got psychotic on dextroamphetamine- although granted I was on a large dose and already manic.

If coffee didn't give me heartburn, I could just drink coffee all day- but it does, so I have to watch my coffee intake. I am looking at natural stimulants- but I am guessing that if any of them could really replace provigil they wouldn't be legal.

I know what would really work- but it would take so much time- and probably a leave of absence, that is wouldn't be worth it. On high dose Parnate I didn't feel the need for a stimulant. But to switch antidepressants, and to an MAOI, would be a big deal.

I was looking at the medical criteria for Provigil on my insurance site. They particularly say that use for depression is considered experimental and is not supported by peer reviewed literature. So I don't think another appeal is going to get me anywhere.

My health insurance company hates me and wants me dead. I know that is personification, but that is how I feel. They just took away my therapist and whatever small coverage they had for my psychiatrist.

I don't know what I am going to do. Maybe I can find another overseas pharmacy- but the FDA has really been cracking down on them.

It never gets better

Every job change I have had has had worse health insurance. And within each job, every time there has been a change in the insurance plan, it has been for the worse. The new plans came out for next year- we now have our choice of two options- but neither includes out of network coverage. They took that away. Neither my psychiatrist or therapist take insurance.

50% of psychiatrists do not take insurance, it is the highest percentage of all disciplines. And in my state the number of doctors-of all kinds-who do not accept insurance is very high. There are hardly any psychiatrists around who take insurance, and the waiting list for those who do is many months. But at $150 every 2-3 months, I think I will stick with my doctor. My therapist is another matter. And I am sure that there are good therapists who take insurance, but I can never seem to find them. I found one- but then she left for maternity leave. Most have been, at best useless, at worst really bad. So I think that as of December 31st, I will be done with therapy for a while. I guess they got what they wanted- they cut costs.

The high deductible option will still be there- with $500 added to the deductible and no more out of network coverage. The other option is an HMO which is no bargain either. There is still a high deductible- but is doesn't apply to doctor visits or prescriptions- there are co pays for these, and these copays are high. $60 to see a specialist (like a physical or occupational therapist, for example- imagine 2 times a week). And for the HMO I would need a referral for all care- which would annoy me, but I don't think would be too hard to get. I have a good doctor.

I think the HMO would save me money- and I wouldn't have access to any more doctors with the high deductible plan. The downside is that there is no health savings account attached to it. So when I try to figure out what is in my financial best interest, my head starts to spin. Shouldn't they teach this in schools? And I really don't like the idea of an HMO. And I feel very sorry for all of the PCP's who have to write referrals. They must have something better to do with their time.

Not a great day for medical news

America has its first Ebola case- that was contracted in the US. And it was a healthcare worker who knew the patient had Ebola and was using protective gear. This is not good. Too many healthcare workers are getting Ebola- here and abroad.

When I do inpatient I sometimes have to wear a gown and gloves. Once, when I was a student, I had to wear a mask as well because I was doing an eval on someone with TB. I was terrified. But really, if you think about it- gowns may not be enough. If someone has sneezed and there are droplets on the floor- you could get your shoes contaminated, etc. Any part of your body that is not covered with protective covering is at risk. So many ways that this could all go wrong. And apparently it has, at least for one nurse.

On a more personal level, I am wondering why the end of life has to be so hard. My grandmother broke one of her vertebrae- and things have been really bad ever since. Her pain is not under control- except when it is, and then she forgets she was in pain. The pain is making her more confused and agitated and more difficult. I don't know if they are going to be able to continue to keep her at home- but my mom has finally agreed to have someone come to the house- but they can't start until later next week.

Part of the problem is lack of continuity of care- my grandmother sees a gerontologist at a major university clinic- but the doctors keep leaving and the clinic keeps moving and reorganizing- so that there was no one they could call this weekend about pain medication because she is seeing a new doctor next week. And I'm not sure that there is anything that they could have called in, anyway, as they are all controlled substances.

I wonder if an antipsychotic would help her. I could send her some of my Zyprexa! Or maybe she will be better if her pain is managed better. Or maybe she just can't stay at home anymore. My mother really wants to take care of her mother at home- but it might be the behavioral aspect of things, rather than her declining health, that makes this not possible.

Another day of struggle

The depression was there today again. I got up late, didn't take a shower or even eat breakfast- hoping that my morning cup of coffee with a lot of milk could tide me over until lunch. I did make it to work just on time. And work did go pretty well- except that by 11am I thought that I would pass out from hunger.

Today is mental health day or week or something like that. I think I have compassion fatigue when it comes to these illness-awareness days. I was supposed to wear pink last week I think- but I didn't. Does mental illness have its own color? It ought to be black- but then everyone would just think you are from New York City.

Do we need more awareness of mental illness? Do these days really reduce stigma? I don't think they do. Not for serious and persistent mental illness. I think this manifests in two ways. Of course there is potential discrimination on the job, from dates, friends, etc. And then there are the other people who will tell you that you are not really mentally ill because you are working and living on your own.  I guess we are not supposed to get better.

What has my interest right now is the Ebola news. I don't think- for the near term- that the US is at risk of a significant outbreak. I think the biggest worry is that it will not be stopped in West Africa and will become endemic in this area, with a huge loss of life and a constant threat of infection spilling out to other areas. Because the economy will go so bad that people will migrate for work, as well as medical care. And it will become just awful in this area.

I have also been reading that India may be next in line to get Ebola, due to crowding and lack of medical infrastructure in places. I hope this doesn't happen. I really hope we get a vaccine. Before the economy crashes.

I have to admit- I have a patient who is recently back from west Africa. And I mental calculated that he had been here over 21 days before I saw him. Safe!

Hard day but a good OT moment

The depression was definitely worse today, and I couldn't be so philosophical about it. But I did have one moment at work that broke through it- getting out a golf club and balls and having a patient with a very painful arm do some putting. A good occupational therapy moment. Purposeful activity. I wonder if I can get my hands on a tennis racket.

I think I might have a UTI. Maybe that is the source of my recent fevers. I felt feverish towards the end of the day- but then I took some naproxen and I felt better- my mood felt better too. But I just couldn't get myself to the support group- I just wanted to go home. To no food- I had milk and m&m's for dinner- it was a very yummy dinner actually.

I did three eval's today and I didn't finish writing up any of them. All of the eval's had complications. The mallet finger patient with a lag- so we will try more splinting. The tendon repair patient who came in with no splint. The patient who comes in and it seems totally like something rheumatological- but the MD wants to try therapy before doing bloodwork. Sometimes I don't understand doctors.

This weekend I am going to a Bat Mitzvah for my step niece. I am kind of dreading it. But I really should go. I don't even know what I am going to wear. But I guess I have something.

I think today was a little better- but I am still down

I think my mood has taken a dive- and I am trying to ride it out. I know that if I am depressed, I need to be gentle with myself. But there is a fine line between taking it easy on myself and turning into a blob! For today, though, I let myself use dry shampoo and skip the shower. I tried to be present at work and focused on mindfulness. I just did what I could do. And I think that it helped. Or maybe it was just the truly delightful fall weather that we have outside right now.

Focus on little things. The radial nerve palsy splint I made today that came out well. The new shoes I bought- all black running shoes to wear at work- which are the most comfortable shoes I have ever worn. And try to forget that I thought about quitting when they told us that we have to fill out more checklists to make sure we have done certain things- just another step and all of these steps add up.

Tomorrow I am going to walk before work. Just a mile, but something. Because I really need that. It is my late day tomorrow to go in, so I have to do it. And for my sanity- it is going to be a really busy day. I have to make a splint, do 2 evals, and I am double booked quite a bit. My schedule has gotten really hectic because Mondays I am at inpatient, so I have to see all of my patients in 4 days.

I want to try to get myself to the support group after work tomorrow. It is a little hectic- I have to leave exactly on time and I still get there a couple minutes late (I hate being late). But I want to try it again and see if it is useful. I could use the socialization.

More than Monday morning blues

I woke up really depressed and had the hardest time getting out the door. I figured it was just Monday morning blues- some Mondays I am depressed. Not that I don't like my job, I am just bad with transitions I think. But usually I feel better as the day progresses. Today I didn't.

By lunch I realized that it wasn't going away. The darkness accompanied me the rest of the day until I could finally clock out and run home. I needed to do some grocery shopping- instead I just stopped for milk and some cookies- I needed comfort food. I'll have some lentils later. At least I had vegetables at lunch.

I know I should go for a walk or something. I just feel so tired. Maybe in the morning before work.

I have to get through this.

Sweet Friday

Friday's are always good. It is my shortest day of the week, and I know I have the weekend coming up- and I always feel so light and free at work. It was also a good day because I had a student job shadowing me to get observation hours so that she could apply to OT school- I have that a lot- but this one was really enthusiastic about what she saw, and I think she might want to go into hand therapy.

Otherwise it has been a week with a lot of discharges and a couple of really interesting patients- but if you are a patient, you don't want to be interesting. You want to be boring. These people are really involved or have unusual things that don't have clear treatment that works.

Today I have finally felt pretty much over my cold, although my throat still feels a little funny. Otherwise I am okay. Physically. I am a little anxious and my thoughts are a little loud at times- I think this is a consequence of going back down on the Zyprexa after taking too much for a week. Or maybe of starting light therapy.

My thoughts aren't exactly racing- but I just feel the weight of all of the knowledge in my head. Like I don't want to think anything, because I know that anything I think is connected to all of these other pieces of knowledge/memories, etc. which are just going to follow and it just all feels so heavy and I think I can't bear it. So this evening I took a quarter milligram of klonopin. The past couple of days I have been taking benadryl, because I have hoped it would also help with the cold symptoms. Oh, and I have been a little talkative too. For me. Probably for someone else, it would not be! But I am usually quiet.

But it hasn't been bad, I'm not too off. I think it will quiet down pretty soon.

I am supposed to go on a nature hike tomorrow, but it is also supposed to rain, so I don't know if I am going. And the last few days my left ankle is really bothering me- and I don't know why. That is not the bad ankle. I kept blaming my shoes- but it doesn't matter what I wear. I think the only thing that would help is my hiking boots. So for tonight I put on my Jimmy Copper ankle compression sleeve- that I bought for the other ankle. It seems to be helping a little bit.

At least it's not Ebola

That's what I said to myself today when I was feeling miserable with my cold, or whatever I had. I actually said that to myself. Not imagining that this evening I would see the news that America has its first Ebola patient. I knew it would happen eventually, just not now.

I almost called out sick today- but after a long, hot shower I felt so much better I went in. But I'm not sure it was the right decision, I was feeling pretty bad by later in the day- but no coughing or sneezing on patients- I only sneezed once. I just had to keep running to the bathroom to wipe my nose or blow my nose. And of course lots of hand washing and purell. But I was really miserable.

A lot of people are sick at the hospital. And they are getting flu patients already. From what I hear, they are going to enforce the flu vaccine mandate this year. The only exceptions will be medical- per CDC- or religious- with a note from some kind of priest.

I don't really think there should be religious exemptions. It gives people with a religious objection an advantage over people with non-religious, yet deeply held objections. So if your religion tells you that you can't eat any animal products- well, there are atheist vegans too. But they would have to get the vaccine. And I don't know what other religious objections there are, unless you worship the devil. Does your religion tell you that you should get sick and infect your patients? If you think that the vaccine doesn't work or is bad for you, well, there are a lot of non-religious people who think that too. That is not a uniquely religious objection.

We might lose some staff over this. There is no good evidence showing that vaccinating the staff reduces flu in patients in long term care facilities (and you would be less likely to demonstrate the effect in the hospital because length of stay is so short that by the time the patient gets the flu, they have been discharged). But maybe it has some small effect. And it makes the hospital look good to Medicare.

I hope I feel well enough to go in to work tomorrow. So much to do. So much that didn't get done today- I just survived. Sometimes that is all that you can do.

The very worst thing I did today

Today I had to put the restraints back on an elderly lady with dementia after putting her back to bed. Supposedly she hits people. She didn't hit me. The PT and I had her up to evaluate her- she just wouldn't do anything we wanted her to do. Not her fault, it's just where she was. So we put her back to bed, instead of letting the aides do it, to see her transfers and bed mobility. And then we had to put on the restraints. And leave her- alone- in a hospital room. Although once she had the restraints on she kind of just shut down, like she knew she wasn't going anywhere. She didn't try to fight them at all.

So I guess I have no right to complain that I am having a miserable day. I woke up feeling so depressed I actually thought about calling in sick for a moment. And then I realized- I am getting sick. My throat hurts. My nose is running. I feel feverish. I made it through the day with some aleve, but I am starting to feel worse as the day goes on. I hope I am okay to go into work tomorrow. I really have to see patients. But if I am going to sneeze all over them, of course I am not going to go in.

I almost went to go get a flu shot today- they were giving them at occ health this afternoon. And then I remembered that you can't get one if you are sick.

Just thinking about family

My grandmother is 94. Her mind is not good and my mother lives with her and takes care of her. A couple of weeks ago she broke her wrist. Then last week she was in the ER again due to severe back pain- she was sent to an orthopedist. She is scheduled for an MRI next week because they can't decide if there is a new spinal fracture or if it is old from the x-ray- and it takes a while to get MRI approval from Medicare. Meanwhile she is on codeine, lidocaine patches, and still in pain.

I started wondering if she is going to make it to 95 in May. Maybe this is her time. Maybe it should be her time- she says this herself. I don't know. My mom thinks that my grandmother is depressed. My mom thinks that my grandmother will live forever.

She won't take my advice- getting some help in the home. Start now, before grandma needs it too much, so that grandma will get used to it. But she won't get anyone, I don't think she wants anyone else in the home. And this gets me so upset that I try to stay out of it a lot. Other than moving down south, there is really nothing I can do other than listen to my mom, who is really overwhelmed.

And yet, I don't know what she will do with herself when my grandmother is gone. This is her purpose. I would like her to move up here- but she won't. She has said as much. And I am the bad daughter- I will not move to be near her even if she starts to need me. I have too much keeping me in the northeast- and don't like the area she lives in. But at least she will have some family in the area if she stays.

I hate generics

I keep getting Zyprexa that look different. I think that last week I was taking 7.5mg pills, which are smaller than the 5mg pills that I recently filled (from a different company). Granted, I should have been paying better attention to what was on the bottle and not looking at the pills to see what I was taking.

No wonder I was so tired and hungry last week. No wonder I couldn't get out of bed in the mornings. I thought it was the seasons changing. And I would come home and go to sleep early too. And I was SO HUNGRY! I thought I would pass out between meals. Just the seasons changing I told myself.

Last night I only took 5mg. And I didn't sleep that well, even after taking benadryl in addition to everything else. But my mood seems to be okay- I am not crashing or agitated or anything. Hopefully I wasn't on  the higher dose for long enough for this to destabilize my mood.

But I really never went into a deep sleep last night, or at least not for very long. I just remember being awake most of the night. I thought I would nap this morning, but I can't. Which I suppose is good. My daytime sleepiness is better. Yesterday I couldn't stop napping.