Daily Archives: December 6, 2012

If It Walks Like a Duck, and Quacks Like a Duck, It’s Probably a Duck; or, The Emperor Has No Clothes On

Yup, if it walks like a duck, and quacks like a duck, it’s probably a duck.  That’s one of the many medical aphorisms that I found true enough to include  in my shopping bag of things to think about when considering a diagnosis.  In other words, particular illnesses have hallmark characteristics.  Let’s take influenza as a convenient example: high fever, body aches, headache, prostration (medicalese for “can’t move far enough to pick up the telephone”), zero appetite.  Sound familiar?  Yup, we could all hit a bullseye on that one from across the room.  It walks like a duck and quacks like a duck.

The corollary to the “duck” aphorism is, “When you hear hoofbeats, don’t think of zebras,” which is a fancy way of stating “common things are common.”

So, to keep with out flu example, if you had a patient with high fever, racking chills, body aches, etc., you would think of the flu, rather than, say, malaria, unless you were in Africa or some place where malaria was common.  It is not common in most of the Western world, so that would not be at the top of your diagnosis list.

On the other hand, I had a patient in the ER once, a beautiful 17 year old black Haitian boy, who had a fever of 105, racking chills, body aches, and a pulse of 60.  Normally the higher our temperature goes, the faster our pulse goes to pump blood around the body to help get rid of toxins.  So a fever of 105 and a pulse of 60 is already a paradox.

Oh, excuse me for forgetting to tell you: the boy was schizophrenic.  That’s important.

I drew some blood, which looked consistent with an acute infection.  Then I went to the hospital medical library.  In those days they had actual books.  I found the answer there, in an infectious disease text book from the 1950′s: it was typhoid fever, which you get drinking contaminated water.

I called the infectious disease consultant, all excited and proud of myself for making a cool diagnosis.  I read her the patient’s chart on the phone.  I got to the part about his being schizophrenic, and I though the line had gone dead, there was such a long silence.

“When you hear hoofbeats, don’t think of zebras.  He has the flu,” was the flat response.

“He can’t have the flu.  His pulse is 60.  It should be at least 120 or more.  His blood count is through the roof.  He has an acute bacterial infection of some kind.”

(Snottily): “Well, if you really think he’s toxic, give him two grams of I.V. Ceftriaxone and send him home.  Have him follow up with you in two days.”

I didn’t feel good about the whole thing.  I drew blood cultures and gave the strong antibiotic, and watched him for another four hours.  The fever did come down, and he actually looked great after the antibiotic.

Two days later he came back looking much better.  He was actually able to talk now.  He told me that he’d been to Haiti on vacation with his mother for a month, and just returned two weeks ago.  I examined him, and the only unusual thing on exam was that the whites of his eyes were yellow.  That means there is something wrong with the liver.

I called the lab and had them fax me all his results stat.  Hah!  The blood culture results were positive for Salmonella Typhi!  He had Typhoid Fever.  Now we had a problem, though.  Giving the wrong kind of antibiotics at the wrong time in Typhoid can drive the bacteria into the liver, where they can live for years, making the patient a chronic carrier, like Typhoid Mary.  So I had to call the snotty Infectious Disease consultant again.

“Hey, you know that schizophrenic kid from the other night?  The one with the flu?”

(Coldly):” Yes?”

“Well, his blood cultures are positive for Salmonella Typhi.  He’s got Typhoid Fever.”

“Who the hell told you to get blood cultures?”

“Nobody.  I just thought it was strange that he had a paradoxical pulse with a fever of 105, so I looked it up.  You know what they say: if it walks like a duck, and quacks like a duck..”  The phone went dead.

Five minutes later, the snotty Infectious Disease specialist was at the patient’s side, examining his liver and everything else.  She wrote a case report in a prominent medical journal about the “Zebra” patient we had.  My name never appeared in the article, of course.

Oh, drat, I did it again.  I have a personal reason for writing these posts, but I haven’t written it here.  Got too wrapped up in the Typhoid case.  I’ll try to do better tomorrow.


Bipolaria

I’ve always liked the saying “I live in my own world, but it’s okay-they know me here.”

Thus I shall dub this world “Bipolaria”.

Though it’s not as much a geographical locale as it is a state of mind I am trapped living in 24-7. A neverending always changing frame of mind.

I was laying in bed last night, after all the stress of the day and the noise and the battle with my kid…and finally, my mind was calming down, my body was calming down…and I reflected on what I had written here…

And I realized: “Do you have any idea what a fucking self absorbed, impatient, whiny jerk you sound like?”

Of course, the part of myself who likes to beat up on me agreed, I am an utterly terrible human being and I don’t deserve any blog readers because I am full of shit, thinking my problems are any more special or different than anyone else’s. Get over yourself, Niki.

Then I remembered reading another blog (and I apologize for not linking to it but I am in a hurry and I will do so at a later date, sincerest thanks to its author) that there is a part of each of us that just wants to drag us down and it is important to counter against it with positive thoughts about ourselves.

Well…In keeping with my honesty is best policy, sometimes when my frame of mind is altered by a mood shift or panic attack, I do become self absorbed and impatient and it’s not an attractive part of who I am.

At the same time, I’m not going to go correcting myself or apologizing because distorted thought is the whole point of sharing bipolar and panic experiences. If your thoughts weren’t distorted by a chemical clusterfuck in your head, then you’d be well, not suffering from a mental illness. So I will just keep ranting, no matter how badly it makes me come off.

Why?

Because it’s real.

I am cyclothymic. My moods shift rapidly. But when I am in a freaking out mood or in the gutter depressed, whether it lasts ten minutes or two days, it is all encompassing and it is real.

It is not melodrama or “look at me, pay attention me, I am so sad.”

I am simply telling it like it is at that moment. In hopes that if someone who reads this blog feels the same way and has always felt like a freak because they fell through the cracks of a proper diagnosis…that it might help,or at least let them know they are not freaks and they are not alone. This is why I share, this is why I write. Because I spent so many isolated years with the wrong diagnosis, wrong meds, never getting better, and no one would listen to me and no on had any empathy.

If I have to let all my warts show in order to accurately depict this lesser known version of bipolar called cyclothymia…

I can deal with that. We are all a little bit of good and a little bit of bad, anyway.

Tis what makes us human.

So…no apologies.

I am what I am, and while I am striving to be a better version of me, I am still mentally ill and I am still struggling.

Ugly, raw, inconsistent, unfocused…

I may never get paid to write, but at least I know when I do write…I am laying it all on the line.

Honesty above all else.

Life is ugly, people have ugliness.

And if you look hard enough, under it all, you will find joy and beauty.

Mood swings providing. :)


Idiotic Foolishness and Just Some Guy on the Internet

Today’s Music:  Crazy  Alanis Morrisette.  a note on today’s music; no notes today. Let’s go folks take 567 for Idiotic Foolishness All day Long… Quiet ..Cue the cheesy music… again annnnd   WAIT!!  It’s just Idiotic Foolishness now.. Yea Yea whatever you are just procrastinating Hey!  I resemble that remark… And so goes the dialogue … Continue reading

So, I walk into this bar with a Doctor, a Psychiatrist, and a Rabbi….

It’s been almost a month since my last post. (Holy shit that sounded like confession! LOL)

I have been having a multitude of issues as of late. Readers digest version: I got a new doc (family physician), I’m back on thyroid medication, was diagnosed AGAIN with Fibromyalgia, but this time folks, we are going to treat it! Doc asked if I felt my bipolar diagnosis was accurate.

*scratches head* Um? I think so? I mean unless there is something else wrong with me to make me act this way? Oh! My thyroid can do that? I head of that… Oh… Fibromyalgia too? Interesting…..

So this has apparently opened a whole NEW can of worms for me.

So, back to square one. What the fuck in my problem? Maybe I have Bipolar. Maybe I don’t. Fuck. And now every medical record I have is tainted with this diagnosis. So what if it is wrong, and I don’t really have it? Well, lets just worry about the here and now and deal with things as they happen. (that is me talking to myself folks…)

I go back next Monday to go over results (i have already seen them, but we will go over them face to face) and to also discuss medication for the fibro. THANK FUCKING JESUS! I have been in so much pain it is not even funny.

About to get my own shovel and dig my own grave

(FYI, for those who aren’t familiar with my primary blog or my odd sense of humor, my running gag when people or something pisses me off has been “get me the shovel”, ya know, so I can dig a grave.)

On a scale of one to ten, with ten being the worst, today was a 3o on the suckometer.

Just…why can’t I catch a fucking break?

The car is going, but who knows for how long or what’s next. I knew I should have kept my 1988, be damned a dented fender, the thing ran like a swiss watch. Upgrading has lead to nothing good.

I picked my kid up and from the word go she was in “test mommy to the max” mode, kicking the seat, defying me while smiling, ignoring me, crying, whining, and all out screaming.  I tried to talk to my dad on the phone about what was going on with the car. The whole time she sat on my lap, shrieking and babbling, not giving me in inch of breathing room. That’s not meant metaphorically, either, we were cheek to cheek and every time I set her down, she threw a screaming mimi. Either way, I was doomed.

Then I felt bad and thought, well she just wants mommy’s attention and mommy needs to quit being a self absorbed mental case. So…

I ordered pizza for supper as a treat.

Then I dared take a phone call (from my boss/mechanic) and her vengeance for my attention not being on her 100% was to pick up the marinara, disobey me when I asked for it back, then fling it to the floor so it splattered everywhere. I told her that was a bad thing to do and she began screaming bloody murder about how I hurt her. Unless my psycho ability has become psychic I fail to see how verbalizing is physically harmful.

I think she is the princess of manipulation.

She does spawn from the king of manipulation, after all.

That’;s not cruel, it’s factual. When your entire life is spent walking on egg shells because someone is constantly manipulating you and making you doubt yourself…I hope it’s a phase, I hope it’s just me coming off one med and starting a new one, I hope it’s anything but my parenting skill resulting in her behaving this way because I somehow failed her.

I am told this limit testing is normal. I hope. I hope. I hope. I know what my parents went through with my sister. Her “phase” lasted nine years and involved her hitting them and committing felonies.

Sunshine spewing counselor says to set limits, stick to them, and be consistent.

I frankly miss the old days when you could swat a kid on the butt and it wasn’t considered maiming them. All it took for me was one good spanking when I was little and I learned to walk the straight and narrow. My sister,on the other hand, laughed and dared them to spank her harder.

And I see this in my kid every day. She wants me to go off the deep end, i think.

Or is that fear and paranoia talking?

I have no idea anymore. This med situation is so fucked up, one thing goes right, ten things go wrong, no one will hire me, I can’t stabilize for more than five minutes…

I really wouldn’t mind digging a hole and climbing into and covering myself with dirt.

I am in over my head here.

Yes, I have done well. I have done pretty amazing, in light of things.

But I am still floundering, and I am scared, and the paranoia is telling me worse things are to come and people are evil and out to fuck me over and every bad choice I have ever made is going to negate any good thing I do or personal growth I manage…

The panic is telling me to find the nearest closet and hide.

And that is not drama or metaphor. In the past, I have literally locked myself in a closet or a bathroom and laid in the bathtub in a fetal position trembling and hyperventilating. People scoff and laugh and preach their “get over it” techniques, but…Until you walk in MY shoes, don’t judge me. Panic is different for everyone just as much as it is the same. I knew a person who excelled with the so called “exposure” therapy where they slowly introduce you to your panic trigger situations in hopes you will overcome it and panic no more.

I tried that and had a two year set back.

I am still lucid enough to know not every paranoid thought I have is fact.

But the panic and paranoia are so strong, I sometimes forget which ones are ridiculous and which ones are plausible.

Sometimes,it’s not even a matter of forgetting, it’s just complete and utter confusion.

Right now, after all the things that went wrong today and my kid just completely obliterating my fragile psyche and nerves…I don’[t want to do anything but slither off to bed and forget this day ever happened.

Mature? No.

Realistic?

No.

But it is what it is.

And my old counselor told me sometimes you just have to give yourself permission to feel shitty, and ride it out. With my cyclothymia, the only certainty is that the mood will shift. Usually every six seconds.

If I fall into a standard winter depression, though, that is even worse.

Already I am having trouble motivating myself to shower and such. That’s depression, telling me I am too tired, I am too sad, no one cares about me so what does it matter if I stink.

Thus far, I am warding it off, but just barely.

Have I made any sense at all here?

My mind is just spinning.

People see what they want to see. Look, Niki is up and functioning, her kid is well cared for, she must be cured.

If they only knew just how close I am to a complete meltdown.

Yes, I am strong. Yes, I have good qualities. Yes, I have done some good things.

But when you’ve also lived a life in instability and mood swing made choices..it’s hard to entirely forgive yourself, especially when you don’t want that forgiveness to become absolving yourself.

How do I own my fuck ups without allowing it to consume who I have become?

I think it may be a Trazadone night, I have a few left.

I just can’t think anymore, my brain hurts.

My chest also hurts, but I assume having hour upon hour of your heart doing a ricochet off the walls of your chest will do that.

Sorry to prattle.

Just very down and stressed and frustrated.

And sick of my brain sending me the wrong information.