Daily Archives: February 9, 2014

In Praise of Invertebrates

No one has ever called me “spineless,” yet there have been times when I’ve sorely envied those creatures without one:

Give praise to the invertebrates, for they shall inherit the Earth.

I don’t know who said that.  Thought I did, but looked up the source and it wasn’t where I thought it would be.  But never mind. For the past, oh, month or so, give or take, I have been limping around on one or another of my limbs.  My knee locked up; my hip hurt; and now my back has eclipsed the rest. My back has been, for me, a symbol of the level of support I am getting from those close to me.  And while some may argue that what’s physical is physical, and that the mental/emotional/psychosocial arenas cannot cross over purely physical lines to cause or worsen structural damage, I disagree.

My point of view lines up with that of the “biopsychosocial model” on which I was nursed and weaned by my Very Special Medical School, the University of Illinois at Champaign Nirvana Urbana, smack in the middle of Corn Country, Illinois, USA.  The biopsychosocial model, as it indicates, teaches that our health and wellbeing are not compartmentalized, but a living organism that is affected by everything in our environment, inside and outside. There is certainly a genetic component to my spinal maladies: my dad started having awful back problems in his early thirties, just as I did.  So I guess I have him to thank for that, along with a lot of other inherited traits, most of them good.

My adventures with Degenerative Disk Disease (DDD), which is a progressive disintegration of the intervertebral disks, started in 1987, in the Big Yellow Truck that carried our little family away from Champaign Nirvana, into the uncharted territory of Rochester, NY, which is even colder than it sounds, being just across the lake from Ontario. I should define terms here, in case there are people reading this who have the good fortune not to know them.  An intervertebral disk is an ingenious structure composed of a thick outer wall of tough yet supple ligament, filled with a gel.  It is in the shape of a hockey puck, and alternates with the vertebrae, insulating them from shock and serving as the means for our spines to be flexible.  Think of gymnasts, or contortionists, or Tango dancers and you’ll get the picture.  Speaking of pictures: Here is an X-ray of a normal lower back.  Note the clean lines and clearly defined spaces between the vertebrae, which look like boxes with little things sticking out of them. Here is a nice comparative image of a normal lower back, top, and its unfortunate cousin on the bottom.  Mine looks like that one, only worse. lumbar_degxray_vertical   All sorts of treatments and non-treatments exist for this extremely painful and often debilitating condition.  I have experienced quite a few of them. When we were driving from Champaign Nirvana in the Big Yellow Truck (or “Big Lellow Truck,” as my son called it, being two at the time and in awe of the Ryder Rental), I noticed that I couldn’t find a comfortable way to sit.  When I was driving, a hot river of molten pain flowed down my right leg into the accelerator.  When I was riding shotgun, the only way I could sit even mildly-to-moderately comfortably was cross-legged, bolt upright.  No sleep on that trip.

When we arrived in Rah-cha-cha, there was far too much to be done to pay attention to a mere case of low back pain, so I forged ahead with helping to unload the van, unpack, set up, and immediately start my internship in Pediatrics. By then I had developed a matching pain in my neck, such that I had to build a set of pillows molded around my neck so that I couldn’t move–or else I would wake up suddenly paralyzed with pain. But I had an internship to start, and my ex had a post-doctoral fellowship to start, so I soldiered on and started my residency.

As is the nature of things, before one starts anything significant, one has to sign all the papers first.  That was a good thing, in the case of the residency, for it gave me something I had been lacking and would be needing shortly: insurance. At that point in my internship/residency program, we were fully staffed, so “call” duty was every third night.  That meant that you came in at your regular time, 5 am, then worked until 5 pm sign-out rounds.  You met with the lucky creatures who were going home, and conferred with them about their patients, whose care you would be assuming until 8 am sign-in rounds the following day.  Then you would continue your work-day till 5 pm, when you “signed out” your patients for the night, went home, and fell on your back in the bed, staring at the ceiling and feebly trying to repel your husband and child, who are trying to greet you after your long absence.

As luck would have it, my first night on call was Night One of my internship.  It was the debut appearance of the infamous “black cloud” that would follow me throughout my medical career.  My neck had been in spasm all day, but I did my best to ignore it and soldiered on.  Sign-out rounds came and went, and I was on my own with my resident.  It was just the two of us to cover all of Pediatrics, Labor and Delivery (the baby part), Newborn Nursery…and admissions from the Emergency Department, which seemed to be a very busy place that night.

My neck felt like it was trying to rip itself off my body and fly away on its own.  I was wishing it would. We admitted a sick little girl with a fever of 104 F (40 C), to the toddler ward for diagnosis and treatment.  Part of the diagnostic work-up involves the collection and subsequent examination of every kind of fluid there is in the body (gas, oil, antifreeze, brake fluid…just kidding).  You have to collect things in a sterile a manner as possible, so as not to introduce germs from the outside of the body into the fluid samples.

Long story short, we needed to get a sterile urine sample from this little girl, and that involved a catheter, and cleaning the “outer parts,” and someone with experience to do that part, and anyone at all to do the all-important Holding The Patient Down part.  I shudder.  I was once Held Down for a medical procedure when I was 5, and I still remember it.

At last we had the hapless little girl spread-eagled and ready for the 30-second procedure.  My job was to keep her in that position, so that 30 seconds would remain 30 seconds and not, say, 20 minutes, which is what might happen if we messed up the first try and had a furiously fighting toddler on our hands. So I got a good grip on the little chubby thighs, and prayed that my superior would get the job done chick-chock, which is Hebrew for “right now.”

She missed.

The outraged little victim jerked her leg away from me, and looking me straight in the eye, kicked me a good one right in the center of my forehead. POP. That was the annular ligament of C5-6 you heard popping, there.  In layman’s terms, the tough outer covering of the disk between the 5th and 6th vertebra in your neck, of which there are seven, gave way and all the gelatin from the center of the disc poured out like fire, compressing the nerves that emanated from my spinal cord at that level.

I was paralyzed with pain.

But I would not give in.

This was my first  on-call night of my internship, dammit, and besides, where would we get a replacement for me at 2 am?  I have always said that the reason more people don’t die during their residencies is that the program does not allow time to attend one’s own funeral.  So I soldiered on, until sign-in rounds, where the Chief Resident noticed that I was in agony and sent me to the Emergency Room.

There I was examined by a medical student, an intern, a resident, the Chief Neurosurgery Resident, and finally, the neurosurgeon himself, who looked at the X-rays and agreed with all the others that I had an acute rupture of C5-6.  They sent me home to rest for a week, with a prescription for Tylenol with Codeine.  I rested, felt absolutely no better, and went back to work.

Another week, and another on-call night, and I truly felt like my head was going to just fall off and roll around on the floor, because my neck could no longer bear its weight.

Another morning in the ER for me.  This time the neurosurgeon just happened to be in the building.  He stopped by and saw me. “What, are you here again?” angrily joking.  ”What’s the problem this time?”

I sheepishly explained that I couldn’t move because of the pain in my neck.  I got a terse lecture regarding the subjective nature of pain, that it was “only pain,” and that I really should suck it up and go back to work.  But my hair was all wet from my tears, so in obvious disgust he ordered a CT scan of my neck.  MRIs did not exist yet. He looked at the scan himself, and his attitude flipped 180 degrees.

“I’ve never seen such a huge rupture in someone your age.  The nucleus (gel center) is sitting completely outside of the disc space!  We will schedule surgery.  Until then, you will wear this spiffy hard cervical collar and don’t take it off.” Surgery was a week from then.

I spent the time arranging for child care (my ex was not good at that), and begging for insurance coverage.  My insurance, you see, did not kick in until I had worked a full week in the program.  Somehow, in some office, someone was compassionate, and I got my insurance.  I was kind of eagerly anticipating surgery, hoping that it would get rid of the awful pain that had somehow become my entire life. To be continued…….


Well, THIS Is A Crock…..

OK, so I took the Vitamin Z for a couple of days and got the sleep thing straightened out….or so I thought. I don’t know why the hell I keep waking up during the night, but it’s making me irritable and itchy, as though I can’t find a place for myself. I also caught myself arguing about politics on Facebook last night, which is NEVER a good sign.

This is such bullshit. I’ve been doing so well and there’s no reason for this to be happening. Yes, I’m dealing with some challenges, but so what, everybody has to…..they don’t ALL get nervous and fidgety and cranky to the point where they have to take extra medication so they can get through it.

I don’t have TIME for this right now. God willing and enough snow melts so I can get out of my driveway, I’m going out on survey tomorrow morning, and I can’t be bothered with these symptoms. I also don’t want to have to resort to taking PRNs every time there’s a blip on the radar. I believe in being proactive, and I was doing so when I took the Zyprexa for those two nights, but I need to develop some other coping mechanisms because things are going to be tough for a long, long time. I have a lot to prove in this job, and my husband has complications from his cancer……I can’t handle all of this if I’m a zombie. Or if I’m off the frigging spool.

At least I recognize what’s happening. I’ve gotten a whole lot better at catching things before they spin out of control, and even though it’s really hard to do what’s in my best interests, I’m still working at it. I’m just disappointed that I don’t seem to be able to keep my symptoms IN control for longer than a couple of months, and of course my first instinct is to blame myself even though I know on an intellectual level that NONE of this is my fault. I’m hard-wired for that, and I don’t know how to disrupt the circuit.

Oh well, enough whining, I’ll just take the miracle stuff for another night or tow, go to bed a bit earlier, and then talk to Dr. A on Friday.  I was looking forward to increasing the time between appointments to 2-3 months—not because I don’t enjoy our sessions, but damn, isn’t it about time to get off the leash for a little while?? I have been at this for TWO YEARS…..seems I should be able to get more than two months in between these stupid mood swings.

Not that this is really a mood swing—not yet—it’s just a combination of anxiety, irritability, and restlessness and I’ve gotta get rid of it by tomorrow. Hello Zyprexa my old friend, I’ll have to talk with you again…..


I’ve Been Diagnosed with Bipolar Disorder. Now what?

now what 4

If you have recently been diagnosed with bipolar disorder, it could be a relief because you finally know there is a reason why you have been going through the things you have been.  You might have found out because you were admitted to the hospital for either suicidal thoughts, extreme depression, or a manic episode.

It doesn’t really matter too much how you found out, now it’s where do you go from here?

I think the most important thing to do is to let your family and friends know so they can be looking for signs and know what to do if they see them.  How to Help a Friend or Loved One who Has Bipolar Disorder 

Creating an action plan is a great idea. This is where if you or your loved ones recognize signs, it tells you all what to do. You have agreed ahead of time what the plan is so that if you are sick, they can tell you that this is what we agreed to.

Having a good relationship with your psychiatrist is important. Getting on the right medicine is important and you need to be honest with your doctor.  Let them know the side effects and be honest about how you are feeling.

Read as much as you can about the illness.  Here are some of the good sites you can read on the internet:.

National Institute of Mental Health

WIkipedia

Depression and Depression Support Alliance 

Possibly go to support groups. NAMI

There are also support groups online.

Start reading threads and starting your own.  The people that know the best sometimes are not your doctors, but the people who are living the illness. I am not saying that they know more than your doctor or that you should not listen to your doctor. I am just saying they have more insight.

If you start getting depressed, start doing things that will hopefully help you from sinking into a deeper hole. Depression Tips by a Person who Suffers from Depression due  to Bipolar Disorder

If you start feeling hypomanic, do things you know need to be done. I would suggest that you let your support group know right away so they can help prevent you from getting manic. 8 Tips If You Feel like You are getting Manic   and Helpful Things You Can Do When you are Manic

I am not going to lie to you, having bipolar disorder sometimes can be really difficult. However, it can be treated.  You are not alone in having bipolar disorder either. Please get involved in a support group online or in person if you need to.   Many famous people have been diagnosed with bipolar disorder too.  Famous People with Bipolar Disorder


Not much going on

Since the Piportil Depot shot I’ve been pretty damn good. Not much to complain about. My mind is clear, my paranoia and delusions are gone, no seeing things, no hearing things.

It’s really nice.

I have a shot on Friday.

I had a cold from hell all weekend, it’s going away.

Getting HD cable hooked up today. Rearranged my room a bit. Reading books on Scribd on my Samsung Galaxy Mega. It’s awesome, I’ve already saved like $40 on ebooks, because I would have bought all the books I’ve read. Right now I’m reading “Stolen Innocent” about the FLDS, and how she escaped.

I read “Sarah Vaughan is Not My Mother”. I may review it. Quick read. Pretty good book, about one hospitalization about a schizoaffective young woman (she’s 26). Interesting read.

Been reading about the 24 Hour Challenge. Welcome to Canada, where cold weather means less clothes and more beer. It IS a fundraiser, though. Who could pass up on that? I hope to get nominated. I’ve seen some funny ones.

My friend Kwinn had her stallion pulling a sled with “Batman” (guy in underwear, boots: gotta have sensible boots at the barn, and a cape) on it, and he got off, jumped in the snow and chugged a beer. HILARIOUS.

Then she did one, where she was riding a horse, in a bra and chaps, jumped off, got in the tractor, and dove in the snow, and chugged something like moonshine.. I have no idea what it was.. So funny.

Ahh, fun at the barn. I’m bringing my friend Steph for a lesson one day. :D

Saw my pdoc Thursday. He’s fine with the Piportil, glad it’s helping. He upped the Topamax to 200mg a day, 50mg am, 150mg pm. It helps me sleep, my moods stabilizing, but I don’t feel drugged. He’s moving up to Toronto, keeping me as a patient (yay! YAY!) and is sending me info and directions once he’s settled. I’ll see him next in May, and he trusts my GP to give me the shots and intervene if necessary. He gave me a ‘script for 6 months. He told me what to do in emergencies and is pleased with my progress.

I’m glad he’s keeping me. I’m glad he gets along and communicates with my GP.

Glad glad glad. Better than bad bad bad.

Reading a lot. My mood tracker site, Wobbly Psyche, is almost done, except for the “Instant Update” part. It is a mood, med and symptom tracker. I think it’s cool. You do have to sign up, so it’s private for you. I’m happy with where it is. I need to overhaul the pages to make them look good, it’s bare-bones, but check it out!

I don’t verify email addresses, it’s in beta mode, so try it out. It’s 100% free and always will be.

So, having a good week.

See ya later!

Suffering

One of the concepts we have been discussing in my Leading a Life That Matters course as we read Man’s Search for Meaning by Viktor E. Frankl is human suffering. As a class, we have determined that virtually every human being suffers. There is no weakness in that assessment; suffering is an unavoidable fact of life. 
While Frankl wrote about his suffering in Nazi concentration camps, the concepts are applicable to all kinds of suffering: divorce, loss of a pet, mental illness. Just like other sufferers, we do not choose to suffer. However, by being human and having agency, we can choose how to react. We can find meaning in our suffering.
Do not waste your time comparing your suffering to another’s. This only increases unnecessary pain. When I was first diagnosed, I was so absorbed in my own suffering that I could not empathize with others. I was frustrated by the “trivial suffering”of my high school classmates. This was wrong of me. Their suffering was very real to them, and it mattered just as much as mine did. Similarly, it is not helpful to belittle your own suffering. Pain is real, and it does not make sense to deny it simply because there are others experiencing more. Your pain matters.
Once we accept our suffering, we are able to make it meaningful. I have chosen to derive meaning from my diagnosis by writing a blog. Spreading awareness and acting as an advocate allows me to find purpose. For me, this means that the tears, the episodes, and the fights were not in vain. I assign them meaning: they were my journey. Those events, that suffering, helped me become the writer I am now. I don’t know what the meaning of life is, but I know that it is possible to find meaning in our lives. Despite our struggles, we can live lives of purpose. We can make a difference. We can create change.
How have you found meaning in your suffering? How do your struggles give your life purpose?
Do  you have a mental or physical health issue and are interested in being an advocate? Look out for my new blogging series, where I’ll be teaching you how to start a blog, write content, and find an audience.