Avoiding a missed dose

Remember a little while back when I was talking about what happens when I miss a dose of my meds? [Tales of a Missed Dose, 22nd June, 2015]

It’s not a fun experience, and so I go a fair way out of my way to make sure that I avoid it as much as possible! Probably my motivation is just as much to avoid the unpleasantness as it is to keep on my prescribed regimen.

So, how do I do it? How do I manage my medications? What is my system?

strips, tablets, capsules

The strips. This is where the real stuff begins

Is it hard? Yes. Is it worthwhile? Absolutely! Does it get easier? Not so far.

Up until the last few months my medications have been all over the place, add one here, add one there, add one here…that went on for a while! Then the doses were changing and the psychiatrist was fiddling with timing and so on. But lately I’ve had the same meds at the same doses for a while, at least until a week or so ago, so at least I got into a bit of a rhythm with what I’m packing into my tablet box. Although then there’s the thyroxine which must be kept in the fridge, and you can only take 14 days’ worth out at a time. And there’s my lithium dose where I take two tablets every morning, but two and a half tablets on alternate nights with three tablets! That takes some keeping up with!

medication box, dosette

Blank canvas – my weekly medication box exhausted and ready to be repacked

Then there’s valproate which literally cannot be taken out of the foil stripping until you need the dose. I found this out the hard way! The problem arises because I take the lowest strength available which is soluble, and therefore designed to absorb water as fast as possible once exposed. So the first week that I packed valproate into my box, I went to tip out my tablets the next morning and had more-than-soggy valproate! In fact it was more of a glob of paste that smooshed on your fingers and fell everywhere all at once! So I had to fish out all the goopy bits from fourteen small sections of my box and throw out some of my other tablets that had also become soggy and learned my lesson. So NOW, I get out my scissors with my shaky fingers and cut out all the tablets of a ten tablet strip, fold each of the sharp corners of the square into the middle so that it’ll fit into the box compartment, then put it on top of all the other tablets, and try to jam the lid shut. P.S. DO NOT swallow the tablet still wrapped in foil! It has been done, but thankfully so far not by me. I think the sharp edges would give me the hint well before it got as far as my throat; or so I hope!

Epilim

So Valproate, I cut the strip into 10 squares, then fold the squares until they fit into the medication box with the other pills

But you’re a pharmacist, it’s probably easy for you?

I’m a pharmacist second, but a patient first. My systems and medication knowledge is invaluable in understanding my condition and sorting out my meds! In fact, I constantly wonder how people without that knowledge get by at all!! I say that because at times I feel like I’m barely keeping it together: what scripts do I need when I see the doctor (among all the other things I need to talk to him about!), what scripts do I have to take to the pharmacy to get dispensed this week, and when will I get there? What tablets are in low supply, do I have a current script for that? Have I got enough thyroxine downstairs in the fridge, an inconvenience to my medication box packing that the company did not consider strongly enough when developing their product?! Have I taken today’s tablets? Did I take the right time, like did I take the morning tablets in the morning or did I not look closely enough and accidentally take the sedating night time doses in the morning? Did I remember that I must not have fizzy drinks within two hours of taking valproate because it will dissolve much more quickly and make me drowsy? Loads of questions and loads of answers, and it’s still tricky matching them up properly!!

The many faces of scripts, handwritten, computer generated and the pharmacy yellow slip. And yes, my doctors have terrible handwriting!

The many faces of scripts, handwritten, computer generated and the pharmacy yellow slip. And yes, my doctors have terrible handwriting!

So here are my many systems.

A very short time into my Prep year, my teacher commented that I’d lose my head if it wasn’t screwed on! This wasn’t prophesy or prediction of how my life would turn out, but simply a comment on how I was then. I was only 5, but I remember it clearly. It was a kind of epiphany moment. She didn’t mean it maliciously, but it was a pretty apt saying at the time, and for quite a few years to come!

Being organised probably comes from my Dad’s side. Every week he would strip back his tradie van to the bare essentials, remove all the Coke bottles and get it stocked, clean and ready to go again. Of course a lot of his motivation was listening to a footy match on the radio on his own without noisy kids! He would come home at night and the messy house was a constant trial to his patience!! He would get up a head of steam and do a week’s worth of chores before dinner! We all just vanished into the paint work and let him get it done; making any kind of noise meant you might get a faceful of steam!! When I was in primary school, he taught me how to pack for a holiday systematically, starting from the feet and working all the way up to make sure you don’t miss anything. Shoes, socks, tights, skirts, tops, dresses, hair ties, hats etc. I used this for packing, but the rest of my life was less designed and more accidental. Rushing from place to place having too many things to physically fit into the hours of the day and accidents happening all over the place! That came from my mum. Surprisingly, since my mum’s mum is uber organized. Forgot my lunch, forgot my jumper, left my USB with my presentation at home, missed a deadline etc! None of this really taught me the life lesson you would think it should!

boxes, bottles, tablets, capsules

The real deal, all of my many tablet boxes and one bottle…and there’s one box in the fridge

Studying pharmacy was a revelation to me, and it really has gradually changed my approach to life. So has the last 12 years with my now-husband, who is very systematic and had taught me a lot about being organised. Pharmacists have to be so systematic that there is almost no possible way that an error can occur. Each of us has to work out our own system that doesn’t fail when curveballs come out of nowhere, but is a failsafe as much as possible. I’m not going to go through that because its tedious from the outside, but next time you’re waiting in a pharmacy, and they’ve told you the script is going to be 10 minutes even though that’s not possible, and you’re wondering what they’re doing, distract yourself wondering how that pharmacist is ensuring your health and safety.

pink bag, surprise, treat

Bag of medications disguised as something pink and desirable! Cunning

So my medication taking has become a system. It didn’t start that way, because at the start I was on one antidepressant. That doesn’t take a lot of managing apart from remembering to take it! Then I was on two antidepressants, one in the morning and one at night. That took a bit more remembering. Then the pivotal moment when I was diagnosed with bipolar and started on a mood stabilizer, and another one, and another one. It got too much to keep in my brain, so I took the old person option and got myself a medication box so that I could make up a week’s worth of pills at a time, and stay ahead of the game, instead of waking up in the morning to get ready for work, and finding I didn’t have any more of a tablet! Having to squeeze a trip to the pharmacy into my already tight getting-to-work schedule was essential, but stress-inducing!

medication box

Nearly done, got to visit the fridge and fold the silver squares

I have an up-to-date medication list that I’ve written on the back of the box, and that I keep a copy of in my handbag, and a copy of in the NPS Medicines app on my phone, and which I update after every doctor’s visit if any medication changes have happened. This is vital. If anything ever happens, the first thing your hospital pharmacist will ask for is your medication list. Having it up to date means increased safety for you. That’s the most important thing. We don’t want to give you something that will make you worse by allergic reaction or by interaction with your current meds or your medical conditions.

medication list

The ‘official’ medication list, updated every doctor’s visit…maybe I should type it out to make it look less made up!

Every week when there are only a couple of doses left in my box, I repack it according to my list. I cross check each tablet as I pack it, i.e. I take venlafaxine 450mg, which is 3 capsules of 150mg, so I check the list and pop out that many tablets. It sounds so easy, but an error right there could be catastrophic. Cross checking makes sure every prescribed medication ends up in the box, in the correct amount, at the correct time of day, every day. So I sit up on my bed and surround myself with boxes and strips and bottles, my list and my box. It’s actually a satisfying job, ticking each med off one by one and ending up with a neat and tidy box of lifesaving pills. I end up with a massive pile of rubbish, mostly in the form of popped out strips. Pharmacy isn’t exactly a green industry; the medications demand certain wrappings and changing that order would be unsafe.

medication box

Ready to go! Time to concentrate, accidents do happen but good idea if they don’t!

Unfortunately the names of the days have rubbed off the box and remembering the order wasn’t working so I had to relabel the medication spots. I ended up writing AM or PM as well, because a couple of times I’ve taken the morning medications at night and ended up not sleeping for hours, or taken the night meds in the morning and been doped out all day! That was because I started checking on autopilot and not really checking. So now reading the label of the dose reminds me, hopefully, whether I’m meant to take that dose or not.

System change #71! Always updating and changing to improve my safety

System change #71! Always updating and changing to improve my safety

Forgetting is a big part of my life now. I start a story and can’t remember why I was telling it, I can never remember names, I forget a conversation from earlier that day, and many other things. Pity help me if I get to 80!! My husband will have gone mad by then! So I have alarms. I’ve always done this since I only had one med. First it was an alarm that you switched off. Then I’d forget all the same. So I changed my alarm to being able to be snoozed three times. I’d snooze it three times, and forget! Procrastination much?? So I found the NPS (National Prescribing Service) excellent Medicines app and put some alerts in there for the morning and night. These can be snoozed endlessly so I know that it won’t let me forget!

reminders, alarms

The cool app from the good folks at the National Prescribing Service – recommended!

When it’s time for my tablets, I go to the box and look for the day and the time. I tip out all the tablets, and take the foil off the valproate. I count the tablets against the mental dose list, or actual dose list if I can juggle the tablets in one hand and box in another. I check that each tablet for that time of day is there, and in the right dose then scull them! My husband hates this, he thinks that I should take them one at a time, but that would take forever! I’d rather just get them down as quick as possible.

20150520_093805

I’ve developed a new system now. My alarms go off at 8.30am and 8pm. I’m meant to take my tablets when the alarm goes off, but however systematic I am I’m still a procrastinator. I know that my tablets are keeping me in the good life, and that without them I’d be in all kinds of awful, but there’s still that little part of me that doesn’t want the tablets, because it doesn’t want the illness! A small part of me that has the hopeful thought that maybe if I don’t take them everything will just go away. Of course that’s ridiculous! But it’s just how it is. So I snooze, and snooze, and snooze. Ridiculous and childish but there you have it! I can’t imagine how much more difficult it must be for people who don’t acknowledge their illness, are in denial, believe the medications are evil or unnecessary or poison, or are being medicated against their will.

My husband does a good job of asking me if I’ve taken my tablets, but my memory is absurd and I remember taking my morning tablets and say yes I’ve taken my night tablets. A couple of times I said yes yes, and I hadn’t taken them. So now, once I’ve taken them, the lid stays up, I don’t clip it down again, and so both of us at a glance can tell if I’ve taken them or not, no confusion.

Some are empty, some are closed and it helps me keep track and avoid slip ups

Some are empty, some are closed and it helps me keep track and avoid slip ups

Well that’s about all my systems. I try to avoid anything that relies on memory, and try to have a clear, repeatable, systematic way of keeping well. At the end of the day, its fingers crossed and trust in all the steps that have been taken to take care of me.

Hope you enjoy the pretty pictures!

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Tales of a missed dose

[Written 16th June 2015]

This is a story of what happens when I miss a dose of medication.

What happens depends whether I miss a morning dose or an evening dose. As I write this I’m suffering from missing an evening dose so let’s go with that.

At night I take several tablets: quetiapine, lithium, valproate, rosuvastatin, pantoprazole. Mood stabiliser, mood stabiliser, mood stabiliser, anti-cholesterol, antacid. Yes, it takes that many stabilisers to keep me going!

In the morning I take thyroxine, venlafaxine, Levlen, valproate, lithium. Thyroid hormone replacement, antidepressant, contraceptive, mood stabiliser, mood stabiliser.

All done! Hopefully...I'll still count the tablets out every morning and night to double triple check

In terms of missing a dose, lithium and valproate aren’t the worst to miss as a patient because I’ll be taking some again soon. This is not an official pharmacist, GP or psychiatrist recommendation! Lithium and valproate should ALWAYS be taken twice a day, as close as possible to 12 hours apart for the best effect! And I repeat! This is because for lithium a healthy person’s kidneys clear it out of you in that time frame so to keep a steady level you should take it consistently. And for valproate it’s your liver. That’s why you should respect these two organs very highly! They are very important. But what I’m meaning is its not the worst in terms of the adverse effect of missing a dose. If I miss taking lithium at bedtime, I take it first thing the next morning which gets it back in my system before I physically notice that it even left. My overall level will be a bit lower for a few days which isn’t ideal, but it will work back up to speed soon enough. And I do have a level at least.

Whereas for medications that I take once a day, I’ll miss the effect for 24 hours. Which sucks. Plainly and simply!

boxes, bottles, tablets, capsules

Quetiapine is one of the once a day tablets. It is prescribed to me to prevent mood swings, reduce my anxiety and has the handy effect of giving me a good night’s sleep. It was doing this a bit too well for some months there and I was doped out all of the time, but my awesome psychiatrist recommended a change in the times I take it and we’re back up to speed. Yes!

So, do I get a mood swing if I miss one dose? No. Really not. The chemistry isn’t that reactive. In the same way that it takes weeks of first taking the medication to get the benefit, it takes longer than one day to mess up the whole thing. But I do have a rough day afterward, and a rough night too! It’s a bit like I’m sitting in my car going along nicely and I know where I am and where I’m going and how I am and suddenly another car rear ends me, or bumps into the side of my car at a right angle. Slowly of course, not fast. So my mood just takes a hit, a bump and suddenly I’ve jumped along or across and I find myself somewhere other than where I just was, a bit disorientated about how I got there and sort of catching up with what just happened and where am I now and how I am and are we still okay? That following day I may be in quite a different mood from the one before, either peppy and edgy and anxious and manic, or slow, and silent, and flat and a bit away with the fairies. But that doesn’t qualify as a mood swing, just a sudden small change that affects my day.

After missing a dose here and there I have now gotten the side effects of missing my nightly dose of quetiapine down in a pretty clear timeline. Yes, there are side effects from NOT taking your tablets, as much as taking them. Something to consider.

So here’s the quetiapine absence timeline.

strips, tablets, capsules

10 to 11pm: I can’t get to sleep.

This is a terrible thing. I need my sleep. Always have, and always will I guess, but especially since I’ve been sick. So does everyone, I realise. If I don’t get a good night’s sleep the next day is a struggle, emotionally. So I toss, and I turn, and I turn, and I toss. After an hour of this, if I’m alert enough, I’ll think to myself, self, why can’t I get to sleep? I usually go straight to sleep! Then I’ll look in my pill box, see my tablets, mentally or physically hit myself in the head, take them and all is good in the world. Just like that. If I’m not thinking too clearly, I might think to take a Valium and at least get some sleep. If I’m dull-witted, which is at least half of the time, I’ll eventually wrestle myself to sleep. It sounds funny to say, but I’ve become very good at putting myself to sleep. I nap most days from necessity, and there is a skill involved in going from activity to sleep in a short space of time. I guess shift workers eventually excel at this sort of thing. So I’m quite adept at getting myself in a comfortable position, getting the temperature right (cannot sleep well unless it is right!), darkening the room, doing a conscious relaxation of as many muscles as I can, and stilling my mind into sleep.

Say I managed that. Next time check?

3am. Yep, wide awake, fresh as a daisy, ready to go at 3am. I toss, and turn, and can’t get comfortable, and I’m restless and my poor husband is rocking and rolling every time I turn and I’m messing with his sheets, and he has to go to work tomorrow even if I don’t, so I try to lay still and physically can’t! Why am I awake, I’m usually asleep, what is happening, oh….ahhhh! Tablets! I forgot them! Duhh! I hate that moment! I try to do my utmost to prevent it, but it still happens and it does feel like a failure every time I somehow mess it up! So, should I take them now? The dilemma! It’s 7 out of 12 or 24 hours through the medication time period. So I can’t take all of them. Maybe just some of them. Can’t take quetiapine, I’ve missed the boat on that one otherwise I’ll sleep all day. And I’ll be taking lithium and valproate soon anyway, and can’t double dose. What about the rest? Which are nothing really, in the scheme of me being wide awake at 3am! Cholesterol and stomach medication. Sure I can take them, they should be taken regularly but it’s too late for my sleep. The next dilemma then: try to force myself to sleep again, or just get up, take my laptop to the spare room and do something else? Who knows? Depends what I’ve got on the next day really. I can never decide!

medication list

8am: I’ve finally given up the ghost on sleep so I’m up and peppy and full of life and only just partially anxious and ever so slightly manic and energetic and going to run the world! If I haven’t already taken one to sleep, now is the time for a Valium to wind back the jets on being super woman and achieving all my life goals in one sweet day! And talking my husband’s ear off and planning one hundred chores like a complete going through of the entire kitchen plus 3 loads of washing on a rainy day and lunch with girlfriends and all kinds of magical things. ‘Woah, says my husband, that’s too many things for today. No do that another day, you’ve got enough things for today. How about you sit down for a minute, what about some mindfulness? I think you should do some mindfulness…how about you go and do that now?’ At around about this point I have now blown my nose for literally the THIRTIETH time since waking for the final time. THIRTY. You just can’t blow you nose till it feels empty; there’s always residual. And it’s pretty much like a tap. The medical term is rhinorrhea, like diarrhea but your nose is melting and there is a constant liquid dripping, dripping, dripping!! Quetiapine dries you out like anything so you get dry mouth (and want to drink Coke all the time!), dry nose which leads to sores and blood noses, some degree of constipation which no one wants to know about and some urine retention. The last one isn’t noticeable on any other day, until the missed dose day and then I realise that yes I really have been holding back! TMI I know, but you wanted the whole story right?

But the nose thing really gets me! If I notice nothing else in the middle of the night, I do notice my nose dripping incessantly! It’s an instant giveaway! It’s different to regular waking up in the morning and blowing your nose. It’s more like hay fever without the sneezing but the medication to stop it cannot be taken til nighttime!!! Cue fierce under breath bursts of ‘idiot’!

And then it’s just getting through the day like usual, but bearing well in mind that you’re a bit high today, a bit edgy, a bit fiddly, a bit anxious, a bit overstrung so remembering to breath, relax, calm, easy, gently does it. And I should mention that the other things ease off too, just not in such an obvious diagnostic way. I have the right amount of saliva in my mouth (who knew that was a thing!) and going to the toilet is a breeze, like really easy, like maybe a bit too much and too many times! So happy thoughts!

medication box, tablets

Now the morning lot and venlafaxine. Anyone who is involved in the prescribing, dispensing, and before too long taking venlafaxine knows about the withdrawals. It’s described in the textbooks and it happens like the textbooks. Exactly like. I used to think this was pretty cool. I still do theoretically, but in practice I either love or hate that they’re so reliable and unavoidable. I love them if I notice it before I’ve left the house for a work day because I immediately fix the shortcoming. I hate them if I notice once I’m already on the way to the bus stop and I don’t have time to turn back, or I’m on the bus, on the train, on the tram, in the building. Then it sucks because I know what’s coming and I can’t do a thing about it! Unless I can get to my doctor for an emergency script but that means paying full price, and after all it’s nothing life threatening. Not bad enough to pay three times the normal price! And believe it or not borrowing stock from the shelves is not strongly encouraged by my employers nor is it in any way legal!

What the symptoms/adverse effects of missing venlafaxine are: electric shocks/tingling in your fingers, light headedness/feeling like my head is spinning/wondering if I’ll faint, nausea. Nothing fun. Nothing dangerous. They don’t make for a good day, and I have to wait til the next morning to fix it! More banging of palm to forehead and severe muttering to oneself!

So that the what. The why is a whole other adventure and I don’t have time today, but hang in there and soon we’ll have another chat and look at the other part of the problem. Chat soon!

Remember…?

I was recently recruited/volunteered for a babysitting gig.

That sounds more official than it was. Really it was just a favour for friends to be a nanny for a couple of days so that both parents could continue to work without disruption while one parent got sent away for training.

I was hesitant. After all, I’m the child that needs an afternoon nap most days, and I can’t even get my own hubby and I dinner, let alone dream up what kids would like to eat and convince them to eat it! I haven’t changed a nappy since I was ten and my baby sister was two, and my stamina for game playing or activity of most kinds tends to be non existent.

But I’ve been having a good run lately. Some days without naps, some mornings without exhaustion, some periods of up to days with no tiredness. Almost like it used to be before I got sick. Almost like an adult human, almost like I could live life without every move being an effort. It mostly has to do with my psychiatrist changing the time I take my tablets. Seem like such a small deal. As a pharmacist I never even thought of it, because I didn’t think it would change much. But it has changed a lot, so I said yes!

And it was exciting! To say yes. To say yes to responsibility, to effort, to what you know will require work and stamina and endurance, even though you don’t know if you have what it takes. So I packed my bags and went.

This isn’t about that, but it’s something of a progress report as an introduction. What it’s about is kids, and the things that make them happy. Watching them play and the kind of things that satisfy them is fascinating! And poignant, because it reminds me of all those things that I enjoyed as a child, and would probably still enjoy, that I haven’t done in years, but maybe should give a go.

Here’s the list from the three days we had together:

*drawing pictures with textas with great abandon, letting the mood take you and drawing everything that comes to mind, not hesitating in case it doesn’t turn out, but drawing free

*riding bikes up and down the drive way and through the puddles, and setting the intention to ride all the way to the end of the road, regardless of how far that might be

*Walking around, then toeing into then walking and stomping through puddles because its satisfying to make things splash and jump out of place like you’re a giant

*making tents that you can crawl into with your dress-ups and fake food supplies and torch and teddies, and sleep all night in the loungeroom because its better than your bed

*reading the same book over and over and over and over just because you like it, and you like how it goes and how it ends and you want to hear it again and again

*drinking anything out of a sippy cup because it tastes better!

*playing with the kitten, getting scratched and bitten while you learn how to hold it gently then playing games with it all day

*filling up the plastic pool and splashing around for hours so that water gets everywhere but it doesn’t matter cos you’re outside, and pretending you’re swimming on your back and your tummy and blowing bubbles underwater and wetting everything within cooee

*playing dress-ups with tutus and tiaras and Mum’s shoes and pretty things that sparkle and shimmer

So its time.

Time to get in touch with having fun like a kid.

Riding my bike, splashing through puddles, playing with pets, dressing up, and I think I might just have to go buy a sippy cup! It’s time to let go just a bit and have fun with abandon like kids know how. Drawing, pools, swimming, playing. I think I would have less stress and more satisfaction in life if I thought and played a bit more like a child.

Of course I’m not going to actually become a child, or do things that are unbecomingly childish. I just want to get into the spirit of childish play, and away from adult structure and rules of play for a while. So hopefully, if you’re looking for me, I’ll be biking, drawing, swimming or wearing my prettiest clothes just because!!

Back on ya bike

Today is the 17th of March.

But you knew that.

St Patrick’s day I believe. Not that this ever has much to do with me, or I with it. Just something that’s going on out there in the actual real world.

All that the 17th of March signifies to me today is that it is not the 9th of March. Quite a bit past it in fact. So I’m over my deadline of writing to you all but let’s put that aside and focus on the fact that we’re here! All alive, all well to some degree.

I have in fact been writing in preparation for my deadline but it just wouldn’t go to plan. It didn’t flow, I wasn’t comfortable with it, the stars weren’t aligned. So I’ve been thinking and thinking and getting nowhere. Then today it just started waking up and forming in my head and here we are! Patience is a virtue remember, and I say remember to myself more than anyone else. Patience! So here we go with the brain flow of today.

Today I strapped on a pair. Strong start, right? But we’re going down a different pathway.

Today I strapped on a pair of runners. Sneakers, joggers, running shoes. I got them out of the wardrobe, literally dusted them off! loosened the laces like the shop lady taught me so many years ago, put a foot in each one, pulled the laces tight again and there I was ready to do battle. I will admit now that I checked last night to make sure they were in fact still IN the cupboard! You know, in case it had been so long that for whatever reason they had vanished!

I strapped on a pair of socks; that happened before the shoes. When did I last get out a pair of socks AND wear them? I get them out every time we go on holidays, in case. I never use them. But I take them in case. Every time. Sometimes several pairs. In case I’m active several days in a row. You know, cos that happens! Along with my runners. I take them too; in case. My socks had burrs in them from goodness knows where! Or when. I guess it’s lucky they didn’t have moths in them, or a family of spiders! Spiders would have definitely changed the course of the day! My horror of spiders long pre-dates all the other fears that have developed in my life more recently. And it’s a hard one to conquer! Their legs move and I run, literally, screaming from the room. Could be a good exercise incentive, although repeated episodes of that much adrenaline cannot be good for me!

I strapped on a pair of sunglasses to contend with the overcast drizzle; good choice!
A pair of yoga pants, the only pair of pants left that I can wear without shame and horror at how much of my body doesn’t fit into them!
A bright yellow T shirt that I bought for a casual top when I grew out of all my other casual tops, but which irritates me by not sitting where it’s meant to. But the request was for bright clothes.

The occasion? I’m re-learning to ride my bike! I’ve signed up to have ‘Wheel Women’ teach me and 7 other ladies the Cycling Australia ‘She Rides’ course. We’ll learn about the bits of our bike, how to fix things, how to ride, what essential equipment you need etc. Our course isn’t the beginner course. We’ve all ridden before. Ours is the confidence course, remembering what we’ve achieved before, how much we already know. It’s also about just how much what we learn will help us to become confident in riding again etc.

Because I have been confident in the past, you know. As primary school aged kids we would shoot out of the car as soon as it stopped in the garage after school, throw our bags inside the house (or in the yard, on the garden, near the chook house) and be on our bikes before you could blink. We’d all ridden since we were toddlers on foot propelled solid plastic indestructible stabilised bikes. We’d all progressed up through a trike, a small bike with training wheels then up through a variety of pretty solidly contructed biked until we made it to an actual store built mountain/commuter bike from Kmart! That was a great moment! It had gears, a stand, flat handle bars, a bell, brakes activated by levers instead of feet!

We had a hill in our driveway where the channel had to be broached and a roundabout for cars to easily turn around. So we’d ride flat out from the road to the top of the bridge and the competition was who could roll the furthest down the bridge, around the house on an S bend curve and the ultimate victory was to make it to the gate into the backyard. It was one on one so there were heats for me and the next down to compete and the two little kids to compete. Then there were speed races down to the garage, technical races around the garden beds and so on. I love it all! We did learn to ride classes at school and the big ride day every year with half the school. We rode to school when mum was working, often with the naughty fox terrier tagging along. We’d tell her to go home but she was sneaky. She’d pretend to head home then sneak diagonally across the paddocks while we round around the square and often beat us to school where, of course, all the kids loved her and made a big fuss out of her!

Great days! And lots of fun. Of course I had the odd accident, ironically the first big one was trying to go too slow while Mum with the baby in the backseat caught up. Our whole driveway was gravel so there were of course many accidents where the wheel slipped out or we hit a bump. Then a bigger one when I was riding up Manningham Road to Heidelberg train station to get to uni. I decided to leave the road for the foot path to cross a big intersection, took it on too much of an angle and landed on my chin! That was the confidence sucking one! That was really the death knock for me riding on roads, and even bike paths.

Thus the course. We have 8 sessions of 2 hours and the first one was this morning. And already I’m stoked!

Which is a miracle considering I spent most of yesterday in an absolute stew about it! What if, what if, what if?!

What if I don’t wake up in time?
We’re meant to be there at 10am, that means I have to be awake at 9am at the latest and ideally leave the house by 9.30am. That’s kind of early given my getting out of bed times lately! Despite my consistent bedtime of around 10pm my morning wake up time can vary from 8am to 11am! This is the result of medication sedation, which is consistent daily but it’s so unpredictable in how much and for how long!

What if I wake up in time but I’m really drowsy and not fit to drive the car?
I’ve been minimising my driving lately when I feel I’m too sedated. That means I don’t do long distances, especially when I’ll need to drive home again later in the day. I don’t need a collision to tell me I’m not fit to drive!
What will I do if that happens? Cancel? Then I’d feel like a failure. Go anyway? That could be dangerous. Get a cab? How would I get my bike there? and etc!

What if it’s too hot for me?
Since I’ve been on this particular antidepressant my temperature feels high all the time. I’ve never actually checked if it is higher, but I feel hotter than the average person unless that person is going through menopause in which case we’d make good buddies! When others are comfortable I’ll be wringing sweat from my brow! Which sounds old fashioned and romantic but it sucks, it really sucks! I don’t like sweat beading on my forehead and running down my face or into my hair! I don’t like other people seeing that. I don’t like them seeing me wiping the sweat off. I don’t mind having them see me wave a fan around or sitting in a breeze but the other stuff? Ergh!

What if I don’t have the energy to get on my bike and ride?
So many days I just don’t have the energy for anything! I’ve become very sedate.
How do I know I’ll be able to do it? What if I just can’t and get humiliated?

Also, what if I’m too unfit?
I know the course description says no one is too unfit for them, but my hubby and I went on a 5km ride a few months ago to try to get me back into riding. The scenery was beautiful but I couldn’t hear anything over the sound of my heart beat and breathing!! And it felt bad!
What if I get left behind and its shameful that I’m so unfit at such a young age?

At about the sixtieth what if my husband suggested a Valium and that helped. A lot. Diazepam, it really is a wonder drug used sensibly. It took the agitation and fretting and stressing out of it. The contingency plan from my husband: all I want you to do is show up. Go there with your bike and at that point that’s a win. Stay if you feel like it, if you have to leave early that’s okay. If you can get through the whole thing that’s fabulous.

Perfect! He always knows what to say! My issue in all things is the starting. Getting out of bed, getting out of the house, getting started on a job, getting to a social event. If there was a time warp around the getting ready life would be easier. It’s the mental preparation that trips me up!
Once I’m there, out of bed, out of the house, started, at the event I’m fine! I’ll be yucking it up with everyone, telling stories, hanging out, ready to get the day going.

So I had my back out strategy, which is vital! If I can’t think of the way out of any place or situation I tend to get panicky. But knowing that I can leave whenever I want and having a specific plan for how I will execute the leaving makes it okay to put myself in that restricted position. It’s crazy but it works! Everywhere, every time.

So I’m stoked with how it all went!

The 3 trainers were lovely and there was no pressure. There were only a handful of us so no hoards of unknowns to face up to. 90 minutes was taken up off the bike with instruction and demonstration so that was a big relief! When we did do riding it was gentle and tiny distances. I seemed to be at least at the same level as the other ladies so no more fear of being left behind!

I looked okay in my clothes which made me comfortable; no more squishing into old size 12 and 14’s; from now on regardless of the size I’m wearing clothing that suits my new figure! I was able to do everything I was asked, my bike is the perfect fit for me, and some old confidence and enjoyment of doodling around on my bike kind of seeped back into my heart.

It made me glad that I was on track to rediscovering riding for fun. Not for competition or eliteness but just good plain fun! I’m excited about that!! It’s so important to me these days to have things that are mine alone to feel good about, to enjoy, to feel satisfied with. My bird watching, my photography, my writing and now my riding. This isn’t so I can go on every Saturday monring 5am 100km road ride with my husband, or brother, or sister, or brother-in-law or father etc! This isn’t so I can go all day up hill down dale mountain biking. This isn’t so I can put on an external skeleton and go hurtling down Hotham or Buller in the off season! Definitely not the last one!

This is for me. This is to remember that I have a kife skill in me that can make me feel better about myself, that I can openly and completely enjoy without any reserve, that is all mine, that I dictate and I steer.

Anything that excites me these days is to be treasured!! Held on to and pursued. And I really feel like this is it!
There are 7 weeks to go, and I’m really truly looking forward to all of them 🙂 YAY!!!

I’m back…

[Started on December 9th]

“I’m back, baby doll…”

-one of favourite quotes from How I Met Your Mother

I’m baa-ack. It’s been a month, apparently. It felt a lot longer! I only know this fact of it being a month since I was here from opening my blog today for the first time since … so it tells me … the 9th of November.

Wow.

And during that time I actually thought up zero topics, had zero inclination to write anything and was pretty much happy to climb into a hole and be a hermit for the rest of my natural life. But the light has broken through and here I am.

It’s been a very full month. I’m trying. A trip away to Werribee, days out of the house doing stuff, hanging out with girlfriends, some actual real live housework. There were, surprisingly, some pretty great times.

And then there were days when I wore my pajamas until 5pm and only left my bed to eat. But you know, looking for the upside!!

There was one amazing week where I thought I’d finally broken through the depression glass ceiling into what normal life could be like, and I loved it! So did my GP: ‘Imagine if this is how life could be from now on? That would be f*@%*^# awesome’. His words, not mine! Just to clarify. But yes, why yes, yes it would.

Sadly for me and anyone my life bumps up against, it was mania.

Oh mania, you heartbreaking devil you. You get us so excited and hopeful and relieved and let us sniff “normal” for 5 minutes, before depression overcomes us again and we all sink back into the swamp!

Normal, or a bit more overdone than normal; either way, it’s a nice change from blergh, uff and erk!

But it wasn’t devastating when mania went this time. Well not as devastating. This time. I’m getting more resilient gradually.

[Updated from here in later December but the computer wiped all my additions and made me so angry I gave up on it! Then I vowed to complete it on January 9th but when the date came around I was staying in a motel without WIFI…ahh the horrors of modern life! So here I am, Feb 9th…and finally I’m back! And saving my draft after every word!!]

Thankfully, bit by bit, episode by episode, high by low by high by low I am taking it less personally, getting less excited and less distraught when my brain chemistry flicks the switch and lands me somewhere I wasn’t prepared for.

So says my mouth, and my head. So I wish, so I hope. And maybe sometimes that’s the case, that I’m less wrung out over it. Maybe.

But actually now that I’m slipping down the slidey slope again I find myself not so okay with that. I don’t want to go down there again. I don’t want to be like that again. But it seems that I’m not being consulted in the matter of what goes on in my own head.

Ironic, isn’t it? My own head, taken hostage by chemicals. Chemicals that don’t even have brains or thinking power or motives – but they pack quite the punch! We’re doing all we can to oppose them but it’s turning out to be more of a war than just a battle.

I’ve been told over that I have tricky brain chemistry. At first I thought it was one of those placating remarks all doctors make to help ease you through the rough period between the diagnosis of depression and the onset of full medication effect, which can be up to 6 or 8 weeks at times in some people.

Although I guess I didn’t hear it said first until I was trying the 5th antidepressant; but I definitely needed to hear something at that point to convince me that I should still hold hope that this one would work! My doctor told me that every time an antidepressant didn’t work, we were one step closer to finding the one that would; we were one step closer to getting better; the depression was one step closer to showing us how it was working and what we could do to oppose it.

That’s a lot of talking for a chemical to do!

Time and experience have unfortunately proved the fact to be true. I have tricky brain chemistry. It’s difficult for the medications that we have available to match the chemicals that are lacking from, but should be in, my brain keeping me from becoming anxious, depressed, manic or a swinging monkey between all three moods!

I’d love to be one of those people who gets diagnosed with depression, gets prescribed whatever antidepressant their doctor has on their mind that week, tolerates it well and after a year or so with successful treatment and other supports, undertakes a careful withdrawal of their medication under supervision of their doctor and continues on with their life drug/medication free. Not trivialising their sufferings, just envious of their rapid and successful long term improvement and freedom from medications.

Of course that doesn’t happen in bipolar disorder; only in depression. Bipolar is not a condition that remits; it’s a life sentence. It’s not going anywhere, and it’s quite unlikely that I’ll ever be free from taking medicines.

But it’s the dream, isn’t it? To be medication free, drug free, not drug dependant; isn’t that the dream of any person tied to medication?

As a pharmacist I have to ask every person/patient I deal with if they take medications. Apparently this is the most annoying question that a person could possibly ever ask! Or maybe I’m just asking it wrong; that’s always a possibility.

When I was working, a distant memory just now, I’d get 50 people a day saying “I’m not the kind of person that takes medication”, “I’m not the type of person who takes tablets”, “I’m not some kind of druggie”! Or my personal pet favourite hate: “I don’t like taking pills”.

Really? Well who does like taking pills? And what exactly is the type of person that would take medications? I guess having to take medications to get by makes me more sensitive to these types of comments spoken from ignorant minds. It’s obvious that they’ve just never given the issue more than a seconds thought, or they’re basing it on inappropriate pill popping they’ve seen on TV.

But just a suggestion, if you ever come across me actually working as a pharmacist in the indeterminate future, please just answer no or pass me a printed list of all your meds with doses, thank you so kindly!

 Moving on.

Tricky chemistry, multiple antidepressants, additional diagnosis of bipolar on top of depression and anxiety.

The diagnosis of bipolar disorder, after the initial shock and rejection of the idea as stupid and crazy (oh the irony of calling it crazy!), was actually not that surprising, looking at it rationally. The failure of antidepressants to work or to work fully is actually an indicator of bipolar disorder, which I knew somewhere in my mind from when I studied mental illness as half of my post graduate studies. Another irony!

What if I’d had the clarity of thought to see it that way back when? To look inside my brain in a rational, systematic, logical manner. But that’s not how mental illness works. It takes a regular brain and clouds it with so much doubt, fear, hurt, pain, sadness, hopelessness etc that you just can’t see.

I’d go to my doctor and say, I was so bleak and black yesterday I nearly couldn’t stand it. And he’d say, how many Valium did you take?

Valium. Brand name of diazepam, used in my case as a sedative and anxiolytic, remover of anxiety and worry.

And every time he said it, it would be such a revelation to me: oohhhh! RIght! I should have taken a Valium! That would have made me feel better. Of course, how did I not think of that? I say every time because there were quite a few times he had to say that to me!! And I’m a pharmacist! Turns out being a good pharmacist doesn’t always extend to yourself! Luckily my husband is happy to jump in and now whenever I’m complaining of my mood he puts on his doctor voice and asks me, did you take a Valium??

I had this sanctioned stash of tablets capable of taking a stressed-to-the-eyeballs or suicidal girl and transforming her into a warm, fuzzy, calm girl ready to take a nice comfy little sleep to get her through the hours until her chemistry improved or she crawled into the doctor’s office, totally empty and out of ideas and ready for the next injection of hope, help and medication changes.

I had it. I still have it. 13 months later! I think I’m getting better at remembering how to render psychiatric first aid to myself when the complicated muddle of meds I’m on just isn’t cutting it, or the depression is just a bit too strong, or the mania is making my limbs dance a jig of agitiation. Or everything is just all too much and the circuit breaker has to be activated to prevent the whole place from burning down! Metaphorically, not literally.

 Because there are still those days. Bleak days. Blank days. Flittering days. Storm in a teacup days. Meltdown days. Frustrating days. Agitated days.

There are less of them. They come less often. They do less damage. They don’t get full control of me. But they do come. They’ll always come.

The key, as they always say, is management. So here we are, my and my team, managing. We’re managing. And that’s pretty great!

Thank you for taking the time to read my great big long shambles and hope to chat again soon x

Suicide *warning: the following material may be very disturbing*

Author’s note: I wrote this piece two weeks ago. Then while re-reading it prior to publishing I had some reservations. My personal editor (aka my husband) also had some reservations about how it would affect other people so we decided to wait a while and see if we really wanted to publish this.

I’ve decided that I do want to write publicly about this issue. I apologise if it is disturbing, or frightening, or confrontational, or triggers emotions that are hard to deal with.

I can write about this issue openly now that I am past these horror days and now that I feel reasonably confident that I won’t experience them again, at least nowhere near the depths that I did sink to before. Thanks to an antidepressant and two mood stabilisers, and a team of psychologist, psychiatrist, very accessible and caring GP, fabulous husband and great friends!!

But I do feel that the population of the world fortunate enough never to plunge to these awful depths should have some understanding of the suffering that is out and about in the world, walking around trying to contain their sorrow and hurt. My favourite saying comes to mind:

“Always be kind. Every person you meet is fighting a battle you know nothing about.”

lease PLEASE remember that however impossible it feels, severe depression can be survived. It doesn’t feel like but just ask for help and let someone in! Tell your partner, your friend, your family, your colleague, a local doctor or go to the local emergency department. Tell someone; don’t suffer alone!! You know the numbers:

Lifeline: 13 11 14

Suicide Callback Service: 1300 659 467

Men’s Line Australia: 1300 789 978

Kids Helpline: 1800 55 1800

Employee Assistance Program (employees of public hospitals): 1300 361 008

beyond blue: 1300 22 4636

Suicide Line (Victoria only): 1300 651 251

Suicide Prevention Foundation: 1300 465 366

So here we go!

Suicide. Death by one’s self.

We don’t talk about it enough.

It’s taboo. It’s avoided, ignored, swept out of sight.

There can be sense of shame about it. Some consider it selfish.

In some places and in some era’s it is and has been illegal.

Some insurance companies won’t pay out life insurance policies if a death is determined to be a suicide.

Yet, along the death spectrum a ways, people campaign for euthanasia, the right to kill oneself if life becomes physically unbearable.

What about when life becomes emotionally unbearable? Mentally unbearable? Somehow people never consider the rights of a person suffering in this way.

But this is a dreadful, terrible, awful way to suffer.

Why are we sympathetic to cancer patients with terminal illness suffering physical agony but don’t give the same thought to mentally ill people suffering emotional agony without relief?

And to some people there seems to be or is no end in sight; treatments that don’t work or take too much time to work, emotional turmoil with no relief, desperation. What then?

Personally, I don’t believe suicide is right. Morally, that is. I believe what the Bible says: thou shall not kill, including oneself.

But it was a whole different story when I found myself in the grips of severe depression and assailed with suicidal thoughts.

Suicidal wasn’t about self-harm and ending my life. Initially.

It was about feeling terribly awful in the midst of my perfect life, so awful that I didn’t know if I could survive, if I would ever feel good or well again and I just wanted a break!

It was about dragging myself through the motions every day and wondering if I would ever feel like every physical step wasn’t a tiresome chore. It was about emotionally forcing myself through the duties of the day, pasting a smile on my face and coping when I felt like crawling into bed and never coming out.

I wanted an escape, to step into a time warp that would take me out of my life for as long as it took for the depression to go away. Then I could just step back into my life and take off where I’d left off, minus the awful distress.

I wanted the escape, but didn’t know how to get it. I was on two antidepressants, an unusual combination and a bit risky. But that was what it took to get me feeling better and sleeping. To start with, but then I started having odd thoughts as my mood took a steep dive downwards, the first time I experienced what I would later find out was a mood swing.

What would happen if I just stepped out in front of the bus? If I just took one step out…

Would it hurt? Would I just die or would I be injured and gain nothing but more pain?

I’ve always been against the idea of committing suicide by using another person driving a vehicle. I’ve called it selfish. I’ve called it unfair and sympathised with train, bus, truck and car drivers used in this awful way.

Is this karma? To be wondering whether I would actually take that step? To be thinking not about the awfulness that the driver would experience, but to be wondering if I could be that person? Wondering if it would solve my problems? If it would just take everything away so I didn’t have to try to deal with it day by day by day.

I’ve always been nervous about people standing close to the edge at train stations. I’ve always been half-prepared to see something so awful that it would damage me for life.

But then nothing happened and this mental disease arrived, bit by bit. Maybe it was the anxiety in me the whole time, all these years worrying and thinking about such things.

This was my thought process, back then, before I went to hospital.

I could never jump in front of a train. I’ve read ‘Dear Miffy’ by John Marsden. I know what happens when a jump in front of a train is misjudged! I don’t want to be in a wheelchair or completely dependant on someone else.

I don’t think I would jump in front of a car; too small, more likely to end up alive and well with a couple of broken bones. So that’s out.

So that leaves a bus.

Or an overdose. But I know that the medications that I’m taking are relatively safe in overdose. They won’t kill me. I’ll maybe sleep for a while then wake up back where I started. With the added stigma of having tried to kill myself!

I don’t want that for me, but mostly I don’t want that for my husband. I don’t want to leave him with the bill, so to speak. He doesn’t deserve a life of questioning what went wrong, where could he have done something or done it differently, of blame. He doesn’t deserve any of that. No one deserves that. So I came to this: I can’t do any of those things. I have to keep on going, to keep trying, to keep fighting. Because I can’t do that to him. But it’s so hard!

Another day I got to thinking again: what if I just jumped off these rocks into the crash of waves breaking? Would it hurt? How long would it take? Would someone rescue me? Would it just be easy and instant?

What about sharps? One of my horrors is paper cuts to my eyelids, no idea why! But I’m always super careful around knives and I hate blades, which is why I now wax instead of shave; I’ve cut myself enough times as a total accident to give away shaving! And our knife set is new and super sharp, but I don’t think I could ever do that.

I don’t have a gun and I wouldn’t know what to do with it.

What about painkillers? I don’t have any above supermarket strength and I know they don’t work in overdose, it’s just long slow painful illness of liver failure that can take forever and is a terrible idea. Or bleeding, also slow and awful, not at all a solution.

I’m not great with heights, I just know I could never make myself jump.

So, all out of ideas.

And that’s how I came to be in my doctor’s office at midday on a Monday, bawling my eyes out.

The doctor asked me, have you had any suicidal thoughts? Yes, I sobbed.

Do you have a plan to harm yourself? No, because I can’t think of a way that would work! Sobbing harder and harder.

If I let you go, can you promise me that you won’t hurt yourself? I don’t know, I think so but I’m not sure, I feel so terrible! Sobbing, and sobbing, and sobbing!

A terrible, awful point for me in such despair and not even able to come up with a good way out. Still believing that it’s wrong, but needing so badly some relief! Just a few hours off, just a day of rest from the hurt and chaos in my mind!

Which I did get, later. I took a Valium on the way to the hospital, they gave me another one in the emergency department a few hours later. I slept then, for a few hours. That was just what I needed. But then I woke up and they wouldn’t keep me. As desperate and at the end of my rope as I was, they sent me home.

With 2 temazepam, double the usual dose of this sleeping pill. Which gave me another 8 hours of absence until I could come to terms with going on, dealing with a new day, another battle, keeping on keeping on. Until they could send members from the outpatient psychiatry team to visit and help me.

And then they started the long path to bring me back to today.

Starting new medications, changing doses, scrapping that one, starting another one, altering, fiddling, trying and failing and trying again in the long haul to now, a better day.

Today it is 77 days since I was in the emergency department of my local hospital (author’s note: written two weeks ago). Not the hospital I work at, another one near home. I could never have gone in that state to work and shown any of my colleagues the face under my usual coping face.

77 days. None of them spent working. All of them spent here at home. Making tiny steps of progress, going backward, coming forward, a couple steps one way, another few the other way, teetering backward and forward on the scale from deep depression to hypomania and somehow, at long last, feeling like I’ve settled in the middle around a place that I could call home, somewhere around about “normal”.

My husband in fact thinks maybe I’m better than “normal”. He sees now that maybe I’ve never been as good as I am now.

Sure I still get tired, and have the odd afternoon nap. But I’m more productive, I’m more energetic, I’m more engaged, I’m enjoying life, I’m driving a bit, I’m shopping a bit, I’m doing the dishes occasionally, the laundry sometimes, making the bed some days, hosting visitors rarely, doing day trips every now and then, actually living my life 🙂

We know there will still be days that are further toward one end of the scale or the other. The aim of all the treatment is to not go so far toward either end. My personal goal is to never ever in my whole entire life get anywhere near as deeply depressed as I have been. I don’t ever want to see the shape or colour of that place ever again!!

But we’re living life, and enjoying life! That’s something to be deeply grateful for every day. We’re alive, and relatively well, and life is good! Well, better anyway. That’s something.

I want to live life to the fullest. It’s a cliche, but that’s what I want. My aim is to enjoy every day that I can enjoy because depression is not ruling my life with it’s inability to enjoy pleasure, or it’s sadness, and hopelessness, and pointlessness.

Now ruling my life is just…life. Just life. Getting less complicated, more predictable, more fun! Yes, it takes an solid dose of antidepressant and a good going dose of two mood stabilisers/anti-psychotics. It takes weekly visits with my GP and psychologist, and fortnightly visit to my psychiatrist. It takes good doses of friends and hobbies and enjoyable activities. Who cares? What works, works and I have no argument against that!

Link: how to talk about suicide

“Totally incapacitated”

Here’s one of the perks of being a health professional.

When the tables are turned and I find myself on the other side of the bench/bed/clipboard, I can understand the language.

When a doctor, nurse or other health professional forgets to translate the Greek/Latin into English I still know what they’re saying.

I know the medical terms. I know the diagnostic criteria. I know the treatment plan. I know the drill.

Because it’s my language, usually.

“Take these tds. Experiencing anhedonia. Query gets elevated. Ruminating. Appropriate. BP1”

I spent years learning all the terminology so that complex medical information can be quickly and easily communicated to other health professionals. And then spent years of practice learning how to translate it back in a simple, un-involved way to patients and non-health professionals.

So now, when I see a doctor it doesn’t matter whether they use the Greek/Latin or English; I can understand.

This has its downsides.

Sometimes doctors use Greek/Latin code to communicate sensitive information amongst themselves that the patient doesn’t necessarily need to know at a point in time. Information that may have a negative impact on the patient. Information that may alarm the patient unnecessarily. Information that may skew the way the patient sees themselves and reports information to the doctor. Or many other reasons.

Patients don’t like this most times. They want to know. They want to be told. They want the translation of doctor-speak.

And so they end up asking for information that is unnecessary; that will later prove to be irrelevant; that scares them for no good cause; that gets them looking for specific signs and symptoms that may not be there and creates a degree of paranoia; that gets them reporting biased information to the doctor instead of giving the full range of  information that the doctor needs to determine a diagnosis or treatment plan.

For example a patient comes to the doctor with a dry cough that has been going on for a couple of months.

In the doctors’s mind the common causes are viral, post-nasal drip after a cold/flu, or chest infection. The less likely causes may include tuberculosis (TB) or lung cancer. But of course no doctor will tell a patient who has just walked in to the surgery that they may have lung cancer or tuberculosis. That would create panic, scare them for no reason and bias the patient to give information that they think is related to lung cancer or TB. It would create a lot of emotion that would take a long time to deal with and is unnecessary.

Instead the doctor runs through a series of questions to rule in or rule out different diagnoses and comes to a conclusion, makes a diagnosis and comes up with a treatment plan. Without causing bias or terrifying the patient by telling them the options that they are ruling in and out. Without giving them unnecessary or irrelevant information. Without telling them information that somehow they think they need to know.

They communicate the diagnosis and treatment plan and send the patient on their way.

(This is an example only and not a comprehensive diagnostic description!)

The unfortunate thing about knowing the language is that I get these sensitive bits of information. I get information that I don’t need, that may end up being irrelevant. I get information that scares me, that changes the way I think about myself and the way I look for symptoms. I get information that is more than I can handle, that weighs me down.

Here’s a translation of the terms above:

“Take these tablets 3 times every day. The patient is suffering from an inability to experience pleasure in, or enjoy, day to day life. There is a possibility that the patient suffers from episodes of mania including high energy, extra happy moods, enhanced appetite, lack of judgement and self control. The patient is experiencing circulating thoughts on the same subject that keep going around and around and prevent other thoughts. The patient is behaving in a reasonable manner and is not demonstrating any unusual symptoms. Bipolar 1 disorder, otherwise known as manic depression where a patient can experience episodes of severe depression and then alternatively experience manic episodes of high energy, excessive behaviour and ultra happy moods.”

So you can see why health professionals are taught Greek/Latin!! It makes communication so much simpler and easier. Saves a lot of talking in critical situations.

But for me, instead of hearing a few blah blah words, I get the whole lot dumped into my brain. Which is a lot of information. Especially about things that aren’t confirmed and are only a “query” or possibility. It changes the way I scan myself and look for symptoms. It changes the way I think about myself. It confirms the negative symptoms. Sometimes it confirms that I’m doing okay. Sometimes it confirms ‘maybes’. Sometimes I just don’t want to know!

A few colleagues have said to me at different times: “so what antidepressant did you choose?”

I guess it’s a tendency of health professionals to semi-diagnose themselves, think out a probably treatment plan and consider the pros and cons before going to another health professional, usually a doctor.

But that’s just not how it has been for me. I got sick. I felt awful. I got desperate.

So desperate that I just wanted to put myself in someone else’s hands, to not have to take care of myself anymore, to give the responsibility over to someone else.

I didn’t want to think about treatments, I didn’t want to know about the decision making process, I didn’t want to have the burden of deciding which antidepressant was most appropriate for me, a 26 year female of child bearing age with irritable bowel syndrome, reflux, previous clotting disorder and high blood pressure while taking an SNRI, venlafaxine, exercise-induced asthma, previous failure of therapy while taking an SSRI, fluoxetine, feeling suicidal despite taking 2 antidepressants for the prior 2 months.

I didn’t want the knowledge. I didn’t want the automatic analysis that I’m trained to give to any clinical scenario. I didn’t want to have to think it all out. I just wanted someone else to figure it all out and fix me.

So my message: think before you ask for knowledge, before you demand a translation from your doctor. Do you want the knowledge? Will you be able to handle it? How will it affect you? Do you really need it?

Or is it better to sit back, trust the doctor, and believe in the treatment that they have tailored specifically for your personal characteristics?

I’m not suggesting blind faith, or unearned trust but my recommendation is to think about what you ask of the doctor. Because they do have to give you the answer, even if it will only harm.

Because some words you can’t un-hear or un-read. Like when a doctor writes an insurance report for your income protection payout and gives it to you unsealed because you understand this stuff. And you read it and the reason he’s written for you not being able to return to work is that you are:

“totally incapacitated”.

That will hit you like a brick! It will make you re-evaluate your progress and current state of sickness/wellness. It will get you wondering if you are actually worse than you thought. It will get you wondering if you are useless.

It will start a chain of self-doubt and pondering. Suddenly you’ll think “can I” instead of “I can” or “I will”.

Am I actually a capable person who lives and breathes and cooks and cleans and drives and makes decisions and has responsibility?

Or is that a delusion? Am I actually not doing anything at all?

KNOWLEDGE IS POWER.

But can you manage the power or will it overwhelm you?

BE CAREFUL WHAT YOU WISH FOR.

Are you wanting to know details that can have no advantage or benefit to you, and are best left well alone to someone else’s responsibility?

Take it from me, if you will: you may save yourself a load of stress and anxiety, sleepless nights, fretting and worrying by leaving be details that will only weigh you down.

Let alone and be free.

wooden boat on an Amazon tributary at sunset

Peaceful serenity at sunset in the Amazon Rainforest near Puerto Maldonado, Peru