Minor issues

[Started Tuesday 27th October, 2015; continued Wednesday, Thursday, Friday, and finally got to the point, sort of, on Saturday!!]

SOo I’m over my deadline again! It’s Tuesday, not Monday. And it’s Tuesday night! Oh dear.

I’ve been trying, but the other two pieces that I’ve been trying to get publish ready are just not ready. I need my chief editor, my husband, to review them and he’s away…poor me! Of course I’m joking about poor me, no poor me whatsoever.

But, since I’ve had some minor issues lately, let’s talk minor. I’m not sure who it is that decides what’s minor and major. I’m guessing someone who doesn’t have issues either major or minor, because if it was anyone with any issues, they would no doubt rate their own issues as major a fair bit of the time.

That’s what we’re like, isn’t it? Whatever affects us, feels like the most important thing going on. There’s nothing wrong with that, it’s just how we are. It’s hard to feel for an issue that doesn’t actually affect us, without a great deal of thought and effort, which we don’t always have to spare.

The issues that I’ve been having are medication related. Side effects; well side effect-ish. Sometimes they’re non specific and vague, or even unexpected and the dots don’t get connected.

You know that I’m a pharmacist, and therefore you expect me to know the side effects of medications. I expect that of myself as well, and I do know them; it’s my job. Naturally I can’t know every single one. The aim is that pharmacists know the majority of side effects, definitely the vital ones, and know where to look for the others in our reference books. Our mantra is: until proven otherwise, assume every symptom is a side effect. Umm, did I read that right? Hmm, seems that I may have forgotten that in relation to myself. Oops!

Side effects are ranked as common, uncommon and rare with a special mention for life threatening effects. Common side effects are those that we expect in around or upwards of 10% of patients; uncommon means around 1% occurrence; and rare is 0.1%. Something like that, as a general rule.

When I counsel a patient on a new medication, we talk about all of the common, and some of the uncommon, side effects, and we discuss rare side effects if they are very severe. Must say, I have been surprised at how much of this information I’ve retained despite such a long time off work! I quite expected to have forgotten a lot! But that part of my brain is still alive and kicking, fortunately! Learning it again would take a great deal of time and effort, and I think I’d give up before I began! So I’m glad that all I have to do is remember the path to that information, and it’s all sitting waiting for me.

Side effects don’t occur exactly as the math indicates, obviously; the math just gives us a ball park of what to expect when a patient takes a medication. Some patients never get side effects, some people get a really rough go with lots, some have one or two, and some people can’t even breathe the air of the pharmacy without developing severe side effects. It depends on all kinds of things; genetic, psychological, race, age, number of medications, how you process the medications through your kidney and liver, and more.

I know the side effects of my medications. But the pharmacies I’ve been to don’t know that. Some gave me CMI leaflets, some mentioned a side effect or two; but I’m ashamed to say that most of my pharmacy encounters have involved a pharmacy student or intern or practicing pharmacist handing me my medication and asking, have you got any questions? This is infuriating! How do people know what they don’t know, and therefore how can they ask questions? Pharmacists really need to pull up their socks on this! The responsibility is on the pharmacist to ensure the patient has enough knowledge to safely use the medication, and if I wasn’t a pharmacist myself, this would not have been the case with a single episode of having a script dispensed.

Did you know that 1 in 3 hospital admissions are medication related? That’s a very serious statistic. Imagine how that could be improved by pharmacy staff just taking a little extra care! I know they do care, and I understand that the sheer volume of workload is very oppressive, but surely we can do better.

Some of the side effects I’ve had have been textbook examples, and I actually find this very satisfying! It impresses me when what I’m experiencing is exactly what someone has described in the medical literature. How clever of them, and how observant! Of course when I say I’m impressed, I don’t mean that I like it, or appreciate it. But I think that the person who wrote it down was very intelligent, and perceptive especially for the era that they worked in which was often centuries ago, and the fact that we still find their information relevant however long later is such a testament to them.

So my textbook issues impress, but frustrate me: sweating, hunger, weight gain, sedation, increased blood pressure and cholesterol, suppressed thyroid, heart burn, memory impairment. And the consequences really get me wound up: chafing thighs, red face, jiggly bits, lethargy. Not all minor, of course.

But as an example, I would never have thought sweating was a big deal. So what? Everyone sweats. It’s just natural. Or perspires; if you’re ladylike! You’re exposed to heat, you exert yourself, you sweat. You wear deodorant to prevent smell, you take a towel to the gym, you shower as often as necessary; and that’s the end of the story. There was this one guy at my old job, an orderly, and by the time I walked into work at 8.30am he already had enormous arm pit, neck and back sweat patches going on. I felt very sorry for him, only a young guy! He is really a candidate for botox injections into his sweat glands to block them permanently and give him some dignity! Or aluminium deodorant, much easier and available at your friendly local pharmacy.

And now it’s me. As always the subtleties fascinate while irritating me. I don’t sweat how you’d think: armpits, back, neck line, like you get from exertion. I sweat like a normal person, with the addition of sweating on my face! Nice and visible, up front and prominent! In defence of this sweating I armed myself with a whole host of clinical anti-perspirant products: under arm roll-on, face gel, leg and groin gel, and used them liberally. Under arm: success, leg and groin: success, face: fail!! To be honest I’m not sure that the others do a lot, cos I don’t sweat there anyway…but the one I really need fails! Or just doesn’t work as much as I want it to, I guess! I’m a bit hap hazard with remembering to use it, but at the end of the day if its slightly warm, if the sun shines, if I have a shower, if I wear too tight or too much polyester clothing, if I get stressed or upset or nervous in any way, I sweat from my face!

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My doctor recently gave me the medical reason: my core temperature has been increased by as much as one degree Celcius by my anti-depressant. It’s to do with the increase of serotonin. It doesn’t happen with all antidepressants; mainly the class that I’m on that also increases noradrenaline. 1 degree isn’t much as far as the outside temperature goes; I doubt you’d notice it. But our body is extremely finely tuned and our core temperature should always sit between 36.5 and 37.5 degrees. If you’ve ever had a fever you’ll know how crook you feel when your temperature is about 38.3 degrees. But that’s where I am all the time! I get hot, prickly, sweaty, slightly nauseated, and irritated at the rolling sweat beads multiple times a day!

My new comfort zone is when the outside weather is below 20 degrees. I’ll be the one in a T shirt deliberately sitting outside just soaking up what its like to not be hot, not be sweating, and just comfortably existing!

Is there a solution? Yes. It involves a maximum of two layers of thin cotton clothing, fans, air conditioners, face gel (might as well keep using it!), tissues, handkerchiefs, anything that will mop a brow, a bicycle to create my own breeze, and suppressing my pride. For every time someone looks at my forehead while talking to me, asks me if I’m okay because I’m sweating, every painful time I’m forced to use my hand to mop my brow because I’ve run out of nicer options, for every time I’m counselling a patient at the bedside with my hands full and sweat is starting to roll down my face! ARGH! I know I’m not the only one, but you can only feel your own problems, can’t you? No one else sweating makes me hot and prickly!

But, this is the only antidepressant that has ever truly worked for me, so I’m sticking with it! Reluctantly, unfortunately, but the show must go on. And if I’m not on this medicine, the show will rapidly cease to go on. This brings up an interesting concept: what side effects are you willing to exist with, in order to get the benefit of your medication?

A lot of people have asked me whether I’ve considered stopping my medication. The answer is distinctly NO!!! Seriously, without knowing anything about my condition, my medication, and the subtleties of mental health, how could you ever ask that? And IF you ask it of anyone, you have to be responsible for the outcome, which may be dire, just like a doctor would be!! I understand that you are asking out of care an concern, I do. But it’s not an option with me.

Some have asked whether I’ve considered natural therapies: well NO, I want medications proven to work. And the ONLY natural therapy with evidence for depression is St John’s Wort which is only recommended in mild to moderate depression, which is not what I have.

So this is life. I sweat, not that big a deal when you consider the grander scheme, but oh so degrading on a day to day basis. A minor, but not so minor problem. Still, it’s not a suppressed immune system, or clots in my legs, or a physical disability. I can live my life, mostly do what I want, and be functional. That’s a pretty good hand to be dealt!

I promise I won’t hate you if you can’t resist looking up when we next talk. I won’t be annoyed at you for noticing. It’s just how I am now, and I’m trying to roll with it. Because in the end it is worth it, you know? I couldn’t live before; now I can live pretty happily. It’s just this one thing, and that other thing, plus the other one that take some dealing with, but it’s okay. It’s worth it!

Bike learning

Last Wednesday I drove out to the Yarra Ranges for a bike ride with Wheel Women.

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You remember Wheel Women? They are the awesome group of women who have teamed up with Cycling Australia to run the empowering She Rides programs for women around Melbourne.

I’ve finished the course and now I’m in that tricky phase after completing any kind of training or education; implementing the knowledge and making changes in my life. But with the great Wheel Women She Rides version it isn’t really a difficulty at all! Each and every week there are several rides posted by Wheel Women for us graduates and other female riders (and occasionally males), and the majority of them suit the level I am at now.

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Not the level I want to get to, or that my husband or friends are at, or that I have been told or feel that I should be at; just the level that I am at. Which is very encouraging to keep on keeping on with regular bike riding.

There are a variety of rides from different starting points with different groups. I participated in the first ever Hawthorn She Rides program, but there have also been programs in Docklands and Knox and Geelong, and I think one in Bayside…don’t quote me on that one. I know the Hawthorn girls pretty well after eight weeks of classes and practice rides and coffees and tech nights together. So I’m always happy to go riding with them. But I’ve also been on a Docklands ride and a Knox ride and one of the all-in rides out at Warburton. And so far I haven’t found a single lady/girl/woman/chick that wasn’t lovely and helpful and kind and considerate. Also encouraging!

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Take the Warburton ride last Saturday. The large majority of the riders started at Lilydale for a 70km round trip to Warburton for lunch and back. In the classes and in my first ride after with the Docklands group (group being an optimistic term as there were two of us plus the instructor!) I’d only done up to 20km; not sure that we’d actually hit twenty. We’d done a 2km round trip to practice starting and stopping and turning, and about the same to practice signalling.

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I’d been terrified of doing really any riding at all before the class because I was, and still am a bit, scared of the effort involved in riding up hills, and that I couldn’t do the distance, being so much less fit than when I last rode. The only ride I’d done in the last two years was an excruciating 5km on the Eastern Freeway trail with my hubby. I wasn’t ready, I wasn’t fit, there were hills and it was just a struggle! It hurt and I wanted to get off and not get back on.

But those first two rides were fine. Then we did a 6km ride into Richmond to the Total Rush store to learn how to fix a flat tyre including taking the wheels off and putting them back on, adjusting the chain and derailleur, taking out the tube and patching or replacing it and putting it back in. That was a great and very empowering session!

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The ride was pretty good but I got too hot going into town from Hawthorn. I always get hot, it’s just a fact of life now that I’m on the antidepressant venlafaxine. I overheat, I sweat, I wipe off the sweat and repeat! I’m so excited for winter! Well outdoors winter, not indoors winter…heaters are the bane of my life!

Anyway, I got hot and that reduces my tolerance for pushing myself. I get exasperated and just want to do anything to get cooler. It’s such an unpleasant feeling, and I hate that people can see all the sweat on my face, and its still my number one side effect to get rid of on my dreamboat wishlist. I’d followed the clothing choices of everyone else with lots of layers including gloves and neck warmer. But I’ve learnt since that in most situations I’m better off in Tshirt and pants. I get hot riding but the breeze goes through my shirt to keep me cool and I’m happy; it works. I take extra just in case, but don’t put it on until I need it.

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Anyway, the ride from Hawthorn to Richmond is a pretty flat ride with a couple of little rises but we’d only learnt gears the week before and I’d had a chest infection and hadn’t practiced. Of course I’d used gears before this course, but not correctly it turns out. Gears makes so much difference when you know how to use them! So being hot and exasperated and still coughing from my chest infection I ditched the 6km ride home and caught the train instead. With a flat phone and scant knowledge of the Glen Waverley train line I somehow got off at the right station and found my way by bike the 2km back to the car. I wasn’t that far behind the others.

But the idea that I couldn’t keep up, and riding was hard had received a boost!

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Luckily the next week we tackled a 14km ride to Herring Island and back that I found easy! From can’t do more than 6km to easy 14km! I don’t know how or why but it happened!

I was worried beforehand, but I ended up chatting to another girl all the way in (the distraction really works!) and at the end I felt like I could have ridden further; I had effort still in the tank waiting to be used! That was a nice feeling.

And for the very first time in years, I felt that exhilaration, euphoria, sense of everything being well and life being exciting that they tell you comes from endorphins! Which was a real revelation! 18 months after my diagnosis of depression/bipolar I finally felt that benefit of exercise that everyone’s been yackedy yacking about! I can see now why they say exercise is good for your mood…but I just couldn’t get anything like that with walking. It was sometimes pleasant but not euphoric. Going to the gym sometimes gave me a taste. Playing squash had gotten me part of the way, but my fitness can’t manage that now. But bike riding really nailed it!

After that ride we rode a longer distance into Fed Square which I managed well, then my Docklands crew ride was 16km, dead flat and along the beach on a glorious day! Perfect!

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So the Warburton ride. I’d made up my mind that I would tackle the 35km loop on the trail from Woori Yallock to Warburton and return. I could have chosen the 20km loop from Launching Place but I wanted to see how I went extending myself. I was reallly enjoying my riding by now, and had proved myself to myself a bit, and was aptly a fitting graduate from the She Rides Confidence program!

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I’d wanted to ride the Warburton to Lilydale rail trail for YEARS but never felt fit enough. And herein lies the beauty of the Wheel Women community. A ride that my husband would do, but which wouldn’t really be as valuable to him as his 100km+ weekend road loop. He would enjoy exploring and the scenery, but I’d feel a bit babysat. I don’t have any other friends who ride right now. And going out there by myself is something I’d never think of! But here is a ready made group of women who also want to ride the trail, don’t have anyone to ride with and we all turn up and do it together! Brilliant!

We were told beforehand what speed range we should be able to hold to keep up with the group. I knew that I could maintain that speed based on previous rides, however I failed to consider the difference between riding on asphalt/concrete and fine gravel; the latter is quite a bit slower! But the leaders put me at the front of the group so that my speed would dictate the speed of the group and I wouldn’t get dropped (a cycling term for being less fit/skilled/able than other riders and getting spat out of the back of the group as they gradually pass you by virtue of their better skills/fitness/abilities!). This still happened to me, twice! But I was never left behind.

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The combination of a slight incline, gravel, starting with no warm up, the group being warmed up and ticking along at a good pace meant the first few kilometres were a struggle! I was maintaining a speed about 4km/hr slower than intended but the first time I was dropped I caught up with the group at a road crossing. I got put at the front but still got inevitably passed one by one as the incline and my quads fought each other! That time I stayed behind for a few kilometres with a very patient partner-of-a-coach tagging me all the way.

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That’s what I love about Wheel Women; they leave no man behind…or whatever the modern expression is. You are noticed, you are part of the group, you are looked out for, you are helped and supported along the way, and if things go bad thay’ve got your back. Although we’ve been taught how to fix our own mechanical issues its nice to know you’re riding with experienced women who can back you up with technical assitance and spare parts.

Speaking of mechanical issues. I went back out to tackle the Warburton trail on Wednesday with the Knox group, also lovely ladies. I rode two easy kilometres to where I was meeting them for the Launching Place 20km loop. My mum and grandma were driving out to meet us for lunch. And lucky they were! As I was waiting I heard the unmistakeable gush of air passing out of the tube valve, and my back tyre went dead flat! Not good, but the group were coming and they could help. Here was a steep learning curve that I needed and won’t forget. The group leader: Where’s your spare tube? Don’t have one. Okay I’ll see if mine fits, no it doesn’t. That’s okay we’ll patch it, where are your patches? Don’t have any. Okay I’ll use mine, start taking off the tyre, where are your tyre levers? Don’t have any…spoken very quietly!

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Oh dear!

And the reason I didn’t have them? So silly! The week before I went in to Total Rush to get all the bits and pieces, but I forgot the $100 Specialized voucher that comes with Wheel Women membership. So I postponed buying until the next week when I would be passing by for my GP appointment. Sadly this ride came the day before that appointment! Missed it by that much!

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Suffice to say I now have all of the above and more! Because the outcome of the day was no one had the right sized tube to lend me, the patch didn’t hold and the valve got damaged and wouldn’t hold any air. The one bike shop didn’t stock my tube size, so they day ended with an emergency pick up from the family, lunch, and a drive home! Very disappointing but I won’t repeat it! 2km total on a lovely mild day with fair weather all round! Dulp!
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But stay tuned for photos of me doing all the mechanical work with my two bare hands while my hubby commentates from the sidelines. You haven’t seen the last of me!

*Much of the photo credit must go to Tina, possessor of the genius behind all that is Wheel Women. Your talent at taking photos while riding knows no bounds! Thanks for documenting my progress in pictures 🙂