One of those things

[written sunny Saturday 9th July, 2016; updated 12th July, 2016]

Today I brushed my teeth.

It shouldn’t be a big deal should it, but it is. No one can remember the last time that I brushed my teeth…last year? It’s terrible I know, and doesn’t exactly match my pharmacists’ health promotion ethos, does it? And it’s not something my husband relishes! Or others, possibly; I haven’t heard! But it’s just gotten to be one of those things. You know, those things? Things that you should do, but it’s just a bit too hard. So they’ve slipped down the priority scale, and dropped off the to-do list. I know I have new cavities from being so slack; I can feel them on the lower left side of my mouth when I eat hot food, drink cold drinks, eat something sugary etc. It’s going to need some attention and I’m happy to give it that, but I’ve got an insurance situation to sort out before I can afford it. Soon. Interestingly, or not, I pack my toothbrush every time I go away. I even pack my dental floss, the same dental floss that I’ve had since no one knows when! That’s extreme optimism for you, right there! I don’t know why I think it’s going to be different on holidays, why I think I’ll get it done. I guess it’s something to do with believing I’ll have more time on holidays, that I’ll feel differently on holidays, that everything will fall into place on holidays. But that’s not how it works, is it? What you have at home, your routines, your schedule, your habits, you take on holidays with you. So it just gets put off a little longer, and a little longer. I’ve never been great at this, but I’ve been a heck of a lot better than this, even committing to daily bleaching my teeth for 3 weeks once! It’s probably one of the bigger of those things.

Today I washed my hands.

That, of all things, should NOT be a big deal but washing and drying my hands has become a stand off with myself! It’s like a rebellion against something, I don’t even know what. But you’re supposed to wash your hands, yeah? Well I won’t! Terrible, childish thought process, I know. But it’s there, and it takes a lot of overcoming! Every time I should be washing my hands, this something rises up in me and I just sneak away without doing it. So silly, yet it persists. Obviously because I work in a hospital there are safety limits but a pump of alcohol or chemical based cleaner is a lot easier to me; maybe I should install a couple of home! It’s just one of those things. It’s not that I never wash my hands. If I think an activity warrants it, like dirt from gardening, dusty or greasy hands from my bike, food matter etc then yes they get a good wash; or a good rub down on a hand towel that will disguise it! I’m practically a kid when it comes to this! It’s the little times when my hands aren’t dirty, but its tradition (and probably hygiene!) like before a meal, after a meal, little things. In my mind. Probably not in others minds, but it feels like unnecessary energy that I can’t afford to waste, so I save my efforts for something more essential, as least to my way of thinking. It’s one of those things which seem like why wouldn’t you just do it, but I feel like it will take too much energy. It’s a fight with myself.

Today I walked one kilometer.

Walking, any walking, has become a big deal since I got sick. I never used to think about the things I asked my body to do. I walked as long as I needed, I ran for exercise, I loved swimming for fun, weights were my favourite form of exercise, I’ve done a couple of bootcamps including one at a boxing gym, pilates was my relaxation, and so on. But now, I struggle a lot with it! For various reasons, I suppose: I’m fat and heavy, I’m slow and sluggish, it takes energy and effort and motivation, I’d rather catch ANY other form of transportation, my legs rub together and chafe til they’re red raw unless I wear undershorts or leggings, it drains my mind and my body, and I’ve come to associate it with pain and suffering. I know, a little over dramatic! But there you have it, it’s one of those things! This walk in particular was slow, and it wasn’t for exercise; it was for bird watching and photography. But hey, it was outside in the sun and breeze, and it was a kilometer. I take it however I get it, and don’t sneeze at the little bits of exercise however they come. I’m meant to be exercising more. Well that was more than yesterday, more than the day before, and more in one go than I’d done for the whole week and probably longer so I’m counting it as a win!

Today I rode my bike.

And it reminded me that I do love my bike! I’d forgotten that. I quickly forget the joys, and never-endingly remember the pains; it’s not a good way to be! I keep planning to ride with Wheel Women and sign myself up for rides optimistically hoping I’ll feel like it by the time they comes around. But then I pull out closer to the day as it becomes clearer that not having left the house or changed out of PJs for 2 days, it really isn’t going to be likely that I’ll be up and dressed by 8.30am ready to drive 45 minutes across the city! Or I heave a sigh of relief when a planned ride is cancelled due to rain, path flooding or wild weather. Then I roll over and go back to sleep. Well that’s been the pattern lately while I haven’t been well. Before today I hadn’t ridden or been on my bike even since the 3rd of June! Five weeks out of it! I think I’ve had 5 weeks out of a lot of things, to be honest. It’s been reasonably bleak for me and with me, and that’s when all of these things, those things, fall away because it’s too much effort to keep them going. But flying downhill brought on that high, that endorphin burst and suddenly I was in my zone, loving it! And I flew all the way home, even up the hills, and that was that, I was back, mentally. And when you’re there mentally, you’re there!

Today I climbed hills on my bike.

If you know me and my riding, you know about me and hills; we have a difficult relationship! Frankly, right now, I’m not built for going up hills! My weight is very much against me when trying to defy gravity by going up. Nevertheless, the hills are there and they do come across my path, and at the end of the day I do have to get up them somehow. So when Wheel Women ran a class on climbing, cornering and descending, it sounded like exactly the skill set that I could benefit from! So how did I get to that class when I hadn’t gotten to any other rides? My innate cheapness!! I put down money for this class, little though it be, but it’s a powerful motivator in someone with Scottish blood, however diluted it be! And I did learn some super helpful tips to help me up those hills. And then I flew down them again, but that’s the fun bit, the bit that gives you a rush! The other bit, the climbing is different, but I guess it’s a means to an end if you like. It’s still hard. But I did it today! I conquered one of those things, at least for now.

At the end of the day, what a day?!

Better than I’ve had in quite a while! I’ve been struggling with depression lately and it has sucked, but suddenly on Thursday night when I woke up from my nap, something shifted! I was high, elevated in an energetic and motivated frame of mind. Just like that! If only I could click my fingers and get that result! Who on earth knows what it was that tipped me over, impossible to figure out. But YAY!

So what you’re seeing here is the chemicals in my brain giving me a booster shot to actually manage to do some of those things. I even cooked tea one night this week! Rare event these days! When the chemicals all line up, life is good. It’s easy, way less effort, far less forcing myself around. It just happens and we’re all relieved. And vice versa, you understand. But for now, for however little time I have this little break, it’s nice to use it to do something. It’s not perfect. My ride was still hard! The hills still hurt. My walking was still slow, although that was more for the sake of finding birds, and it wasn’t far, but still. I washed my hands but not all the time. And I brushed my teeth.

What I didn’t do today was shower. It’s probably the hugest of the things. To get into our shower you have to climb into the bathtub. Every time I think of having a shower, I think of having to hoick my leg over the side and it just seems like too much effort! It’s such a small thing, right, but it literally seems like it’s impossible. Once I’m in its great; I love a nice hot shower and feeling clean again, once I’m there. It’s just the getting started, which is after all, the issue with all of these things; getting started. It’s pretty much classic depression: issues with motivation, energy, self care. It is amazing what lengths I’ll go to not to have a shower, and how long I’ll go between showers. And by amazing, I also mean embarrassing! After Bali, I had a mega battle and I almost lost count but I think I went more than two weeks and no shower, and unwashed hair! You may have noticed! I still used deodorant and perfume so hopefully I didn’t stink, but it wasn’t a nice episode and finally my husband had to drag me to the shower and make me get in. And it was delightful! All that fuss and bother and argument, vanished, and I had a lovely time and came out feeling wonderful! It’s one of those things!!

That’s today [read: Saturday 9th July]. Tomorrow we have to wake up and do it again so we won’t get too carried away, but today those things have had a bit less hold over me.

So, the next day: Sunday morning, the hardest morning of the week. Mainly because I ideally would aim be up and going earlier than I may have done for the other 6 days of the week. But today I was up by 9am and actually feeling like I was up and going, not sluggish or doped out. My anticipation of the coming Sunday can mean that I go to bed late, and so not take my tablets til late just before I go to bed, and so I can be a bit sedated by the effect of my tablets lasting well into the morning. I have this contrary thought process that not going to bed will prolong the next day’s arrival…obviously it’s just the opposite. But it’s another reason why waking up Sunday is a complicated thing. Sunday morning is also traditionally when I wash my hair. I should really change that, if common sense prevails. It’s just another thing to get past to get to church: waking up, clearing my head, getting fed and watered and tabletted, showering, dressing and getting out the door not long after ten.

But today was pretty successful. I actually had a shower, and even dug out some moisturizer and did my legs! A miracle of a day! I’m energetic but not irritably manic, the best way to be. Touch wood for more days like these. I’m active, I’m wanting to fill in my day instead of hiding from it; I’m like a normal person!! YAY!

The price of good health

Here’s my thing about the current mental health system. I know everyone has a different “thing”; this is mine at the moment.

Despite really needing them, I have exhausted the maximum number of Medicare-subsidised psychologist appointments that I am entitled to in a calendar year. I ran out in April. 4 months into the year!! Leaving me in the unenviable position of having to pay $145 per one hour session weekly with no Medicare rebate of $85 if I want to keep seeing my counsellor and improving my mental health. Not a great encouragement to continue therapy.

$145 is a lot of money for someone who has been off work for 100 days and ran out of sick leave after four and a half weeks! But this is not just about me, it’s about every patient who is getting treatment for mental illness. It’s a lot of money to anyone! So I tried to go without my psychologist session,then I tried spacing them out to two weeks or three weeks. Didn’t work terribly well or please my doctor or psychiatrist! Or me for that matter.

Luckily for me, in a freak moment of paranoia in 2010 I signed up for income protection insurance after a work colleague was diagnosed with cancer and couldn’t get insurance. Because of this I am getting a kind of substitute wage. So I am doing 10 tonnes of paperwork every month for the insurance company to pay me a benefit in arrears. So far I’ve had one payment. It was a great payment, but it was once! But there are a lot of people out there in the world who wouldn’t have been prepared to pay $85 per month for the last 4 years for the sake of an insurance payout that might never be needed. Thank goodness I did pay for it, though!!! It cost me but I am getting the benefit now.

In the case of people without income protection insurance they would be doing 10 tonnes of paperwork for Centrelink disability or sickness benefit or health care card or something else similar! For a lot less money probably. The government doesn’t match your current wage.

In an effort to address this problem with paying $145 out-of-pocket each week, I changed my insurance over in April so that I now pay a lot more per month for better psychologist and psychiatrist and inpatient psychiatry cover. Again, not something a lot of people would be prepared or able to do. Unfortunately I then had to wait two months to be able to use it! And I only get $250 worth of psychologist cover, not even two sessions!! Not quite worth it for that part.

Luckily, there is another benefit of income protection insurance that I was not aware of; in their portfolio of helping me they have agreed to fund 10 sessions!! Thank goodness!! And they have offered to put me through a meditation course, which I was already thinking of doing, so there’s a few perks to having paid privately for this insurance. But like I say, how many people could or would pay for this? How many people develop mental illness, which never comes in a planned way or at a convenient time, and have to make the choice between paying a huge amount  of money or go without treatment?

So this is the reason why there are crazy and hurting and needing-help people walking the streets; the private system is expensive!

And you can’t get admitted in the public system unless things are diabolically bad! They refused to admit me when I was suicidal and didn’t think I could keep going. I begged them to!! They would not do it. They just kept saying it would do me more harm than good. I kept begging. They kept refusing. They won. I got sent home. It wasn’t nice!!

They asked me if I had private insurance. Yes, yes I do. Well we’ll look for a private hospital bed for you. Okay sounds great, I just need to have someone look after me. Well we’ve called your insurance company and you will be $2500 out of pocket up front plus $400 per day. We don’t know how long you will need to be in hospital. Ummm, okay, maybe not! That’s a whopping lot of money! I know you can’t put a price on your health, but that’s a large pile of money that could be put to some other large life investment! Another reason for upgrading my insurance.

Now that I’ve served my waiting period of two months, I can get private hospital admission for only a few hundred dollars out of pocket. Will I need it? Maybe not, but I’d rather know that I can get it if the need arises because not being able to access it last time left me feeling even more desperate when I didn’t think it was possible!! But it’s a toss up, spend over a hundred a month to save a couple of thousand…how long til it adds up to that much anyway? But I have a plan to reduce my insurance if I don’t use it this year.

So instead of a hospital admission, the community psychiatric team came and visited me or called me once a day for 10 days until the new medication had kicked in and I started to see life in a more hopeful light. I have to say they were amazing and helped me so much. And I continued to see my usual GP and psychologist in that time, as well as a psychiatrist in training at the local office.

Which brings me to another point. I have been seeing a doctor once a week since last November. After the worst episode of suicidal thoughts and desperation I saw my GP twice a week for a couple of months, then went back to weekly. We’ve planned to stretch it out to fortnightly but we’ve never quite gotten there due to either a relapse or medication change.

The first doctor I saw charged me $73 per session. This is pretty standard. My current GP who I’ve been seeing since December usually charges $70 per session but bulk bills me because I’m a mental health patient and he doesn’t want mental health patients to not see him because they are worried about the cost. Which is a very important consideration!! And it actually does make all the difference! I know I can go in and see him anytime and I don’t worry about the cost, when I would otherwise consider that before booking an appointment.

Imagine $70 at least once a week since December. That’s 6 months. 23 weeks. If I had had to pay $70 per session I would be at least $1600 out of pocket!! Again, a lot of money for someone who hasn’t worked for 3 of those months. Or anyone, for that matter!! The Government has put in place a medical safety net so that if you have medical costs over a certain amount you can get a benefit at tax time. But you have to spend even more than this before you get the benefit, as I understand it. You really have to spend a fortune to get any help or subsidy.

Bulk billing is one of the greatest inventions but it relies on doctors being willing to take a Government-determined payment for their services rather than the larger fee that they could justifiably charge. That takes a dedicated and altruistic physician, and I’m so glad for every doctor that offers bulk billing! You are the hope of the sick and poor!!

Doctors that don’t bulk bill are private (non-hospital) psychiatrists. Which is understandable because they invest more than 10 years of their post-high school life to achieving the knowledge and expertise to work in that position. My psychiatrist charges $315 for the first consultation and $215 for subsequent appointments! Understanding this the Government rebates $221 for the first appointment and $113 for the second appointment. Not bad but still a fair amount of money to pay on a regular basis.

Then of course there are the medications. Lithium, venlafaxine, quetiapine. Diazepam for emergencies when I’m really anxious. Pantoprazole for gastric upset on lithium and venlafaxine. Levlen to avoid becoming pregnant on lithium and quetiapine. Cholecalciferol for reduced vitamin D from spending the last 3 months mostly indoors. Tooth mousse for increased cavities on quetiapine due to dry mouth. Anti-perspirant for over-heating and increased sweating on venlafaxine. High protein diet for iron deficiency. Low cholesterol diet for high cholesterol due to eating badly and quetiapine. Calorie restriction for increased appetite due to quetiapine and lithium and venlafaxine. Altogether it comes to about $150 per month for meds. There is also a prescription safety net, but this only comes into play after you have about 60 scripts dispensed in a calendar year. I’ll come in just under this so no safety net for me.

So that’s my whinge for today. From my position I feel lucky for the investment I made in insurance years ago, and I’m glad that I now have better insurance for the present and I’m glad that I’m in a position to afford these things. I’m not wealthy but I’m comfortable, and I feel for those people who really don’t have the money to get the treatment that they so badly need. Should we be subsidising treatment more than we do? Should people be made to have better insurance? Who pays for all of this? It’s not really an answerable dilemma, but I’d like to be more thankful that I’ve been able to get the treatment that I needed at times when I’ve really needed it!! Maybe not as much as I wanted but enough to keep me safe and pushing on.

And as I always say to my patients, I need to thank my stars that I was born in Australia not America. If I lived in America I would have had to pay for all of this and pay for it dearly! I’d probably have taken out a $20,000 personal loan by now or have completely used up our life savings.

Health. When it’s good, you don’t even think about it; it’s just there and we all take it for granted. We expect our bodies and minds to work in a predictable manner. We feel let down when they don’t work to our plans despite it being quite the miracle that all the intricate functions of our bodies work smoothly without a hitch.

But I’d like to take more time to be thankful for the days when my health comes to me easily! When it doesn’t take doctor’s visits, hospital admissions, psychologists, psychiatrists, medications, time off work to achieve a type of health. When I wake up and I’m just well! It really is a miracle and I want to appreciate it.