Revolt

*WARNING (and spoiler alert): contains self-induced vomiting*

12th April, 2017

From one drama to the next! Honestly! Did I learn nothing from yesterday? The whole phone thing? Nothing about being careful and deliberate in my actions?

See, I have this system. Yeah right! A system is useless unless you stick to the system. Which I mostly do, but mostly isn’t really enough when there’s a system involved. You stick to the system, or you don’t.

This system involves my medications. I’ve probably been over this but I have a nice purple medicine box with 4 rows. One row for my morning tablets, one empty row, one row of 3 valproate tablets for each night still in their original foil because they go smooshy when exposed to air, and the final row for the rest of my night tablets. The valproate for the evening doesn’t fit with the other tablets, hence its own row, but the morning single valproate tablet fits it, hence the empty row. I have carefully marked the morning tablets, and the night tablets so that I can’t get confused. Plus there’s the fact that I unwrap one valproate tablet in the morning and three valproate tablets in the evening. The morning row has red and pink capsules of venlafaxine and 3 little white tablets; the evening row has a dark red iron tablet, a little pink cholesterol reducing tablet, and three chunky quetiapine tablets, apart from the lithium that is in both morning and evening. They are different, the morning and the night tablets; clearly distinguishable. They are not the same. If you take the time to notice, which I periodically don’t! Theoretically, I check all the tablets lying in my palm, to make sure every one is present and accounted for before swallowing them down. I have a list written on the back of the box telling me exactly what should and shouldn’t be there, for reference. But I’ve been on this same combination of tablets for well over 6 months now, and I’m very careful when I pack the box, supposed to be anyway, so sometimes I just pop the tablets and scull them down, get it over with!

Like yesterday. Before I knew what I was doing I had opened 3 valproate tablets, shaken out the dark red and pink tablets, noticed subconsciously the big chunky tablets, and sculled the lot! Even though it should have been obvious that I was taking the wrong tablets: wrong compartment, wrong colours, wrong amount. It took about 20 seconds to get that same shot through the gut as I had yesterday when I realised that I’d lost my phone. I knew then, consciously, that I’d really stuffed this one up!! It has happened before, once I think, but seriously! What was I thinking? And here’s the thing, I wasn’t. I was on auto pilot, distracted and that’s how it all blows up in your face. What’s the big deal? Those 3 valproate tablets, plus the 3 quetiapine tablets, they’s the big deal. They are basically my sleeping tablets, and here I’ve taken them 10 o’clock in the morning! They aren’t actually prescribed for sleeping, they are mood stabilisers but this is their major side effect. Any other day I’d just resign myself to going back to bed and sleeping them off, but not today.

Because there’s something else that I haven’t told you. I’ve got a job!!

I was going to save the excitement for my official start date on 29th April, however this happened, and on the first day that I’m going in to do the official orientation and get all of my paperwork sorted! I have a 4 hour shift starting in an hour and I’ve just taken my sleeping pills by accident/carelessness!! You can see the problem here. First impressions and all that, I don’t want to call in sick for my very first shift; I’m determined to be there and on time and get this job off to a good start. I don’t want to have to go home sick part way through the shift because I can’t keep my eyes open. I definitely don’t want anyone to think I’m under the influence, or unfit for work! That would be extremely unfortunate! Not just for this job, but for my career; the pharmacy board frowns heavily on pharmacists using any substance while on duty, oddly enough. So, what to do? I think you can see where we’re going now.

The ONLY way to try to prevent the sleepy pills doing what sleepy pills do is to get them out of my stomach before they are released from my stomach to my intestines, and absorbed into my bloodstream, making their insidious way to my poor brain. The only way to get them out of my stomach is to induce vomiting!! Honestly, I cannot think of a more revolting, horrifying task to have on ones hands than this. I don’t think I have ever made myself vomit before. I recognise now how compelling a disease bulimia is to convince you that this is a way to live. To me it is extremely repugnant. But what are my options here? It took a lot of psyching myself up for it, and a couple of false starts, don’t ask me how, but we got going. Here’s the killer: I ended up throwing up my entire breakfast which I’d had an hour and a half ago, yet there wasn’t a sign of the tablets and orange juice from 10 minutes ago. Here is the cleverness of your stomach. It knows that its job is to break down food into smaller pieces so that your intestines can do their job. But there’s nothing to break down in fluids, so your stomach lets them right past. In that 10 minute period, my stomach had already released all the fluid/orange juice, and the tablets with it, and they were gone. That whole disgusting, humiliating, distressing episode, for nothing!!

What next? Well, its time to go to work. Fingers crossed that I can handle this and get through what I need to get through.

Here’s the odd things about my sleepy pills. When I first started taking them I would be dead to the world within 30 minutes, or less. Honestly, I would take them and immediately get upstairs to bed because within 10 minutes all of the muscles in my legs would be jelly and I couldn’t step up a stair if I was being chased by an axe wielding madman! My arms would be equally useless. A couple of times I got into bed and then needed to go to the toilet. I would bounce off the wall, my bed, the dresser, my bed, the wardrobe, the bedroom door, the bathroom door and back again! I’m sure it looked completely hilarious from my husband’s point of view but I couldn’t even see straight, let alone have control of my legs. My eyes would go evil vampire red because of how much the medicine dried them out. Basically I was gone for the night. And I got the best sleep! I was drugged out really. And of course as my dose went up the effect continued.

But over time, as the dose has steadied out, I’ve become more tolerant. I don’t get that drugged out feeling now, and I can stay up sometimes for a couple of hours after taking my night tablets. On occasion it does make me drowsy enough to start blinking heavily, struggling a bit to keep my eyes open, but if I really want to I can keep them open; it doesn’t overpower me like it did before. It still helps to give me a good nights sleep, and without it I sleep pretty lightly and spasmodically. As I experienced last night, because after taking my night dose in the morning, I had to take my morning dose of valproate at night to keep the balance, and one tablet isn’t enough to sedate me; plus I had no quetiapine in my system.

So, I took the wrong dose, and didn’t manage to catch it before it got into my system. And now I have to go to work. Well this should be fun! Here’s hoping I can fight the effects for more than a couple of hours.

Okay, next strategy: a large Coke, no ice from Maccas. Hopefully the caffeine will do something!! I drove all the way to work (I was questioning whether that was a great plan, but I felt fine at this stage) feeling okay, until the last 5 minutes when that warm, fuzzy, about to go to bed for the night feeling settled in. I got a little lightheaded on standing, slightly dizzy if I turned my head quickly, and just plain drowsy. My eyes wanted to shut and go to sleep, my thoughts got a bit thicker, I was trying not to speak slower. I hope to goodness I managed to pull off looking as enthusiastic and committed as I wanted to. But there was a big challenge waiting for me. Most of the 4 hour shift involved sitting at a bench reading policies and procedures and signing off on them, and doing orientation quizzes on the computer!! I mean, seriously! Of all the days in the world, I really needed a stimulating day today, and I got reading of less than riveting material!! I think I pulled it off, I mean I got it all done, but I have no way of knowing whether I was doing it way slower than usual, a bit slower than usual, or how many micro sleeps I had sitting there at that bench! Luckily the chair was very uncomfortable so that keep a bit of an edge on my alertness, and after 2 hours when my supervisor went for lunch, I went out and got an iced coffee with plenty of sugar! I think that did help a bit to keep me going for another couple of hours! Plus the fresh air was good.

Yikes!! What a day! But I did survive, somehow, by some miracle, and I’m going back on Tuesday after the Easter break. To be continued.

Did I come home and go straight to bed? Yep, you betcha! A couple of hours sleep did wonders. Usually I can go straight back to sleep at night after an afternoon sleep because of my night tablets so I did struggle a bit getting to, and staying asleep without them. But I didn’t struggle catastrophically. I think I actually had a pretty good night’s sleep in the end, although I was awake from 5am on the dot this morning, Thursday 13th April.

I can’t double up once I’ve taken the tablets, even if they were the wrong tablets. So what’s the plan to get back on track from here? Most of my tablets can only be take once in 24 hours meaning I can’t take night tablets again today. So I’ll take my morning ones tonight, then my morning ones in the morning (the morning doses are smaller so it won’t be such a big deal taking them back to back) and my night ones tomorrow night; then I’ll be back on track. Until then I’m sniffing my head off because of the longer gap in between doses of quetiapine, from morning one day to evening the next. It usually dries me out so sniffing is unusual and annoying! Apart from that, and the obvious drowsiness there shouldn’t be any consequences from stuffing this up, luckily. When you take the same medication all the time, a one off dose mix up doesn’t tend to affect your overall medication levels enough for issues to arise.

And here it is 7am and I’ve written this blog and I’m ready for breakfast, bright and early. I could possibly be very productive without those night tablets, but it wouldn’t be worth it for my mood. Ah the catch 22’s in mental health treatment! 

So, have I learnt my lesson in being more careful? I’d like to hope so, but I find the lesson only lasts as long as my memory of it, and that’s a whole other story!

Day One

swing, girl, book, 'Today your efforts will be rewarded'

My inspiration

I love this poster!!

It inspires me every time I walk past it at my local shopping centre.

It’s actually an advertisement for HSBC insurance, somehow, but I love the thought that the effort I put in will absolutely bring results. It keeps me feeling like there is a point to what I’m doing, and that the goal isn’t so far away.

Okay, time to get serious.

Yesterday I had an appointment with a dietician. Yes, a dietician. To discuss my diet.

Oh boy!!

My GP was lucky. He did some blood tests and found some nutritional deficiencies. Quite a few actually!!

So all he needed to say was that he wanted the deficiencies corrected through diet rather than by adding yet more tablets to my current regimen, and referred me to a dietician on that basis. This is why he didn’t want to add more tablets, and this is just the morning!!

capsules, tablets

My morning kickstart!

He escaped having to go through the process of telling me, ‘you’re fat”! Lucky him! Although we both knew that underneath the conversation that we were actually having was another silent conversation along the lines of “since we met 6 months ago you have gained a tonne of weight and you really have to do something about it, starting now!”

But coming at the subject from a less obvious angle made it a lot easier for him to bring it up, and for me to accept it. Clever!

I’ve seen a new side to being a health professional lately; the ‘getting patients to see things from your viewpoint without thinking they’re being forced there’ skill. It’s vital to successful relationships with patients, and to achieving the outcome that’s best for them. Even when they may not think so.

Kudos to the excellent health professionals that have cared for me over the last year! I respect and appreciate your negotiating and information-giving skills in hindsight, even if I was a difficult patient back when we met. Thank you!

So the dietician. A lovely softly spoken slim fit-looking girl who told me I was beautiful and had amazing eyes! Nice work!! Just like that she had me feeling flattered and accepting of everything she was about to say; well done. Seriously, I’m impressed! And I’m learning new skills in people-management.

So, what did she have to say? Nothing that I wasn’t expecting, to be honest. I knew the ‘what’ of the appointment, although maybe not quite the extent.

Here’s the facts:

1) On October 24th 2013 I weighed 77.65kg. I had spent 14 months from August 2012 to October 2013 losing weight, and had dropped 9kg which I was pretty proud of.

2) On May 23rd 2014 I weighed 95.4kg!! Nearly 18kg gained in 7 months!! Oh dear…

3) My cholesterol level has been borderline high since my first WorkSafe health check in 2010, at that point due to 4 years of chocolate bingeing. Unfortunately in the last 6 months it has gone from borderline high to do-something-now-before-you-have-a-heart-attack-or-stroke high!! At this point, it’s due to 8 years of chocolate bingeing!! My LDL cholesterol (so-called “bad” cholesterol) is 7.5, and the upper level of the range is 5.5! So, quite high!!

Question from the dietician: “do you want to live a long life with your husband?”. Me: “yes, of course!”. Dietician: “then you really have to do something about your cholesterol”!!

4) My vitamin D level is getting progressively lower. It was normal last year and at the start of this year and low a couple of years ago so I guess it fluctuates. Spending the last 3 months at home and not getting out much has not helped my incidental sunshine exposure! So back on supplements.

5) My iron storage level (ferritin) is low. This one puzzles me and everyone else because there’s no obvious cause. So diet, you need some change. More meat, but no more fat…interesting conundrum!!

6) My waist measurement is 100cm!! The safe upper limit of waist circumference to prevent heart disease in women is 80cm…quite a bit of work to do there! Oh, and I look like I’m 5 months pregnant!!

7) Most relevant fact: I now have 3 skirts left that fit (ish)and 90% of my wardrobe no longer fits!!! Or it squishes my waist into weird shapes and bulges, or clings to wide parts of me – not nice for anybody!!

So we know the what. Now for the why.

I know this one too.

Binge eating, comfort eating, boredom eating, drug-induced craving eating, habit eating…are there any other kinds? Oh yeah, guilt eating, shame eating etc.

Food has always been a weakness with me. I love it, I enjoy it but it has gotten to be a habit and comfort to me.

While I’ve been really sick it was one of the only things that I could still get enjoyment from when I’d lost interest in everything else. It was nice to be able to enjoy the flavour, texture, taste when everything else had lost it’s interest and enjoyment.

In times of severe depression when I have lost all my energy, motivation, and was tired, flat and struggling to do anything, I would eat sugar after sugar after sugar to try to get just a little scrap of energy so that I could do SOMETHING!! Sour straps, chocolate, licorice, berries, frozen yoghurt…the list goes on!

The rest of the time, just having the food near was enough reason to reach out and eat.

Did it work? Did it give me energy? No. But it made me feel good for a little bit. And I kept doing it, because I like it!

But then it would make me feel bad. Guilty, ashamed, embarrassed, feeling over-full and gross.

The dietician gave me a diagram that perfectly describes how I’ve found over-eating:

a diagram of the cycle of emotional eating

The Vicious Cycle of Emotional Eating – perfectly described!

But it’s time to stop. Time to break the cycle, for once and for all.

I’m (hopefully!) past the worst mood swings and have a bit more energy and time to put into Project Danika. So here we are, Day ONE.

And here’s the plan.

My cholesterol is shocking so it’s the first thing to be addressed. I’m trying a radical new meal plan: eat breakfast, lunch and tea. That’s all.

Hmmm. It’s a long time since I’ve eaten 3 meals and nothing else in the day!! I’m allowed morning and afternoon tea but from today, no more mindless snacking, eating from boredom, for sugar hits, mood improvers or anything else along that line.

What I eat for my main meals is actually fine, no dietician amendments needed. It’s everything in between that needs to be eliminated. So here goes, no snacking!

A few things I learned yesterday: cravings last from 9 to 12 minutes therefore if I can keep my mind and body busy for 10 minutes whenever a craving hits I will be able to get through feeling the need for food to feeling satisfied for food. Such a great tip!! Now I feel like I have an active plan that I can work on to achieve my goals.

I now know the ‘how’ of the equation! I love it. I have strategies and goals and it feels achievable. I’ve been letting myself have a free run but no more. Time for the better me to have a go at life.

The next dietician strategy if I get as far as the fridge; start asking questions! Why am I eating? Will this snack make me feel healthy? Am I hungry? Should I have a glass of water instead?

And if I get as far as actually eating? Next lot of questions: am I enjoying this? can I stop? Did I really taste that?

Failing that, just finish what you’re eating, put it down to experience and try again from now on. I’m psyched!! Having someone give me all these plans and strategies makes the biggest difference to me. I guess it may seem obvious to others, but I really need to have it broken down for me.

So with a fruit bowl full of mandarins and kiwi fruit, some celery sticks and baked bean cans, and a new approach of not buying anything that has more than 2g of fat per serve, off I go. I’ll keep you posted along the way to the 3 week mark when I revisit the dietician.

Wish me luck!