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!

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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!