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!

sweating, cooling

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!

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!!