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!!

Back on ya bike

Today is the 17th of March.

But you knew that.

St Patrick’s day I believe. Not that this ever has much to do with me, or I with it. Just something that’s going on out there in the actual real world.

All that the 17th of March signifies to me today is that it is not the 9th of March. Quite a bit past it in fact. So I’m over my deadline of writing to you all but let’s put that aside and focus on the fact that we’re here! All alive, all well to some degree.

I have in fact been writing in preparation for my deadline but it just wouldn’t go to plan. It didn’t flow, I wasn’t comfortable with it, the stars weren’t aligned. So I’ve been thinking and thinking and getting nowhere. Then today it just started waking up and forming in my head and here we are! Patience is a virtue remember, and I say remember to myself more than anyone else. Patience! So here we go with the brain flow of today.

Today I strapped on a pair. Strong start, right? But we’re going down a different pathway.

Today I strapped on a pair of runners. Sneakers, joggers, running shoes. I got them out of the wardrobe, literally dusted them off! loosened the laces like the shop lady taught me so many years ago, put a foot in each one, pulled the laces tight again and there I was ready to do battle. I will admit now that I checked last night to make sure they were in fact still IN the cupboard! You know, in case it had been so long that for whatever reason they had vanished!

I strapped on a pair of socks; that happened before the shoes. When did I last get out a pair of socks AND wear them? I get them out every time we go on holidays, in case. I never use them. But I take them in case. Every time. Sometimes several pairs. In case I’m active several days in a row. You know, cos that happens! Along with my runners. I take them too; in case. My socks had burrs in them from goodness knows where! Or when. I guess it’s lucky they didn’t have moths in them, or a family of spiders! Spiders would have definitely changed the course of the day! My horror of spiders long pre-dates all the other fears that have developed in my life more recently. And it’s a hard one to conquer! Their legs move and I run, literally, screaming from the room. Could be a good exercise incentive, although repeated episodes of that much adrenaline cannot be good for me!

I strapped on a pair of sunglasses to contend with the overcast drizzle; good choice!
A pair of yoga pants, the only pair of pants left that I can wear without shame and horror at how much of my body doesn’t fit into them!
A bright yellow T shirt that I bought for a casual top when I grew out of all my other casual tops, but which irritates me by not sitting where it’s meant to. But the request was for bright clothes.

The occasion? I’m re-learning to ride my bike! I’ve signed up to have ‘Wheel Women’ teach me and 7 other ladies the Cycling Australia ‘She Rides’ course. We’ll learn about the bits of our bike, how to fix things, how to ride, what essential equipment you need etc. Our course isn’t the beginner course. We’ve all ridden before. Ours is the confidence course, remembering what we’ve achieved before, how much we already know. It’s also about just how much what we learn will help us to become confident in riding again etc.

Because I have been confident in the past, you know. As primary school aged kids we would shoot out of the car as soon as it stopped in the garage after school, throw our bags inside the house (or in the yard, on the garden, near the chook house) and be on our bikes before you could blink. We’d all ridden since we were toddlers on foot propelled solid plastic indestructible stabilised bikes. We’d all progressed up through a trike, a small bike with training wheels then up through a variety of pretty solidly contructed biked until we made it to an actual store built mountain/commuter bike from Kmart! That was a great moment! It had gears, a stand, flat handle bars, a bell, brakes activated by levers instead of feet!

We had a hill in our driveway where the channel had to be broached and a roundabout for cars to easily turn around. So we’d ride flat out from the road to the top of the bridge and the competition was who could roll the furthest down the bridge, around the house on an S bend curve and the ultimate victory was to make it to the gate into the backyard. It was one on one so there were heats for me and the next down to compete and the two little kids to compete. Then there were speed races down to the garage, technical races around the garden beds and so on. I love it all! We did learn to ride classes at school and the big ride day every year with half the school. We rode to school when mum was working, often with the naughty fox terrier tagging along. We’d tell her to go home but she was sneaky. She’d pretend to head home then sneak diagonally across the paddocks while we round around the square and often beat us to school where, of course, all the kids loved her and made a big fuss out of her!

Great days! And lots of fun. Of course I had the odd accident, ironically the first big one was trying to go too slow while Mum with the baby in the backseat caught up. Our whole driveway was gravel so there were of course many accidents where the wheel slipped out or we hit a bump. Then a bigger one when I was riding up Manningham Road to Heidelberg train station to get to uni. I decided to leave the road for the foot path to cross a big intersection, took it on too much of an angle and landed on my chin! That was the confidence sucking one! That was really the death knock for me riding on roads, and even bike paths.

Thus the course. We have 8 sessions of 2 hours and the first one was this morning. And already I’m stoked!

Which is a miracle considering I spent most of yesterday in an absolute stew about it! What if, what if, what if?!

What if I don’t wake up in time?
We’re meant to be there at 10am, that means I have to be awake at 9am at the latest and ideally leave the house by 9.30am. That’s kind of early given my getting out of bed times lately! Despite my consistent bedtime of around 10pm my morning wake up time can vary from 8am to 11am! This is the result of medication sedation, which is consistent daily but it’s so unpredictable in how much and for how long!

What if I wake up in time but I’m really drowsy and not fit to drive the car?
I’ve been minimising my driving lately when I feel I’m too sedated. That means I don’t do long distances, especially when I’ll need to drive home again later in the day. I don’t need a collision to tell me I’m not fit to drive!
What will I do if that happens? Cancel? Then I’d feel like a failure. Go anyway? That could be dangerous. Get a cab? How would I get my bike there? and etc!

What if it’s too hot for me?
Since I’ve been on this particular antidepressant my temperature feels high all the time. I’ve never actually checked if it is higher, but I feel hotter than the average person unless that person is going through menopause in which case we’d make good buddies! When others are comfortable I’ll be wringing sweat from my brow! Which sounds old fashioned and romantic but it sucks, it really sucks! I don’t like sweat beading on my forehead and running down my face or into my hair! I don’t like other people seeing that. I don’t like them seeing me wiping the sweat off. I don’t mind having them see me wave a fan around or sitting in a breeze but the other stuff? Ergh!

What if I don’t have the energy to get on my bike and ride?
So many days I just don’t have the energy for anything! I’ve become very sedate.
How do I know I’ll be able to do it? What if I just can’t and get humiliated?

Also, what if I’m too unfit?
I know the course description says no one is too unfit for them, but my hubby and I went on a 5km ride a few months ago to try to get me back into riding. The scenery was beautiful but I couldn’t hear anything over the sound of my heart beat and breathing!! And it felt bad!
What if I get left behind and its shameful that I’m so unfit at such a young age?

At about the sixtieth what if my husband suggested a Valium and that helped. A lot. Diazepam, it really is a wonder drug used sensibly. It took the agitation and fretting and stressing out of it. The contingency plan from my husband: all I want you to do is show up. Go there with your bike and at that point that’s a win. Stay if you feel like it, if you have to leave early that’s okay. If you can get through the whole thing that’s fabulous.

Perfect! He always knows what to say! My issue in all things is the starting. Getting out of bed, getting out of the house, getting started on a job, getting to a social event. If there was a time warp around the getting ready life would be easier. It’s the mental preparation that trips me up!
Once I’m there, out of bed, out of the house, started, at the event I’m fine! I’ll be yucking it up with everyone, telling stories, hanging out, ready to get the day going.

So I had my back out strategy, which is vital! If I can’t think of the way out of any place or situation I tend to get panicky. But knowing that I can leave whenever I want and having a specific plan for how I will execute the leaving makes it okay to put myself in that restricted position. It’s crazy but it works! Everywhere, every time.

So I’m stoked with how it all went!

The 3 trainers were lovely and there was no pressure. There were only a handful of us so no hoards of unknowns to face up to. 90 minutes was taken up off the bike with instruction and demonstration so that was a big relief! When we did do riding it was gentle and tiny distances. I seemed to be at least at the same level as the other ladies so no more fear of being left behind!

I looked okay in my clothes which made me comfortable; no more squishing into old size 12 and 14’s; from now on regardless of the size I’m wearing clothing that suits my new figure! I was able to do everything I was asked, my bike is the perfect fit for me, and some old confidence and enjoyment of doodling around on my bike kind of seeped back into my heart.

It made me glad that I was on track to rediscovering riding for fun. Not for competition or eliteness but just good plain fun! I’m excited about that!! It’s so important to me these days to have things that are mine alone to feel good about, to enjoy, to feel satisfied with. My bird watching, my photography, my writing and now my riding. This isn’t so I can go on every Saturday monring 5am 100km road ride with my husband, or brother, or sister, or brother-in-law or father etc! This isn’t so I can go all day up hill down dale mountain biking. This isn’t so I can put on an external skeleton and go hurtling down Hotham or Buller in the off season! Definitely not the last one!

This is for me. This is to remember that I have a kife skill in me that can make me feel better about myself, that I can openly and completely enjoy without any reserve, that is all mine, that I dictate and I steer.

Anything that excites me these days is to be treasured!! Held on to and pursued. And I really feel like this is it!
There are 7 weeks to go, and I’m really truly looking forward to all of them 🙂 YAY!!!