Fountain of Too Much Going On

Hello Friends:

So usually when I take a series of long writing breaks, it's because I am too depressed to write.  I'm happy to say that my long absence has been due more to having too much going on, rather than nothing going on (for a change).  The year has been overflowing (like a fountain, see pic :) although there has been both good and bad, it's mostly been good.

Yet, it's always unsettling to go back to the blog and keep trying to blog, no matter what has been blocking the writing.  It's tough.

It's been an anxious year.  I've had a lot of health concerns I've been trying to nail down, as well as lots of travel.  I haven't been able to really get out and see friends, so I've been sort of isolated.  And the kicker is that I've been trying an experiment to see if I can get back into 'real' work, at least part time.  Very anxious.

It isn't as if I don't have oodles of ideas for posts.  Since there has been so much going on, there has been lots and lots of fodder for posts.  I just have to get the stuff down on 'paper' and get it, you know, posted.  And I have a lot of catch-up reading to do on all of your blogs, as I get myself back into the swing of things here.  Or try to, once again.  Which is also an anxious sort of thing.

Up until about December or January I was pretty down, and I think getting out of that can be credited to adding some Abilify to the med mix.  Celexa and my many supplements just weren't cutting it alone.  I'll also give some credit to my light box as a good 'brightness fix' in the winter months.  If you are like me, and feel down in winter, you might want to consider one of these.  Mine is pretty effective.

So to wrap up this rambling post, I'm not going to promise too many more posts too soon, although I'd really like to get some of these ideas down.  I've just been too sporadic over the last year.  But as I try again to get back into other activities that put me into the world, I'm going to keep on trying.  I look forward to reading up on your blogs!

Your Hostess With Neuroses

Image credit/info:  Picture of a fountain, on Flickr via Creative Commons CC 2.0.

So What is My Civic Duty When Sick, Anyway?

Woman pretending to
contemplate mask.

Hello Friends:

So okay, after my last post I kinda feel like the universe is having a bit of a joke with me.  I am now the sicky.  And I'm back on the train.  Yep.  No, I'm not wearing a mask, but I swear I know how to use a tissue, and I also use handiwipes constantly.  Still, I would not be offended at all if you chose to sit next to someone else.

In fact, I sort of wish the woman who would not get off her cell phone had done just that, instead of smiling, sitting next to me in the quiet car, and then proceeding to chatter away.

Anyway, in my last post I was talking about how everyone on the train was sick but me, and now there is some turn around for that.  I am sick, and feeling guilty that I am out in the world.  But for the moment, it seems to be a mild cold, and I can't justify not getting on the train and getting back home, as scheduled.  Nobody wants to sit around hundreds of miles from home in a different city.  That's what I'm telling myself, anyway.

So the ride is this strange combination of good and bad.  On one hand, I don't feel that same fear of all the other sick passengers, because, well, now I am one of them.  I caught a bug and now it is sort of like there is nothing to fear.  But on the other hand, I'm feeling guilty that I'm here at all, and not in fact wearing a mask.  I guarantee I'm not coughing or sneezing all over, really, but is that an excuse?

This obsessive thinking about this ... well, I know it is just another aspect of the OCD and anxiety disorders.  I ended last week saying I needed to learn to be more compassionate.  I know I need to learn that compassion for myself.  It seems to be the hardest person to feel compassionate towards.

Okay, except for the ladies on the cell phones in the quiet car.  I'm having serious trouble with compassion for that.  But I'm even making a go at it, because, well, people are people and we are all in this together.  (I mean, who isn't doing their civic duty, here, me or them?  What is the more anti-social thing, no mask or constant chatter in a quiet space?  Why sit in the quiet car if ... wait, I'm ranting again.)

So I'm not sure what the point of this post was.  First, I guess, to express that strange feeling of being sick, and so not having to be afraid of getting sick anymore.  And then to talk about that guilty feeling and sense of social duty.  Am I making the people around me as anxious as they were making me last week?  I'd feel rotten about that.  And where is the line of civic responsibility, anyway?  Masks aren't common in the US, but aren't a bad idea.  Of course OCD wants a definitive answer.  A final ruling about exactly how I should act when I'm sick.  There is no such thing.

How about I just keep up with the good use of tissues and handiwipes?  And maybe try some more compassion for myself, and for the others on the train.  Even ... ahem ... cell phone users in the freaking quiet car.

Your Hostess With Neuroses

Image credit/info: Woman with Mask, Photoxpress.

New Doctors and Other Triggers

Hello Friends:

So here today is a happy picture, in honor of Easter, obviously.  I found out that a long time reader was very distressed over the picture I had in my last post.  She wanted to check and see if I had posted anything more recent, but had stopped checking the blog since the picture was too triggery.  This is a good lesson for me.  I had, of course, intentionally chosen the image since it was a good match to the subject of the post, and because it generated an emotional reaction.  I wanted to express some of the outrage I felt at the subject, but I hadn't meant for it to be actually painful to view.  I'll be a bit more careful with my images in the future.  Here is a new post, with a happy image, so that the other one moves on down the line.  We all have enough sources of stress without running into creepy images on our favorite mental health blogs, eh?

And speaking of sources of stress, how about the one where you lose three of your mental health providers within two months of each other?  This is what I have going on in my treatment life right now.  My pdoc (psychiatrist) and two of my somatic therapists are moving on to other things, or have taken extended leaves of absence.

My reaction has been pretty typical of a patient losing a doctor that they have become attached to - denial, anger, fussiness, pouting, and then trepidation at trying to find someone new.  My pdoc has already provided a list of possible alternate doctors, and since I only see this person once every three months, I'm trying not to get too bent out of shape.  I just need someone who will write that prescription and keep me on track with my meds.  But still, I am anxious that I'll have to go about justifying myself all over again to a new doctor.  It is a process I hate.  I know I need the meds.  And I despise the fact that there is someone else who actually has the veto power over my ability to function.  Being dependent on another person to deign to allow you access to your meds is demeaning.  Or at least it can feel that way to me.

I'm more worried about finding new somatic therapists.  In the last two years I've made a lot of progress because I've engaged in this mix of massage/talk/energy work that goes straight to the deepest emotional memory of the body.  It has made a huge amount of difference in my being able to process issues around my CPTSD.  But the trust level involved is huge - it takes a long time to get to the point where you can be that honest with anyone, while at the same time they have their hands on you, possibly causing actual pain as they realign your pelvis.  A strange but effective process that hinges on the trust in the therapist.  No surprise there.  But finding a new energy therapist is going to take a lot of time, indeed.  I'm not even sure there is another clinic in proximity to where I live.

So this might the time for me to try some other kinds of therapy that I haven't really given a fair shake in the past.  And I have hardly been keeping up daily with my mediation and yoga at home, either.  Still, I'm not quite sure where to go from here.  I guess I'm still in the denial/fussy phase, where I just don't want to find new people.  It is so hard.  How is it that those of us with such low self esteem have to be in these positions of thinking we deserve new and good therapists, anyway?  I'm glad I'm not really depressed right now, since in a low like that it would be impossible even to consider finding new people.

Okay, enough ranting about that there.  I'm interested to know how you cope when you need to find new providers.  How long do you spend in denial, and how do you go about filling in the gap?  Do you have any strategies to bolster yourself, and finding new people?

Your Hostess With Neuroses

Image credit/info: Rainbow Easter Eggs D. Sharon Pruitt on Flikr via Creative Commons CC 2.0

Sane? Depressed and Overwhelmed, Instead.

Hello Friends:

I am choking on the irony of having posted "Apparently I am getting more sane ..." and then having the week I just had. No, nothing 'bad' happened. No illnesses or accidents or any of that. It is, as usual, the depression that comes out of nowhere. People see me, notice I am down, and say "What's wrong?" I want to say "Where have you been for the last two years (or ten or thirty)? Do you see the list of diagnoses at the top of this page? That's what's wrong. Do I need more?"

People are surprised. "But you were doing better." I want to pummel them over the head. "So that means I never have another bad day, or week, or month, then? Progress is always straight up, eh?"

Grumpy, down, overwhelmed, sad, and cranky. What a great combo. Oh yeah, I have a migraine, too, with that wonderful nausea that goes with it. I'm blaming this one on the Celexa. But I'm blogging, and I'm going to count this as my "functional" success of the day. Whoo.

I can, however, see a trigger for my current state of bleh. I went from anxious, to overwhelmed, to unable to cope, to depressed. It is a pattern I am familiar with, but before this last year I don't think I would have seen it quite this clearly.

What I think set me off was a series of health related stuff. Again, nothing bad, just stuff that is starting to need attention. I've been overweight for decades, and was able to get away with it because I was young.  I'm not young anymore, and my last physical shows me on the border of having some cardiac issues; my good cholesterol is going down, my lipids are no good, my triglycerides are on the line. Doc is saying that if the niacin does not work, I'll probably have to start a statin drug. This is ridiculous. I'm too young and the wrong gender to be on Lipitor. Yes, that's a stupid way to think, but here I am thinking it.

But taking all those supplements she has prescribed is hard. My OCDs are mostly contamination based. Pills are a daily struggle. I have seven total to deal with, given the mind meds and the supplements. It's too many. I showed her all the bottles and said I couldn't promise to be med compliant with all this stuff, and she had to eliminate some of them. She didn't. So I have the same lineup of bottles to deal with every morning, and that means some mornings I turn away from them in defeat.

So I have to lose weight. Which means exercise for real. I can do it, but it takes an inhaler to do it without practically passing out, since I have exercise induced asthma. And I'm afraid of the inhaler. I've been using it, but it makes me feel terrible. I need a different prescription. That means calling and getting one. And then finally picking it up and using it. Inhaling weird stuff. And then I'm still supposed to have mental resources left to get on the treadmill?

And then there are the flexibility and strength exercises. I have those from my somatic therapist. She at least agreed when I said she could give me three and no more. So there they are, another thing to do every day, added to a list that I can't handle as it is.

Include food. Food, which is one of my real trigger issues regarding OCD. Shopping, cooking, and then cleaning up. I can do one of those, not three. But losing weight and eating right means planning meals, shopping, keeping the pantry stocked, using leftovers, etc. etc. I can't even bear to think about it. My mind is not dealing with planning, and I don't have the energy to stand in front of the stove and cook.

Okay I could continue with the depressive ranting. But the picture is pretty clear. I am trying, really trying, to get better. It is never good enough. Never fast enough. There is always more more more to do more to try. Pressure. And then when I get some random physical chronic illness it'll be my fault.

There's my whiny post. I'll try to get something less self-indulgent next time.

Your Hostess With Neuroses

Image credit/info: 

http://www.flickr.com/photos/76074333@N00/ / CC BY 2.0

A Successful Visit to the Doc for that Pesky Exam

Hello Friends:

I had my annual physical exam yesterday, and it actually went pretty well. This is in contrast to my physical last year, which ended up being something of a disaster. That situation was what motivated me to try harder to express my needs and get advocates for health care. I have too many CPTSD flashback triggers in doctor's offices and hospital settings. The environments are too threatening. And as you know I recently geared myself up to visit the obgyn for the first time in years. I used a lot of my tips and ideas (from post I and post II) to make that visit go better, and it worked pretty well.

So I went into my yearly physical a bit more prepared. I took my Ativan the night before to ensure a good night's sleep. And since it isn't fully out of the system in twelve hours, I had some left to help buffer the visit itself. I had my husband come with me, so that he could listen to the advice I was given, and make sure I didn't forget to mention anything important. He also gets to sign all the forms so I don't have to touch any contaminated pens and clipboards. Ewww. I wore comfortable, loose fitting clothes and a tank top. This turned out to be a big bonus since they didn't have to remove it to do the standard EKG test. (Having to take off clothes makes me feel shaky and vulnerable.)

Let's see ... I brought a food bar to scarf after the blood test, and asked right up front for juice. Last time I spent the visit in a state we call, "gone a$$hole from hunger induced madness of the brain." This time I got my blood sugar right back up. I also had made sure to drink lots and lots of water the night before and day of, so the tests were easier. Nothing like performance anxiety when you are trying to pee in a cup.

I told the nice nurse I wanted her to take my blood. She says the same thing every time, "There are others better at it than me.  It might hurt more if I do it." She still does not quite understand that it isn't about pain, it is about personal trust. The pain of the stick is not what bothers me, it is the feeling of helplessness, the loss of control, the sense of violation (along with the fear of contamination.) All of these things are much less of a problem if I know that the person I am working with sees me as a real person, respects my limits and boundaries, and will take me seriously when I say "There is one vein. One. Only one that will work. It is right here." And she does, and did. We hit it on the first try, and the rest was cake.

But most importantly, my doctor is finally catching on to what it means to have a patient with PTSD and very bad anxiety. I asked specifically for continuity with the staff. This is a trick in that practice since people are always coming and going. But she is going to try. She made of point of having me introduced to the new nurse I'll be working with (when the old nice nurse retires, boo hoo) and introduced me to the manager of the front office. I've also been told to ask specifically for the manager any time I have an issue. This "permission" will make it easier for me to feel like I have a right to stand up for myself. Even if they forget, and they often do, I'll remember.

And even if I get the run-around for something in the future, just having gone through this will make me feel better. I felt respected. I felt like people cared about my individual needs. They still don't really understand. For example, my doctor still has me on five different supplements (I do need them, I do have all the deficiencies they are supposed to fill.) But when I told her I couldn't take them consistently, there were just too many, she couldn't understand that. No matter how many times I tell her that every single pill is a struggle, vitamin or not, she doesn't get it. So I will probably remain semi-compliant with my meds. I will always try, but there is only so much of me.

However, they are trying. And I am trying. It all feels much better. Still very scary, but it has become something that can be managed, something that can be coped with.  I didn't dissociate once during the whole visit, even during the blood test. I was present in the moment, and had only a few episodes of hyper-aware anxiety. And then I got a french-toast breakfast. Oh yeah.

Your Hostess With Neuroses

Image credit/info: Photoxpress

A Successful Visit to the OBGYN

Hello Friends:

Visit is done! Yeah! And hopefully all tests will be negative and I won't have to go back for a year! I said I'd report out on the visit. If you don't know what I'm talking about, check out Part One and Part Two of White Coat Anxiety.

One of the first things that helped was that I'd made a field trip to the office two weeks before the visit. I'd scouted the location of the building, where the office was inside the building, had checked out the waiting room, and had dropped off the forms I had downloaded from the web. So no worries about where we were going day-of-visit, or what the place would look like when we got there.

I took my Ativan as planned, and gave it time to kick in. I wore what I said I would, took music, a book, and Stitch. Stitch is the curious sort and generally likes strange new things and places, so he was game to come along. He also liked the idea that if anyone was mean to me, he'd get to bite them.

The place is big; sort of a factory, really. In my head I was calling it Tw@ts-R-us. There are sixty five chairs in the waiting room (yes, I counted, since what's an OCD person supposed to do in a waiting room, anyway?), with a lot of floor space. Big room. There are sixteen doctors listed on the various signs, and arrows pointing you to stand in the correct line based on doctor. Factory.

But a nice one, pretty comfortable. Friendly receptionist.  Here's where I got my first small surprise. There is no chance you can get all the paperwork filled out ahead of time, even if you ask for it all. They had 'secret' forms waiting for me, which must somehow be special since when I asked two weeks ago if I'd filled out all the forms, they'd said yes. So hubby had to deal with them, since I don't do forms at visits. But I had managed to get the biggest and longest forms finished ahead of time, and dropping those off gave me a chance to see the place. So, not perfect, but better.

The wait was only ten minutes, and we were in. Hubby was with me. The alcohol smell in doctor's offices always puts me on edge. Very triggery, and unless I'm careful it can bring up a flashback. I have to keep telling myself where I am, NOW, right now, so I don't slip out to another incident in the past. But the smell wasn't as bad as at the general doctor, and there were not nearly as many people coughing and all that. So in a way it was easier than gdoc.

This doctor was very nice. Talked to us beforehand, and was very understanding about my diagnoses and what I needed to do to stay comfortable (like hold hubby's hand, have Stitch threaten to bite them, etc.) And then, well, there was the exam itself. There is nothing that makes that part better. It hurts like hell, mentally and physically.  For others, I'm sure it isn't like this.  But with the endometriosis this procedure is terribly painful.  And having to be in that pain, there, when you were abused is nearly insupportable, no matter how much positive-cognitive whatever you've been telling yourself.  I always cry hysterically, and this time was in so much pain I bit my hand until it nearly bled.  But two minutes of torture, and it was over.  I was shaking and had tears all over my face.  The doctor did a good job of walking the line between being sympathetic and acting as if this was all normal.  Then she gave us a few forms, and we could leave.

There is always that moment after the the obgyn doc has left, and you are standing there in a half-open, too-small robe, in a cold room, 'alone' (hubby was behind curtain at that point). There is no getting over the sensation that you've just been violated and then abandoned. Left to sort of clean yourself up, get dressed, and then go back out into the world as if nothing has happened. That it is all a big secret, like your past. But the sensation went away and I pulled myself together. Then I started to feel pretty happy, because, well, first of all I was going to blog all about it, so it was hardly a secret. That felt good.  And second, I had actually done it. All over.

Almost. Of course now that I'm 'of an age' I have to get a mammogram. Haven't had one since I was about 24 years old, when they were looking to see what the cause of my chest pains might be. I certainly remember that having my frontal chest parts shoved between two collapsing plates was really pretty damn painful. And any x-ray procedures make my contamination issues flare. But still, I'll bet it will be easier than having metal shoved up my tw@t.

A few other items of note. I need to bring something I can bite on next time. The place on my hand where I bit myself is a painful, bruised lump the size of a quarter. Also, another success, I didn't have to wash my clothes or purse after I got back. I felt pretty uncontaminated, overall, and only needed to use my towelettes once. And of course, when I got home I asked for flowers and chocolates.  So hubby went to the grocery store and came back with flowers and chocolates.

Overall, 100% mission success. Except Stitch was disappointed that the only biting that went on was me biting myself.`

Your Hostess With Neuroses

Image credit/info:  My Stitch.  Him eyeing my chocolates.  Or knowing him, he's thinking of eating my flowers.

Going to the Doctor Part II of II - The Visit (or More Tips for Dealing with White Coat Anxiety)

 Hello Friends:

Well, today I go to the doctor for my 'yearly' check of my womanly bits, as I noted yesterday in my post Going to the Doctor Part I of II.  I can't tell you how very badly I do not want to do this.  I really don't want to go.  But I am going.  I am going to put on my brave persona, and I'm going to do this.  First of all, because I need to get this done.  Second of all, because if I let myself be frightened away I won't be able to test how well my suggestions worked.

And then I won't be able to post about it.  Blog as motivation.  Whatever works.

Anyway, here are my tips for the day of the doctor visit. Assume you already did what you could from my list of tips on yesterday's post, and now you have an actual appointment to go to.  (Like, say, I do.)  Again, all of these tips might not work for you, but some might be of use.

Some preparation the day of the visit:

• If you are, in fact, experiencing anxiety about the visit (har) try to put your finger on exactly what you are concerned about.  Claustrophobia from the small rooms?  Afraid of needles, contamination, germs?  Maybe it is a sense of violation or that someone will take advantage of you.  Some people are afraid they will get bad news about their health.  One of my fears based in past trauma and PTSD is the fear of being yelled at, put down, told I am irresponsible and such.  If you can identify the things that are causing your anxiety, you can work to try to accommodate them yourself, or to get the doctor's staff to do so.  You can also be proactive simply by naming your fears and doing some cognitive self talk to mitigate them before you go.
• Do you have a med you can take as needed for anxiety?  If so, take it.  In my case I have a prescription for Ativan to take when I travel, to deal with crowds, and in case of a sudden panic situation.  If you don't have a med like this, you can always talk to your doctor about getting something to help you through tough situations.  I will be taking my Ativan an hour before I go.
• If you know you need to have a blood test done, drink water.  Dehydration makes it more difficult to spot those hidden veins, and water will increase your overall blood mass.  Naturally, you'll need some water for that urine test, too, huh?
• If there are specific issues you want to bring up with your doctor, write them all out ahead of time.  I can't think in that office with my anxiety running so high.  If your support person will be in the exam room with you, give them a copy, too, so they can help keep the visit on track for you.

What to wear:

• Comfortable clothes that are easy to get on and off.  
• Short sleeves in case of blood pressure test, etc.
• Socks to keep feet away from cold floors and cold, ahem, stirrups.  
• Shoes that slip on and off (in my case that is critical since I can't tie shoelaces that have touched the floor of a doctor's office.)
• A sweater to keep warm in chilly examination rooms.
• I'll note that sometimes I wear something very specific to make me feel safer or more powerful.  I have a necklace with a dragon on it that I use for 'protection'.  Sometimes I will wear a suit jacket to the doctor because it makes me feel like people take me more seriously.  Consider what might make you feel more at ease, or more in control.
• Also in my case, I don't wear anything that can't immediately be stuffed into the washing machine when I get home.  Doctor's offices feel contaminated to me, and I want those things off and washed as soon as possible.

What to bring:

• Bring spouse/friend.  My hubby will be driving me there, sitting with me in the waiting room, and will probably be in the exam room with me, depending on how I feel.
• Bring bottled water and a protein bar to munch immediately after the visit, especially if you had to fast beforehand.  My blood sugar plummets in stress situations as adrenaline spikes and then wanes.  A little food and water help me a lot.
• Bring your OCD coping items.  Normally I try hard to keep from overusing things like disposable hand towels, but a doctor's visit is not the time to be stingy with coping mechanisms.  So I bring my own towelettes, hand sanitizer, pen, and even tissues.
• Take a really engrossing book for the wait around.  
• Take a purse or bag that you can wash.  This is a big one for me.  I put my things into the bag, and then when I get home I dump them out.  My book is 'clean' and I put the bag into the washer along with all my 'contaminated' clothes.  Whew.
• Do you need a comfort object?  They do it for kids, and really, all of us have wounded inner children.  Kids might bring a favorite toy, story book, or stuffed animal.  Treat yourself the way you would have wanted to be treated as a child in this position, and bring a symbol of comfort.  I'm taking my stuffed Stitch 'animal'!  (He'll bite the bad guys.)

At the visit:

• Ask for the accommodations you need from the staff.  They might not be able to do everything, but sometimes a little is all you need to know that people are looking out for you.
• Stay as relaxed as possible by distracting yourself with your book, talking with your friend, meditating, listening to ipod, whatever.
• Keep reminding yourself that you are at the doctor for very good reasons.  Tell yourself about how the tests are a necessary part of health care, and that doing them is important.  You are taking control of your own life, health, and well being.
• Remind the staff and doctor about your mental health issues.
• Ask the doctor what to expect during any procedure.  How long will it last?  Will it hurt -  how much and how long?  Where will you have to touch me?  Will I be in this room alone with stuff attached to me?  Will anything like alcohol or another substance be spread on my skin?  Ask about anything that concerns you.
• Refer to your list of questions, and have your friend help make sure you get all of your issues addressed.  Don't let yourself be rushed.  You are paying for this visit.
• If necessary, have you or your friend write down comments and suggestions from the doctor so you can refer to them later.  This takes the pressure off of having to remember the whole conversation while trying to ignore that small drop on the floor that might be ... who knows what.

After the visit:

• Give yourself a big cheer, you deserve it!
• Reward yourself.  If you had to fast for a test, maybe a great breakfast or lunch would be a good reward.  Personally, I like flowers and chocolate.  Anytime.
• Be especially gentle with yourself for the rest of the day.  The visit might have been tough, no matter how well you prepared.  Give yourself the slack to relax, take a nap or a hot bath, read a book, play video games, have a glass of wine in front of the fire, or whatever works for you. 

And that's what I have to offer, today.  I'll be doing a lot of this myself, obviously, and I'll let you know how it went.  Please send comments on this list, or more suggestions for stuff I might have missed.

Your Hostess With Neuroses

Image credit/info: Photoxpress

Going to the Doctor Part I of II - The Background Work (or Tips for Dealing with White Coat Anxiety)

Hello Friends:

I stumbled over a site today that was talking about the "little known or ignored sources of trauma" that can result in PTSD.  One of them was "hospitalization before the age of three."  I already knew my childhood medical history was a source of trauma, but had never seen it called out quite so specifically.  It is both validating and scary.  Doctors do suck, especially when you are a kid.


And Thursday, I have my first ob/gyn appointment in four years.  Yippie.

As you know I've posted occasionally about the fun you and I have dealing with health care.  It is hard enough these days getting decent insurance, finding a provider, scheduling appointments, and then actually showing up for them even if you are a 'normal' person.  The challenges are magnified when you have a history of abuse, never get enough sleep, are too afraid to leave the house, are terrified of needles, and on and on.  For me, visits to the doctor have always, always been terrifying.

One of the main reasons for that is, of course, that I was very sick as a kid.  I had a near fatal childhood illness that put me into the hospital at the age of two and a half.  A boy who was hospitalized for the same thing as I didn't make it through the week.  So I certainly caught the vibe, even then, that Something Was Very Wrong With Me.

In those days care for children was pretty barbaric; nobody was worried about traumatizing kids, just getting them out of the hospital in acceptable physical condition.  I was in the hospital for about a week or so the first time, and then had to go back again and again for the next nine years to have scar tissue removed and such.  From 2.5 to 11.5, I was on meds, dealing with visits to the urologist, hospitalizations, and the occasional bladder and kidney infections that were both painful and scary.  I was lied to by doctors, nurses, and lab techs about: how long procedures would last, if my parents would be in the room or not, if there would be needles, how much it would hurt, what I was or was not supposed to do, and more.  So I have some good reasons to hate going to the doctor, and good reasons why doctor's visits cause me some of the worst anxiety I have to deal with, along with great fodder for flashbacks.

Dealing with health care specific to female needs is the worst, at least for me.  In addition to the childhood illness, there was the abuse, and then I lived with an abusive boyfriend for five years just to make sure I had myself really, really messed up.  I'll also mention the painful endometriosis, polyps, and fibroids that went undiagnosed and untreated for more than a decade.  So I'm a bit touchy about my 'female areas' shall we say.  But for some reason, I got it into my head that it really was time to go back to the ob/gyn and get a check up.  And I actually managed to schedule it myself.  What was I thinking ...

So for the rest of this post, I'm going to write up some of the tips and strategies I've collected about how to be as comfortable as possible with your doctor, whatever the specialty in question.  I'll do the general stuff in this post, and then tomorrow I'll post about the specific stuff one can do on the actual day of the visit.

So first of all, "White Coat Anxiety" is apparently the general term for people who really do not like going to the doctor, any doctor, including the dentist.  It is pervasive, and as I noted in a previous post, I have no idea how it is doctors don't realize how badly people suffer just trying to take care of their health in a responsible fashion.  I'll mention that "White Coat Anxiety" is not the same as "White Coat Syndrome / White Coat Effect" which is the syndrome where some people's blood pressure skyrockets in the doctor's office, and they can't get a good reading.

These tips are not going to be useful for everyone, especially if you are in a deep depression right now or live in another country with different heath care rules.  But this is what I gots to give ya ...

• Recast the idea of a doctor from someone who has control over you to someone who you are paying to provide a service for you.  You are the customer, and you can "fire" any doctor any time you want, and find another one.  Ah yes, power.
• Find a provider of the gender you need.  I'm seeing a female ob/gyn, female dentist, female dermatologist, female optometrist and female general doctor.  My therapist is male.  All these were conscious decisions on my part.
• Try to do some "interviewing" to find the doctor you like.  Find one who is in a clean, non-threatening facility.  One who has staff and nurses who are friendly, relaxed, and competent.  If you don't like the "interview" don't go back.  Get recommendations from people you know, and even from the doctors you visit; they will be happy to recommend their colleagues.
• If it is right for you, tell your doctors about your mental illnesses up front.  When I called to schedule this particular visit, I made my history clear and requested a doctor who could deal with it.
• Be kind to yourself and remember how hard all this is.  Pat yourself on the back any time you schedule an appointment.
• If necessary, have a friend help you schedule and keep track of appointments.  And then perhaps that friend or another can help you actually get to and from those appointments.  If you have help set up ahead of time, the visits will be easier to handle.
• Try to show up for every appointment you schedule, rather than canceling or postponing.  It will only cause more anxiety and hassle in the long run.
• If possible, download forms ahead of time from their website, or get them faxed.  I hate filling out forms in a doctor's office with their disease-ridden pen, and with my anxiety-addled brain.  Filling the forms out at home relieves some of the stress.
• Establish a relationship not just with the doctor, but with the staff.  If necessary, request to see just one staff person for having vitals taken, blood drawn, etc., and then only make appointments when that person is available.
• Get all the help you can from your health advocates.  That's everybody: your spouse, family, friends, and especially your therapist.  Have your therapist call your doctor and make your needs clear.  Discuss possible accommodations with your therapist and make sure your doctor is on board with it.  I think advocacy is the strongest tool for making health care more manageable.  

Nuff for now.  More later when I'm contemplating how I'm going to make this next visit go as easily as possible.  Got any ideas for me, or for this list?

Your Hostess With Neuroses

Image credit/info: Free-StockPhotos.com

Time for Dentists to Talk to Doctors

Hello Friends:

So this is something of an experiment. Not the dentist - I've done that before. The experiment is trying to blog when really depressed. Up to this point I've blogged at the moderately depressed level, and then punted when truly in the dark land. I'm trying to keep the tone here in Anxiety Land sort of upbeat, and I'll admit that for most of the time that is actually how I feel. I had this idea that I shouldn't blog depressed since I'd sound stupifyingly stupified. Or maybe just pathetic. Or too emo. I like a little emo, being a closet goth, but too much emo makes me feel like I'm still a teenager. I hated being a teenager. More than twenty years later and I still hate it.

Anyway, the point is this. As it stands, if I don't blog depressed you might not hear from me again for another two months (which may or may not be a bad thing). So here goes.

Ahem.

The dentists really need to get the doctors up to speed about how to deal with freaked out people. I made a point of talking about 'dealing with the crazed' when I was at the dentist on Monday. The receptionists, hygenists, and the dentist herself all have had some level of training, however informal, in dealing with scared people. Apparently, the idea that 'nobody likes dentists' is well known. Axiomatic. We all know it, they know it, and they work hard to get and keep clients in spite of it. And that means learning how to deal with anxiety disorders in patients.

I wonder how it is the doctors have not figured out that nobody likes them.

From the time I walk in the door at my dentist, everyone is smiling. The receptionist knows my name, and remembers I have 'issues'. They all say lots of soothing things as I go back to 'the chair'. Here is some of the conversation, assuming you define that word loosely.

- "Can I take your purse?" "Ah, yes, if you don't put it on the floor." (No problem)
- "We'll be using this room right there." "I can't touch the door knob." (No problem)
- "Anything we can do to make you more comfortable?" "Yeah, I need breaks sometimes, I want that topical anesthetic you use on the five year-olds, you need to constantly be telling me what you are going to do before you do it, and I want to control that suction-thingy myself. And by the way, point that x-ray machine away from me." (All no problem)
- "I'm going to floss your teeth now." "Nope, nobody flosses my teeth but me." (No problem)

And then, after much of this, I get to leave. Everyone tells me how great I did. And even though I have to come back for another cleaning in three months, I'm feeling dramatically better about making the appointment. It has taken them only a few visits to gain a certain amount of trust and confidence from me. When I say I want something, it happens. No matter how wacky it sounds, or how baffling my behavior, they all make it seem totally normal, and take me seriously.

So, again, why is it so very different at the doctor? The dentist pokes in your mouth, sure, but the doctors are constantly taking blood, prodding intimate places, and asking personal questions. How is it they don't try three times as hard as the dentists to make up for this? Is it simply because people can put off the dentist for ages, if they want, but everyone ends up at the doctor, eventually?

Well, not sure. And I don't have any witty words to end with, either. I just wish really hard that someone would close the gap on this. If there is a whole profession (dentistry) that accommodates anxious people with ease and normalcy, there is no reason for any other profession to fall behind. And those same skills make the place nice for everyone, not just us crazy people. You'd think it would just be market driven.

Oh, wait. I do have something to say in closing. Would you check out that pic up there? Pictures of women in corsets never cease to amaze me. I thought it had to be fake and then I saw her waist. Yes, I've forced my kidneys into my lungs, and my intestines are now in my uterus, but I keep my teeth all pearly white. Yep.

Dear God, talk about body issues. How did men feel it was safe to even touch creatures that looked like that? They look like they'd snap right across the middle. The news reel, "A local woman sneezed tonight while brushing her teeth. Distraught husband finds upper half still smiling." When I'm feeling bad about all the stupid things I do to try to meet some stupid society's stupid idea of beauty, I'll think of her. What I'm doing will still be stupid, but I won't feel so alone.

Your Hostess With Neuroses

The Nurses Can Be Nice

Hello Friends:

In December I had my yearly physical, which included a need to get follow up blood work three months later. (A great way to fill a nice three months with an increased sense of dread). I wrote about my attempt to do the follow up in The Nurses Can Be Crazy, which details how I had a rather inconveniently timed, yet ultimately unsurprising flashback episode, resulting in my leaving before they got any blood from me (other than what was oozing out my pores).

My lessons learned from that, as well as other wonderful and inspiring encounters with the medical profession, emphasize the importance of advocates. It is so hard to ask for help, but when it comes to this medical stuff, I either get help or it just does not happen.

After the whole 'wife leaves the doctor's office in a fit of madness and then winds up at my place of work in hysterics' event, my hubby was understandably concerned that I'd never go back to the doctor again. He's the number one person in the support network, the captain of crazy wrangling, so he was on call to try to make this happen, anyway. But he couldn't get me to make another appointment. There was always some very good reason to put it off. Really there was.

And then I ran out of my mind meds. Naturally, the doc wasn't going to refill the prescription for a patient who was AWOL, so I was sort of forced to confront the need to go back. Hubby agreed both to make the appointment, and to come along to be sure they didn't get out the spear guns or any other torture devices. And because I wanted his help trying to explain to my doc why it is that nurses who need me to interpret my own 'quick dip' urine data inspire very little confidence.

Snippet of conversation from previous visit with crazy nurse:
Me - "I'm sure you'll note the specific gravity is pretty high. I know I'm dehydrated."
Her - "There is a lot of blood in this sample."
Me - "Really? Oh, that's bad. I don't have any symptoms of a UTI at all. Are you sure?"
Her - "Yes, it says right here on this strip that ... oh, wait, that's the specific gravity."
Yes. Really.

Anyway, we did go back, and I did sit down with my nice doctor and try to explain. She was great about it, actually. She absolutely agreed that a person with a history of trauma needs to see as few different people in the office as possible so that a trusting relationship can be developed and maintained. She asked me who I liked, and made it clear that they, and only they, would do my blood work. She told me to call that person specifically and finally set up the appointment to get the follow up work done.

I couldn't quite bring myself to do it. So even after that encouraging visit, I had to have, yep, the hubby, do it for me. He set up the appointment, and then had to take a half a day off of work to make sure I got there and then got fed afterwards. Getting blood drawn is an event for more than just the possibility of hysterical trauma-drama. I also am a bit hypoglycemic, so can't be trusted to drive on an empty stomach. And I'm about the furthest thing from a morning person imaginable (I became an astronomer for a reason, you know). The combination of all these factors creates, shall we say, a somewhat volatile situation that has to be dealt with with compassion and then a great breakfast buffet.

Today was the day. So this morning I got up. Early. Didn't eat, of course. And then got driven to the doctor's office. I tried hard to maintain an upbeat and non-bitchy attitude, which was easier with my husband there. We get along really well, and so it is nice to have the excuse, any excuse, to spend more time together. We got called to go back, and the nice nurse I like was there, and smiling. Mostly at my husband, who they seem to remember well from his physicals. Probably a result of his always having had some success in charming the ladies. The nurse listened to me when I told her of the one - the one and only - place you can drill me in the arm and get a gusher on the first try. And she didn't need to be told to use a butterfly needle, either. I was also let off the hook of 'trying to act normal' since my husband was entertaining her with conversation through the whole thing, and I could just sort of shake, bounce, sweat, or whatever and not feel like I was the star of the show. And then she believed me when I said was allergic to bandaids (I really am) and needed paper tape instead.

By the time we walked out, I was already back down to Defcon 3, which is almost my 'normal' level. The whole thing went off nearly flawlessly, as far as I am concerned. And then I got that great breakfast. Which I almost remember eating.

This to me is all reinforcement of the support network and advocacy ideas. I can't believe I need this kind of help to get blood drawn, but I really do. And feeling bad about it does not change anything (not that it stops me from feeling bad, but at least there is perspective). It was worth all the hassle of trying to find a good primary care person; it is really paying off now. And it is definitely worth the hassle to resist the urge to 'knuckle down', 'take it on the chin', and do it all myself. To resist the voices that say asking for help is weak, childish, and why would anyone want to help me, anyway?

Oh, hubby also made me a dentist appointment.

Yea.

Your Hostess With Neuroses

Image is a promotional pic from the Dutch 2002 film "Yes Nurse, No Nurse"

Bats – Part Two of Two – Bats are Scary

Hello Friends:

Welcome to one of my more tangible images of hell - imagining standing wherever the heck this photographer was standing and looking up at a sky full of flapping, and probably pooping, bats. My mind conjures all sorts of sensations, like what the air must smell like, or maybe more to the point what it might feel like, taste like.

And I am totally creeping myself out.

(Note for bat lovers - If you missed Part One – I Like Bats, you might think I’m an indiscriminate bat basher. Nope. Go read Part One. I’ll wait right here …)

My fear of bats does not stem from ignorance, is an irrational fear, based on my OCD related concerns about catching diseases from animals. My head knows that not all bats have rabies. My gut however, has its own ideas. In my gut, I ‘know’ all bats have rabies (all squirrels do too, for that matter). I also ‘know’ that you don’t even have to touch a bat to get rabies, all you have to do is touch anything a bat as touched. This counts triple for bat poop. None of this is fact true (you can go to the Bat World rabies site to learn more). But the point isn’t what is or is not true about bats. The point is if you have OCD that centers on diseases, violation, and contamination, bats are damn scary and the truth is next to useless in changing how you feel.

In a previous post, The Big Three, I mentioned how I have three diseases with a special place in my heart, and rabies is one of them. I ‘know’ rabies is everywhere, along with all sorts of other super scary diseases. The Bat World site attempts to put my fears to rest, “A person living in the U.S. is more likely to catch polio, leprosy or the plague than to contract rabies from a bat.” Great. Just great. Let’s do some OCD math. If Rabies = Everywhere, and Plague > Rabies, then Plague = All over the freaking place.

I feel better now.

My personal bat odyssey happened two summers ago when my husband and I were coming home from vacation. At about 2 am we approached the front door, where I had hung one of my usual decorative seasonal wreaths of fake flowers. As I leaned in to unlock the door, something small and brownish hurtled out of the wreath and into my head. Thump. Then it flapped away.

I stood there for several seconds trying to get a grip on what had just happened. I had been hit in the head with a bat. No question. I’d never been within a dozen feet of one before, but it was pretty unmistakable. A sort of warmish softness. Not like a bird at all, I’ve held birds. This was more like a wing-ed mouse kinda thing.

Needless to say, I was completely freaked. My husband spent some time trying to help me by being rational (because God knows how well that usually works). I ‘clearly’ hadn’t been bitten. There was no indication the bat was ill at all. The chance that there was any transfer of disease-ridden-yuckies was vanishingly small. He even did a bunch of research on the internet to make it perfectly clear that I would be fine.

I didn’t work. I tried. I tried so hard. I really, really didn’t want to get rabies shots. I am terrified of needles, terrified of what’s in them. Getting a tetanus shot is like being injected with poison – panic attack is impossible to avoid. I spend a week after a tetanus shot wondering every minute if this or that pain is me dying. Nothing, nothing could be worth going through the rabies series.

Wrong. About thirty-six hours of torture, wondering what the hell I should do, turned out to be worse than the fear of the shots. I absolutely had to be certain I would not get rabies. If I didn’t get the shots I’d spend the next full year, every day, wondering if I was showing symptoms. And by then it would be far, far too late. The uncertainty was too much. My husband called up our primary care facility and told them what was happening; that the war between anxiety over rabies and anxiety over shots had been settled, and rabies won. We went to the clinic.

Then added insult to injury.

My normal doc wasn’t there and instead we had a temp. She spent about fifteen minutes trying to diagnose me herself, and make up her mind for me if I really needed the shots or not. I almost lost it. Really. Having already made this terrifying decision, I was being dragged back through it. Then Providence intervened in the form of the nice redheaded nurse at my clinic, who pushed open the door and said, “You can only get the shots at the emergency room in the hospital. I’ve already called them. They are all ready and waiting for you.”

I don’t understand why my normal doctor did not have the stuff. It was bad enough going to the clinic. The doctor’s office is about as scary as it gets, what with all the sick people and heaven knows what on the floor, and people who think that having blood work done is a walk in the park. But the emergency room? Not good. Not good at all.

But I was now determined. So we went to the ER. I was so bent out of shape that I could hardly breathe. My husband tracked down someone who would listen, and got them to come up with a dose of Ativan to keep me from looning completely. After that kicked in, the doc on duty came by and fortunately was both a nice guy and also informed. He said that there was occasionally some rabies in the county, that the shots were a nuisance but more than worth the peace of mind for someone like me. He said I had made a good decision. I love that man.

So one thing they don’t tell you is that the rabies shots are not the really painful part. Turns out that the rabies shots don’t confer immunity for about a month. Until then, you need something to beef up your immune system. Immunoglobulin. And those shots are given in proportion to the weight of the patient. I am not a small woman. I had seven of them. One in each arm, each leg, each butt cheek. Then back to the leg again cause we ran out of spots to stab. And they burn like F&%!S&#T. Hurt like M&#%$ING hell, in fact, each and every one of them. And it takes time, too. Get the shot, fill another hypo, do it again. Pick another spot to get stabbed. I was already in tears, and then ended up shaking like crazy as an encore. And of course pretty convinced I was going to die from whatever was in the shots, anyway. Then they finally got out the rabies shot, which I figured would be like getting your arm sawed off. Wasn’t though, it was a lot like a tetanus shot. Bit burny, but not like those immunoglobulin things that I’m assuming must have been invented by a certain Marquise.

Then they give you a form. This form is the schedule for the other five shots you have to get over the course of the next month. This about knocked me over. I thought I’d be getting them all at once, not coming back to the emergency room five more times that month. Pwned by the medical establishment. We went home and I contemplated my fate. A month. I was going to be a complete basket case. Might as well face it.

I did what I could to control the damage. I got some leave from work. Called certain people and told them my usual line, which is “I’m dealing with a flare up of a chronic illness.” Which is completely true and totally misleading, of course. My husband had to leave town, so I had to get myself to the emergency room a few times alone. Dealing with the contaminated, hacking, traumatized, crying and scared people one generally finds in the ER of a large hospital. Making sure I had my little form, and getting all the right signatures with each shot, then having them make a copy for their records. Dealing with a new nurse who had no idea what to do with the shot and was reading the directions off the box right there in front of me. One time they couldn’t find their copy of the form, so they figured mine was the most accurate. I am not heartened by a hospital that assumes my records are better than theirs.

And then I had some bad reactions to the shots. Headaches, bruising, muscle pain and nausea. This on top of the panic attacks they caused, and the anxiety from just going into the emergency room in the first place. I was messed up. Seriously.

But one after another I got the shots, and eventually my form was filled up. I got over the acute anxiety, and was able to go back to work for a while. Although I have no doubt that my subsequent decent into a year’s worth of terrible depression was assisted by this medical farce. For me anxiety always leads to depression. Stopping the anxiety is the key to breaking the cycle. So this little episode was contra-indicated in oh, so many ways. I try to remain upbeat about it all, and in fact, it’s hard not to joke about it now. I had always thought bats were cool in an angsty-goth way, and then I was given the opportunity to have a personal encounter with one.

And by the way, I hang the fluffy flowery wreaths on the inside of the door, now.

Your Hostess with Neuroses

The Nurses Can Be Crazy

Hello Friends:

What is it about the medical profession that makes it so very difficult to get your needs understood and met? Now, nurses have a craptacular job, dealing with sick people all day, and much worse. And yet I have this idea that compassion, gentleness, and empathy ought to be part of any nurse's emotional makeup. Ah, my treasured illusions go smasha smasha once again.

Okay, I'll back up and say I visit a great practice with a very understanding primary care doctor, a great head nurse, and staff that does make an attempt to meet my needs. And still, in spite of three years of building relationships, I get taken off guard. On a routine visit I run into someone new who does not seem to have had the common sense to review my file for the split second it would take to spot the (no doubt) big red flag saying THIS ONE IS A FRUIT LOOP and treat me accordingly. Instead, after saying "You are not on the schedule" and "It's important that you understand that this is not appropriate for a nurses visit" (which wasn't actually true, by the way) she wonders why her patient is starting to get flustered and cry. Having spent the last fifteen minutes staring at the empty blood vials on the counter before me hadn't helped, mind you. But this is not the woman who will have the honor of drawing my blood, unless she plans to use her nails.

What is going through a nurse's mind when she looks at a crying patient, and instead of saying, "Oh dear, you are so unhappy. What can I do for you?" she says "Now, you need to calm down." If I could &%$@# calm down by wanting to, it wouldn't be an anxiety disorder, would it?

Ahem.

I ended up leaving in tears before they got to the blood work. I wasn't even sure they intended to do it, given I was "not on the schedule" for an appointment that my doctor told me to make - in writing - with her own staff. Man. Can we all get ourselves on the same page people?

The contrast, and the ray of hope, is the response of three people. My husband, who is as supportive and attentive as a person can be without being an eighteen-hour underwire bra. Then the head nurse I like calls my house - she talks to my husband, apologizes, and asks what we can do in the future to make things different. And then my psychologist, who is going to call my primary care doctor and have "a bit of a chat". Advocates. I think we could all use more advocates for our needs, especially in the medical field. So often it seems they try to treat us in parts, not realizing that a person is a whole package. You try to get well, and you end up leaving battier than when you showed up.

My mind isn't perfect, but I'd sure like to keep what I have left.

Your Hostess With Neuroses