I checked in with my behavioral psychiatric nurse practitioner today. She was shocked by my accidental overdose and very glad that I did not have a seizure. Me too. She quizzed me before I left and asked how many of each kind of pill I needed to take. I got an A+
This blog turned out to be a very valuable resource because I could use it to go back and see when I changed to 450mg of bupropion, when I accidentally upped it to 600mg (I even mentioned not being sure that I had remembered to take 4 pills-- I am supposed to take 3).
I was also able to track a more-than-coincidental relationship between taking my bupropion later in the day and having some zombie-like experiences or having that foggy feeling. So I am going to make an extra special concerted effort to make sure that I always take the pills in the morning (which is the plan anyway, so good).
She was quite happy with the work that I am doing with the blog, with the brilliance of my friends (thank thee F/friends) in their stellar advice. And in general gave a stamp of approval to the general direction that everything seems to be going.
Old me would translate this into "Woo Hoo! I am C-U-R-E-D." Especially when it seemed like she was giving me a non-verbal "What do you need me for?" I would use that as an invitation to take myself off my meds and gradually slide back and back and back. The new me things this is a piss poor idea. New me wins.
I feel like the meds (when taken properly) are at the right dosage and the right combination, at least for now. I have an appointment set for six months out. This is good. It gives me time to try and get some of the non-medication stuff into more regular rotation.
So without letting myself off the hook medication-wise I need to look at being mindful of the nutrition and daily exercise. I think I should get a pedometer. Makes it easy to collect good data and make incremental changes in my routines.
On my list for tomorrow:
Grateful Crap: today is over. (got a haircut from a beauty school that took 150 minutes.)
took meds (150mg sertraline, 450 mg bupropion)
checked in with behavioral psych person
that's really it. I promise I will go to bed reasonably well tonight
So I am not always good at telling whether something is an emergency or not. Emergency always conjures up panic and imminent death. So if I am not panicking, and death is not immenent it must not be an emergency.
Perhaps I need to start thinking of these cases as urgent situations rather than emergencies. They don't involve panic and near-fatalities. They do, however, require some prompt attention and probably outside help.
Here are some historic examples of urgent situations/emergencies:
I fall on my head and suffer a concussion while biking but insist that I am fine and continue on the 20 mile bike/camping trip. One month later still suffering from terrible headaches I go see a doctor. She berates me and says that anyone who has a head injury and waits for a month to be seen deserves to have headaches. She rattles off the horrific list of things that could have (but did not) happened to me if I had a "slow leak."
While playing intramural soccer an opposing player kicks the ball squarely into my face, causing me to fall flat on my back and dislocate my jaw. I insist that I am fine and don't go to see the nurse until another player is injured and he drags me to the trainer's office. Then I spend three hours in the emergency room and three months in recovery. This was a poor start as a first year French horn student in conservatory.
Old Knitting Injury
I have a lovely set of rosewood knitting needles from a roommate in college. I make the mistake of leaving them on the floor of my room. While standing in my bare feet I inexplicably bring one foot toward the other and use this foot to solidly jamb the point of the knitting needle into the arch of the opposit foot. It sticks. Oh, I think, so this is what a puncture wound is like. Yanking the needle from my foot, I hop down the stairs to get help from my roommate, but I can see she is on the phone. As I stand on one foot and try not to drip on the floor and start feeling woozy, I wonder if I should bother her. She fetches me bandaids. The scar fades after ten years or so.
While living in the "garden level" apartment-- my first home with my spouse-- a water main bursts directly under our living room causing a catastrophic flood. Within minutes the wall-to-wall carpet is floating on a sea of water. Everywhere I step a geyser of cold water. I throw everything I can carry into the bathtub-- the only place that seems to be safe. I wonder what will happen when the water reaches the level of the electrical sockets. I stand on top of the piano bench as the water rises, clutching the phone in my hand. Before cell phones, you understand. The phone is giving me mild electric shocks as I debate whether or not this is an emergency that warrants a call to the apartment manager. It is the only weekend that our regular manager is out of town. He has left a number to call in case of emergency. Is this one?
Five weeks before my due date my water breaks while I am home alone-- a forty-five minute drive from the hospital. I have no car. My spouse is having a root canal. I have called in sick to work with a terrible headache. I call my midwife to see if she might want to see me. There is a pause on the other end of the phone before she says very slowly and clearly, "You are having a baby, so yes I would like to see you today." She does give me permission to wait until my spouse is done with oral surgery before I come in.
I wake up one morning about 3:00 am feeling terrible. I call the nurse care line and report that my blood pressure is Wicked High. In his best calm voice the nurse asks me to please wait and then says (after a long absence) that labor and delivery would like to see me. The only time he panics is when I ask if I can wait for my mother in law to come watch the kids or if I should drive myself. PLEASE DON'T DRIVE!
I am informed at the hospital that I need to be evaluated for pre-eclampsia. And they push IV fluids, collect blood and urine samples, take my blood pressure every twenty minutes (causing the alarms on the monitors to flash and buzz). I am told to lay on my left side. The lights are kept low. They tell me they need to induce labor because I have mild-to-moderate pre-eclampsia. More equipment is brought in. They say they have to put me on magnesium sulfate to prevent seizures, coma, and death... So does this mean I can't have a water birth? I am so glad I didn't watch Downton Abbey prior to this delivery.
Not sure what the point of this exercise was other than to make me realize in hindsight that all of these situations are glaringly, obviously, ridiculously urgent. But at the time I just wasn't sure. It didn't feel urgent. Things could have been worse, doncha know.
But with all of these physical situations there are external signs that anyone can see. If I am so bad at identifying urgent or emergency situations when things are so ridiculously clear how am I expected to self-identify urgent situations in my own head. I don't think I am having any sort of urgent or emergent situation now. Don't worry.
I wish that technology and medicine were just a little more advanced on the mental health front. I could use a little more straightforward data. A little less touchy-feely stuff. Because there is something physically happening. There is some chemical, measureable aspect to Depression. I just don't have access to the data.
Grateful Crap: No emergencies today, thank you.
took meds (150mg sertraline, 450 mg bupropion)
talked to a friend
went to meeting
did some crafty stuff
Today we went to Carpenter Nature Center for a raptor release event being run by the Minnesota Raptor Center. Ironically we didn't make it in time to see the first batch of releasees and had to leave before the second batch.
So the only birds we saw are the ones that will never be released. Birds that are too damaged either physically or psychologically to survive in the wild. Barred owl, great horned owl, peregrine falcon, bald eagle, black vulture, kestrel, merlin...
I really didn't want to post today. I think maybe because I skipped yesterday and that always puts a pall on the act of writing. Maybe because I don't feel particularly wordlike. Wordy? Wordificant. I have nothing wordificant to say.
I have been told by many people in person that they are impressed by my courage in writing this blog. "That takes guts." I'm not sure why. The things I write are the same things that I tell people in person (when persons and I are on speaking terms).
Courageous would be allowing strangers to comment on blog posts. Oh, wait, that would just be stupid. The two are so easily confused. I didn't check my email today and I don't want to. Or facebook. I just want to hunker down and hibernate. For no particular reason, you understand. That is just my general inclincation at this time.
So instead I am going over to my neighbor's house to chat and have tea. The inner grown-up in me (fighting to be heard most days) has decided to do things that I know are good for me even if I don't particularly feel like doing so. This means i can be done trying to come up with anything pithy and just log off. La!
Grateful Crap: kids who dragged their parents out of the house to drive half an hour to see raptors in the rain.
took meds (150mg sertraline, 450mg bupropion)
slept really a super lot. maybe too much.
Side note: I have disturbingly had Emily Dickenson's poem "The Heart Asks Pleasure First" on continuous repeat in my brain. That and something irritatingly familiar that I am convinced is by Tchaikovsky but I cannot for the life of me find it. It will no doubt wake me in the middle of the night with its obviousness.
This is a backdated post because yesterday kind of got away from me. Here are the bare bones:
I did go pick up my prescription.
I did put all my pills in a pill minder so I don't have to rely on my swiss cheese memory to take the proper amounts of everything. Although this in itself was a comical event. I had three different medications to put in: two anti-depressants and an antihistamine. I believe that I spilled all of the contents three times in the course of getting everything in.
I did a bunch of crewel and read some comic books. Geeking out a bit. It was fun. But I lost track of the time and really didn't have the energy to post.
Grateful Crap: pharmaceuticals and the people who despense them.
took meds - finally the right ones and the right amounts. Sheesh. (
Why is it that your tongue always seeks out the rough spot? The broken tooth, the painful spot that you hope is not a baby cavity waiting to grow up into a root canal...
And why can't we ditch this whole evolutionary advantage of encoding negative memories better than positive ones. I don't need to remember that the cave with the sabre tooth bears is a place I should avoid.
I don't, for instance, need to remember that in seventh grade some chick whose name I don't remember made fun of the shirt I was wearing while I was changing after gym class. It was a garage sale find with a gathered waist and a delicate calico print. My mom got it for me as a possibility for a costume in my sixth grade play (I played a maid in "Hassle in the Castle"-- A retelling of Sleeping Beauty), but I liked it so I decided to wear it to school. It was Lee brand. Nobody else was wearing anything like it, which for some reason I didn't think would be a problem. "Nice Shirt." sneer.
What is the possible advantage of remembering that with such vivid detail? And this is not some memory that I have dwelled upon and stewed on for years and years and years. I haven't thought of it for a very long time, but when I was trying to come up with negative memories this popped right into my head.
Come up with a positive memory from the same era? Earlier? I do have memories, but they don't have such vivid details. I remember where I stood in the locker room. I remember which way I was facing. How my hair was done up. Honestly.
Still don't have my bupropion. It didn't work with my schedule today. Under ordinary circumstances in the past this would mean that I would stop taking my medication entirely and wallow in ever-increasing ineptitude until someone noticed that I hadn't bathed in a month. Or I started crying when they asked me how things were going, but I couldn't say why. Or I didn't answer any phone calls, emails or texts.
Now, mind you, this could take a long time. It could take a year or more for things to get that bad. But they probably would get that bad. One of my psych people told me that in the case of situational Depression people can crash rather quickly when they go off medication. But those of us with chronic Depression go to pieces more gradually. Gently. So we think we're cured.
However, this time I am not going to throw the baby and bathwater out with the forgotten lapsed overdosed medication and badly mixed metaphors. Instead I will call the pharmacy tonight even (they have an automated service) and pick up the prescription tomorrow. Get a nice pill minder. Get back on the horse. On the juice. On the take. On the wagon.
Grateful Crap: I woke from a nap (snuggling with two-year-old) to find that the older two children had voluntarily stopped playing their video games after 30 minutes and decided to work together to make dinner: fried eggs, lemonade, pickles and sourdough bread.
took sertraline 150mg; thought about the fact that I wasn't taking my bupropion and felt bad about it
did 1 hour on the elliptical trainer. I wanted more solitude than the yoga class would give me today
played horn. LOUDLY.
It is official: I am turning in my Mary Poppins umbrella. I have decided that the Pursuit of Perfection is Pholly. No, I have never really pursued perfection, I have just assumed that when I am not there it is because of some character flaw.
Reminder: perfect people suck. Also, they do not exist. I, however, do exist and I am frickin' amazing.
Last night after realizing my accidental but not catastrophic overdosing (for ten days!) on bupropion, I was unable to sleep for most of the night. I lay in bed with my eyes closed in the dark thinking of all the stressful things that I should not be thinking about since they would make it hard for me to sleep. In the morning I was convinced that I had not slept at all.
And I was very very wigged out about the overdosing. Even though, as I have told myself, Nothing Happened. And Mistakes Are Only Human. I don't have great recall for what I did today. I am pretty sure that I took my sertraline. I didn't put things in a pill minder yet and I haven't called Psych Recovery or renewed my prescription. This sounds like a confession.
Really, it is a reminder of the things that I will do tomorrow. When I am more awake. Today, I am cutting myself a little break. An early Thanksgiving Day present.
Grateful Crap: I have three kids and they are awesome.
I think I took my meds. I for sure didn't take too many
I climbed 6 flights of stairs
A dear friend once came to dinner with my family and somehow, magically, within five minutes she had managed to say devastating things to everyone at the table.
Things like "How is your job?" to someone who had just been laid off. Or "How is soccer going this year?" to the person who had just been forced to quit playing competitively due to a recent chronic health condition. "When are you graduating?" to the person who had stopped taking classes...
Honestly I can't remember what it was that she said to everyone, only that she had just enough information about their lives to be amazingly, accidentally, agonizingly hurtful. Then she wanted to crawl under the table and disappear. I wish I could remember what she said. It really was amazing. Five minutes and she found the sore spot for everyone at the table.
I am completely unbothered when friends and family and coworkers express concern for me in my capacity as the Woman who is Kicking Depression's Ass. It feels nice, actually. This is the opposite of that dinner experience.
Since the whole mind/body health thing and the shrinking role that Depression plays in my life is front and center in my mind, I don't feel bad when people ask me how it's going, say they are thinking of me, or even that I am in their prayers. (At one time I was quite allergic to people praying for me, but I seem to have gotten over that since becoming Quaker.)
I do feel terrible and guilty and awful, though, when I am asked about how other things-- things that I have not been doing-- are going. Hey, how's that novel coming? Have you put in that egress window yet? Used the power tools in the garage to make anything awesome? How is Weight Watchers going? Are you done with that present that you started for me six years ago? Sent thank you notes to everyone who has given you a gift for the past 42 years? Crap. I have been meaning to do that. And then the guilt.
I wonder if I do this to people? Ask them about things in the hopes of making conversation and accidentally totally destroy their peace of mind...
At least twice I know for a fact that I did this.
I was in high school in All State Band. We had rehearsals in the summer and a concert in February. In the summer my stand partner mentioned that she had just met some boy that she really liked. In the winter I asked if she had ever gotten together with that boy. Yes. in fact she had been impregnated by said boy and then dumped by him and in the aftermath of that she had the most trying year of her life... and this turned out to not be a very good topic for casual small talk.
I was in college and I idly wondered if a friend of mine might be gay. I wondered this aloud to her. We had plenty of friends who were not straight so I didn't think it was a big deal-- just casual college conversation. Unbeknownst to me she woke up every morning thinking to herself, "My life might be messed up, but at least I am not gay." Some time later she realied that straight people do not wake up thinking this every morning. But at the time having a good friend wonder this about her was devastating. I had no clue.
Perhaps this is why I do not like small talk. I am not good at it. I probably have just enough information to be absolutely, amazingly, agonizingly devastating.
I forgot to take my meds this morning. I can tell because I am sneezing without ceasing. Ker CHOOOO! I will post this, then go take my meds and call to have the bupropion refilled.
Side note: at some point I accidentally started taking 600mg instead of 450mg of the bupropion. I was wondering why I ran out so fast.
I remembered that I was supposed to take "more than I used to." Apparently that was not good information to go on since once I got used to taking 3 pills I thought, "Oh, I am supposed to take more than I used to," and started taking 4. Which means I have been UNINTENTIONALLY LYING when I wrote that I was taking 450mg per day. How long? I don't know. I could probably figure out if I counted the days that I was supposed to be on 2 pills and the days I was supposed to be on 3 pills and see how many I should have left... which I might just be anal enough to do.
And holy crap I just read that going from 450mg - 600mg increases the risk of seizure by tenfold. I knew that 450 was the maximum recommended dose. I just didn't think about how many mgs were in the pills I was taking.
So, the day that I thought I was having rapid heartbeat and trouble breathing and I had noticed an "intentional tremor" and wondered if it might be a side-effect of the bupropion... it was probably a side-effect of unintentional overdose. Holy frickin' crap. And I just didn't do a good enough job of telling either the nurse on the care line or the doctor at the clinic that I wondered if what I was feeling was drug-related. Of course at the time I didn't realize that I had been regularly O.D.ing
Nothing Horrible Happened. And tomorrow I will call Psych Recovery and let them know what happened and make sure that I can refill my prescription tomorrow even though I am not supposed to have run out yet. Also, I am going to start using a pill-minder in conjunction with this blog to track my meds.
Crap. Crap. Crap.
Grateful Crap: that I did NOT have a seizure or hallucinations or suicidal ideatiion or any of the other possible things that could have happened with an overdose.
will take sertraline 150mg
exercised today: 1 hour on elliptical trainer
packed my lunch
Crap. Crap. Crap. Crap.
(Back-dated due to technical issues)
Today I thought about writing. Not this kind of daily bloggish writing, but working on my book that has been collecting dust while I protect it from the whims of... me.
I began making plans for how and when I could work on it. And it seemed like a reasonable plan. If I could just figure out a regular time to do this. Sunday afternoons? Monday mornings? I don't know.
The book has been on my mind partly because in the news today there is a story of a hostage situation at a shopping mall in Nairobi. My book is set in Kenya. And I think (although I am not certain) that it is likely the shopping mall where I purchased a cookbook on "Indian Cookery" when I visited more than a decade ago.
I am also thinking that I might be ready to do some more thorough tracking of nutrition and exercise. Because thinking about doing that no longer causes me to feel exhausted.
And also, thinking about thinking and getting too much into my head is just not useful in terms of Kicking Depression's Ass. I need to get the whole body involved in the effort. Less brain. More body. Geez does that not sound like fun.
...then I went to work, made a bunch of bone-head mistakes (which anyone can do), realized I had forgotten to eat lunch, had some dinner, came home and went to bed at a reasonable hour. Unfortunately that meant that when I tried to post this it was from my kindle fire that sometimes has let me post things, but which did not so much work last night. And I was not about to get out of bed and fire up the regular computer because that would have led me into four hours of tinkering on nothing important whatsoever...
Grateful Crap: People who tell me they are concerned about me. While I am not looking for people to express this concern, I am never bothered when they do.
took meds (150mg sertraline, 300mg bupropion) - need to get more
ummm... I don't remember what else I did
How does common sense differ from trivia? Maybe what is common sense in another culture is trivia in your own country. Common sense is what you think everyone should just know. And you get irritated when they don't.
Pineapples have a set amount of sweetness. So you want a smaller pineapple, because in the larger ones the sugars have been spread out over a greater area. Not so sweet. I found that out from a friend who grew up in Hawaii.
In Kenya you need to boil the water or treat it with chemicals to kill the parasites that live there. Unless you want them to live inside you. Even when you shower you need to be careful. And you don't use tap water to clean your teeth either.
When it is snowy outside (in Minnesota) it is polite to take your shoes off when entering the house, but it is not compulsory.
In Japan you ALWAYS remove your shoes when entering a home. There are no exceptions. Even if you just have to run back into your own home to get something that you forgot. Okay, there is one exception; if there is a dead body in the house you are free to wear your shoes. Because death is the only thing more contaminating to a space than shoes.
No one who grew up in Minnesota uses an umbrella for snow. No one knows why this is.
Canadian coins are accepted in many stores in Minnesota, which is adjacent to Canada but is in fact part of the United States. You can't expect that every store will take Canadian currency. But it is common enough for people to have Canadian coin in their pockets that some stores will specify that they do not accept them. (Mexican coins are not accepted as legal tender in Texas, presumably.)
When you walk on ice you need to put your weight forward, make sure that as much of your foot as possible comes in contact with the ground and take small, waddling steps. Like a penguin. A friend who moved here from Boston did not know this. More than once she tried to walk like a human and fell on her tailbone.
In Minnesota windows that open all have screens on them to keep out the mosquitoes. They aren't malarial-- just irritating. When I visited California I was stunned to see screenless windows flung wide.
The safest place to be during a tornado is in the basement under the staircase. If you have no basement, get in the bathtub and put a mattress on top of you.
In Australia it's important to check your shoes for scorpions before putting them on in the morning.
I often accuse myself of lacking common sense. I don't think that is quite accurate. I have common sense, I just don't use it as often as I might. My inner grown-up has trouble taking the reins sometimes. More so when I am feeling unwell.
I think there should be a word for a slight downturn in Depression. You know, like the mental version of the common cold. And you could take time off work if it was severe enough. How about "brainstorm."
Or a whole series of weather-related terms with the most serious being "brainhurricane." Less severe could be a "brainsquall." Although the mild words sound just terrible: braindrizzle? brainshowers? brainsprinkles? ewwww.
Because Depression is not a steady state. Whether recovering or getting worse or even staying stagnant... there is great variability in mood and brain function. And the idea of being able to refer to the day as being quite good with just a slight brainsquall in the afternoon appeals to me greatly.
Grateful Crap: Beautiful day today. Wonderful to see people in meeting. It's good to be back.
took meds (150mg sertraline, 450mg bupropion) -- I need to get bupropion tomorrow. The larger dosage ate up my supply.
went to meeting
spent time with family and friends
And now I will stop editing this and go to bed so I can beat my 1:30 am hard deadline for "This is Way Too Ridiculously Late To Be Up But I Was Lost In Project Land"
Common sense would dictate that if I am tired I should go to bed. Perhaps it is my perverse desire to be creative causes me to rebel against sense that is "common." If it were "unusual sense" I would be all over it.
Quaker, teacher, parent,