Feim Zii Grom! (Become Ethereal)

trigger warning: pressure from medical professionals to lose weight, a potentially suicidal thought
content notes: From this point on, assume I’m being sarcastic, unless otherwise indicated.

I’m so grateful to my APN for forcing me to schedule a sleep study at the particular center she chose! I met the most wonderful doctor ever at my consultation. He had the miraculous ability to diagnose me with obstructive sleep apnea before conducting an actual sleep study, based on my answers to a few questions – and my weight!

Did you know that losing weight will solve all of my problems, including but not limited to sleep apnea! Clearly my lifelong history of depression, irritability, and anxiety are the result of my recent weight gain (which caused the sleep apnea) and not a lifetime of difficult family dynamics, codependency, emotional & physical abuse, and painful losses I never fully mourned. If I just lose weight, the sleep apnea will go away and I’ll be a happy, healthy, energetic, fully-functional adult! I’m so excited I want to go bake some cookies – but I won’t eat them!

[not sarcastic: Okay, I need to take a breather. *takes deep breath* My ability to put on this false, overly-cheerful tone is scaring me.]

I thought I was going to learn more about what the sleep study will entail: what kinds of tests they’ll run, what I’ll be expected to do, what treatment options might be proposed. Maybe a boring discussion about “practical” things like what my insurance is likely to cover and how I can access whatever I’ll need to get a better night’s sleep… why would I ever want that?

I’m so glad that instead, I got a lovely lecture on how weight loss could help me. You know, there really is an unfortunate shortage of information about dieting and what ideal bodies look like in this culture. I could almost cry to think of how fortunate I’ll be to have the opportunity to consult with a nutritionist and learn things about healthy eating that aren’t plastered all over the internet and every physical object that stands still long enough!

Even more exciting is the idea of having an exercise regimen! Ooh! The word “regimen” inspires so much joyful anticipation in me! I wonder how many crunches I’ll have to do each day, and how frequently the number will increase. Most of all, I look forward to seeing the expressions of disappointment and hearing the additional lectures about how important weight loss is every time the number on the scale isn’t what they’ve determined it should be. I just revel to think of it!

[not sarcastic: Actually, if they require me to adhere to an exercise regimen and be held accountable to someone else for weight loss – especially if treatment for my very real and serious mood disorder is contingent upon my successful compliance – I will … be dangerously tempted to kill myself.

also not sarcastic: By the way, there is one area in which I’m fairly confident taking Lamictal/lamotrigine was helping me: it reduced my suicidal ideation a great deal. I went from having suicidal thoughts almost every day and urges more frequently than I’d like to admit, to only occasionally having suicidal thoughts and rarely having suicidal urges. Even with all the stressful stuff I’ve been writing about, the temptation to harm myself has been a lot less severe than it was before I started taking this medication.]

Think you’re excited now? Just wait until you learn what happens next! When I – like practically everyone else – fail miserably at my attempts to intentionally lose weight, I can try bariatric surgery! (or, as Chrome’s spell checker wants to call it, “barbaric” surgery!) I can’t wait to trade in treatable conditions like sleep apnea for new long-term complications like low blood sugar, malnutrition, ulcers, and death (rare)! Equally exciting is the opportunity to struggle (for the rest of my life) with the same dieting I failed at when trying to lose weight without surgical interventions…

By far, the best part of today’s consultation was the rapport I developed with this amazing doctor. I was worried that he might listen to me when I told him about how my past efforts to intentionally lose weight have resulted in long-term weight gain. It would have been so terrible if he had respected my silly assertion that I “don’t” want to have bariatric surgery.

Ah, what a relief it is to have a doctor who dismisses my clearly-stated preference to receive treatment for the condition that brought me to his office in the first place. I’m so glad he spent most of our time together advertising for a surgeon he knows. Now I have the name and number of a doctor I may never be able to afford, and who most certainly doesn’t take my health insurance! I have never been more blessed.

I can’t wait to go to the surgeon’s free seminar and plead with him to take mercy on my poor obese soul by mutilating my body for a reduced cost. Perhaps he will take pity on me by referring me to a butcher whose fees are within my meager budget. I shall commence saving for it immediately. I know! Let’s use the money we foolishly used to spend on groceries! That should kill two birds with one stone.

[not sarcastic: I wish I’d read Ragen Chastain’s recent post, When You Have to Confront Weight Stigma before going to the consultation this morning. I could have brought her cards from What to Say at the Doctor’s Office with me. Maybe they would have helped me keep the focus of the sleep study consultation on my need for help getting a better night’s sleep! At least I know of these resources for next time, and now you do, too!]

The Healthcare Headache Continues …

I thought I had the answer: I would take a 3-credit course, in part out of interest and in part because it would make me eligible for my school’s “voluntary” part-time student insurance. But today I learned that there are no longer any part-time student plans available – whether that’s because my school dropped them, or the insurance company stopped offering them, I don’t know. I just know that I was very confused and frustrated when one part of the site still said I could opt-in to the voluntary insurance, but when I clicked the link it said no plans were available.

I’ve reluctantly accepted that they’re not offering insurance to part-time students, based on the mail-in forms having last year’s dates. They just didn’t bother to update the whole website. Lazy bums. (Acceptance doesn’t make me any less angry. It just saves me the trouble of trying the same thing over and over again just to be repeatedly disappointed by the results.)

I’m disinclined to trust the $400/month short-term insurance plan offered by an affiliate of my school’s insurance company. The very nice representative I’d talked to called back, reminding me to apply in time for coverage to start on the date I’d requested. She also re-sent the information she’d initially sent me. I’m tempted to call her back and thank her for her help. But the attached PDF clearly stated that prescriptions weren’t covered; when I tried to see if other plans were available, the one she’d recommended disappeared, so there were no plans available at all! I know I can call her back and ask questions, but I don’t want to risk wasting money (that I don’t really have) if the information she gives me turns out to be wrong.

In light of all this, paying nearly $2,000 to take a class purely out of interest became a lot less appealing – especially since a similar one might be offered for free on Coursera. I started listening to the lectures for one of my Coursera courses last night and found them to be positively fascinating. It felt so good to just soak in the information. No deciding what to wear, traveling, finding parking, potentially being late, awkward social situations, and consequences for not doing assignments required. So, I’ve decided to drop the 3-credit course I’d registered for at my school, and go the continuous matriculation route. A relatively small fee means I’m still a graduate student, really!

That still leaves the matter of health insurance.

I’ve decided against going to see a psychiatrist for the time being. The SAM-e (along with other factors) seems to be helping quite a bit, especially on days when I remember to take 2 doses of it (400 mg 2x/day, total 800 mg per day). It’s not perfect, but it’s at least as good as the antidepressants I’ve tried so far, with less adverse side effects (maybe because it doesn’t contain weird, unnatural chemicals?). It’s not exactly cheap, but I think I’m saving money over seeing a psychiatrist and paying for medication, especially if I need brand-name instead of generic. I can buy the SAM-e in 3 clicks and have it shipped to my front door – no phone tag, traveling, disclosing personal information to a stranger, and waiting at the pharmacy required. It might not be the best, but it works better for me right now. I can’t help wishing I’d found out about it years ago.

Health insurance suddenly seems a lot less important if it’s not the only way I can afford to treat my depression. Wakana doesn’t take insurance; I’ve been paying her at a discounted rate out-of-pocket. Insurance wouldn’t cover the SAM-e anyway. Hospitals are required to give life-saving care regardless of whether you have insurance. The only thing left is preventative care, which I’m hoping I can find a clinic for nearby. To my knowledge my state isn’t among the insane ones trying to shut down Planned Parenthood, so I intend to begin my search there.

(In case it’s not blatantly obvious, I hate going to see doctors. So, for most things, I wouldn’t bother seeing a doctor. If I’m miserable with a cold or something, I’d rather be miserable at home where I have access to things that help – like tea and soup – instead of at the doctor’s office.)

And in October I should be able to shop for an insurance plan on Healthcare.gov, so hopefully I’ll only lack health insurance until January. Hopefully.

Let’s be honest, I hate making these decisions. But this is the hand I’ve been dealt, and I need to do (or choose not to do) whatever it takes to protect my mental health. I’ve been burned by conventional medicine and the insurance required to make it remotely affordable, so I’m finding alternative ways to take care of myself.

Stop having Cancer so you can Find a Doctor who MIGHT be able (and willing) to Treat your Cancer

It’s been over a year since I conceded that I need medication if I’m ever going to recover from depression. “Recover” seems so far away, is it even possible? How can I “recover” from how I’ve been my whole life? Maybe “manage” is more appropriate. I need medication to manage the symptoms so I can live.

Attempt 1: A Depression Study

image from rodale.com

image from rodale.com

A year ago I learned of a study in my area that seemed like a good opportunity to receive medication, earn a small amount of income, and possibly even help others with depression through my contribution to research. I answered countless uncomfortable and redundant questions on the phone while feeling incredibly emotionally vulnerable. I let them take my blood (I hate needles). I submitted to other medical tests. I was honest, maybe too honest: I admitted to feeling suicidal.

The study psychiatrist seemed concerned when we sat down to talk about my participation. He said they would have to put me on a medication and just keep giving it to me for the duration of the study, whether it was working or not. In my case, he thought that wouldn’t be safe; that I should receive more personalized and flexible care – care designed to treat my depression, not gather research data. I appreciated his honesty.

Attempt 2: Psychiatrist A

brand Wellbutrin XL 300mg

I can’t help wondering if this could have worked for me.

Wakana referred me to Psychiatrist A. He prescribed Wellbutrin and gave me 2 weeks worth of the actual brand-name drug. For the first week I took 150 mg/day and thought it was helping. In the second week I (following his instructions) started taking 300 mg/day and found it to be too much. He prescribed 200 mg/day, split over 2 doses. I received generic bupropion HCl when I filled the prescription.

I felt like it wasn’t working and wanted to increase to 250 mg/day. Instead, he added Lexapro. Due to a miscommunication, I ended up taking 200mg of bupropion HCl in one dose, followed hours later by the Lexapro escitalopram (generic). I had symptoms of serotonin poisoning and became very upset when Psychiatrist A said they were due to “anxiety” but I could stop taking the Lexapro escitalopram if I wanted to. I did so and, under his advisement, cut the 200 mg bupropion tablets in half so I could take 100 mg twice per day. I became incredibly irritable and was almost always angry with Fox, through no real fault of his own. Wakana and Psychiatrist A both urged me to stop taking the bupropion, so I did.

My trust in Psychiatrist A had been shattered, so I refused to go back to him. Part of my justification was that Fox’s sister – a registered nurse – had talked to him and expressed anger at how he responded to her. In other words, it wasn’t just me! But now, in hindsight, I’m wondering if there were factors none of us could see; maybe I was too quick to judge and too harsh in my judgment. I was seeing him through the same lens that makes me feel worthless, makes me overly judgmental of Fox, makes every obstacle feel completely insurmountable. I’m trying to look back at the situation through a different lens; who’s to say my perception now is any more accurate?

I had terrifying experiences while under Psychiatrist A’s care, and – whatever his intentions were – he failed to help me feel supported and cared for. Lens or no lens, I can’t risk that happening again.

Attempt 3: Psychiatrist B

Zoloft blob, sad, in cave

a good depiction of how I’ve been feeling, both on and off sertraline HCl

I switched to Psychiatrist B just before starting this blog in December. At first I was hopeful that he would help me – if nothing else, he seemed very confident when he prescribed Zoloft. I, of course, received the generic, sertraline HCl, from my pharmacy. It made me very sleepy but seemed to help calm some of the chaos in my brain – the racing thoughts and raging emotions – without intolerable side effects. When I told him about anxiety-related symptoms I was having, he added Buspar; I received buspirione HCl.

At the very least, those medications haven’t been enough to help me through the difficulties I’ve been having this year: moving, the death of my uncle, having to drop my graduate courses, Mom’s surgery, Fox moving in with me, my rats’ health issues. It’s hard to say whether they’ve been hurting – via side effects such as increased sensitivity to clanging sounds, suicidal ideation, and temptation to self-harm.

Whatever was going on with the medications – I’ve been off them for about 2 weeks now, so they should be completely out of my system – the bottom line is Psychiatrist B didn’t take my symptoms seriously either. He interrupted me in the middle of telling him about my suicidal and self-harm thoughts. He wouldn’t talk to Wakana about my case. He didn’t seem to care at all.

Okay, maybe it’s not really a psychiatrist’s job to support his patients emotionally. It’s his job to evaluate their symptoms and prescribe medication. Psychiatrist B failed to do his job. He interfered with my ability to report on my symptoms. He did not seriously consider the connection between my reported symptoms (suicidal ideation) and known side effects of the medication he was prescribing (also suicidal ideation)! Whether I am inclined to act on the thoughts or not, they are extremely disturbing – and quite the opposite of what successful treatment of depression should entail.

Attempt 4: The Ongoing Search for Psychiatrist C

frustrated woman holding cell phone to ear

why me?

I’ve been procrastinating, but Wakana has been urging me to actively search for Psychiatrist C. On Tuesday, July 9th, she supervised while I searched my health insurance company’s website for potential psychiatrists in my area and called one.

The psychiatrist’s receptionist called back on Wednesday; I returned her call on Thursday. She asked a few questions (What are you coming in for? What medications have you taken previously? Any substance abuse?) and said that the doctor would contact me to make an appointment if she thought she could help me.

Excuse me? I felt like I was applying for a job – when, really, it should be the other way around! I couldn’t even make an appointment because I felt the need for one, sit and talk face-to-face with the Almighty Doctor before she made a decision about me! (I should be the one evaluating and making a decision about whether she’s worthy to treat me!) What is this?

I expressed my anger to Wakana and she agreed that that is no way to treat a potential client. It’s been a week, by the way, and I have yet to hear back from the psychiatrist. To be honest I didn’t really expect her to call me, and I’m not holding my breath until she does.

Riding the wave of my swelling anger – that is, energy – I went to HealthGrades to try and find a psychiatrist in my area who is recommended by patients. I have contact information for one who received 5-star reviews from all 9 of the people who reviewed her. She has 2 offices, both of which are within 15 miles of my home. And I was also able to find her on my health insurance company’s website.

All I need to do is pick up the phone … but that’s where the wave crashes into the shore and I’m left lying there, soaked in sand and struggling to breathe, feeling like any moment the undertow will pull me back out into the ocean. I don’t want to experience any of these disappointments again: the unreturned phone call, the discomfort reporting my symptoms, the lack of being taken seriously, the unhelpful and potentially harmful meds. So it’s been a whole week and I’ve “done nothing” to secure the health care I need; how can I expect anyone to take that need seriously?

.

I’m trapped behind a lens through which every obstacle seems insurmountable, every effort doomed to failure, nobody cares, and I don’t really deserve the help I need, anyway. Somewhere there’s the tiny part of me who knows that none of this is true, that hopes that if I just keep trying I’ll be successful, eventually … but right now its voice is very soft and, through the lens, it looks quite naive. Asking me to call another psychiatrist is like if someone had told my mother she had to climb Mount Everest unassisted in order to get her knee replacement surgery. (No one climes Mount Everest unassisted, even if they’re in “perfect” shape.) The reason why she needed the surgery is because her knees were hurting her so much she could barely climb the stairs.