Still Here

I haven’t posted in 3 weeks, so I thought I’d just mention that I’m still here. I’m taking Thesis Seminar this semester; so far my topic has been approved and I’ve got some ideas bouncing around regarding it. I’ve been rather preoccupied with The Elder Scrolls V: Skyrim, – not just my Let’s Play, but mods as well. I’m also concerned/depressed about my health. I might have some kind of neurological problem (besides my psych issues) that’s affecting my visual perception and giving me headaches. To make things worse I’m between HMOs and my state’s program sent Fox a “reminder” to verify my citizenship, even though I’d addressed that 2 months ago. I’m trying to get myself to spend some time outside in the beautiful weather we’ve been having, but lately I’ve been more inclined to hide in my nice dark nerd cave. Basically hanging on to my life preserver, trying not to get seasick, and praying for this storm to pass.

How Social Anxiety Fuels My Depression

I haven’t just been “out of sorts” the past couple of weeks. I’ve been moderately depressed. Tired, sad, unfocused; I spent an entire day watching The Legend of Korra on KissCartoon because I couldn’t get myself to do anything else (and I wanted to know what would happen next; it’s a great story). I’ve also been isolating, having self-harm urges, and occasionally thinking I don’t deserve to live. The abusive voice is back; when he’s feeling kind he just tells me I’m worthless.

I feel like I’m right back where I started: feeling depressed and overwhelmed by the prospect of applying for internships. (And jobs, but if I have to choose between a job and a music therapy internship, I’ll pick the internship. It’s the last major obstacle to starting my career.) There’s nothing else for me to do, nowhere else to run, no excuses. But everything feels wrong. I haven’t been practicing my instruments, it’s been over 4 years since I last worked with real clients, and I don’t have appropriate attire for an interview. I know there are relatively easy ways to fix at least two of those issues, but I’m finding it hard to get myself to do even something as simple as stepping outside for a few minutes to enjoy the sunshine.

It doesn’t help that I’ve been fighting with my health insurance since mid-June. This is a huge trigger for me; I feel like they’re threatening my very existence. We were a couple days late re-applying for our program, so there was actually a temporary lapse in coverage while our information was being processed. Fox was taking half his dosage to make his medication last for as long as possible while we waited to regain our benefits; that made it harder for him to cope with stress and he came home from work even more exhausted than usual. When we finally got our letter confirming eligibility, I rushed to the pharmacy to refill his prescription – only to discover that our HMO wouldn’t resume prescription benefits until August 1st. I didn’t know we could have our medication paid for directly by our state’s program, and I didn’t have his card with me anyway. I got ridiculously angry, started yelling, and had to use all my willpower not to become violent.

The eligibility letter was followed closely by a letter requesting proof of my citizenship and identity. I was furious – for two reasons. First of all, they required Fox to certify my identity and used the term “child” on the form; I found this exceptionally insulting because I’m the one who’s been doing everything to get and keep health insurance for us both. More importantly, the only reason I could think of why they would have trouble confirming my identity (but not Fox’s) is because I changed my last name when we got married. I updated Social Security and got a new driver’s license over a year ago, but for some reason they couldn’t make the connection themselves. It really wasn’t much of an inconvenience to send them copies of my certificates and IDs, but I felt threatened by it anyway. I was born here, I’ve lived here my whole life, we clearly marked that I am Fox’s spouse, and it’s a long-standing tradition for one partner to take the other’s last name when a couple gets married. They should have no trouble connecting my current name to my pre-marriage identity, it should be a normal part of their procedure.

I did nothing wrong, why should anyone question my right to be here?

That’s my problem: I question my right to be here. Bullying; physical and emotional abuse; living in a world that doesn’t want to admit non-binary pansexual people exist; having a body that is hyper-sexualized, censored, stigmatized, and discriminated against; persistent invasive media promoting impossible beauty standards… It’s hard to avoid internalizing messages that I don’t have a right to be here – or, at least, that if I want to exist I must do everything both inside and outside my power to conform. I feel like simply existing day to day (and being honest about who I am) is a radical act of defiance.

Radical acts of defiance take a lot of energy.

I’m tired.

This latest return of my depression – especially so soon after I thought I’d overcome it – proves to me that I must do something to directly address my anxiety. No matter how well I feel in terms of the depression, as soon as I try to start doing things again, my anxiety fairs up. It’s so bad I can’t do anything, so I don’t do anything; the depression sets in again.

It isn’t part of my official diagnosis (yet), but I’m pretty sure I have social anxiety disorder – which is described as “extreme fear of being scrutinized and judged by others in social or performance situations.” It explains most of my functional difficulties that lead to some of my worst depressive symptoms, particularly being late for class and the couple of times I’ve chosen not to show up for job interviews. Even just going for a walk outside is difficult: I don’t want to be seen by anyone because I expect them to judge me harshly.

Fortunately, I have an appointment with my prescriber on Tuesday. She has offered to refer me for individual therapy – I think within the clinic where I meet with her. I can will ask her to refer me to someone who specializes in cognitive-behavioral therapy (CBT) for social anxiety disorder. (CBT is more effective than medication for treating social anxiety.) Hopefully I’ll be able to start with that person right away and gain the confidence I need to finally move forward with my life.

On Being Wrong

I’ve been feeling more depressed than usual since my tooth was extracted on Monday. I’m more socially withdrawn, sad a lot of the time, with low energy and motivation, and more muscle aches that aren’t immediately attributable to the physical effects of the extraction. The constant dull pain is grating on me, making me irritable and impatient. I had to drag myself to class on Wednesday, had trouble concentrating, and role-played the “very loud client who remains disengaged from the group” fairly well. I’ve spent a lot of time improvising on piano in preparation for my midterm; everything I play sounds sad, melancholy, dark, surreal, and/or angry – even scales! It makes coming up with an intervention other than “Let’s sing about the crappy situation you just described” very difficult.

(In my defense, singing about crappy situations can be extremely therapeutic. Not only does it allow expression of repressed or taboo emotions, it helps one look at the situation and oneself differently, assert oneself, and heal. It is safest to do with the assistance of a certified music therapist.)

The primary reason why my symptoms have worsened can be found in this line from my post on Monday:

The extraction “felt wrong on some fundamental level”

I think anyone would feel depressed if they were constantly being reminded of something they considered fundamentally wrong!

Part of me remains convinced that “I had a perfectly healthy tooth pulled for no good reason” – even though that wasn’t the case at all. Multiple examinations revealed the tooth to be dead. The x-rays showed that there was a problem in that area. The dental professionals who examined me noted swelling in my gums and attributed it to that tooth. I saw the infection on its roots with my own eyes!  The tooth needed a root canal; I saw an endodontist who attempted the procedure but only succeeded in causing me more pain. Instead of risking a repeat experience, I chose a treatment that would be faster, easier, and possibly even more effective. At the moment I’m not happy with the results because I’m in even more pain. (I keep reminding myself that Mom regretted her knee replacement surgery when she was first recovering from it, but has since experienced improved quality of life and recommends the procedure to others.) Time will tell whether this has helped at all, or only caused more problems…

The point is, the belief that “I had a healthy tooth pulled for no reason” is irrational and factually incorrect. The tooth was not healthy, and I had justifiable reasons for getting it pulled. Extraction may not have been the recommended treatment or even the best treatment, but it was MY decision to make. Others may disagree with my decision, I may even regret my decision, but none of that makes it wrong.

I know this rationally but can’t shake the feeling that not only have I done something wrong, I am wrong. I was supposed to keep going back for endodontic treatment and thank the endodontist for hurting me, regardless of whether she was able to solve the problem that brought me to her in the first place. (Because that’s what she suggested, what Mom seemed to want, and what I agreed to at the time.) That I even thought to do anything other than conform to the protocol “you are a patient; you comply with whatever treatment your healthcare provider recommends” is proof that there is something wrong with me!

When I talked to Wakana about this on Wednesday, she asked if there was anyone in my life who taught me that I was wrong in some way. Thinking about it now, there are a lot of people whose behavior may have given rise to that belief: family members, peers, teachers and other school officials, mainstream media… but we ended up talking about our favorite topic: my mother.

I mentioned one way in which Mom has communicated to me that I am wrong: by telling me I’m like the “opposite” gender from the one I was assigned at birth, as an insult. She’s been doing it since I became a teenager. Wakana urged me to write about how that might have influenced the development of my queer gender identity. Part of me wants to comply and learn that I’m actually cisgender, which would make my life a million times easier. (I suspect it’s the same part that insists I gave up a “perfectly healthy” tooth.) Part of me thinks my desire to be cisgender purely so I can access the associated privilege is evidence that I am, indeed, transgender. Otherwise I would just identify as the gender I was assigned at birth, decide how I want to deal with some of my behaviors not conforming to my mother’s expectations, and move on with my life. Right?

I explored the topic somewhat and came to the conclusion that my mother’s expectations for the gender I was assigned at birth are limiting; I’m pretty sure her expectations for the “opposite” gender are just as limiting. I could not conform to them even if I were cisgender; if I’d somehow managed to do so she probably would have expressed disapproval anyway (of that or something else).

The problem isn’t my gender identity (which I’d really like people to accept), it’s that my mother doesn’t see me as a complete human being who is separate from her and has the right to make independent decisions. She sees everything I do through the lens of her expectations and me not meeting them. It often seems as though she goes out of her way to express disapproval, over whatever else she might be feeling. This problem originated long before my early teenage years, possibly when I was born!

Actually, I think she’s learning to see me as a separate person and respect my right to make independent decisions; our relationship has improved quite a bit since I’ve been in therapy. She hasn’t given me a hard time for deciding to have my tooth pulled; all the criticism of that decision has come from my own mind. The real problem is that I’ve internalized her (and others’) disapproval and feel on some fundamental level that it’s wrong for me to make my own decisions. I’ve internalized the belief that I must conform and go along with what other people seem to want from me.

Regarding my gender: I’m pretty sure I’ve always perceived the division of people into “men” and “women” as arbitrary. I know what the expectations for the two widely-recognized genders are – and I know that a lot of people are trying to weaken or even eradicate those expectations, so men and women can just be themselves (these people are called feminists). I know that a lot of men and women defy those expectations, to the point where one can’t use behaviors, interests, aptitudes, beliefs, or even biology to define “men” and “women” as two mutually-exclusive categories. As far as I can tell, the only universal difference is that all men identify as “men,” and all women identify as “women.” This isn’t to say that gender is a choice – if that were the case, I think we’d all be men and reap the numerous benefits. Gender is an inherent sense of self that may change over time but can’t be intentionally altered.

So, doing things that Mom associates with the “opposite” of the gender I was assigned at birth is not the basis of my queer gender identity. I could say “I am a [the gender I was assigned];” that would make things at lot easier for me, and everyone around me. No one would question it. I doubt anyone would even ask me to change my behavior to meet their expectations. I could be myself and use that label and let people refer to me using pronouns they already know…

But I’d be lying. I don’t identify as a “man” or a “woman,” I identify as a “person outside of the gender binary.” I am not a man, nor a woman; I am a person outside of the gender binary. I could allow you to categorize me as, well, whatever you’d like! for your comfort and convenience… but I can’t inherently identify with whatever you choose. It’s just not in my nature – any more than it’s in my mom’s nature to identify as a man or in Fox’s nature to identify as a woman. All I’m asking is for people to respect that.

Unfortunately, people are going to perceive and treat me the way they want, no matter what I do. They may express opinions about the decisions I make. This applies to so much more than gender and dental treatments; it’s just a universal fact of life. There comes a point where I just need to decide that I am what I am, that I make whatever imperfect decisions I make, and that other people’s perceptions of me are their business, not mine. Whatever they send my way need not impact how I perceive or treat myself.

Pro-Choice Legislation for Once

I was very pleased to learn that U.S. Senators Patty Murray (D-WA), Barbara Mikulski (D-MD), and Senator Barbara Boxer (D-CA) introduced the “21st Century Women’s Health Act” today! It is a bill intended to protect and expand access to reproductive health care.

Please contact your Senators and urge them to support this bill. It might not hurt to do the same with your Representative in the House. Hopefully, with enough public pressure, this bill might actually get passed!

source: Female Senators Introduce Pro-Choice Bill to “Fight Back Against Those Who Miss the ‘Mad Men’ Era”

 

To Lose a Tooth

I went ahead and had Root Canal Molar removed today. It was surprisingly straightforward: I went in and said I wanted the tooth extracted. They sent me for an emergency examination, during which the student dentist asked me about my previous visits, etc., then called the instructor over to review the case. It was the same instructor from the first time I’d been examined at this facility. He looked over the information, then said they shouldn’t have sent me to emergency and that he was going to expedite the process. (I assume he called my insurance.) Several awkward minutes later, I was on my way to oral surgery.

The instructor who examined me made some comments about “people sometimes change their minds” and “it’s a shame, all the other teeth are present” that were… awkward. Whatever her intentions were, it seemed to me like she was sticking her nose in my business and trying to manipulate me. I’m really not happy about having my tooth pulled; I would have preferred to save it. But the root canal just wasn’t viable; the endodontist couldn’t access the tooth well enough to do the work. And I couldn’t continue living with the problems it was causing. I needed to do something about it, and this was the option that was available to me. After living with intolerable pain for 7 months, receiving even this less-than-ideal treatment is a positive thing!

I won’t go into gruesome detail. Suffice to say the extraction was unpleasant and felt wrong on some fundamental level, like part of me was being ripped out… oh, wait, it was! I was pleasantly surprised that not only could I close my mouth during the procedure, it was actually beneficial and relieved uncomfortable pressure on my jaw. (I thought I’d have to hold my mouth open.) It didn’t take long at all; the assistant described it as “atraumatic.” When it was over I got to see my tooth, complete with some goo on the tip of the root that the assistant said was the infection. I felt relieved to have that out of my skull.

I felt a bit shaky and woozy immediately after the procedure, but I was glad to have it done. I became somewhat irritable as time went on, particularly because I had to bite on gauze to stop the bleeding and that was causing my jaw to hurt quite badly. Then the adrenaline and anesthetic wore off, leaving me feeling drained and in a lot of pain. It’s like a part of me is missing, and there’s a gaping wound in its place. (Actually, that’s exactly what’s going on….)

I eventually decided to remove the gauze; it seems to have stopped bleeding. I took some ibuprofen and am sipping warm black tea (without sugar). It’s very soothing. Now instead of an obnoxious dull ache that spreads from the area, causing jaw pain, ear aches, and headaches, I get to experience a wide variety of pain. The gum is irritated. The jaw is sore (but not particularly stiff – we’ll see how it feels in the morning). There is an occasional throbbing pain that’s sharper and more interesting than the dull ache was. The ibuprofen is taking the edge off, so I notice the pain but I’m not overwhelmed by it. Hopefully I’ll be able to sleep tonight.

It’s kind of ironic. Originally I didn’t even know there was a problem with Root Canal Molar. Especially when my gum infection worsened, I wanted Endangered Molar out of my mouth! But it’s still there, and (according to the dental insurance representative I talked to on Friday) the periodontal referral has been sent to a supervisor to expedite its review. Contrary to what they told me two weeks ago, my dental insurance received the referral on January 26th and just let it sit around for a month, while my jaw bone continues to rot. I should have a decision by tomorrow – something tells me I’ll have to call them to find out what it is.

My hope is that I’ll be able to receive treatment and get to keep that tooth. Now that I know what it’s like to have one tooth missing, I really don’t want to lose two right next to each other! But, in the end, there’s only so much we can do. “What will be will be” and all that.

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!]

I enjoyed nearly 2 hours of being poked, prodded, and x-rayed by a very friendly and thorough dental student… whose diagnosis is what we already knew: Root Canal Molar needs a root canal – apparently it’s dead but worth keeping around because I can use it to chew – and we don’t know what’s wrong with Endangered Molar. It could also need a root canal – that’s what he suspects – and/or I might need to see a periodontist. I think it’s a bit telling that I feel more confident about his assessment of the situation than my primary dentist’s – mostly because he listened to me and took my concerns and feedback seriously (and had the agreement of his professor). He was even willing to use unconventional means to get the best picture of my molars possible – resulting in the clearest x-ray of that area I’ve ever seen! I especially appreciate that he’s addressing the problems of both teeth.

The x-ray of Endangered Molar looks even more ominous than the one taken 6 weeks ago. There’s a giant dark area that shouldn’t be there. It suggests to me that there is something very seriously wrong with the tooth and its roots, but my responses during the examination suggest that it – unlike Root Canal Molar – is still vital. Quite the enigma. The dental professor said it may be something as simple as a piece of food that got stuck up there and needs to be cleaned out by a periodontist. (Good luck getting a referral…)

Despite my readiness to pull the teeth and get the whole thing over with, I’m going with the dental student’s decision to treat and attempt to save the teeth. He gave a much better argument than “I don’t want to feel guilty.” The last x-ray clearly shows that both affected molars meet the ones below them and are therefore functional for chewing – definitely worth saving. I’m convinced that I’ll be better off receiving treatment for them and not “giving up so easily,” as the dental student put it. If nothing else, having those teeth will help me make a better case for treating the ones below them, should it ever become necessary. I hadn’t thought of that before…

The person in the endodontist department verified that the school was submitting a referral for both teeth to receive root canals, gave me her card, and said, “if you don’t hear from me in four weeks, call me. If you have any problems with your teeth in the meantime, call me and I’ll try to get it expedited.” I liked that she took ownership of the situation and expressed willingness to advocate for me. It was a nice personal touch.

Everyone I interacted with helped me feel like a fellow human whose well-being was important. I’m going to see about changing it so the dental school is my primary dental facility. In addition to having more competent dentists, it’s in a better location for me and has a far more pleasant atmosphere. They even included “transgender” as an option on the patient registration form!

Mom accompanied me and was patient and supportive through the whole process. She seemed more upset than I was about, well, everything. I took it to mean she was concerned about me and that felt good. I treated her to a casual dinner as thanks. It wasn’t an ideal bonding experience, but it gave us time to talk and connect with each other and I found that to be meaningful.

I never thought I’d call a day that involved going to the dentist a good day, but it kinda was. Chew on that…

Vote Like Your Life Depends on It

For anyone who thinks the major parties are the same, congressional elections aren’t important, or their vote doesn’t matter, please remember the government shutdown that happened last year and cost us $24,000,000,000. It happened because the Republican Speaker of the House chose not to vote on the federal budget in an attempt to undermine the Patient Protection and Affordable Care Act, or “Obamacare” – which, by the way, is the reason I have health insurance and can afford the medication that seems to be helping me change my life.

One person should not have that much power, but for the time being we need to ensure that person isn’t in the pocket of right-wing extremists who exist to do the bidding of the ludicrously wealthy at the expense of everyone else. They would rather allow people to starve to death or commit suicide than risk losing a small portion of their profits. (Suicide is the 10th leading cause of death in Americans.)

The only way we can have a federal government that comes remotely close to representing us is to get a Democratic majority in the House, and the only way to do that is for those of us who can vote to do so – wisely.

.

Here’s the relevant part of my post from last year about the shutdown:

I’ve been having a really hard time lately and there’s no end in sight. Sometimes I feel so hopeless, it’s painful to keep breathing.

This government shutdown orchestrated by a small handful of right-wing extremists who somehow managed to take control of the House is such a huge, overwhelming problem. I know one person who works for the government who has been extremely stressed out, and another person who just lost their job – I suspect at least partially due to the shutdown. I’m concerned for them, and for the hundreds of thousands of people out of work, and for the millions of people who won’t receive the assistance they need for Zek knows how long. The impact on the economy is devastating, and more importantly people could die as a result of this.

It completely and utterly infuriates me that the Republicans won’t even acknowledge that they played a role in the shutdown, never mind taking responsibility. […] All we need is for the House to vote on one bill that’s been sitting on Boehner’s desk, but that he refuses to call a vote on. I don’t even understand how or why the Speaker of the House – one person – has that kind of power. I thought our government was set up to prevent one person from ever having that much power.

We can petition them all we want but it’s like they live in a different universe. […] I think the only solution is for the American people to somehow take direct control of the House – at the very least, force them to vote on the bill that would provide funding to the departments that have been shut down (without removing access to birth control or delaying implementation of the Affordable Care Act / Obamacare for a year, thanks). At least then we’d have some semblance of transparency, a record of who voted to keep this country afloat and who voted against us all.

So far I’ve learned of one way to bypass Boehner and force a vote on the clean funding bill: the discharge petition House Democrats have been pursuing. I encourage readers (especially those in the U.S.) to sign this petition urging House Republicans to join their colleagues in ending the shutdown. Also please consider contacting your representative directly (House.gov). I know I just wrote that petitioning them doesn’t do anything, but I don’t really see any other course of action. People know that the Republicans are responsible; there are several races for Republican seats in the House where polls show the Democrats to have an advantage.

(But only if the people who support them vote!)

And here’s part of another post I wrote around that time, Running Red:

I read an article that said the Tea Party is actually pleased with Boehner and that this shutdown is part of his career strategy. That’s right folks, starving mothers and babies, survivors of rape and domestic violence put out on the street, head start programs ground to a halt, hundreds of thousands of people without work or pay, parks and monuments closed, a lapse in veterans’ benefits, etc. etc. etc. … merely the pawns in Boehner’s game of chess. If he’s winning, he’s not going to listen to our petitions – unless perhaps there is a massive outcry by the people in his district, who can vote for his opponent in the next (this!) election. Without their votes, all the support and campaign funds from his party will be nothing.

So please, please vote today, if you haven’t already. If you’re inclined to vote Republican, please look up what your candidate and other Republicans have been doing and think critically about whether they actually represent you, your needs, and the rest of us who aren’t bazillionaires in terms of the practical, this-world decisions they’ve made and the consequences of their actions (or inaction). If you’re inclined to vote Democrat, please stop reading this right now and go vote!

Additional Voter Resources at Vote411.org

To Save a Tooth

“How can someone so young and healthy have such a serious problem with their teeth?”

The endodontist (root canal specialist) actually asked this during our meeting today – after I’d described a previous dentist’s theory that over a decade of grinding my teeth had caused a cavity to form inside one of my molars. It had decayed from the inside out, to the point where I almost needed a root canal when the cavity was finally detected about a year ago. I thought the dentist had fully treated it, but he only inserted a temporary filling. Some miscommunication must have occurred because I didn’t realize any follow-up was necessary.

Now my gum is badly swollen from an infection – that came back worse after I’d finished the antibiotics I was prescribed four weeks ago. It’s actually less painful now, but still very uncomfortable and so sensitive to the touch I can’t brush my teeth the way I’m used to. I feel like I have a bean wedged between my gum and cheek, and my jaw is sore on that side. I really miss being able to chew on both sides of my mouth and I’m concerned about how a gum infection might affect my overall health.

The endodontist couldn’t have performed the root canal with the infection there anyway, but he pointed out a bigger problem. I’m in danger of losing the molar next to the one that was supposed to receive the root canal because it’s the one that is infected. Ironically, the endangered molar is the one I thought needed treatment; my only complaint about Root Canal Molar is that it feels weird when I touch it with my tongue because it’s the very back tooth and I think half of it is missing. No pain; food gets stuck back there sometimes but I get it out with floss, everything’s fine. Apparently it might actually need a root canal or I could lose it, but again, there’s a much bigger problem.

My poor Endangered Molar has been assaulted by an alien civilization for at least the past two months! In addition to the gum infection, there is evidence of significant decay in the roots, possibly bone? I am in serious trouble. I really need to receive treatment for this … well, apparently, about a year ago.

The endodontist is not qualified to deal with gum infections, and is not authorized to give referrals to see a periodontist (gum doctor) or oral surgeon. So, I had to go back to my primary dentist in order to take further action. I was so furious, I was ready to start destroying things. When we got home I saw that Dog had gotten into my kitchen garbage! I was so angry, I told Mom to take him upstairs so I wouldn’t kill or seriously injure him. It was terrifying and so frustrating because I didn’t have a safe, socially acceptable way to express my rage!!!

I called my primary dentist and learned she could see me if I arrived within the hour. Within about 5 minutes Mom was driving me there; we arrived just in time. She asked questions and took X-rays and said I had two options: I could go to the periodontist to try and save the tooth, or I could go to an oral surgeon to get it pulled.

To be completely honest, if money weren’t an issue I’d say pull the fucking tooth, clean out the infection, and give me an implant. But implants aren’t covered by insurance and can cost up to $3,000. That’s more than my wedding dress! I could get the tooth pulled and not get an implant; this might be what I end up needing to do, anyway. I don’t think a bridge would be an option due to the location of the tooth; the dentist didn’t mention it as one.

But everyone – by which I mean the dentist and my mom – seems hung up on “but you’re so young!” and “it’s really better to keep your own teeth.” There’s a chance a periodontist might be able to help me, so it’s best to take that chance and get the tooth pulled only if it doesn’t work. I expressed some uncertainty, so the dentist made the decision for me: we’ll try the periodontist first. This way the dentist doesn’t have to feel guilty (I don’t think I’d feel any guilt, sorry Endangered Tooth – regret maybe if I then experience problems, but not guilt) and I might get to keep my tooth until I’m old enough for extraction and replacement to be okay. I’d need to wait for the antibiotics I’m now on (again) to kick in and (hopefully) clear the infection before I could go to an oral surgeon, anyway.

Here’s the really fun part. I could get an emergency referral to see an oral surgeon, but my insurance doesn’t see gum infections as requiring emergency treatment. They wouldn’t approve the emergency periodontist referral over the phone; there’s a chance they might not approve it at all! I have to wait 2 to 3 weeks before I’ll even know if I can see the periodontist, never mind then having to make an appointment! The infection will probably come back and/or get worse in that time, and who knows? Maybe more of my teeth will be in danger.

The receptionist said I have to wait for the referral to come in the mail, but if I had X Better Insurance she could write a referral and hand it to me.

Pissed doesn’t even begin to cover it.

You might be wondering, what do dental issues have to do with mental health? Well, let’s see.

1) “How can someone so young and healthy have such serious problems with their teeth?” Well, sir, perhaps my health issues are not readily apparent because they aren’t medical, in the sense most people are used to. I have mental health issues, which impact physical health as well. In my case, they clearly affect my dental health! For example, I GRIND MY TEETH!!! due to chronic tension from repressed anger and overwhelming anxiety.

2) I’m not working because my mental health issues are severe enough that I can’t even follow through with a job interview. I don’t trust my mood to be stable enough for me to show up for work consistently, and my anxiety levels to be low enough to function once I get there – assuming I can manage to be on time. Wakana would say I’m being too hard on myself and I should focus on the times I have been punctual and consistent. But I don’t have to do it every day; when I have had to do it every day I’ve struggled. I need help getting to the point where I can try it again.

Anyways, not working means no income means I can’t afford better insurance or to just pull the fucking tooth already and give me a titanium implant.

3) It’s really hard to do things like stand up for yourself to make sure you get the best possible care, drag yourself to the dentist and wait Spock knows how long hoping you’ll get seen as an emergency patient even though you don’t have an appointment, and deal with the stress of going to the fucking mall to see an overbooked dentist with staff that is probably overworked and underpaid and sick of being the person patients get angry at when their insurance is being sadistic. It’s even harder when you have mental health issues (especially being more attuned to other people’s needs and emotional states than your own). I would rather pull my own tooth without so much as taking ibuprofen first, than deal with the headache that is going to the dentist!

Hmm…

4) When you have a mental illness(es), you start to rely more on other people’s judgment; sometimes you trust it more than your own. “Maybe I thought he was being a jerk because I was wearing depression goggles.” “Maybe the chest pain I’m experiencing is from anxiety.” “Maybe I’m having these symptoms because I read that they’re potential side effects of the medication I’m taking.”

I know I can’t always trust my thoughts and feelings because they tell me things like “nobody loves me” and “I can’t do anything useful” and much, much worse. I rely on people reminding me that those things aren’t true and encouraging me to think about situations from other, more creative, and generally more positive perspectives.

So if you’re in a situation like I was last week, when the hygienist who did my cleaning said the pain I was experiencing from my infection was “normal,” it can seem a bit “crazy” and “excessive” to insist on seeing the dentist anyway. They were busy, I was feeling overwhelmed, I didn’t want to be on antibiotics again anyway, and I’d just been told that my problem was no big deal. So I left. If I’d stood my ground (or had someone advocate for me like my mom did today) my gum might not be swollen. I don’t know if my teeth would be in any better shape, but at least I could brush them!

5) Extremely frustrating situations like this can trigger all sorts of painful, unhealthy, and outright dangerous thoughts. It’s even worse when the people who are supposed to help me when I have a serious health concern like this either don’t seem to care or care but can’t do anything because of bureaucratic red tape. I’m fortunate that I’m in a place where my primary concern is protecting my health, and that my mom was able to support me in expressing my anger – probably because she was angry and worried too.

I’m furious to think that I can’t get the help I need because of a rule my insurance company made up, that someone who has never even met me has to review my information, make a decision with more concern about the company’s bottom line than my health, and use fucking snail mail to communicate with me. It can be all to easy to internalize that ruthless capitalistic complete and utter lack of compassion, to absorb the message that I am worth less than someone who can afford to pay for a better insurance plan (or worse, unworthy of medical interventions, period). So for now I’m clinging to my anger like a life preserver; the hard part is doing that while keeping it directed away from myself.

Psychiatry Strikes Back

I had my second appointment with the APN on Friday. It was at 4:30pm and I was a little late so I guess that played into it because it was near closing time but… she seemed very rushed. The hospital where I’m trying to schedule a sleep study needed more information and had called her, so she tried calling them back at the beginning of our appointment. They were probably closed for the day, so she left a message asking them to call her back… but I have no idea whether or when both sides will be available to talk in real time. She doesn’t seem to have time outside of appointments with clients to do anything relevant to their cases; I think that’s stupid and inefficient and a symptom of bigger problems in the U.S. “healthcare” system. But I digress.

I showed her the self-report measure she’d given me to track symptoms such as depressed mood, mood swings, irritability, food cravings, anxiety, sleep issues, difficulty doing things, and physical symptoms. I’d marked most items somewhere from “mild” to “severe” on most days. She asked questions about how I’ve been and family history of “mood swings” and filled out a form on the computer as I was answering her. She cut me off in the middle of trying to explain my family history, so she doesn’t have all the relevant information. At first she thought I’d never been on medication before; this freaked me out because I’d spent so much of our first appointment telling her about my experiences with the generics for Wellbutrin, Lexapro, Zoloft, and Buspar. I had to tell her a lot of the same information a second time. But she didn’t have any time to glance through my file before meeting with me, and there’s no way she could remember my specific case from meeting with me once a month ago. So I don’t hold it against her, personally … I just find it a bit difficult to feel safe working with someone under these circumstances. (And, well, she could have worded things a bit differently.)

Lacking the results from my blood work (I can’t find my copy and the doctor’s office has been closed every time I’ve called to have them faxed to the APN) and sleep study, aware of the problems I’ve had with medications in the past, and faced with some fairly severe self-reported symptoms, she said she would like to try putting me on Lamictal. I’d never heard of it before, so I asked what it was. It’s an anticonvulsant typically used to treat epilepsy but also bipolar. She said something about a possible rash and it takes a while to start working and you have to work up to the therapeutic dose slowly… at the time, it all sounded fairly terrifying. I’m not sure exactly what I expressed, probably a mix of anxiety and confusion, so she wrote the name of the medication down for me, told me to research it, and offered to meet again “as soon as possible.” Session over. I’d wanted to ask if she could refer me to group therapy for people with depression and anxiety, but there wasn’t any time for it.

I asked the receptionist for an appointment as soon as possible and she said the next available appointment is on September 26th! Another month. I … I can’t even comment on that. Another month before I even get to find out whether Lamictal might work for me … or I might be deathly allergic to it. Another month before I can even hear the name of another medication that might be worth considering. Hell, another month before I can ask her why she thinks it’s worth trying!

The receptionist made an appointment for me on the 26th, but also made a note to contact me if anyone cancels between now and then. I thought that was very considerate of her. It’s the same place Fox and I are going for our marriage counseling (which has been quite effective), so I can also check in with the receptionist before and/or after our weekly appointments. I appreciate her willingness to take that extra step to help me out. As frustrated as I was at the time, I also appreciate the APN encouraging me to research the medication instead of dismissing my concerns.

I haven’t been able to find anything particularly useful about Lamictal online, just a terrifying list of side effects. Most of the psychological side effects have become the norm for me, so I’m not too worried about them … I’m kind of “damned if I do, damned if I don’t” in that department. The thing that concerns me the most is that the online sources I’ve found so far claim Lamictal has only been found effective in preventing episodes of depression or mania, not treating current episodes. I really don’t want to take something that has the risk of adverse side effects if there isn’t any evidence that it might help me.

A friend of mine who has bipolar and works in a mental health setting told me that Lamictal is one of the bipolar medications that have been monitored (and found to be safe enough to continue using) the longest. It’s considered to be safe and effective, particularly for treating depressive symptoms. The severe side effects are very rare, so it’s unlikely I’ll experience them. Basically, I’d be crazy not to give this medication a try.

My friend also made a very good point: I’m not going to be able to have a productive, in-depth conversation with the APN. If I want to know something about Lamictal, I have to do my own outside research. I have to make my decision on my own, before I meet with her again. I already know the answer to the question, “What do I do if I get a rash or experience other severe symptoms?” – go to the emergency room. She won’t be available whenever it happens; I’ll have to wait a month to meet with her. So when I do talk to her, I need to ask the one thing I can’t get answered anywhere else, in order to make the best use of our limited time.

I’m going to ask her what the plan is for getting me started on the medication and adjusting the dose to find the one that’s effective and safe for my body. That way, we can work together to create one… or I can at least hear her thoughts and have a basic idea of what to expect. I need that in order to feel safe working with her.

If you’ve taken and/or know someone who has taken Lamictal, would you recommend it? Anything I should be aware of?

Can you recommend any resources that might help me make an informed decision?

Any thoughts about navigating the system?