Medical Update

I ran out of Lamictal because my appointment with the APN on Friday was cancelled for reasons outside my control. The receptionist said the “other doctor” would refill my prescription that day. Nada.

I called today around 11am and the same receptionist said the APN would take care of the prescription within the hour. “I’ll call you.” Four hours later, no call. I called back at 3pm and she said “by the end of the day.” I had important things to do today, so I couldn’t sit around waiting for it. But, according to the voicemail I just listened to, it’s waiting at my pharmacy.

I called my dental insurance to find out if there was any update regarding my periodontal referral for my Endangered Molar. I had received authorization for a consultation only; the periodontist (whom I saw on January 22nd) had to request authorization to actually treat me.

The dental insurance representative said they hadn’t received any such request from the periodontist! It’s been almost four weeks! And to make matters worse, she tried calling the office three times and kept getting a busy signal. She said she’d leave a note for someone to try again later.

When I’d met with the periodontist, she seemed to be on my side. They said “we’ll call you to make an appointment,” so I was a good patient and waited. They made it seem like any delay would be because of the insurance. I trusted them! I feel betrayed.

In related news, I went to get a root canal on Root Canal Molar last week. The endodontist-in-training attempted to perform the root canal, but had difficulty accessing it for several reasons – including but not limited to my inability to open wide enough for her to reach the back top of my mouth. Apparently the tooth is also rotated toward my cheek, making it even harder to access. We both put in our best effort, but all she really ended up doing was beating me up.

We’re officially at 6 months since I started having unbearable toothaches, and I still have yet to receive treatment! The bone damage near those teeth keeps getting worse; I can see it as a growing dark area in the x-rays.

I have an appointment to go back and try the root canal again… In two weeks… But I’d really rather not. We’ll need at least a couple of painfully long visits just to complete the root canal, then another 2 or more for the crown – if it’s approved – and there’s a chance I may have a problem with it later and have to come back again…

No, just no! That’s not happening! I’d rather just get the damn thing pulled and be done with it! I don’t even want to replace it with anything.

So now I have to convince the endodontist-in-training to refer me for an extraction and wait for that to be approved… I just hope I can communicate with her directly – and that she’ll follow through in a timely manner – without jumping through a million hoops. I can’t tell you how often I’m tempted to try and pull both teeth out myself!

But wait, it gets better! The sleep study that contributed to my crisis two weeks ago failed to reveal whether I have sleep apnea! The doctor had called me to discuss the study and, when I told him I’d slept much worse than usual, suggested we try an in-home study. I agreed and he said someone would contact me to set it up…

I was just thinking it was time to call them and find out what happened, when I received a letter from my insurance company saying they were terminating treatment by an out-of-network provider. The letter didn’t say what treatment; in fact, there is a sentence that doesn’t make any sense because the [insert colourful phrase in gorram Chinese here] who prepared the form letter didn’t bother adding what I consider the most important information! The only clue I had was at the very end: “cc Obnoxious Sleep Center.”

I was very worried that they would turn around and make me pay for the on-site sleep study (that had proven to be a waste of time and fucked up my head). I had trouble focusing on other things all weekend, I was so angry! I hated the insurance company for sending me an unedited form letter – instead of calling me to address the issue and offer help. I also suspected the sleep center of lying to me, billing my insurance for treatment I hadn’t received, etc. In short, it all made me feel very unsafe.

I called my insurance about the letter today. It had been intended to inform me that the in-home sleep study was denied because they don’t think I need out-of-state treatment. I explained that I wouldn’t be treated out-of-state, both the sleep center and my home are in the state that’s currently paying for my healthcare. But apparently the company (parent company?) that would ultimately receive the funds is based in another state. My results might have to be processed in another state, etc. To be honest, I understand why they wouldn’t want to pay for that. I just wish they’d told me in a more straightforward way!

The doctor who is ostensibly treating me was and may still be trying to get the decision reversed. As far as I’m concerned he’s welcome to continue (or not); I’ll follow through with whatever works best for me. I now have a list of names, addresses, and phone numbers that may or may not be accurate contact info for in-state sleep specialists.

I’d almost rather not even bother! But if I do have a sleep disorder, treating it could go a long way toward helping me function better in my daily life. I need all the help I can get – especially with two emotionally-intense graduate-level classes. I just need to consider whether trying to access treatment is worth the disruption it’s causing to my everyday life…

I’m considering the possibility that I might be better off going untreated, at least until my classes are over. Then I don’t have to play phone tag, listen to musak while on hold, reschedule my life around appointments that only add to my difficulties, and constantly feel like I’m beating my head against a wall. I estimate that more than half of my current stress would be eliminated if I weren’t trying to access healthcare (particularly dental) at this point in time. I kind of need to stay on my psych meds (I think), but perhaps the rest of it should be put on hold.

On a much more positive note, I took some steps toward finding a potentially-therapeutic group experience today. I met with the leaders of the “coming out” counseling group and told them that I’m trans*. They admitted that they’ve been having trouble finding members and expressed concern because the couple of clients they do have are cis, coming out as lesbian or gay. They would want to have at least one other trans* person in the group so there would be someone I could relate to on that level.

I appreciate that, even though it is a bit disappointing. At least they’re willing to work with me to find a group that might work, whether it’s the “coming out” one or another focused on general interpersonal issues. I expressed my interest in the latter and they said “if you don’t hear from us in two weeks, give us a call.”

They also encouraged me to join the extracurricular LGBTQ+ group I’ve been considering; that helped me overcome my reservations and actually show up for it today.

The facilitator was sitting at a table, surrounded my empty chairs. I walked over, said “my, what a lively group we have today!” and sat across from him. We talked for a bit about random things (completely unrelated to sexual orientation and gender identity) and had several awkward pauses.

Then he asked what I was hoping to get from the group. I told him I want a safe place where people will see me as I am: queer. He said that’s exactly what he intends for it to be, and what it had been in previous weeks when people actually showed up. His words were welcoming, but he seemed skeptical regarding whether he would see me again.

I think I’m actually more encouraged to return than I might have been if there had been a group. I felt like I bonded with the facilitator, and that makes me want to come back. I felt safe there; knowing it’s a safe place will make it easier to be there as part of a group. I feel less like I’m inserting myself into someone else’s party and more like I’m helping to establish the group. Next week we’ll be starting on the same page.

Just For Me

At the end of the music therapy session I described in my last post, Wakana told me to make a list of all the things I’m doing “just for me.” She often gives me homework without holding me accountable for doing it, but this time I want to make an honest attempt at it.

I feel the need to justify doing anything “just” for me; to be honest it feels kind of selfish. I’m not sure if that’s the gender training talking (“women should put everyone else first”) or the depression; they’re most likely interrelated.

Whatever the case may be, and as much as I may struggle to believe it, my justification is this: everyone needs to do things that are just for themselves, it’s a vital part of self-care and all-around health / wellness. Doing things just for oneself does not reduce or limit the things one can do for others. On the contrary, it helps one to be more capable of helping others.

I can’t really help others while I’m hurting myself – especially not as a therapist. Even (especially!) with my mom, she asks me for help all the time and I try to help her, but I resent her and end up doing something to hurt her in my attempts to reestablish some kind of boundary (or just as a reaction). Ultimately, it’s not healthy for either of us.

If I want to help people – if I want to do anything! – first I need to take care of myself. That’s what this post, and ultimately this entire blog, is about.

Things I’m Doing Just for Myself

  • Writing this blog
    • As much as I hope readers benefit from it, too, it’s primarily a safe place for me to process my experiences and feel seen and accepted.
  • Receiving music therapy as a client
  • Playing, listening to, and composing music
  • Playing video games
    • I might spend unhealthy amounts of time playing and thinking about them, but I also enjoy them for the story, strategy, and as a means of self-expression. If Fox and I are playing the same game, I need to play at my own pace, make my own decisions, and remember that I’m playing the game for me.
  • Watching awesome TV series
  • Reading
  • Trying to eat healthy food whenever possible
    • I only get one body (in this lifetime, at least); my body is me. Taking care of myself means ingesting things that will benefit my body me as much as possible and hurt me as little as possible.
    • I focus on eating minimally-processed foods free from weird chemicals, and on trying to balance my diet. Chocolate is a delicious treat to enjoy every day, but I need much less of it than I do vegetables, fruit, protein, grains, vitamins, minerals, garlic, and healthy fats.
  • Cooking
    • Cooking is a fun and often social activity that helps immensely with trying to eat healthy food. It’s also a great opportunity to try new things and be creative.
  • Exercising
    • I feel much better on the rare occasions when I do exercise (usually taking a walk); it’s beneficial to my body (me).
  • Meditation/Relaxation
  • Receiving massages
  • Sleeping
  • Maintaining personal hygiene
    • Showering, brushing my teeth and hair, moisturizing, applying deodorant, and wearing clean clothes all help me to feel good. I can go out in the world and do things – if not confidently, then at least without worrying about how I smell.
  • Cleaning
    • Cleaning gives me some control over my environment and makes it more pleasant, which helps me feel good. Fox and I are both responsible for cleaning.
  • Having pets
    • Pets are a huge responsibility; you have to spend a lot of time, energy, and resources taking care of them – even when you don’t feel like it or have other responsibilities. But they also bring a lot of joy and comfort, sometimes just by existing. I try to provide a good home for my pets where their needs are met; other members of the household may benefit from their presence, too. But I have pets because I benefit immensely from having cute warm fuzzy critters to hold, pet, talk to lovingly, be groomed by, teach, feed, watch, build box forts for, take walks with, etc. They are also most excellent at getting me out of my head and back into reality.
  • Learning
  • Developing adaptive software for people with anxious depression and other mental health issues
    • I have ideas for a program (or possibly several programs) that would help me take better care of myself – if not to overcome my anxious depression, to at least have an easier time living with it. If I’m successful, I want to share the software with others at low-to-no (preferably no) cost to them. But my primary reason for developing the software, the reason why I thought of it in the first place, is because I need it. I need the software to help me function and do the other self-care items on this list more consistently. Perhaps more importantly, I need to actively create the software for the experience of identifying a problem and working toward my own solution – taking active steps to meet my own needs.
  • Choosing to live

Healthcare Headache

My health insurance finally paid their share of the bill for my first visit with Psychiatrist B, which occurred 7 months ago to the day.

When I learned of this, I decided to (finally) look into options so I’ll have health insurance after my current plan – which is dependent on my being a full-time student – expires. There is an option through my current company. When I called for a quote, the person I spoke to was very nice! She asked a few questions and suggested a plan that costs – wait for it … – $400 per month! This is marketed to students who are between leaving school and receiving health care coverage from their employer, mind.

I took a look at the information she sent me and became quite concerned. One of the criteria that prompted her to suggest this plan instead of a less-expensive option was my need for prescription coverage. When she told me the benefits, I thought they included prescription coverage. But when I looked at the explanation of what the plan covers, it explicitly excluded all prescription drugs – even generic! It also explicitly excludes mental/behavioral health care.

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I thought, there has got to be something better out there! I searched for “affordable health insurance” and found ehealthinsurance.com. Through that site I was able to find a plan with a different company that costs $320 per month. Their prescription coverage includes a $15 copay for generics and coverage of 50% of the cost of brand-name drugs up to a certain limit. They also cover 70% of mental/behavioral health care, up to a certain limit. Sounds pretty good.

Except that, according to their brochure, I might not be able to switch companies and I might have to wait to enroll within a specific range of dates and I might have to go several months without coverage. I have no idea whether I’ll be able to find a psychiatrist who is in-network for both companies. “Long-term care” is on the list of services they don’t cover – I have no idea whether that applies to me or not or even what it means in terms of practical considerations.

Worst, I read a customer review by someone who said coverage was denied for treatment of a “pre-existing condition,” and ze had to fight for what coverage ze did receive! WTF?! I wouldn’t care so much about health insurance if I didn’t have a “pre-existing condition” that (likely) requires inhumanely expensive medication to treat! And there’s the nagging voice in the back of my head asking, am I really saving any money if my health insurance costs over $300 per month? That’s before the copay for the doctor’s visit, the copay for (or half the cost of) the prescription medication, and 30% the cost of any additional (limited to a certain number of visits) mental/behavioral health care I receive.

But then, I’m reminded of the first time I used my school’s insurance to help pay for a prescription. Long story short, I literally saved $100 on that month’s supply of the generic drug. Add the doctor’s visit that finally got paid for ($250, minus the $25 copay) and I’ve already saved $5. Never mind if I do need to go to the hospital, etc. And preventative health care … I have yet to compare insurance coverage vs. going to a low-cost clinic (e.g. Planned Parenthood), but there’s a decent chance I’d be saving money there, too – especially since companies are increasingly required to cover preventative care at no cost to the patient.

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Oh, I just took a look on Planned Parenthood’s website, which has a link to HealthCare.gov. Starting October 1st, I’ll be able to search for low-cost insurance options there, with coverage to begin in January. Yay, Affordable Care Act!!! Why, oh why couldn’t you be fully implemented immediately?! (I’ll refrain from soapboxing about what healthcare should look like in the US – and still won’t, come 2014 – … at least for now.)

Anyways, I still haven’t decided what I’m going to do about health insurance from mid-August (when my current plan expires) to January (when coverage begins for any low-cost plan I manage to find on Healthcare.gov). But at least I have hope that paying through the nose for whatever plan I do find (or going without insurance, as millions of Americans do) will be a short-term solution.

What’s your experience with health insurance, particularly trying to find an affordable plan? Any suggestions? International readers, how does access to affordable health insurance in your country compare to what I’ve described here?

First 3-Month Review

I wanted to take another look at the more important posts I’ve made in my now-3-month-old blog – not just rehashing them, but finding the connections among them that can lead to new insights. Toward that end, I have organized the posts primarily by theme, but also (somewhat) chronologically. The themes include:

  1. Medication
  2. Web Mandala
  3. Stigma
  4. Limits and Boundaries
  5. Gender
  6. My Inner Menagerie
  7. My Healthy Side

Medication

I started out a day with depression with my search for the right medication (much as I do each morning). As I see it, the role of medication in treating (my) mental illness is to “take the edge off” the symptoms so I can live each day and do the important psycho-therapeutic work I need to heal. Both aspects of my treatment are an ongoing process; I’ve reflected on my experiences with medication (and mental health care providers) in the following posts:

Web Mandala

Web Mandala 2012-12-13My earliest non-medication-related post was the Web Mandala I colored. In short, the star-burst in the center represents everything good about me: my strength, creativity, spirituality, intellect, life energy, determination, etc. – while the grey pillars on the corners represent my mental illness. It’s hard to say whether the pillars are invading, or the star-burst is driving them away. Which interpretation is more accurate really tends to change from day to day. The point is that they are both present in the same moment and in the same person: both the illness, and everything I need to overcome it.

Stigma

I wrote Mental Illness and Mass Shootings after the tragic events of December 14, 2012. Writing that post helped me to develop a stronger awareness of the stigma associated with mental illness. That stigma poses a real danger to people with mental illnesses and to society as a whole.

blogformentalhealth20131As part of my commitment to helping end this stigma, I have pledged to Blog for Mental Health in 2013 and joined the Mental Health Writers’ Guild.

Limits and Boundaries

Christmas Eve was An Emotional (and functional) Roller Coaster for me. I was happy while enjoying music and holiday traditions with people I love. But I had a lot of difficulty coping with lack of sleep, feeling overwhelmed by all the tasks I needed to complete and stressed about my pending move, loud noise coming from my roommate’s TV, guilt and frustration over my mistakes, and insecurity about playing viola. I might have also felt some ambivalence about spending the day with Banji, due to the emotional effects I experienced while she was living 14 hours away.

In my post: “We all know it’ll never happen, so why do we waste our breath?” I described the other stress and difficulties I experienced during the winter holidays, including cancelling plans at the last minute. At the end of the post I made 2 New Year’s Resolutions:

  • to figure out my limits
  • to set and enforce clear boundaries

I’m not particularly confident that I’ve been doing either of those, but I have been making at least a small amount of intermittent effort. Continuing work on My Efforts to be Codependent No More and Detachment should help. I just need to stay focused – which is not always easy!

Gender

genbenjanI wanted to focus on gender-related issues during January, so I called it Gender Bender January and planned to write gender-related posts multiple times per week. I learned that keeping up with a theme-based posting schedule is hard! – and not always in line with what I need this blog to be. Gender-related issues do play an important role in mental health, though – particularly for me – so I think it is an important topic to come back to.

One gender-related issue I’ve written about since January is the ideal of the slender body, to which I say: “FUDGE THAT!” I felt liberated while reading a chapter of Unbearable Weight: Feminism, Western Culture, and the Body by Susan Bordo (1993, University of California Press). The messages about the body that the article exposed have been hurting me my whole life, but I was finally able to get angry at them instead of at myself. On February 13th I recast them as the enemy and allied with my own body – cellulite and all! “FUDGE THAT!” was my first post to be reblogged by someone; I consider that a great honor. 😀

My Inner Menagerie

2013-01-11-02On January 10th I began a multi-post process of connecting with different aspects of myself that I generally would prefer to remain hidden.

The Dark Horse represents my difficult emotions – especially anger – which tend to cause me a lot of pain, but can be valuable allies if only I can harness them.

The Critic voices my self-criticisms, doubts, and insecurities – often very harshly. Although it tends to hurt me, the true problem with the Critic is that I have not accepted it as part of myself. If I can own those thoughts, I can word them in a nicer way and use them as constructive feedback.

Mushussu-Sirrush, dragon of chaos. Drawn in mechanical pencil. Colored with oil pastels.

Mushussu-Sirrush, dragon of chaos. Drawn in mechanical pencil. Colored with oil pastels.

Mushussu-Sirrush is the chaos in my life, some of which stems from early childhood experiences and much of which is self-inflicted (for example, by allowing my home to become cluttered). In that (February 5th) post, I expressed my feelings about the 15th anniversary of my father’s death and explored the theme of chaos.

wyvernOriginally, I did not want to draw the Wyvern because it is a dragon that spreads disease and death; I prefer Anne McCaffrey’s portrayal of dragons as allies. However, I cannot deny that disease and death have both had a profound impact on my life. If I have to deal with something and often experience painful emotions related to it, I might as well take some time to make it something I can see – and make it as ugly and mean-looking as possible. At the time I did not want to color it in, but every time I look at the image online I want to add color to it.

The Ostrich in my poem, Trapped, represents the part of me that fears change and believes that I cannot recover / free myself because of some aspect of who I am. The Ostrich thinks I would have to change my very nature to be free.

Li-Ying comforts her husband; though sad herself, she thinks she can only imagine what he must be feeling.

Li-Ying comforts her husband; though sad herself, she thinks she can only imagine what he must be feeling.

I featured several secret aspects of myself in my post, Ending a Life. I’ve summarized the ones I consider most important here:

The Comforter  is the part of me who places others’ emotions and needs before my own, believing that their needs are more important.

Surrounded by the guests at the funeral, Elaine is completely unable to connect with them. All she can feel or think about is her sorrow.

Surrounded by the guests at the funeral, Elaine is completely unable to connect with them. All she can feel or think about is her sorrow.

The Ghost represents my reaction when I feel too overwhelmed by my own painful emotions to connect with others; when I feel alienated from them and from the life energy around me.

Ruth pours drinks for the guests to enjoy, feeling detached from "their" sorrow.

Ruth pours drinks for the guests to enjoy, feeling detached from “their” sorrow.

The Servant is the part of me who sees the good in death: it ends the suffering of the person who dies and allows them to move on, and it allows loved ones to mourn, move on with their own lives, and sometimes have aspects of their lives that are better. This part of me feels detached from others’ sorrow but at the same time obligated to participate in the rituals that have meaning for them, but not always for me.

Yuan cannot even bear to be present at her grandfather's funeral. She escapes to the kitchen and plays with her imaginary friend instead.

Yuan cannot even bear to be present at her grandfather’s funeral. She escapes to the kitchen and plays with her imaginary friend instead.

The Deserter is the part of me that wants to leave this world – and all its pain – behind. It is the part I struggle with regularly to remain engaged in my own life.

So far, I’ve been doing fairly well: I’m still here. But I’d like to be doing better; I’d like the struggle to be easier.

I revisited the Deserter on March 5th, literally taking a walk with it in darkness (i.e. at night). In the process, I came to understand that the Deserter is extremely frustrated with the lack of stability in my relationships.

My Healthy Side

On January 30th I was challenged to look at myself in a more positive light, and responded by considering two “What If …” questions:

  1. What if  instead of seeing myself as a person who struggles with depression, I see myself as a person who successfully lives with depression – one day at a time?
  2. What if  I have recovered from depression?

These questions give me a break from focusing on pathology and turn my focus instead to my strengths, the characteristics I already have and need to overcome depressive symptoms, possibly even the disorder in its entirety. Focusing on the ways in which I live successfully with depression, the ways in which I am already living the recovery I seek, also requires me to take personal responsibility. I can’t cower like the Ostrich: hoping someone will save me from the predators, and wishing I could be someone/something else. I need use my existing strengths to protect and free myself.

overnight.org

theovernight.org

I have been interested in the Out of the Darkness Overnight for a couple of years now, and on February 7th I finally committed to walking this year. The final push I needed came during one of many instances when suicidal thoughts invaded my mind, but this time they asked a very useful question: What do I have to live for, besides other people? I replied with little things that I enjoy, many of which are sensual. That post serves as a very useful reminder of what is truly important to me; it can help me stay grounded.

When I realized what it would take to be able to complete the Overnight, I didn’t shy away. Instead, I recognized the changes I need to make to my lifestyle to be healthier and decided now’s as good a time as any to start acting on them.

Week 1 of training for the Out of the Darkness Overnight

Week 1 of training for the Out of the Darkness Overnight

Although it took me almost a month to really start training, I remain determined to take action to improve my own quality of life – and achieve a goal I can be very, very proud of!

Last, but certainly not least, there are strategies I can use to rewire my brain to focus more on the positive: my positive attributes, positive things that happen in my life, positive aspects of interactions with others, etc. It can be hard to do this, especially if I’m having a bad day. Even on the days I find difficult, I can find 3 things that are positive – or at least one:

I’m still here!