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.

Depression Pool

I felt very tired and sad all day today; it took all my energy to do anything. I felt like I was trying to interact with the world from the bottom of a pool.

We went to talk to the representative at the venue where we’re having our wedding celebration; I felt like he was being very curt, talking down to us, lecturing us, and trying to get us out of there as quickly as possible. It had to be at least partially depression goggles; I can’t imagine he would still have a job if he treated everyone the way I felt like he was treating us. We accomplished most of what we wanted while we were there – I think, the whole thing felt very disorganized – but I left feeling as dissatisfied as if we’d missed our appointment or something.

We went grocery shopping on the way home. We kept to the list, found everything we needed, and headed home tired but satisfied. At one point I even found myself dancing to the music playing in the store. When we got home I just sat in the car for a couple of minutes, then got stuck holding the same weird position for a while as I was trying to get out of the car. I was sitting sideways in the seat, one or both of my feet on the ground, leaning against the door frame and staring at a spot about 5 feet away. My limbs felt too heavy to move.

I’m kind of amazed that I managed to stay awake for about 13 hours today. If my body had its way, I think I would’ve spent the whole time¬†drifting in and out of sleep. Should I be proud that I accomplished things even though I was feeling so miserable?

I’m moving ahead with wedding planning and the summer course I signed up for begins on Monday and I have a job interview over the phone tomorrow morning (which I already postponed twice because I was sick). Maybe this lethargy is a sign that I’m not ready to pick up my life again just yet… or at least that I’m trying to do too much at once.

A Cure for Anxious Depression

Today’s Daily Prompt asks:

If you could create a painless, inexpensive cure for a single ailment, what would you cure and why?

My immediate reaction to this prompt was “depression (duh!)” – but then I thought, “you know, my anxiety causes at least as many problems as the depression, possibly more. It may actually be the cause of the depression.” I bounced back and forth for a couple of seconds, on the assumption that I had to choose one.

WRONG!!!

I’ve long believed – particularly as I read other people’s mental health blogs – that I have one disorder and the “anxiety” and “depression” I experience are overlapping subsets of the symptoms of it. Treating one subset of symptoms won’t do anything for the other subset, nor the underlying disorder. Anyone who wants to treat me needs to treat the whole package, even if it doesn’t fit neatly into a convenient label. This is actually a very common problem among those of us with mental illness.

I need to thank Michelle W. for today’s prompt because it, well, prompted me to do some research. I’m hopeful that if I bring my findings to potential health care providers (particularly psychiatrists) I’ll be better able to receive the treatment I actually need.

The research supports my idea that, at least for some people, anxiety and depression are symptoms of the same disorder – called “anxious depression” in much of the literature. Cameron (2007) compared individuals with anxiety alone, individuals with depression alone, individuals with comorbid anxiety and depression, and healthy individuals. The individuals with comorbid anxiety and depression were unique in that their hypothalamic-pituitary-adrenocortical (HPA) axes (plural of axis) were hyperactive. It seems to me like finding a way to address this hyperactivity directly may provide a key to effectively treating this disorder.

http://total-body-psychology.com.au/stress-response-hpa-axis/

There is (currently) no simple way to cure imbalances in the HPA axis, but the article this image links to does list ways to address them via lifestyle interventions, psychological treatments, nutrition, and medical treatments.
http://total-body-psychology.com.au/stress-response-hpa-axis/

And it’s a very important thing to do, not just for me! A good 5% to 9% of the adult population struggle with this disorder every year (Cameron 2007). “These patients have greater severity of symptoms, increased risk of suicidality, a more chronic and persistent course, and more functional impairment. This syndrome is also more difficult to treat, with longer time to remission and need for increased medication.” (Cameron 2007). Most if not all of the other articles I read agree that people with anxious depression have a poor response to medication – probably because they’re receiving the wrong medication!

There are some guidelines for treating anxious depression differently from other types of depression. While they may be helpful, I’m concerned that they seem to conceptualize anxious depression as one or more variations of a disorder (anxiety or depression) rather than as a distinct disorder (which may itself have subtypes). Simon & Rosenbaum (2003) suggest multiple courses of treatment depending on the specific type of anxiety disorder that is comorbid with depression. Marano (2002) describes different types of depression – including anxious depression – and how they can be treated.

The latter article is particularly relevant to me because I found the description of atypical depression to be quite accurate to my experiences. I’m hoping I can use the information therein to help my someday mental health provider make a more accurate diagnosis and treat instead of poisoning me. Maybe I have “atypical-anxious depression?” I don’t know, I just want to find a way to fix it! And if I could create a painless, inexpensive cure for it, I wouldn’t hesitate to do so.

References

Aina, Y. & Susman, J.L. (2006) Understanding Comorbidity with Depression and Anxiety Disorders. Journal of the American Osteopath Association, 106(5 Suppl2), S9-14.

Cameron, O.G. (2007 December 1) Understanding Comorbid Depression and Anxiety. Psychiatric Times.

Grohol, J.M. (2008 January 3) Anxious Depression Predicts Poorer Treatment Results. PsychCentral.

Hirschfield, R.M.A. (2001) The Comorbidity of Major Depression and Anxiety Disorders: Recognition and Management in Primary Care. Primary Care Compantion Journal of Clinical Psychiatry, 3(6), 244-254.

Marano, H.E. (2002 July 1) The Different Faces of Depression. Psychology Today.

Rao, S. & Zisook, S. (2009) Anxious Depression: Clinical Features and Treatment. Current Psychiatry Reports, 11(6), 429-436.

Simon, N.M. & Rosenbaum, J.F. (2003 March 27) Anxiety and Depression Comorbidity: Implications and Intervention. Medscape.

Daily Prompt: Undo – Smash the Clock!

Daily Prompt: Undo | The Daily Post.

If you could un-invent something, what would it be? Discuss why, potential repercussions, or a possible alternative.

I would get rid of the clock. It drives me crazy, especially when it imposes deadlines. I can’t deposit my check because the bank closes at 5. I have to be in class at 5:30 or I’m late – I’ve experienced so much anxiety and self-hatred from that! The best is when something has to be completed by 11:59:59 pm – 1 second can be the difference between success and failure.

Right now I’m feeling depressed and paralyzed because I’m supposed to hand in a hard copy of an essay for my 5:30 Thursday class. I forgot about the essay and didn’t have a chance to work on it while moving over the weekend. If I’d thought ahead a bit I could have informed the instructor of the scheduling conflict ahead of time, as required in the syllabus, but of course I didn’t do that! I was too stressed out by the move, other school-related stuff, etc.

Now I feel guilty and uncertain: should I show up for class late and empty handed? Is it better not to go at all? When should I email the instructor? Is it fair to ask her to meet me on campus so I can hand in a hard copy as requested? Or to send it electronically when everyone else had to print it out? I don’t mind the penalty to the grade for handing it in late – I’d rather receive a lower grade for a better essay than avoid the penalty by handing in something I’ve rushed and am not proud of. But I don’t want to allow enough time to pass for that penalty to get very high, and I feel guilty anxious about how she might react to my confession / explanation / excuse / request that she still accept the assignment!

And there’s the clock, tick-tocking away, mercilessly adding to the stress every second, every minute, every hour of every day. I just want it to stop! If the clock didn’t exist then the paper would be due “sometime around sunset” and I could probably get it done on time. No one would know precisely which minute I walked in through the door; getting to class “in the evening” would suffice. I could deposit my check “during the day” which is now because the sun hasn’t set yet (yay longer days!). Etc.

I know we need some way to keep track of time and to hold people accountable, both for working the hours they’re being paid to work, and for paying employees for their time! My instructor, classmates, and I might all have different ideas about when “the evening” is, making it nearly impossible for us to meet at the same time. Without some kind of deadline I’d never get anything done. And so on and so on. They’re not perfect, but clocks are a working solution to those problems.

I just hate having my life broken down into increasingly minute portions of time, measured and regulated. I get too stressed as a result. It isn’t how my body seems to function. I wish we had a more flexible means of tracking time, determining when a task needs to be completed, etc.