Monday, June 23, 2014

A long, strange list of supplements I can't tolerate

The reality of the new job is starting to sink in. For one thing, our temporary headquarters are fairly makeshift. I hate my chair -- its seat is too big for my thighs and it gives me a backache. I'm trying to navigate a role that's new to me in an agency that's new to me, which is a whole lotta new. I thought I was doing fine until my heart started beating really fast, really often.

At first I thought it was just anxiety. A week ago I was scheduled to visit the residence, which is still being renovated. I was wearing sandals because now that I no longer work for a hospital, I can. Unfortunately, you need to wear closed-toe shoes on a construction site. Since it was late in the day, I ran to Payless with my supervisor, bought a shoddy $25 pair of flats, and went to the site. Walked all over it, up and down stairs.

I woke up the next day in knee agony. Could barely walk. Which was a damn shame, since that evening I was supposed to go to my niece Shira's graduation. I  missed a day of work and the graduation.

Missing a day of work made me nervous, so early on. I'm still on probabation for five more months and four more days. Missing the graduation made me miserable, and having a severe resurgence of the knee pain was terrifying. So the next day, I woke up with a pounding heart. We -- the program director, two of the four case managers I supervise, and I -- were supposed to go to a psychiatric ward and meet with potential residents. I had to appear normal and in control.

We met at another site because they had a van we could use to drive to the psych ward (it's not well served by mass transit). All the way there I was nervous and conscious of my heartbeat. When I got there at about 8:50 a.m., I was greeted by one of the care managers.

"I've been here since 8!" she said. "The email said the meeting was at 8."

Really? I thought. I was almost positive I'd said the meeting was at 8. Had I screwed that up? "I'm so sorry," I told her. "I thought I set it for 9."

"No problem," she said, sitting down at the table in the small conference room near the entrance and busying herself with her cell phone. We sat in silence for more than a few minutes until the other care manager joined us, and then the program manager arrived.

I was kind of surprised she didn't want to talk to me, since I'm her supervisor. Then again, I've never been a supervisor before. I've done clinical supervision, but never had to address someone's behavior or demeanor. Also, I was terrified that they might realize how anxious I was, how confused my thinking. I could barely concentrate. I tried to calm myself down by reminding myself that anxiety is just a feeling and it passes, which didn't really help much.

After we met and reviewed a few things, we set off in the van for the psych ward. I wasn't 100% sure what we were going to discuss with the residents -- my supervisor had left things kind of undefined. When I'm thinking clearly I'm fairly quick on my feet and able to respond appropriately to situations. But I wasn't thinking clearly. I was terrified, and I had no idea what I was going to do or say.

We got to the ward and they put us in the dining hall. Where we waited. I was annoyed because I'd spoken to the housing specialist about this meeting and we'd set a precise time: 10:30 a.m., after they've finished morning rounds. At about 10:50, the housing specialist came in.

"Are you sure we were supposed to meet today?" she asked.

I'm losing it, I thought, but I committed. "Yes, we said today at 10:30," I stated firmly. Did I screw up the date or time? I wondered.

She didn't have anyone for us to meet with that day. So we took the case managers back to the locations where they work, and my supervisor and I were taken back to our temporary offices. I immediately checked my calendar and emails. In black and white, they said that the meeting with the care managers was at 9, and the meeting on the psych ward was at 10:30 on that day. That was a bit of relief.

But it didn't erase my anxiety. Okay, so I wasn't completely losing my mind, but my heart was still pounding. I started wondering if my Cymbalta dose was too high. My psychiatrist, Dr. New, raised it during last winter's deep depression. But now I have a job that I don't hate, a schedule that's not killing me, and it's summer. Could I be hypomanic?

I made an appointment to see Dr. New at the end of the week, just two weeks after my last appointment with her. She didn't think my symptoms supported a diagnosis of hypomania.

"No pressurized speech or racing thoughts, no increased spending, no hypersexual behavior, right?" she said. None of the above. "How are you sleeping?" Quiet well, actually. I wake a few times but fall back asleep.

"It sounds like anxiety, and maybe a little more depression," she said. I couldn't understand why. Nothing bad has happened to me recently except that the guy I met and liked pulled a disappearing act. But that's nothing new. "I wouldn't want to reduce your antidepressants. If anything, I'd maybe want to increase the mood stabilizer, but I'd hate to put you on four medications."

I would hate that too. So we agreed that I would take the Klonopin more often than once every month, which is about how often I usually take it. "Take it every day if you need it," she said. "Half a milligram twice a day." I'll see her in another two weeks.

I put the Vitamin K in my purse and resolved to try that. Then I thought of something else that might be the problem. Something about the pounding heartbeat made me think of calcium. Because I have a shameful little secret: In addition to the calcium supplement I take daily, I've been consuming calcium-based chewable antacids. Since my most recent bout of bronchitis, I've been taking Nexium prescribed by my internist/gastroenterologist, but I've still been feeling the burn at the back of my throat. And those calcium chewable antacids are good. I've been chewing them every night.

I looked up the symptoms of calcium overdose:
  • Abdominal pain
  • Bone pain
  • Coma
  • Confusion
  • Constipation
  • Depression
  • Diarrhea
  • Headache
  • Irregular heartbeat
  • Muscle twitching
  • Nausea
  • Vomiting
Well, clearly I didn't have all the symptoms. But bone pain? Sure -- my knees were killing me. Confusion? Somewhat. Depression? Definitely. Irregular heartbeat? Abs.o.lute.ly.

So I've stopped taking the supplement, and I've given up the chews. And already, I feel better, although not 100%. Add calcium to the long, strange list of supplements I need to be careful of -- turmeric, tea tree oil, ashwagandha, passionflower, oregano oil. So far I don't think Vitamin D, fish oil, and folic acid are hurting me, but I'll definitely check next month during my annual physical.

Tomorrow I'm sending my laptop off for maintenance -- it's developed an annoying pink line across its screen. Don't worry, I'll be fine -- especially since I've laid off the calcium.
Copyright (c) "Ayelet Survivor"

Wednesday, June 11, 2014

Your brain's no better than my brain, bitch

I went to a smoking cessation training today that was pretty good. (The residence where I'll be working is going to offer smoking cessation groups, so I needed suggestions to develop the curriculum.) It would have been awesome if the other participants had shut their damn pie-holes. Several agencies sent more than one person, and they sat in pairs or groups and yap yap yapped while the trainer was trying to speak over them.

Yes, I sound a bit testy. Lately I've been noticing a greater mindfulness about my anger, both how I experience it and how I think about it. I'm increasingly aware of the adrenaline surging in me when I rocket from annoyance to fury. And more and more, I realize that the reactions I have (or the actions I want to take) when I'm angry are unwarranted, disproportionate, or both.

Most likely this is the result of the new job and the success of the knee therapy, which have led to an immense increase in my sense of satisfaction and well-being. My baseline is much more serene, so it takes a lot more to get me angry. Since the disparity is greater, the difference between serene and angry is much more noticeable, which makes it easier to be mindful of my anger. Sadly, being mindful of my anger does not always prevent me from reacting to it.

I was simmering most of the day because of all the yammering. But one participant really hit a nerve. Several of the training participants are smokers, and the trainer asked them to share their experiences of trying to quit. Della had taken Chantix, a prescription medication that partially blocks the nicotine from acting on the brain and also eases some withdrawal symptoms. Unfortunate, its side effect profile is fairly draconian.

"I had nightmares!" Della said. "And suicidal ideations! I'm a licensed clinician -- suicidal ideation is something my clients have, not me!"

If I had the ability to raise one eyebrow, I would have. Yes, most "licensed clinicians" don't experience their patients' symptoms. However, those of us who have experienced symptoms can utilize that experience to empathize with our clients, not denigrate them.

Your brain's no better than my brain, bitch, I thought. Way to miss an opportunity to hone your clinical skills.

During my 2010 hospitalization, after I got the excess Klonopin out of my system and waited for them to release me, I spent a lot of time observing and talking to the other patients. It was quite informative, especially one episode of violence.

I had a feeling something was going to go down late one night. Katressa, my 19-year-old roommate, was striding back and forth across the patients' lounge, muttering to herself. She'd been moved into my room a few days prior. We had some great conversations about her confused sexuality.

"Maybe I like girls, maybe I like guys, maybe I don't know," she said. "Everyone keeps asking me."

"You don't need to decide either way right now," I said. "This is something you're allowed to figure out slowly."

In the lounge that night, sex wasn't on her mind. She was angry. I thought back to my Violence & Aggression class, taken while earning my first master's. The professor described how anger escalates into violence on the ward. First the person sits and broods, with an angry expression, possibly muttering. Then the person gets up and begins pacing and complaining, sotto voce. It's best to intercede earlier rather than later.

Her pacing should have been my cue to fetch an employee. But I was frozen on the spot. I didn't know if I should leave or stay. I was afraid to try to talk to her.

Another patient, Irma, stepped out of the bathroom, and Katressa leapt on her, smacking her with open hands. I ran to the nurses' station and screamed for help. A nurse and a few orderlies walked quickly to the lounge and pulled Katressa off Irma. I was relieved to see she wasn't badly hurt; I guess I'd thought Katressa was a more skilled fighter.

No idea why Katressa hated Irma. But I didn't want to sleep in the room with her that night. So they put me in the isolation room with a mattress on the floor. I was haunted and agitated and guilty. I couldn't sleep.

Another patient, Raymond strolled by. "What you doin' in here, Ayelet?" he asked. He and I hadn't talked much, but he'd listened to me talking with the other patients and had apparently decided I was cool.

"I was scared," I said.

"Scared of what? Katressa? Shoot, she wouldn't hurt you! She likes you!" he said. He crossed himself, kissed his fingertips and pointed them at the ceiling.

Well, that was some relief. Patients can sometimes be a good source of information on other patients, although when they're unreliable you might not know until it's too late.

Raymond strolled away, and eventually one of my favorite fellow inmates shuffled by. Kwan was a very sweet and quiet kid, about 19, with terrible insomnia. We talked at strange hours, usually early in the morning or late at night, since he slept most of the day. Kwan didn't seem surprised to see me in the isolation room, or awake at 2 a.m., but came in and sat down with me.

For a while we talked about his situation. Then he asked me, "You know so much about all this stuff. Why are you in here?"

Trenchant. Why was I in there? What did I have to offer other people with mental illnesses, if I couldn't keep myself together?

Sleepy though I was, I think I had a good answer for him. "Because these are illnesses, and we don't have a cure for them yet. Only treatments that aren't perfect. I have an illness, so sometimes I get very sick, and I have to try different treatments to get better. That helps me to understand what other people, like you, go through, and helps me figure out treatments that might help you."

Kwan accepted that amiably, nodding. I was afraid he'd fall asleep at the foot of my mattress, but eventually he got up and shuffled away.

I don't have much respect for clinicians who think they're all that much healthier than their patients, because I've felt how mental illness can knock you on your back and disable you. Maybe it can't happen to anyone -- I doubt Antonin Scalia will ever suffer any kind of mental illness, smug and complacent as he is -- but it can happen to a lot of people. People who have psychiatric disorders aren't categorically different from all other people, just as people who have diabetes aren't categorically different. You can develop diabetes through lifestyle as well as genetics. Same is true of mental illness: environment has a huge impact on mental health.

So that's probably why I was so angry at what she said. Not that I was fully aware at the time. I didn't think back to my time on the psych ward and reminisce about Katressa's anger and Kwan's insomnia. But what Della said set me off. Of course, I was already halfway to angry because of the incessant jabbering from some of the ruder participants.

I have to admit, sadly, that my response to my anger was not entirely appropriate. One response to anger, probably the best response, is to say and do nothing. Nobody needs to know you're angry. Nobody wants to know you're angry -- it will only make them uncomfortable or defensive. A cluster of five or so jabberers were sitting next to me; two loudmouths were directly across the room. At one point, I "shushed" the loudmouths while I was trying to listen to the trainer.

"Did she just 'shush' me?" said Loudmouth One.

"Oh, no, she didn't!" said Loudmouth Two.

Really? I thought. People actually still say that? They continued to discuss my rudeness, which, of course, made it even more difficult to hear the beleagured trainer. When their chatter faded away, the jabberers next to me kicked into high gear.

Should I say something? I thought. I'd considered approaching Loudmouth One during the break and asking him about his job (not that I was actually interested, but as an excuse to ask where he worked and did he work with Loudmouth Two). Then I thought I could say, "Could I ask you a favor? When you and Loudmouth Two talk while the trainer is talking, it's really hard for me to hear what he's saying."

I chickened out. It seemed indirect and manipulative, which probably means it's diplomacy far above my paltry skills. And I didn't say anything similar to the gang of jabberers. But I didn't keep myself from looking at them and rolling my eyes, which one of them observed and shared with the rest of her pack.

"Look at her rollin' her eyes. So inappropriate," scoffed a 50something woman wearing an off-white lace t-shirt that was only lined in the front. From the back, her bright white brassiere and back rolls were clearly visible through the lace.

I'm not about to study appropriate behavior from an aging woman who apparently still shops at Forever 21, but she did have a point. I shouldn't have rolled my eyes at them. I shouldn't have done anything. Nobody else needed to know I was angry, because my anger was not going to accomplish anything. The trainer tried to shush people several times, to no avail; obviously I wasn't going to be able to. I could have tried to ask them nicely to be quiet, but given Grandma Lingerie's response, I doubt it would have been successful. I should have put up and shut up.

Maybe I'm finally approaching maturation, now that I've processed and more or less resolved my adolescent sexual trauma. Maybe I'm gaining some ascendancy over my anger. It's unfortunate that a training room full of mental health clinicians can act like a kennel full of adolescent chihuahuas, but it is what it is. I did like the trainer, and he seems to know the material very well. Although he said something I disagreed with vehemently. (Fortunately, I was able to keep my vehemence cloaked with a mask of professional neutrality.)

"A good therapist never answers a direct question," he said, noting that he'd been through 30 years of therapy -- two psychoanalyses -- and had four years of psychoanalytic training. I'm pretty sure that most CBT clinicians would disagree with that statement. You're trying to provide a rational viewpoint and explain how their beliefs about themselves and the world impact their feelings. You need to be direct.

I was kind of appalled at the length of time he'd spent in therapy, but of course, most of us agree that I'm not quite finished yet either.

A person I don't particularly like posted a meme in one of my Facebook groups. I consider 99% of poster memes absolute garbage; in fact, people who post tons of them in groups annoy me. But this one really said something:

There are some people
who always seem angry
and continuously
look for conflict.
Walk away;
the battle they are
fighting isn't with you,
it is with themselves.

What can I say? True dat. Oh no he didn't!
Copyright (c) "Ayelet Survivor"