Category Archives: Neurologists & Neurological Stuff

Premenstrual Dysphoria, Mood Disorder, And All The Joy That Comes Along With It

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It started during the first round of the NHL playoffs, I know that for certain.  Well, that’s the first time I noticed something, anyway.  I remember sitting in my family room, overwrought and having murderous thoughts about my father every time he would flip to another channel during period breaks.  It got me timing them on my phone, 17 minutes to the second, and after that he had better watch out.  I didn’t really think too much on it, after all, hockey is the closest thing I have to an organized religion, and I’ve been pretty intense through playoff seasons in the past.

Except a few days later, it progressed to me watching the games on the television in the basement.  I was very upset and reactive, and not just about hockey.  My father became the target for my anger, and my mother for my not-quite-hysterical crying jags.  I thought it was hypersensitivity and anxiety, and in many ways, it was.  Just not quite the ways that I thought.

Then my head started pounding with migraines.  I became exhausted.  I already knew my emotions were all kinds of erratic.  And I was spacey and generally unfocused.  I would stop in the middle of sentences and just stare off at nothing, losing thoughts – or even the ability to generate them – completely for a minute or so.  I knew by then things were not at all right.

The migraine tied it up into one neat little cluster of symptoms for me.  It was all related to my headaches, a seed my psychiatrist had planted with complete innocence at one of our early visits.  He had discussed my migraines, my mood, and done some very casual speculating about temporal lobe epilepsy.  I brushed it off entirely in the moment.  When I was having psychogenic nonepileptic seizures (PNES) from the post-traumatic stress disorder (PTSD) that manifested due to the electroconvulsive therapy (ECT), I was sent to see a neurologist specializing in seizure disorders, the Man, every doctor in the land knew of him and how good he was (and I had to wait six months for an appointment).  He cleared me absolutely of epilepsy, or any kind of pathological seizure disorder apart from the one induced by the trauma.  And yes, it was fun to stick all of those unpleasant acronyms into one sentence, thank you.

But with my bipolar disorder stabilized, there was this strange cluster of symptoms that I knew beyond a shadow of a doubt were not bipolar-related, and the migraine was seemingly the pivotal item upon which they all rested.  There had to be more to explain it.  Especially because shortly after the migraine episode passed, my symptoms remitted.  After a second episode when I was back home to visit my family in Pittsburgh, I began to poke into information on partial seizures, and even made an appointment with Dr. the Man.  But while, in theory, things were coming together, something about this explanation didn’t feel right to me.  I canceled the appointment and just kind of left things alone to simmer.

Then last month, a light bulb went off.  The light started in my uterus, but quickly made its way to my brain.  I was holed up in my room, I had been for days.  I wanted to smash someone or something, I was gobbling up Xanax and weeping, everything around me was irritating and stupid, I was exhausted and my head hurt. . .  And then I had a cramp.  Just a small one, but it pulled everything together in my mind.  I looked up the symptoms of premenstrual dysphoric disorder (PMDD), and voila!  My mom had it, too, which I knew somewhere in my brain.  They gave her a couple of medications to try back in the day, but apparently the cure was worse than what ailed her, and she just had to ride it out. Cooped up in a house all day.  With two small children.  Good Lord, that woman really is a saint.

So between me, my OB/GYN, and my psychiatrist (except mostly it was me), we’ve got it all set to where I up my mood stabilizers (Carbatrol and gabapentin) at a certain point in my cycle, and I’m a normal (well, my version of normal), mostly functioning human being again.  I’m still a little more anxious, irritable, and weepy, but I have been getting by pretty well on the balance. Especially since I started kickboxing again. Such joy, such release, endorphins, everything that is good.

So since things are going so well, let’s throw something into the mix to fuck things up.  It’s the way things work for me, I think I would be caught more off of my guard if things just went to plan.  And honestly, there is no bitterness in that statement.  I am completely used to it by now.

The IUD.  Oh God, the saga of the IUD!  Everything about it has been great, except the excruciating pain after insertion and the unholy cramping of my last period.  I don’t think I gave quite an exact idea of that, and even if I did, I’m going to again.  Keep in mind, ladies, that this is super-atypical.  There is usually increased cramping during your first couple of periods, but not, not, not anything like this.

Last period, I spent the majority of time basically bed-bound.  I had a heating pad cranked up to very high, I was taking Vicodin, alternating every three hours with mega-doses of ibuprofen, and I added in some old, expired muscle relaxers that belonged to my dad (he was happy to contribute what was left in the bottle as long as I shut up after I said the word “cramps” – and by the way, don’t be stupid and ever try this at home), and I had worked out a technique to keep myself immobile from the chest down by the end of the first day.  It was a simple thing, I moved, I wanted to die.  Pain really is a fantastic learning tool.

And still, and still, all of these measures only made my pain just bearable.  I swear to you that I am not playing up the intensity of this.  It started in my back, wrapped around my abdomen, and actually went shooting all the way down through every nerve in my left leg, out through my foot.  My OB/GYN said that it sounded as bad as labor pain to her.  I have no frame of reference, but I did feel totally legitimized and not like I was being a whiny bitch about things.  So that was nice.

And now I’m counting down to go time again.  I’ve got my shiny new bottles of (doctor prescribed) medication in my nightstand.  I’ve got my heating pad next to my bed.  I am all prepared.  Only I’m stressed as fuck about it, of course.  And ladies, you should know what stress can do.  It can delay your period!  Which for me means a longer time on an increased dose of mood stabilizers.  Which at this point is honestly making me a little dopey.  Time is passing oh-so-incredibly slowly, I’m walking around in a bit of a fog, and I just feel like there is something like a medication buildup clogging my brain.  But I can’t knock my doses down, because even now I’m still edgy.

Of course, there is somewhat of a light.  The good doctor and I agreed that we’ll (we’ll? what, is she going to go through the pain, too?) try two more cycles, and if the pain doesn’t get any better, the IUD comes out.  Which is a bridge I shall cross if and when I can see it in front of me.  Right now it’s a pretty long way off.

© Ruby Tuesday and I Was Just Thinking. . . 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

Through Pain Comes Growth

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I’ve heard that, you know.  I remember it most specifically from an episode of The Nanny, of all sources.  But I have no idea what has come from my latest pain save meals of hydrocodone and promethazine, and a renewed terror of the Migraine Monster.

I’ve had severe headaches since I was quite young, so young, in fact, that my mother remembers them more vividly than I do.  What I remember is a diagnosis of common migraine (a migraine lacking aura – all the weird, usually visual changes that precede the pain by roughly 20-30 minutes in a complex migraine) more than half a lifetime ago.  There was one emergency room visit with CT scan (normal), injections and prescriptions of every drug developed for migraine ever (please don’t make me reiterate them all), prophylactic meds in failed attempts to prevent them, or at least lessen their frequency, about a half-dozen specialists who all confirmed that my brain wasn’t doing anything underlying to cause this pain, and from all of that we have arrived where we were more than a decade-and-a-half ago.

The only thing for the pain is Vicodin (unless someone wants to hospitalize me and give me a nice shot of Demerol in the butt, makes me throw up every time, but oh! how it obliterates that pain!), and thank God I have a doctor who trusts me and is willing to write me for it. And now I’m drinking promethazine for the nausea, because last November, for the first time in all of my life, the nausea progressed to actual vomiting. It was traumatic, having never happened before, so I now work to avoid it.

All of that being said, this time was entirely different.  Trying to even remember. . .

About two-and-a-half weeks ago, I started getting horribly irritable, reactive, anxious, emotional.  These were no mood symptoms, at the time I had no thought of what could be causing them.

Then, last Tuesday into Wednesday, the dam broke and there was pain.  Oh, was there ever pain.

But there were pain-free periods interspersed, and they were sometimes worse.  Because I experienced in them such confusion, the first night was nearly an emergency room visit because my blood pressure jumped and I felt as though I was dying.  The problem is that after my ER experience for a dystonic reaction, I realized that sometimes that little voice is there for a reason, and that it’s better to err on the side of a little hypochondriasis than to, well, die.

I basically lived through some psychosis that was entirely unrelated to mania or depression.  My mood has been completely stable throughout this.  Really stable.  Almost frighteningly stable, if that can be said.

So the pain alternately remits and returns through this past Monday, with less intensity each time.  But it wasn’t until late afternoon on Monday, when I finally passed out in the middle of a text conversation, and slept for nearly 24 hours that I felt like I was on the mend.  I always need to follow my migraines with a good, long sleep (I’m told this is not uncommon).

I still expect another few days of being “out of it”, convalescing, recovering.  My writing alone should indicate that my brain is not yet back to where I want it to be.  This is decidedly not my best effort, but I don’t know how really to share a migraine with you.  When it’s intense, there is no looking at any light, so I cannot type something up.  During the brief periods of remission, I have been able to type short emails, comment responses, etc., but no long trains of thought.

I guess I want to post this because my brain is still so addled.  It will give you some sense. It is not brilliant work, but it meets Ruby’s standards for valuable because it is honest work.

Incidentally, I have never in all of my days experienced a three-week-long migraine.  I have an inkling of what may have caused it, but if I’m right, well. . .  It’s going to be ugly for a while.

© Ruby Tuesday and I Was Just Thinking. . . 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

Tonight, Tonight Won’t Be Just Any Night

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Tonight marks the long-awaited, anticipated, and longed-for return to the ice of the Pittsburgh Penguins’ captain, Sidney Crosby.

image via nhlsnipers.com

Now, before you roll your eyes, say, “Ruby, who cares?”, and stop reading, let me assure you that this really matters.  Not just because I adore Sidney Crosby (though I do), have missed him so (though I have), and want to see the Penguins’ roster further invigorated by his presence (though that I want as well).

The story I am about to tell you is one of hardship, heartbreak, and triumph.  In two generations of Penguins’ men, no less.

Sidney Crosby made his NHL debut with the Pittsburgh Penguins at the ripe young age of 18, in 2005.  Called many things (hockey players/coaches/commentators/devotees to the game in general love them some nicknames), including “Sid the Kid” and “The Next One” (for those of you missing the connection, it’s a reference to the amazing Mr. Wayne Gretzky, The Great One), he has been an all-around wunderkind in the six-ish years he has been on the ice.  The grown-up, spotlighted, NHL ice, I should say.  He was skating probably in his mother’s womb (ouch!), and was already a well established presence in junior league and earlier play.

But in the interest of keeping your interest, I won’t detail all that (plus I don’t want to spend my day fact-checking stats).

Oh, and no, I’m not bad at math.  At least not the simple kind.  I know that 2012-2005 = 7, not 6 years.  Stay with me here, all will be revealed in time – though I trust a number of you already know where this is going.  Let me tell it my way, aight?

Even just beginning with Crosby’s NHL play, I could throw so many stats and records at you.  Don’t worry, I’ll just pick a few things.  Named team captain at 19, the youngest NHL player to receive that designation. . .    2009 put a Stanley Cup ring on his finger, at the time he was the youngest captain ever to win one. . .  Oh yeah, and there was that Olympic Gold Medal he helped to win at Vancouver 2010.  This guy was unbelievable.  This guy was unstoppable.  This guy was on fire.  This guy lived in Mario Lemieux’s basement.

Mario Lemieux. . .  Lemieux, Lemieux, how sweet is thy name on my breath, truly on the breath of all who love hockey, most particularly all who love Pens’ hockey.  Super Mario (they just erected a statue to him in Pittsburgh, you know). . .  Stop, Ruby!  You haven’t gotten to that part of your story yet.

Oh, and in case you’re wondering, according to everyone in the know in the hockey world (most everyone, maybe let’s don’t ask Alex Ovechkin - or any Caps’ player while we’re ahead), Sidney Crosby is an incredibly nice guy.  So root for him when you read this.

I come to where the very difficult part of Sid’s story begins.

By most every account it was due to a couple of hits he took in the first two games of January 2011 (starting with the 2011 Bridgestone NHL Winter Classic on New Year’s Day).  Now I’m not interested in naming names, nor debating whether the hits were clean.  In another place and time, perhaps, but here and now I want to stay with the positive and write only good things about people.

These hits caused concussion symptoms to appear in Sidney Crosby.  Concussion symptoms that were so incredibly severe, he missed the rest of the 2011 regular season, as well as that year’s post-season (for those of you who don’t know, the hockey post-season is long – which makes me a happy girl – lasting into June for the teams that go all the way to the Stanley Cup Finals).

He missed the beginning of the 2011-2012 (the current) season, but came back to the NHL ice in November of last year.  And all was right with the world.  Until he had to stop playing again the very next month, due to a return of his concussive symptoms.

There has been some mudslinging done by fans and hockey writers in the city of Pittsburgh – and no doubt some other cities.  They say Crosby is a whiner, that he is too soft to play, etc., etc., ad nauseam.  I say you don’t screw around with brain injuries in any arena, but particularly not in one where it is part and parcel of play to take blows to your body and your head (the latter is very strongly discouraged, but still a real possibility) each time you skate out onto the ice.  I think the majority agrees that Sidney Crosby is being intelligent and judicious.  Also, I’m sure that for a lot of the time he has been off, team physicians, owners (hello again, Mr. Lemieux), and Pens’ teammates have been laying down the law and telling Sidney, ‘No way.’

Because you’ve got to realize this isn’t all Sidney Crosby’s decision.  Twenty-four years old (we all know boys don’t make completely rational choices at that age) – which is in your hockey prime – unbelievably talented (with the hardware to prove it), and absolutely in love with the game.  Just think of the frustration, the fear, the internal battles that he must have faced.

image via askmen.com

I imagine team owner/Pens’ legend/mentor-to-Crosby Mario Lemieux had an idea of it.  Mr. Lemieux had many injuries through his career as well (and was still incredible, I’m sparing you his awards and stats completely – okay, I will permit myself to tell you that he is the only person to ever win a Stanley Cup as both a player and an owner).  But what I remember most vividly as far as his health battles was when he was diagnosed with Hodgkin’s lymphoma.  Uh-huh.  Cancer.

Mario Lemieux had cancer.  Mario Lemieux beat cancer.  Mario Lemieux came back to play amazing hockey after cancer.  Mario Lemieux established a foundation to help others fight back against cancer.  Mario Lemieux has kicked cancer’s ass in every way, upside-down and sideways.

So who better for Sidney Crosby to have as a presence in his life during what has undoubtedly been an agonizing period?  I don’t know any details on interaction between the two – and I don’t think anyone should (to my knowledge no one has make this stuff public).  That’s such unbelievably personal territory for both men.

But tonight, when Sidney Crosby skates back on to the ice for what I hope so much is a permanent return, I will hold my breath.  I will probably hold it for 60 minutes of regulation play, plus any potential overtime, plus 34 minutes of period breaks, plus all official on-ice and t.v.-time outs.  I’ll manage somehow not to asphyxiate.  ;)

And I will hope and I will pray for this young man, because the battle may not be even halfway won for him.  Head injuries are scary, and they are tricky, and they are (when this serious) for life.  Bravo to Sidney Crosby and the entire Penguins’ organization for making sure this doesn’t become something even worse, something that could end not just his career, but his life.  Bravo to team owners Mario Lemieux and Ron Burkle for putting Sidney Crosby’s health and well-being before games and trophies.  Bravo to all of Sidney Crosby’s teammates for supporting him and playing amazing hockey in their own right.  Bravo to all of the team staff, most especially the medical and training staff (whose names don’t get flashed around so much), and to the specialists from all over who have evaluated and treated Sidney Crosby.  Bravo to the fans who have supported Sidney Crosby throughout all of his career, the fair weather and the foul.

Tonight is not just about Sidney Crosby, it is about so many individuals who have helped him to get to where he is.

Which, when the puck drops at 7:30 EST, will be exactly where he belongs.  On the ice.

Note made on the first period break: I don’t know how I managed it, but I forgot to add bravo to Dan Bylsma and the rest of the coaching staff. They deserve high praise for their handling of everything in this situation as well.

(Any errors in stats, writing, or behavior generally are completely my fault.  I’ve been sitting with this post for several hours now – I don’t like inserting a whole bunch of hyperlinks, but here it seemed necessary – so my editing may not be up-to-snuff.) 

© Ruby Tuesday and I Was Just Thinking. . . 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

“Psychotic Drugs”

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a.k.a. “My Extreme Dystonic Reaction And How I Wound Up In The Emergency Room For The Fourth Time In Less Than Nine Months”

It was my intention to write a post about another night, another ER visit.  It was also my intention to get a little rest first.  The latter was not to be.  About the former, I guess we’ll see.

(If you think I ever actually know and plan and decide upon what I’m going to write here, you’ve lost the thread somewhere along the way.)

I watched the movie Serendipity instead.  Everyone reading this should know by now how I love the concept (why haven’t I made a category for it, I need to do so, post-haste. . . okay, done).  I don’t just love it, I hold a very strong belief in it.  The movie is cute as can be, at any rate.  It also features a wonderful score, with a particular song running through it that was also in another movie released I think around the same time, also wonderful and with a not dissimilar concept, Practical Magic.

I don’t know why I stopped liking movies, but if anyone could, please tell me in the comments, what has John Cusak done lately?  Or Sandra Bullock, Nicole Kidman, even Kate Beckinsale?  I’m terribly out of my element with modern-day movies, I’m forced to admit.

So.  I’ve put it off long enough.

What happened was this.  I had an extreme and acute (I promise you I am not overstating the situation by deliberately using two absolute declarative adjectives to describe it) dystonic reaction to perphenazine, also known by the name Trilafon.  It’s a conventional antipsychotic, and thus much more prone to cause this (and other neuroleptic symptoms and syndromes).

Which forces me to explain dystonia, a task I don’t much relish, particularly after experiencing it so severely.  Here goes (I’ll also throw in a couple of links for a more clinical picture).

It started with my voice, actually.  It had this funny affect, and it was hard to get my tongue to make the sounds I needed it to.  But I got that under control and didn’t worry too much (that would have been. . . Monday night).  Last night (Tuesday) I noticed it again a little, but everyone went to sleep and so I did no more talking.  But as I lay on the couch, and later in bed, trying to fall asleep, I noticed some rigidity and tension in my face, my tongue especially.  I couldn’t fall asleep, and it spread through my body, little by little.

I kept talking myself down from thinking it was anything, except something in me must have known better.  I got out of bed and went and got my mother, at my age and at three a.m.  And then we sat on the couch and I cried, because I was terrified.

I settled down some, and even tried a few odd moments of humor, which were lost in translation because I basically couldn’t speak.  Long rest of the story short, I got worse, my mom got more concerned, we both put on our shoes and coats and got in the car to go to the emergency room.  I remember when she was backing out of the driveway, I just about told her to call 911 instead, but I lost my direction at that point.

It was worse on my left side, my toes were curled tightly, my head tilted, my abdomen locked.  I couldn’t keep my eyes open.  I described it to my mom as like a very long, drawn out, slow motion seizure, and she said she had thought the exact same thing.

Apparently I was as gone as I think I was, because she also said everyone in the ER seemed freaked, and I couldn’t even sign my name to consent for treatment, I had to do a “verbal consent” (policies).

My blood pressure and my pulse were high enough to set all of the machines beeping, and then after a minimum of discussion and the magic word “perphenazine,” a wonderful young doctor had a dose of Benadryl shot into my IV that knocked me silly.  Seriously.  I kept going, “Oh wow.  Oh, wow.”  My poor mother sitting there, eyes filled with tears from her terror over my state, and I had to reassure her that they were good “oh wows,” because I was feeling completely back to myself within a minute or two.  Well, kind of floaty, but otherwise very much myself.

So with some discussion, an injection of diazepam (Valium) for good measure, a prescription and instructions, I was sent merrily on my way, better than before.  Better, because now I know to say “fuck all” if a doctor tries to put me on a conventional again.

Add those to the growing list of drug allergies.

Moral of the story:  “Don’t ever hit your mother with a shovel, it leaves a dull impression on her mind.” ~ Paul Newman, Butch Cassidy and the Sundance Kid

I decided this one needed a light moral, because it’s been a heavy post for me.

And, oh, the links:  Dystonic Reaction (one link, I’m tired)

Whoops, a last note:  The title of this post, my mom was trying to find the word ‘psychotropic’ in reference to my meds, but came up with ‘psychotic’ instead.  Based on recent experience, I’m coming to agree with her Freudian assessment.

© Ruby Tuesday and I Was Just Thinking. . . 2011. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

My Very Favorite Weapon

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You don’t have to be frightened and call the cops to report me for felony menacing.  Not even a misdemeanor.  In all my vast arsenal of trusted means of contention against any enemy combatant, it’s my capacity continual propensity to have said enemy underestimate me that I like best of all.  So I do what a girl can, under the particular circumstances, to distract and misdirect and generally confuse to the best of my ability.  The best of my ability – as you might guess – is pretty damned good, after all of these years.

Speaking of weaponry and misdirection, I made a page a few days ago, Beauty Snob.  I’ve had these pictures of my beauty products and my makeup collection for some time, and have been trying to figure out where to put them.  But I think I had a sixth sense when I made that page that I was going to have to marshal the troops for battle on Friday.  And I did.

Incidentally, if you are brave and look through all of those pictures, you can see that the possibilities are endless.  Depending upon my mood and the situation, I can be an ingenue, a sexpot, a firecracker, I can look completely natural, like your best friend or your guiltiest fantasy.  And that’s just going from the neck up.

When people who don’t know me (especially men, but women are guilty of it too) see me, they see a beautiful face, lovely clothing, and drop-dead shoes.  Unless I’m running out for a Starbucks in my pjs.  And so most of them are caught off guard – or more frequently floored - by what comes out of my mouth when I open it.  The insightful, probing questions, the extremely intelligent, specialty-focused terminology, the constant demand to know the method behind things – not the dumbed-down layman’s method, but the ‘You might confuse me with another specialist in your field (except I dress much better)’ method.  I wrote about the psychiatrist who acted as though I had to be hiding an advanced degree from some prestigious university in my back pocket, as opposed to me having fled dropped out of high school.  Yeah.  It’s like that.

Even my primary still treats me this way on occasion, to a lesser degree.  Facts in this world are, unfortunately, facts.  People are intellectual snobs and they are taken in by looks.  I don’t happen to consider this unfortunate, though, because it means things are “Advantage, Ruby” from the get-go.  And by the time folks realize their error in judgment (if they do), I have usually left with that for which I came.

I know we’re all hating on the neurologist who wrote my assessment right now, and grateful though I am for that support, I may not have painted the clearest picture of him.

He is a genuinely nice guy, a slightly shy guy, a very easily led and distracted guy.  I think it’s a combination of a genuine fascination with the brain – such that he was happy to just let mine do its thing and not redirect it, because he wanted to know where it would go (and I truly appreciate that novelty of perspective) – combined with the above factors.  Advantage, Ruby.

I had my follow-up consult with him Friday.  I know I said next week, but I realized with enough time to spare that I had the date wrong.  I wore my Gunmetal Primer Shadow, a dash of Venus eye color, and a Dark.  Black.  Eyeliner.  Many people reading this (especially the men) may be confused by that.  After all, black eyeliner is black eyeliner, right?  Ha!  It is to laugh!  There is black eyeliner and then there is BE Black Diamond.  That one has the most incredible effect on men, I don’t know why.  The last time I wore it was Whoring Myself For Charity - and “If you have to ask, you’ll never know.”  If you are a man and I am wearing Black Diamond, it’s because I’m there either to slaughter or seduce you.  In either case, be very afraid.

My poor neurologist never saw it coming, he never had a chance.  I was running him ’round in circles before we even made it to the consult room.  At one point during the appointment, and only one, he did actually stop me to say, “Wait, you’re throwing out all of my ideas and suggestions before I can even make them!” (as in I was throwing them out into the conversation, not dismissing them).

Poor guy.  He really did want to help me.  And as I briefly mentioned, it’s very nice and refreshing to have someone who is as completely fascinated by my brain and the way it works as I am, and who is not trying to keep me focused so he can move on to his next “case” (in his report he actually referred to me as “this interesting woman,” and I wasn’t insulted, I was complimented).

And I gained some insight from this process.  Not much, but some is better than none.  I could write about it here, but it gets highly technical.  It isn’t that I don’t think you all could grasp it, you could, but wasn’t the above account thoroughly more interesting?

Moral of the story:  There are all sorts of ways of being smart.  And I am.  ;P

© Ruby Tuesday and I Was Just Thinking. . . 2011. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

I’ll Be Alright, Just Not Tonight. . .

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Why do smart women do stupid things?  That is the (eternal) question.  Or am I really not very smart and everyone throughout my entire life has just planned a big conspiracy to humor me and make me feel like I am?  Going back to the Greeks, when Plato and Aristotle wrote things (what are now books) which you weren’t “supposed” to be able to understand in school without the help of your Philosophy teacher, but I read in my teens, on my own, and understood perfectly well.

And this isn’t even me being stupid over a guy.  Not in the traditional sense, anyway.

I had my day of neurocognitive testing at the beginning of September.  I have a follow-up scheduled for next week, to discuss the results I got in the mail today and just went over.  I knew, I knew when it was taking the doctor a month-and-a-half to send out a report to me, instead of four weeks, that he was having trouble with my results.  I thought he was just trying to be thorough, and perhaps he was.  But what he sent out to me was instead thoroughly unhelpful and upsetting.

In eight specific areas of testing, I was noted to be “mildly,” or more often “mildly to moderately impaired” twelve separate times.  I knew it would be bad, but this is what they deal with, so obviously they have some kind of reasoning for a causal agent and a direction for improving my functioning, right?  That was the whole point of me doing this.  I already knew I was having problems, or I wouldn’t have undergone the testing.  I wanted to know why and how we could improve it.  Expectations not met, not even marginally.

I quote, “The etiology of the patient’s current pattern of neurocognitive deficits is somewhat unclear at this time and may be multifactorial in nature.”  The rest of the summary says that my “complaints seem to be out of proportion” to what the tests came back with.  Does it never occur to this man (the doctor) that perhaps that has something to do with the fact that two years ago, before the ECT my brain was much more highly functioning than it is now, and I have that as a frame of reference, whereas he just met me?  I’m not upset about the way my brain is functioning compared with the average person’s, I don’t have any idea how the average person’s brain functions, as I don’t live in it and depend upon it daily.  My complaint is that my brain is not functioning in any way like it used to.

He goes on to surmise that my issues arise from “. . . a variety of potential etiologies, including psychiatric symptoms, medication side effects, chronic pain (including migraine pain), and sleep difficulties.”  Nowhere does he account for the fact that I lived for years with all of this without experiencing any issues with cognition.  He then makes the cogent and always greatly appreciated observation that I need psychiatric care.

Apparently his cognitive functioning, memory, and recall are more than a little impaired, as I told him that I was in the process of transitioning between psychiatrists, not that I had ceased to see one.  I would have to fall into the category of severely impaired not to realize that I need continuing psychiatric care, and will for the rest of my life.

I don’t know, I suppose I’m just extremely upset because I’m still trying to negotiate my way out of this minefield of a mixed episode, and after our initial meeting, I had a favorable impression of the doctor.  I was dumb enough to believe he had a good grasp on my specific situation, and further I thought he would actually try to take the time to figure out what was wrong and provide constructive solutions – and maybe he did initially, but when he hit the wall the doctor/God complex kicked in and instead of simply saying “I don’t know,” he had to write it off as a laundry list of other things that didn’t undermine him and his “expertise” in any way.

But you had better believe that I will go in next week with a million questions and demands for explanations such that he’ll wish he had copped to not being able to figure it out to begin with.  I won’t do it out of vengeance or pettiness, I’ll do it because I need to know all of the finer points of the situation.  I’m on my own as far as how to proceed with this, which was a conclusion I had reached once the time stretched and I realized there was no way they were going to be able to classify me, nor stick me in their comfortable little boxes.  And being on my own, I will pick every morsel of information I can from that doctor’s brain, so that I can figure out what best to do with it and where I go with myself next.

And if I can get him to admit that he really doesn’t know, more’s the better.  I would have so much more respect for doctors, and dislike them so much less if they could just man (or woman) up and confess to it when they don’t have the answers.  I never in all of my life believed that doctors were super-human or gods, not even as a small child.  To me saying, “I don’t have an answer for this,” doesn’t hurt my opinion of them, actually it usually improves it considerably.  So few are willing to admit it when that is the case.  My PCP will, which is a major reason why I’ve stuck with him all of these years.

But I guess we’ll see next Friday how impaired this doctor thinks I am.  Generally when I go in prepared, both guns blazing, doctors quickly realize that not just giving me a straight answer in the first place was a big, big mistake.  Ain’t no one knows how to get a person to admit they screwed up like I do.

Moral of the story:  We live in a world where doctors are automatically accorded certain privileges and respects simply because they made it through medical school.  A great paradigm shift needs to take place here, and if I have to dedicate my life to being the impetus for it, don’t think for a minute that I won’t.

© Ruby Tuesday and I Was Just Thinking. . . 2011. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

Distracted Driving? ME???

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So usually I am very focused when I drive, almost militant in my attention to the road and the car and the homicidal maniacs all around me.  I admit that I blast my music.  But I don’t even turn it on until I’m done backing out of the driveway or a parking space.  I also will occasionally take a phone call.  Yes, I am horrified to admit to that (it may be legal where I live, but there are plenty of things which are legal and still stupid).  But I only, only do it with my earpiece and when it is expected and it is an emergency – i.e. my shrink.

This morning, though. . .  Oh.  My.  God.  Drinking a Starbucks (okay, I do still also do that one from time to time).  Not so high on the meter of distraction.  I know my car well enough to pick up and set down a drink in the cup holder without removing my eyes from the road.

Incidentally, I drive a manual (stick).  That’s incredibly relevant and adds a whole other dimension for focus, as well as a much greater need for using both hands while I drive.

So I had made myself late for a doctor’s appointment.  I wasn’t “running late,” nothing “happened to make me late,” it was just carelessness on my part.  Hey, I see a theme for this post.

The first thing was the worst.  I had filled out all of my pre-appointment paperwork, but I realized I had left off one medication I had just started.  So what did I do?  I grabbed a pen and wrote it on the back of my hand while on the on ramp to the highway.

Breaking all rules - probably the only picture of me you will ever see on here

Now it isn’t quite so bad as it sounds.  I mean it is, but it was an on ramp with a light, one car per lane (there were two) per green, so I wasn’t actually moving. . . much.  Justification.  I know!

I had to take the picture because I can’t remember the last time I wrote on the back of my hand.  It was probably middle school, I used to do it all of the time.

So I didn’t kill myself or anyone else getting onto the highway.  And I’m driving along and realize I need to call my psychiatrist.  So what do I do?  I search for his number in my phone book, then call and leave him a message on speaker.   You have to push a button to leave a message, too.

I blame the fact that I have had severe insomnia and woke up at 2:45 this morning.  No, I take full responsibility and I blame myself.  I know better than to do shit like that.

Moral of the story:  Let this be a lesson to me.

© Ruby Tuesday and I Was Just Thinking. . . 2011. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

Dreaming In The Real World

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Everyone has dreams in their life.  Unless you have a traumatic life course from birth, usually the younger you are, the bigger and more plentiful and completely in your grasp those dreams are.  As we grow up, different things work to shape and limit our dreams, both from within and without.  You find your passions and begin to focus more on those, and like it or not, the world at large can and does have an impact on what we are able to accomplish.  All of these factors vary from individual to individual, but the premise is consistent.

I’ve had a rather unusual life when it comes to my dreams.  Less than a decade ago, I was still going to take on the world the way a child does – and even more so, because I had the maturity and life experience and skill and confidence that you acquire only by living, but while I had lost many things since my childhood, my belief that I could do anything, anything I decided upon was entirely intact.

I have to smile, because I wasn’t going to detail what dreams I let fly free from my grasp, specifically, but one begs to be mentioned right here.

I was going to be an emergency room doctor.  I would have made an excellent one, too.  I had begun to take my courses, so I know that I had aptitude.  I also had the temperament, the more stressful and chaotic the environment and circumstances, the calmer and more logical I became.  And was I ever quick to think on my feet!

But of course there were my moods.  By the time I had slapped a label on part of what made me who I was, but before I received a formal diagnosis, I knew that I couldn’t do med school and an internship and rotations and keep myself in top form.  Most individuals can go 48 hours without sleep and not run into catastrophe.  Me, I knew even then that would have been a dangerous choice for me, and consequently – and more importantly – a dangerous choice for my patients.  So I let that dream go, I sent it back out into the Universe for someone else to grasp.

The reason I’m mentioning it, though, is because I have something else that would have compromised my abilities.  It wasn’t much back then, even now it’s just diagnosed as an essential tremor.  My hands shook some from time to time.  Back then it was barely even noticeable.  It has progressed in the years since, it no longer affects just my hands, and different things may exacerbate it greatly.  For example, I just took an asthma inhaler.  Now my fingers are having difficulty hitting the right keys on my laptop.  That’s why this story is in this post.

In any case, I had a breakdown, my moods hit me unbelievably hard and my mind went for a time as well.  Coming out of that (and I won’t claim that I have completely yet) there were no dreams.  Partially I didn’t think I could ever do anything with myself, with my life, but probably most of it was because I wasn’t thinking beyond my next pill and making it through the rest of the day or the rest of the hour, even.

But I began to recover.  In fits and spurts, the process is by no means smooth and linear.  And one thing I had possessed a long time ago that returned to me in spades was instinct.  I don’t know if I classify instinct as a purely unconscious, animalistic response or trait.  I think if you really have instinct there are at least three factors.

There is the unconscious mentioned above, that you cannot change your capacity for.  Next there is the semi-conscious level.  The part of you that absorbs and assimilates everything that is going on around and inside of you, and stores and classifies and remembers and gives you the ability to make use of it.

Finally, there is the fully alert and aware you.  The being as a whole, who is cognizant of not only the two deeper components of instinct, but integrates them with the third level.  The part of you who listens for every whisper that emanates from deep within, and who feels the slightest breeze brushing your skin from without.  This part has an unbelievable ability to tune out the static around and hear only what you are saying to yourself, and what the Universe is saying just to you.

My first “dream” is no longer that, it has become a condition for my life.  I mentioned it in my post of a few days ago, Magic, Part Two (Well, A Little).  I wish that post could have captured what I wanted it to, but it captured instead what I was feeling, which is what I do when I write a blog.  In case you missed it, the dream turned condition is writing.  As I said, no matter whether anyone ever reads my words save me, I have to write them in order to live.  This I know.

I discovered a second. . . dream, condition for living, message from the Universe while I was floating in the Gulf of Mexico.  Live in the water.  Live your life in a bikini and bare feet and feel the sand and the salt and the liquidity and utter peace and chaos co-existing.  It may seem silly after just a week, but this one is going to be a way of life for me as well.  My dresses will get lonesome on the hangers, my stilettos will cry out for me to strap them on, my makeup will beg, and my jewelry will plead.  And I will feel pity and utilize them all.  Sparingly.

Moral of the story:  Listen.  Listen.  It isn’t too late if you open up your heart so it can hear.

© Ruby Tuesday and I Was Just Thinking. . . 2011. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

Effing PTSD, Effing Sleep, Effing Brain

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So I thought I had myself figured as far as sleep issues.  Usually it was pretty impossible, but once I finally passed out I would sleep extra-long so my mind could catch-up on shutdown time.  Occasionally I would have periods of sleeping 16+ hours a day.

My newest sleep problem has gone thus:  Woke up late morning Thursday.  Did not sleep at all Thursday night, Friday, Friday night, most of Saturday.  As in no naps, no drifting off, zip, zero, nada.  No mania or anything, just an almost complete brain shutdown by Saturday morning.

Late afternoon Saturday I got a bit of a reprieve.  I finally slept some, two-and-a-half hours, max.  Was up for a bit, then I got myself to the in between place, you know, drifting in and out but never going fully to sleep (thus in no way allowing my brain to recover).  Two hours tops there, not that it matters because it didn’t help at all.

I’m blaming the PTSD for this.  Lately, dramatic changes in behavior, reaction-sensitivity, and all things in any way tied to my mind (and often body) can be traced back to this, even if I can’t give an exact linear progression.  Also, I’ve been grinding my jaw horribly (bruxism), both while awake and asleep, which I have done while awake before, but never in my sleep.  That started with the latest post-traumatic stress episode.

My mind is completely blown (and not in a good way).  I have no idea what to do.  The only sleep meds left for me to try are barbiturates.  One doctor brought it up entirely on her own as a possible, my two regular docs (PCP and psych) had previously said no way, and I get why.  I may just try to get in touch with the one who suggested it.  I know the risks and certainly don’t want to develop TD (tardive dyskinesia, I’ll explain it some other time), but I am getting so desperate here.  I cannot understand why two doctors who know me and know bipolar well don’t view this with serious concern.  Even if I don’t go manic, sooner or later I will start hallucinating hard-core and progress to full-blown psychosis from lack of sleep.  In the meantime, my mind is pretty useless in general, and completely non-functional about the important stuff.

And this is really important stuff.

Also, I want to hunt down all of these assholes who publish anti-medication, anti-sleep med “articles” (none of whom I have found to be professionals – probably at anything) and who insist that you can manage everything “naturally” and that you just have to “reset your body’s natural rhythms” and make them spend a month with a completely unmedicated me. Let them see how insane and desperate I get, and how hard I struggle. Really I want to kick the shit out of them, but, well I was going to say seeing me in my deepest desperation would be more effective, but you can’t change the minds of ignorant reactionaries who are so used to listening only to themselves that they can’t hear or see anything else, no matter how true.

Moral of the story:  
“To be, or not to be: that is the question:
Whether ’tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take arms against a sea of troubles,
And by opposing end them? To die: to sleep;
No more; and by a sleep to say we end
The heart-ache and the thousand natural shocks
That flesh is heir to, ’tis a consummation
Devoutly to be wish’d. To die, to sleep;
To sleep: perchance to dream: ay, there’s the rub;”
~  William Shakespeare, Hamlet

© Ruby Tuesday and I Was Just Thinking. . . 2011. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

Lessons I Have Learned About The Interweb And Me

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This is the post that has been stewing around in my mind.  That’s probably why I didn’t write it yesterday, because it wasn’t done cooking.  My ideas don’t come out until they’re good and ready to.

This really goes back to when I got my new laptop about eight months ago and started using Word.  The Auto Correct got me so bugged, because when I write, I write according to my rules, not Microsoft’s.  And mine are usually correct where theirs are not, for the record (which is not to say I don’t make conscious choices to break them, because I do that when I feel it’s warranted).  I was given an incredible education in grammar thanks to my first elementary school (in Pittsburgh).  We began diagramming sentences in the third grade, my high school out westward didn’t broach that concept until Honors English in the tenth, I think.  And of course I have major issues about anyone or anything changing my writing without my explicit permission.  I’m going to be hell on an editor one day.  :)

But I knew how to turn that feature off, so okay.

Here’s how that relates.  Google Chrome is awesome for some things, one of them being that it underlines a word when you’ve misspelled it.  In theory, this is handy.  But not unlike Auto Correct, the predictive text feature on my phone, and every spell check/pre-designed electronic dictionary feature I have ever encountered, there are words that I use that Google Chrome doesn’t have in its repertoire.  You can add words to the dictionary, which is nice.  But more and more I found myself relying on it to just ‘click and fix.’  I would have it just change the word for me and not pay attention to what my mistake was.

I started making more and more errors.  I thought it was due to my memory issues and general mental state.

One day, I don’t know what exactly prompted it, I stopped with the ‘click and fix.’  If I saw a word underlined, I would look at it and figure out how to fix it myself (I have always been an excellent speller, that probably would have been something good to include prior to this).  From there I progressed to fully using my own brain, and when that couldn’t get it completely, a real, actual, print form dictionary.  I heart my dictionary.  It’s enormous and beautiful and I spent well over one hundred dollars on it thirteen years ago.  I hunted and hunted until I found the perfect one.  It’s a Merriam-Webster, for anyone who cares.  I love Oxford, and one day I would love to get my hands on a copy of the complete OED, but Oxford is an English language dictionary – as in British English – and I live in the United States, so I write in American English (even though the British English variations so often look much more aesthetically pleasing).

So guess what has happened since then?  I have been making fewer and fewer mistakes, and the ones I do make are usually because I’m not focused or my fingers are flying across the keyboard too quickly.  It’s helped me have so much more confidence in my brain’s abilities.

As to other things online, I got into this terrible habit of leaving my email open while I wasn’t using it, so I would get a new message while I was trying to do something else, and even if I tried to ignore it, I would still lose my focus a little.  I would leave tabs open which I didn’t need at the moment, all sorts of things that not only ended up making me crazy and distracted while online, but in life.  I stopped doing that less than two weeks ago, and I am so much more focused and relaxed, generally.

I noticed something else, which is using the computer makes me sleepy but unable to sleep.  Things like reading, or even watching a film, only make me sleepy when I’m genuinely tired, and I fall asleep easily (easily for me).

Of course computers and the internet have their positives.  Documents are easier to edit and don’t have to be rewritten in their entirety longhand.  You are given the ability to easily connect with loved ones states or even continents away – although I still say letters and phone calls beat emails and IMs any day.  You have access to articles it would take you ages to locate at the library (love me some PubMed!), I’m not trying to bash the whole concept.  But I know that in many ways computers and being online were making me lazy and contributing immeasurably to any cognitive deficits I am already dealing with.

Oh, and because I am a huge believer in full disclosure about the important stuff, I always use the proofread feature after I have written something.  But if there is ever a doubt about what the computer says versus what I think is correct, I consult an impartial expert – my dictionary.  :)

Moral of the story:  Try relying on your own brain some time.  You’ll be amazed what that sucker is capable of!

© Ruby Tuesday and I Was Just Thinking. . . 2011. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.