Tuesday, November 24, 2015

The Latest

First thing's first.  I was depressed from last Wednesday (the 18th) through yesterday (the 23rd).  But I feel GREAT today.  I was depressed through lots of work, an appointment with my psychiatrist, and an appointment with the cardiologist.  Good times [sarcasm].  But I'm encouraged that my depression only lasted six days.

So my appointment with my psychiatrist didn't go great.  I must first concede, she didn't get on my nerves nearly as much as she has in the past.  Maybe I was too depressed to care.  Maybe she was treating me with kid gloves because I was so obviously down.  And I know it's her job to determine when I should be admitted.  But discussing suicide with someone who is already depressed is not uplifting, needless to say. So I didn't even remotely enjoy the time spent with her.  Nothing new there.

Before I left, I talked with my counselor, who seemed a little concerned with how I was doing.  So he wants us to get together Wednesday.  But I'm feeling MUCH, MUCH better, so that appointment will go well.  Sometimes when I'm not feeling good, I don't look forward to my appointments with my counselor.  Actually that's not true.  ALL THE TIME when I'm not feeling well, I don't look forward to appointments with my counselor.  So I'm no longer dreading this appointment.  Bring it on!  He'll remind me of things I should say to myself when I'm down.  He'll teach me another trick or two to try to get my mind out of that bad head space.  I expect it'll be productive and well-spent.

My appointment with the cardiologist went very well.  He says that my heart is in GREAT shape.  Yea, me!  He also asked me if I was working out.  I told him that my primary care provider had me scared to death to raise my heart rate any higher and suggested that I walk without breaking a sweat.  The cardiologist told me to start working out 30 minutes a day.  So I need to do that.  (This eating 350 calories right before bed to accommodate the Latuda is quickly making me gain weight.)

He was well aware that I was depressed yesterday.  I told him that my psychiatrist has been mucking with my anti-depressants in an effort to get my heart rate to drop.  He wanted to make sure I knew that he never suggested to anyone that my anti-depressants were the culprit.  I assured him that my primary care provider championed that cause and my psychiatrist was more than happy to jump on board.  To help quell the continued science experiment, he suggested that I take a calcium blocker to lower both my heart rate and blood pressure.  I started taking that last night.  I'll follow-up with his nurse practitioner in a month to see if that works.

In the interim, I need to call my primary care provider to see if he wants me to stop taking the pill he put me on a year ago, to help lower my blood pressure.  There's really no need at this point for me to be taking two.  So I need to make that call.

Work has been busier lately.  But depression or not, I've been able to keep up.  Praise the Lord!

No day is better in my world than the day after a depression passes.  "This is the day that the Lord has made; let us rejoice and be glad in it."  Psalm 118:24

Tuesday, November 10, 2015

Just an update...

I know it's been awhile since I've provided an update.  My picture today, chance of sunshine.

First of all, I've still heard nothing concerning my echocardiogram.  Maybe I should call them and simply ask.  But between my other appointments, I'm doctored out.  I figure if it was bad news, I would have heard about it already.  I can wait until the 23rd.  Honestly, I'm trying not to take any of this all that seriously.  It helps me to NOT stress over it.

I made an appointment with my primary care provider's office last Monday (the 2nd) to get my blood pressure and heart rate measured.  Yes, I had to make an appointment.  I'll never do that again.  I'm not going to call the office for more than an hour just to get through, wait in the lobby for 15 minutes, and pay for an appointment, just for a two minute task of getting my blood pressure and heart rate.  Not when I can do it myself.  At any rate, my blood pressure was perfectly acceptable at 117/77.  And my heart rate was still a whopping 103.

My psychiatrist called me three times last week.  One of those conversations took well over an hour.  But I'm not going to vent about that.  One thing I learned though was that I've been taking my Latuda wrong for more than a year.  It says to take it with food.  I do.  But normally medications tell you that to prevent an upset stomach.  I only need a boiled egg or a handful of crackers to avoid any upset stomach and I've never had an upset stomach with my Latuda... so I thought I was doing things perfectly fine.  But no.  When they say take it with food, they mean 350 calories!  Who eats 350 calories at bedtime?!  But at Robin's suggestion, I'm drinking an Ensure Plus with my Latuda every night.  This is going to kill my diet!

As for my moods... I found myself being both angry and weepy last weekend (the 30th - 2nd).  But I've been mostly good since then.  Who knows if it was the increase in calories with my Latuda or not.  But I feel good.  No complaints.

My psychiatrist is going to call me again tonight.  Hopefully we don't have another marathon call.  I'll tell her I've been taking my Latuda with food and that I've been feeling well, and that my heart rate is still averaging over 100bpm.  My guess is that she'll take me off the Fetzima completely.  The only thing I don't know is whether or not she'll increase my Latuda to 60mg.  My guess is that she won't until next week.

Bottom line, I still feel like a science experiment, and I'm still scared of my next crash.  I've credited the medication for making my depressive episodes farther apart and shorter in duration.  But I'm trying to enjoy the current feelings of being good.  No sign of depression today.

But I have been thinking... what if I come completely off the Fetzima and my heart rate STILL doesn't come down?  The assumptions that were made about my medications will be wrong and we still won't know where the actual problem is.  Ugh!

Thursday, October 29, 2015

After the echo and a counseling session...

A couple of days have gone by since my echo and counseling session.  Just know that I'm not nearly as upset as I was on Tuesday.  Really, truly.  So you're going to get a watered down version of events.

First of all, the echocardiogram.  I'd never done that before and didn't really know what to expect.  I had to get undressed from the waist up and lay on a bed while covered with a towel.  All the while the radiology technician pressed a hand-held wand against my chest looking at various angles of my heart.

My responsibilities were fairly easy.  Once I had to move my left arm.  Once I had to move from lying on my left side to lying flat on my back.  Otherwise, I just kept up my end of the conversation.

I got to hear the blood flow through my heart.  I got to hear my heart beat... and I can verify that it is fast.  I also got to see the occasional picture of my heart... though I couldn't have told you it was my heart.  But if there was ever any question as to whether or not I actually HAVE a heart, the verdict is, I do.

My primary question was when I might expect to hear the results.  The tech said that it might not be until my follow-up appointment, which in this case is four weeks away.  I guess if I have to wait that long, it's only good news.  If there's bad news, I'm sure I'll hear from them sooner.  I've heard nothing as of this blog.

As for my counseling session.  I didn't request the appointment, my counselor did.  I simply agreed to show up.  I assumed that he knew this process of changing my meds this quickly would be stressful and he wanted to offer emotional support.  The appointment didn't really go that way though.

So I started off with telling him that I'm going to miss the warm fuzzy I felt with Dr. Callaghan, because I didn't feel that with Dr. Woodward, that she was much more clinical, much more mechanical than I'm used to.  Whereas I fell in love with Dr. Callaghan the first time I met her, the same wasn't true of Dr. Woodward.  (Between you and me, I don't care if I never see Dr. Woodward again and I'm truly going to miss Dr. Callaghan.  Just sayin'.)

I told him that I was nervous about changing my meds twice in ten days.  I told him I felt like a science experiment last year, trying to figure out what dosage of medicine I should be taking.  And here we are doing it again this year.  And since my meds just got upped to 120mg in March, I felt like that's probably the dosage I needed in order to avoid emotional crashes.

Ultimately, Robin told me that all patients are science experiments, that this is nothing new.  He told me that every doctor is going to treat the physical symptoms before the emotional ones.  He didn't seem to understand my real fear.  I also think that everyone is concerned about my heart and NO ONE (but me apparently) is concerned about my depression.  I'm paying a lot of money and spending a lot of time and energy on mental health care... yet I don't feel like I have an advocate for my depression, for my fear of the next crash.  I feel like they're okay with me just crashing again.  And I can't get anyone to hear that I'm NOT okay with that plan.

By the time I left, I realized that it doesn't matter what I think.  It doesn't matter what I feel.  It doesn't matter what I expect.  It just doesn't matter.  Even though I'm the patient and I have concerns.  Even though I'm the one spending the money.  Even though I feel like I'm screaming at the top of my lungs that this process scares me.  It doesn't matter.

And so what?  What difference does it make if they 'hear' me or not?  What difference does it make if they don't care?  I should just keep doing what they say and let the chips fall where they may.  I should trust the process, trust the professionals... even if they don't listen to their patients, which I don't find all that professional.  What's the worst that can happen?  A crash.  I've survived them EVERY.TIME.BEFORE.  I'm not looking forward to it.  But what difference does it make what I am and what I am not looking forward to.  None of my doctors are all that concerned.  So maybe I shouldn't be either.

So my Fetzima, which is assumed to be the culprit of my high heart rate, was reduced by 40mg on October 16th, nearly two weeks ago.  It was reduced by an additional 40mg again on Tuesday the 27th, only two days ago.  So far, there is no change in my heart rate.  When I took my blood pressure and heart rate last night, my heart rate was at 100bpm.

The next action item is for me to stop by my doctor's office on Monday to have my heart rate officially done by a professional and report it back to my psychiatrist.  If my heart rate is still high, I'm pretty sure I can count on buying yet another smaller dosage of Fetzima.  Yea.  [sarcasm]

Sunday, October 25, 2015

After seeing my new psychiatrist...

I don't think I like her.  And I hate that because she obviously wants to be much more involved in my treatment plan than my previous psychiatrist was.  After spending a grueling two hours with her yesterday...two hours that I didn't even remotely enjoy, she insisted on calling and talking to me for the first 20 minutes of the Colts game today.

She's already given me bad news.  She wants to change my meds again.  That will be the second time in ten days that my anti-depressants have been adjusted.

I spent the better part of last year being a science experiment for Dr. Callaghan, changing medications regularly, trying different combinations to try to get me to an even keel.  And at times it was painful.  I even spent a month on short-term disability due to the affects.  Obviously Dr. Woodward wants to do that same thing this year.  Not only is it expensive, it's scary as hell.

Dr. Callaghan reduced my Fetzima from 120mg to 80mg and increased my Latuda from 20mg to 40mg last week.  That happened a week ago Thursday.  I've been on those meds for less than ten days.  My new psychiatrist says that I should have already seen a change in my heart rate.  And obviously I haven't.  So she wants to change my meds again, lowering the Fetzima to 40mg.  So even though I already spent money on Latuda once this month and Fetzima twice this month, I get to spend more on Fetzima yet again.

Last year, I was on every dosage that Fetzima offers along with Latuda.  So I have absolutely no faith that taking 80mg less of the Fetzima will maintain any emotional stability for me.  But by Tuesday, we'll be trying it again.  She says that I should see a difference in my heart rate by the weekend.  She's going to call me next Monday to find out.  I can't wait. [sarcasm]

Also, she keeps telling me to let her know if I have any signs of 'discontinuation syndrome', which will feel like flu symptoms and last 3-5 days.  I'm not the least bit worried about freakin' flu symptoms that will last a few days.  I'm much more concerned about hitting another long depressive episode.  I can live with the damn flu!

She already told me to calm down and not take this as bad news, that I'd be bringing on a depressive episode with just my thoughts.  Great to know that my next depressive episode is already my fault.

I know this is blunt, but I'm going to say it anyway because this is how I feel today.  Being dead sounds much more appealing than being depressed.  Depression sucks more than any other feeling I've ever known EVER.

Thursday, October 22, 2015

After seeing the cardiologist...

So I saw a cardiologist for the first time in my life on Monday.  His name is Dr. Leonard and he's treated my dad before.  I really liked him.  He was kind and answered all of my questions.  And in return I was able to answer all of his questions.

He listened to my heart and my lungs.  We talked about my blood pressure being up to 142/100 that day, as well as my heart rate being 100bpm.  He didn't like either of those numbers.

We talked about what Dr. Potts (my primary care provider) said and what Dr. Callaghan (my old psychiatrist) said.  We talked about the fact that my anti-depressant medications have already been adjusted and how that might be enough to make a difference in my heart rate... though not yet.

He wants to see if any damage has already been done to my heart, so he ordered an echocardiogram for next Tuesday.  Otherwise, he's okay with waiting another four weeks to see if this medication change is enough to bring down my heart rate to something more reasonable.  If not, he mentioned adding a beta blocker to my regimen.  Dr. Potts had negative things to say about that option, as apparently they don't mix well with other medications.  But we'll see how everything turns out.

Ultimately, if the echo doesn't show any heart damage, we're pretty much just looking for anti-depressant meds that will allow my heart rate to be lower and I won't likely have my own cardiologist.  If the echo DOES show heart damage, I'll have a couple/few more appointments with my new cardiologist.  Dr. Leonard doesn't think there's much chance in there being any damage though.  I found that to be a positive outcome to that appointment.

So let's all pray together that the adjustment in my anti-depressants brings my heart rate down to something more reasonable while still managing any depressive tendencies.  Amen.

Friday, October 16, 2015

After seeing the psychiatrist...

I met with Dr. Callaghan yesterday afternoon.  She too is convinced that my Fetzima in particular is causing the high heart rate.  She too was surprised to hear that my heart rate is averaging over 100bpm.  She said that Dr. Potts (my primary care provider) was adamant with her that she see me right away.

So she got me in.  It was great seeing her.  She supports patients at Transitions through the Daviess Community Hospital.  The good news for me is that she knows my new psychiatrist, Dr. Tracy Woodward and even introduced her to my counselor, Robin Maglinger.  So she's going to ensure that a copy of our record gets to both Dr. Potts and Dr. Woodward.  (I was a little concerned about meeting with Dr. Callaghan when I'm supposed to meet with Dr. Woodward any time now.  I kind of felt like I was cheating on Maglinger Behavior Health Services.  But there was no need for that concern.)

So, Dr. Callaghan completely agreed with Dr. Potts that we need to make a change to the medications controlling my bipolar II.  Thankfully she didn't suggest changing the meds.  That was NOT pleasant the last time I had to go through that kind of transition.  But she did suggest decreasing the Fetzima from 120mg to 80mg and increasing the Latuda from 20mg to 40mg.  Hopefully that allows my heart rate to come down to something more reasonable, while still managing my depressive episodes.

I'm a little nervous.  But I've got good doctors who care.  So I keep reminding myself to trust the process.

I wonder if my heart rate could drop as fast as three days.  I see the cardiologist on Monday.  Wouldn't it be great if he sees marked improvement and doesn't require me to visit with him regularly.  One can only hope.

The fact is, I don't deal with stressors all that well and I'd just as soon not have this one.  But I'll know more after meeting with him on Monday.  I'll let you know!

Wednesday, October 14, 2015

The Old Ticker

So I know I talk/write about my challenges with depression regularly.  But it's not the only health concern I have.

I've been taking medication for high blood pressure for a couple of years now.  And its done it's job perfectly.  But lately I've had issues with an elevated heart rate.

It was brought to my attention on August 13th when my heart rate was too high to donate blood.  It was up to 118 that day.

So I started recording my blood pressure and heart rate shortly thereafter.  I have a cuff that fits around my left wrist and makes it easy for me to use.  My heart rate for the last (nearly) two months has averaged 102.6.

Do you know what they call a heart rate that's hit 100bpm?  Tachycardia.  I'm pretty sure I've only heard that word on shows like "ER" and "Grey's Anatomy".  Well I guess it could be used to describe my heart rate.

I'm sure it's related to my bad fitness level and the fact that I'm grossly overweight.  And I'm sure that's where my doctor will start my treatment plan... as well he should.  That doesn't mean I'm looking forward to it.  It's definitely not something I can fix overnight.

I was encouraged to make an appointment with my family doctor by my gynecologist who I saw Monday morning.  My blood pressure and heart rate were high at that appointment.  He asked what my primary care provider was doing about it.  I told him that I hadn't yet told him about the racing heart rate.  He suggested that I do so... and soon.

So I had an appointment this morning.  I ended up being there for two hours.  His primary concern was that it might be my anti-depressants.  And sure enough, after doing a bit of research, he was convinced.  But just to be on the safe side, we did blood work and an EKG.

He didn't like the T-waves on my EKG, saying that they could lead to an arrhythmia.  I've already received my initial blood work results.  I had six indicators that were out of normal range.  But I don't know how concerning they are.  All I really know is I have an appointment with the psychiatrist tomorrow to discuss possibly changing or adjusting my meds.  And I have an appointment on Monday with a cardiologist.

So I'll know more in a week.  I'm looking forward to seeing Dr. Callaghan tomorrow.  She's a great psychiatrist.  But I'm a little nervous about mucking with my meds.  Right now, my depressive episodes are farther apart and don't last as long.  And transitioning from one set of meds to another was fairly painful the last time I had to do it.  But my primary care provider is convinced that my problem is being caused by my meds.  He just wants the psychiatrist and cardiologist to weigh in with any concerns.  So like I said, we'll know more in a week.