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]

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.

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.

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!

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.

Girls' Night Out

I know you've heard it before, but every woman needs girlfriends.  I don't care how old you get.  I don't care what stage of life you're in.  You need strong, independent, loving women in your life to share it with.

I have those women.  And I love them.

I had a great day yesterday.  I worked, I walked, I did the laundry, I got a workout in.  And I got to have dinner and watch a movie with three of my favorite people.  What a great way to end the day.

The plans were dinner and a movie.  We talked.  We laughed.  We ate.  We make up inside jokes as we go.  We laughed some more.  We laughed so hard, we get our ab workouts in.  We make fun of ourselves.  We make fun of each other.  We make fun of the people in our lives!  And we laugh.  We catch each other up and talk about when we're doing it again.

Then we went to see a movie.  Last night it was "The Intern".  And it was great!  I love going to a movie and laughing with everyone in the entire theater.  And that's just what we did.  You know what else I enjoyed?  The car time.  We are hilarious when we get going.  It was such a great time.

I can't wait until we do it again!

The Sun Is Rising

First of all, I'm feeling much better than I was last weekend.  I am once again depression-free.  Let's see how long I go this time.

I met with my counselor last weekend and he reminded me of all the things we've talked about in the last year, things I should be doing regularly to increase my chances of staying depression-free.  But I get complacent and stop doing them.  So I've created a schedule and put it on my refrigerator to remind me daily.  I need to be moving my body, challenging my mind, and focusing on taking better care of myself EVERY DAY.  So...

What I'm Reading
Fiction:  Suzanne's Diary for Nicholas (James Patterson)
Non-Fiction:  The Catholic Guide to Depression (Aaron Kheriaty, MD) How the Saints, the Sacraments, and Psychiatry Can Help You Break Its Grip and Find Happiness Again
Bible:  The New Testament from the Gospel of Matthew to Revelation.

I've read Suzanne's Diary for Nicholas before, but it was years ago.  It's an easy read and a sweet story.  As for the non-fiction... I have SEVERAL books that I've purchased in the last year or so and haven't taken the time to read them.  Now the time is scheduled on my calendar.  I'm also reading three chapters of the New Testament each day between now and the end of the calendar year.  I should be able to finish it by then.  Then I'll start on the Old Testament.  That'll take me a whole year!

How I'm Moving
Workout - Les Mills Combat 60-day schedule
Walking - three times per week

I love Les Mills Combat.  It's all punching and kicking.  Just over and over again, punching and kicking.  It makes me feel powerful.  But walking is probably the best workout for me right now as I'm so out of shape.  So three times a week, I'm going to get a significant walk in, at least two miles.

There are other things I've scheduled just because I've been slacking on doing them and it's affecting me negatively.

• My journal - I want to journal daily, just vent the good and bad so I can mentally and emotionally move on.
• A clean, organized, comfortable environment - I want to spend 15 - 30 minutes each day focusing on one room in my home, just to maintain a healthy environment without having to spend my entire weekend cleaning.
• A Budget - I want to get back to a strict budget.  I read Dave Ramsey's "The Total Money Makeover" last December and want to get back to his suggestions for saving money and getting out of debt.
• Writing - I want to write more often.  I used to write all the time, whether it was just a blog entry or the next chapter in my latest novel.  I miss the writing process and want to spend time on that again.  It'll be mentally challenging as well as creative.

I just want to be a better version of myself.  I want to follow my counselor's suggestions to focus on more positive things, healthier things.  And by doing these things -- moving my body, challenging my mind, and focusing on taking better care of myself -- I'll have a much better chance of fighting off depression before it takes over my life.  And if I do happen to slip into a depression, I'll have several positive options for distracting my mind.

That's my plan.  And I started yesterday.  (I usually wait until the first of something to start anything new.)  Yesterday, I successfully read three chapters of the Gospel of Matthew, read The Catholic Guide to Depression for 30 minutes, straightened my bedroom, and did Combat 30 (which kicked my butt).  Today, I'll take a walk after work, balance my budget, read three more chapters of the Gospel of Matthew, do the laundry, and get a Les Mills Combat workout in... all before having dinner with the girls tonight.  It's all good!

Now my next challenge is sticking with the plan even when I don't feel like it.