Sunday, June 2, 2019

Doctors: The Bane of My Existence

I do not like doctors. I never really have, and I can't tell you when my dislike of the medical professional started. I can tell you that now my dislike of doctors stems from the fact that they don't seem to listen. They seem to talk to the diagnosis, but they don't talk to your humanity. When I sit across from the doctor in the small exam room, I don't feel that they take my questions seriously.

I can understand why some patients distrust doctors' professional opinions. Doctors, in general, don't listen very well, and they often dismiss your concerns or cut you off. They may be experts in medicine, but they are not experts in calming irrational fear.

When you have a chronic disorder, such as anxiety, you have no choice but to interact with doctors. It's a pain in my butt. I have a hard time advocating for myself, but unfortunately, when you deal with doctors, you have to be able to speak up and stand up for yourself. I've never developed the skill of assertiveness, and I feel when I've tried to stand up and speak out, I've been shot down. It's a difficult thing to do, especially if you lack self-esteem, like I do.

There are calls to change the way doctors interact with patients and to introduce empathy into the medical system. In particular, some clinicians and patients are using graphic novels to tell their stories. They've even developed a whole website and conference for this genre: Graphic Medicine.

But I think waiting for the medical system to change to favor patients' humanness over diagnoses will take entirely too long and will not help me in the long run. I'll need to learn how to stand up for myself and my medical needs even when doctors are dismissing my concerns. This feels like an extremely uncomfortable position for me to be in, especially with anxiety because sometimes my anxiety does blow things out of proportion. I can't tell if what I'm feeling should be taken seriously or if it should be dismissed as irrational, and unfortunately, the people who do have knowledge that can help me aren't sharing it as much as I would like.

If I had one wish for the medical community, it would be for my doctor to offer more information on how biological mechanisms work and also for our appointments to be longer so that we could actually talk. The current system does not allow doctors to really spend time with their patients and discuss their concerns.

Disclaimer: I used to work for the Press that publishes the Graphic Medicine book series.

Sunday, May 26, 2019

Social Blunder: He Needs to Learn Some Manners First

When young children approach my dog, I tend to tense up. My dog isn't aggressive, but he does have a lot of energy and could easily knock over a child. I don't let him approach children, and a few times young kids have asked to pet my dog, I've told them no and held my dog back. While I love my dog, I don't let him near children because I don't want him to accidentally hurt a kid. This is all a bit funny since my dog loves young kids and always pulls towards them.

A few weeks ago I took Neeko for a walk in the park. Everything was going well until I saw a young boy, around 2 or so, petting a large calm dog. Oh, no, I thought. Please don't let them come this way. And of course, they came my way. I held Neeko back as best as I could, and I moved off the walking path. When the young boy approached, I tried to dissuade him from petting my dog, and a couple seconds later, his guardian encouraged him to walk away. You can't pet all dogs. Some dogs have too much energy, his guardian said. I was grateful for the guardian's intervention, but I also felt a bit sad. A tear rolled down the young boy's cheek as he walked away (I'm not making that up either). That boy really loved dogs.

As they walked away, I exclaimed, "He needs to learn some manners first!" with a smile. The guardian gave me a strange look, like I had just insulted him, and then I realized with horror, he thought I was talking about his kid! I was talking about my dog! My dog needed to learn how to calm himself and keep his paws on the ground while people pet him.

This incident keeps replaying over and over again in my head, and I find it difficult to shut off the shame. I didn't mean to insult the well-behaved toddler, who was much, much better behaved that my overexcited pooch. Every time my brain reminds me of the episode, I talk a deep breath and remind myself it was a silly miscommunication. It's not a big deal. Perhaps over time, the shame of yelling "learn some manners" will fade away.

Sunday, May 12, 2019

The Perils and Perks of Medication

A lot has changed since the last time I wrote in 2018. I was officially diagnosed with generalized anxiety disorder, and my primary care doctor persuaded me to go on medication. I took escitalopram (Lexapro) since it was thought to cause fewer side effects than other SSRIs (selective serotonin reuptake inhibtors; essentially the medicine blocks neurons from absorbing serotonin so that the serotonin lingers longer between the synapses inbetween neurons, causing your serotonin levels to artificially increase).

Side effects warnings are always terrifying. The FDA requires companies to list all side effects, even those that are rare but have been reported, such as death or blood clots. The worse side effects are typically the rarest, but my anxious brain latches onto them, focusing on the biggest threat (even though they are highly improbably). So, as you can imagine, after I read the side effects of the medication, I did not want to take it. My biggest fear is that I would experience depression again. I didn't want to go to that dark place a third time. However, my doctor was convinced that since we had exhausted our other venues, which included yoga, therapy, and reducing caffeine intake, he thought it was best that I go on the medication. I eventually relented.

SSRIs are drugs that take a while to build up in your system before they can actually work. While the medication was building up, I did experience some side effects. The two biggest side effects for me were nausea and feeling tired 24/7. I struggled to get work done in the office, and all I wanted to do was nap. Even though the pharmacy recommended that I take the medicine in the morning, I decided to take the medicine at night so that I could hopefully avoid falling asleep at my desk. It did work. I felt like I had fewer side effects throughout the day, but I also feel like the medicine didn't work as well. I also felt more anxiety during the day, though not as much without the medicine.

The medication did work. It didn't prevent all of the anxiety, but it did numb it so that I could combat it with my thoughts. I felt calmer and had less trouble falling asleep at night. For once in my life, I felt normal and that the anxiety that I was feeling was manageable.

Fast forward to February when I decided to foster a dog (and eventually adopt him). That dog managed to grab a full bottle of medication that I had just gotten from the pharmacy off of the table, and he destroyed the bottle. He ripped the plastic to pieces. When I opened the door to my apartment and saw what had happened, I gasped and went into panic mode. I immediately cleaned up the plastic and counted the pills. Phew. All 30 were accounted for, and the dog hadn't eaten any. But I hadn't vacuumed that carpet in over 4 weeks (nasty, I know). I tossed the pills in the garbage and didn't look back. There was no way I was putting those in my mouth.

I still had half a bottle from last month, so I started to ration the pills. Going off SSRIs cold turkey leads to some very unpleasant side effects, and those side effects tend to mimic anxiety. It sucked. I took the pills every other day and then every three days, hoping the pharmacy would refill the prescription soon before I ran out of pills. I ran out three weeks ago, and these last few weeks have been extremely difficult. I've had a lot of nausea and brain zaps. I also dealt with muscle pain and vertigo. It's felt like an emotional roller coaster, and sometimes I cried at the drop of a hat. For three days last week, I had insomnia, especially on the days before and after my annual performance review at work. However, since American insurance companies only pay for so much medication a month, I didn't think I could afford another bottle of pills without insurance. I didn't even bother to call and negotiate since negotiating is just unpleasant for a doormat like me and I expected to get denied anyway.

I just got the automatic refill on Saturday, but I still haven't taken it yet. The anxiety is welling up, and I'm so anxious that I can't even sit down to enjoy some leisure time. I turned on the Xbox to play a video game, but then turned it off when I thought I most likely couldn't beat the difficult level I'm stuck on. I laid down in bed to take a nap with my dog curled by myself, but I was unfortunately unable to calm my mind. I think I should start the medicine again, but I feel anxious about it, not as anxious as before I started it, but anxious enough that I'm not ready to take another pill.

Since adopting my dog, I've been getting more bruises. I had a huge system of 4-5 bruises on my thigh where you can typically see a large vein. There were bruises on my other thigh, on my calves, and on my forearms. I don't know how they got there. It could be that all the walking we do is causing me to bruise. I haven't gotten as many bruises since I've been off the medication, and I think I'll talk to my doctor before starting again. I should have called my doctor weeks ago, but I've been putting it off. If I'm going to get my anxiety back on track, I'll need to make that phone call.