My First Day Back to Work

I woke up yesterday morning about 15 minutes before my alarm had been set. I got six-and-a-half hours of sleep and felt well rested. I woke up earlier than I had to in order to enjoy some time drinking my hot tea and settling my anxiety about this eventful day. I had no idea of what to expect.

I spent my last day on full time disability (Monday) talking to my manager. He assured me that everything would be fine. The disability claims group approved me to go back to work from the 5th to the 11th at fours hours a day and from the 12th through the 18th I’d be working 6 hours a day. I explained to him the downside of my vitamin B1/Thiamine deficiency with regard to my short-term memory loss and he understood that it was going to take some time for my brain to heal.

This first week back all he wanted me to do was to go through my email inbox and blow away the majority of the unread emails as my back-up team members were taking up the work covering my clients while I have been away. For these two weeks, my out-of-office email auto reply and my outgoing voicemail message still shows me being out of the office. My manager does not want me to interact with my clients for these first two weeks. He felt that I needed a gradual immersion back into the fold. I am so grateful to have such a wonderful manager. After talking with him, my anxiety levels were reduced.

Well, the moment I had been dreading was finally upon me—opening up my email account. There were 1000+ unread emails just waiting there for me. I took a deep breath (and an Ativan, I will admit) and sorted by sender. It turns out that there were so many I could just delete. When all was said and done, I ended up keeping 73 emails that I felt I had to read which I did. Many came with important attachments about my specific accounts that I would have the need to use later. I saved and filed all of those in the appropriate folders; the next thing I knew, it was 1100.

Oh yeah, my boss did agree to letting me change my work hours and now I will be working 0700-1500—no more overtime hours allowed. I am so grateful for those two situations. I wake up so early anyway; to have to wait until 0800 would be counter-productive. In addition, the upside is getting off at 1500 while there is still sunlight. This gives me the chance to accommodate any doctors and therapists appointments. I never did like working the normal eight hours where the sun was just coming up when I started work and already set by the time I was finished. I hate Standard Time and the sun setting so early in the Winter.

My day actually went quite smoothly. I was very methodical in how I approached the day; I received excellent support from my boss; what more could I have asked. Since my day started at 0700 I was done at 1100. I had the rest of the day free and I realised that I needed a distraction so I would not dwell on what may or may not occur my second day back. A friend of mine had been sick over the weekend and I called her up telling her I was going grocery shopping and asked her what I could pick up for her.

When I arrived at her house, my heart just went out to her. She looked liked she felt so miserable. We settled in and spent about two-and-a-half hours just talking. It was exactly what I needed to divorce myself from anticipating the worst for the next day.

Overall, it was a good day. I am not going to fret about the upcoming days or pile more on my shoulders (emotionally) by projecting outward on the worst-case scenario. I have hope that my job will be far more manageable now than it ever was before. Staying in the moment—what a marvellous tool!.©2009

Appt with Psychiatrist #8

We’re still doing psychotherapy for 50 minutes weekly with phone calls interspersed. He’s concerned over my profound depression. I made a half-hearted attempt to commit suicide Sunday night. I say half-hearted because I didn’t drink any alcohol which I know would seal the deal. I think halfway through, once I swallowed the pills, I realized I didn’t want to go through with it. My consequence: well, I did sleep for 4 hours, but felt very groggy. That morning tried to drive my self to group and got sideswiped by an 18-wheeler—my fault, I veered into his lane. Luckily, I self-corrected and stayed in my lane. Unfortunately, my car has the scars to prove it. Moreover, I fell asleep during the whole first session of group (no I didn’t snore, but no one woke me up either). At the break, I guess all of the noise woke me up, but my therapist wouldn’t let me drive home, so I called a friend to pick me up. I guess some of the drugs I had only taken a few hours earlier had not fully metabolized.

Well, back to my shrink, he has increased my Lexapro to 30mg. I found out that the normal dose is 10-20mg. I sure hope this helps me. I am on so many medications. Maybe once my Thiamine levels get within appropriate range things will start to change.©2009

Appt with Psychiatrist #7

Following on the heels of my appt earlier with my GP, I gave my psychiatrist the results of the blood work and he was clearly pleased that my Thiamine (B1) levels were undetectable. Pleased because there was a solution. He did express concern that I had to begin treatment right away so I would not suffer any more brain damage if some of my cells had already started to die, a result of how long the B1 had been so low. Since it was not measured until November 12 and I had already begun showing the signs of ataxia well before that, (I had never sought any medical advice because I just thought I was getting clumsy), he said there might be some slight damage. However, if I don’t begin the B1 treatments immediately, there will be continued damage to my brain cells resulting in continued ataxia, possible permanent short-term memory loss and possible ocular involvement (I am already showing signs of saccadic movement in my eyes when I am reading—worst case scenario is to develop Wernicke-Korsakoff syndrome—some symptoms I am already showing). I told him that I gave all the information to my GP’s nurse so they can call in the prescription to my medical insurance prescription service (no local pharmacies carry it). That means at least ten days without treatment. If they choose not to call in the prescription, but write one for me to send in, that’s an additional five to seven days. Since today is Thanksgiving day, I probably will not hear back from my GP’s nurse until tomorrow or Monday, still more additional days until treatment can begin.©2009

Appt With My GP #2

Well, the results of the rest of the blood work has come in and what my psychiatrist and GP thought has been proven true. My Thiamine (B1) level was so low it was undetected—clearly the cause for my ataxia, which has grown worse since first diagnosed—my balance has worsened. My GP is looking for an injectable form where I can give myself the IM shots as I do with my B12. None of the local pharmacies carries it, but I did find out that my medical insurance prescription service could supply me with a 90-day supply that is not outrageous in price. I called my GP’s nurse back, gave her all the information with which to call in the prescription, and asked her to call me back with a confirmation that the order had been called in. I left the message around 1400, but I have yet to hear back from her. I don’t know how often I will need to give myself the B1 shots (I do the B12 once a month), so I will need those instructions as well.©2009

Appt with Psychiatrist Week 5

On Tuesday, after posting this entry I called my group therapist out of politeness (yet another quirk—I can be completely suicidal and yet stop to be polite…go figure!) to let her know I would not be attending yesterday’s session. This was after canceling my psychiatrist’s appt for today and my appt with my GP tomorrow. In that state of mind, I did not want to be around anyone who was going to parse my emotions. When she asked me why I wouldn’t be attending, I simply replied that I couldn’t deal with being around anyone. Then I sorta lost it on the phone despite my keen attempts to be stable. I ended up telling her what had been going through my mind on Monday night when I was quite suicidal and how reading a comment yesterday morning on this post before calling her upset me so greatly. She asked if I could read to her the comment and then my response to that comment. She tried to remind me that this comment only represented one person’s opinion—an opinion that she was allowed to have, but one I did not have to agree with, nor let it have power over me. We talked on the phone for about an hour (unheard of with most in this community). I also told her that I had canceled the other two appts as well. She asked me if I was still feeling suicidal and I had to tell her that I did not know. Then she asked me if I could make a commitment to her to remain safe. If I didn’t tell her what she wanted to hear, I knew she would call 911 because she said as much. Not wanting to go there, I told her what she wanted to hear. Then she asked me if I would be able to call her before she left the office later that afternoon and I said I would.

When I get in this state, I always sabotage myself. That’s why I canceled the other two appts. I simply no longer cared about wanting to get better. However, after talking with her, I rescheduled both appts.

Well, the rescheduled appt with my psychiatrist gave me a valid reason for missing Wednesday’s group that I wanted to do in the first place. When I went in to see him yesterday morning, I could not make eye contact with him. His primary concern is that the meds cocktail he has me on is not working to get me out of this severe depression. He decided to finally add an antidepressant to the mix and gave me a sample of Lexapro. Not wanting to trigger a manic phase, he only wants me to take 5mg once a day. I also told him of my financial problems since I incurred all these medical bills. I also found out Monday afternoon that my 16-year-old Honda with 250,000+ miles on it was not long for this world (power train and transmission—the same quote I got from three different auto shops). I simply cannot afford to buy another car, and the cost to repair my car was going to be four to five times the blue book value of the car, an amount I couldn’t afford anyway. He told me not to worry about the cost of the Lexapro, as he would keep me in samples for the time that I felt I needed it. That doesn’t even touch the $175 I just had to shell out on my other bipolar 90-day scripts.

I also convinced him that my balance was much better and that I thought he and Wallace had just been alarmists. I said that because I don’t them to make such a big deal of my continued imbalance. I received some of the results from that blood work that Dr Wallace had ordered.  The Magnesium, Phosphorus and Zinc were all within normal limits (albeit on the low side). Now we are just waiting on the Selenium and the most important one of all, the B1 which, in part, may be causing my ataxia (we already know that my B12 is on the low side of normal, so I’m back to giving myself the shots again once I mail off Dr Wallace’s scripts—and I don’t even know if I have the money for all of those). I am sure my B1 should come back too low to account for the ataxia; I just don’t want to think that it may be because of an organic process in my cerebellum. If my B1 is too low, I wonder if they make an IM version I can use to shoot myself in my thigh, or if it only comes in IV form (we already know that I can’t absorb it orally because of my bypass surgery). Dr Wallace also wants me to schedule a time when I can get the Infed, the iron infusion by IV, but when I did that before, it was approximately $1600 a pop. The doc said I might be able to participate in a clinical trial currently being offered so I could receive the Infed for free, but I’ve yet to hear a reply on that one. If I can’t qualify, I won’t be able to raise my Ferritin levels, already abnormally low, even though my hemoglobin is only just slightly lower that normal in comparison.

So here I sit Thursday morning with nothing to do. I don’t know what I am going to do with my car. At some point very soon, it will die on me. I just hope I’m not on some interstate when it does. When it does crap out on me I will truly be up a creek.©2009

Appt With My GP

Ahh, Friday the 13th—ya gotta love it!

OK, yesterday I went to see my GP as a follow-up to all that fasting blood work. My psychiatrist actually called him at lunch before my 1615 appt to discuss his concerns about my apparent declining health. My psychiatrist told him that I flunked the Romberg test, so my GP performed some additional neurological tests on me. He confirmed that I have Ataxia, a neurological sign and symptom consisting of gross lack of coordination of muscle movements. There are many culprits, so I am choosing to ignore the more dreaded causes. There does appear to be an association with B-12 and B-1 (Thiamine) deficiencies, however.

On my lab results, my B-12 was within normal limits; however, not suspecting anything along these lines three weeks ago when my GP ordered the fasting blood work, he did not test for B-1. He decided to order more lab tests: Magnesium (serum), Phosphorous (serum), Basic Metabolic Profile (a repeat from the last one), Zinc, B-1, and Selenium. They are suspecting that the Ataxia may stem from a vitamin/mineral deficiency. The only problem is that my body does not absorb vitamins and minerals properly (I had gastric bypass surgery in 2003 which bypassed the ileum and a good portion of my jejunum, the two sections of the small intestine into which the stomach dumps). Most vitamins and minerals are absorbed in the jejunum, which may explain why I may have a serious deficiency. I can’t take vitamin pills; I’ve tried with no success with iron when I was severely anemic before resulting in an IV infusion of iron. Couple this with the fact that I am not eating anything (I lost 17 pounds since 21 October), thereby not gaining any nutrients from food; this can make for a nasty combination. It took three years for my ferritin (a protein that stores iron and releases it in a controlled fashion) levels to tumble down to 2 (normal is 20-200ng/mL for females) (and now it is down to 5), so maybe it has just taken longer for these vitamins and minerals to reach abnormally low levels. Sure beats the hell out of the idea that I may have some morphological problem in my cerebellum, a region of the brain that plays an important role in the integration of sensory perception, coordination and motor control. [gosh, I bet you didn’t think you’d be getting anatomy and physiology lessons on this blog :)].

I didn’t leave the GP’s office until 1800. He spent two hours with me. Now we wait for the results and these are specialized tests, which may take a couple of weeks on one or two, especially the Selenium (I hope that doesn’t translate into big $$$—I’ve enough medical bills as it is). These are so rarely ordered that the lab manager had to get out two huge reference books to look up what color top the test tubes had to have in order to collect the blood in the right test tube. And here she though she was wrapping it up for the evening when I was walked back to the lab! (I never seem to do anything half-assed). Meanwhile, I bought a cane this afternoon so I can walk without falling over. Yeah, that does a lot for my butch image…lol.©2009