Let’s Talk

January 25 is Bell Let’s Talk Day.

One day a year the world comes together to help end the stigma of mental illness.

One day a year, a large corporation donates $0.05 for every tweet and hashtag that says “#BellLetsTalk” towards funding mental illness.

Meanwhile the province I live in is underfunding mental health across the board.  I can’t get a delusional/psychotic patient timely access to a psychiatrist without sending him to the ER or placing him on a Form 1 (ie involuntary 3 day hold).  I can’t get the chronically depressed and suicidal middle-aged woman a psychiatrist to follow her and manage her 3 psychotropic medications.

So yeah, let’s talk about mental illness.

Why don’t psychiatrists actually do what they are trained to do?  Why don’t they follow patients and see those that need weekly psychotherapy? Why doesn’t the Government adequately fund mental health?

How about we talk about mental illness every day of the year and not just one day?

Let’s talk.

Facing the Void

My brother and I had a long talk the other day about our parents.  He has positioned himself to be their power of attorney for finances and I am their power of attorney for personal care.  In the past year, it has become evident that we may need to start exercising our roles.   I can’t tell you how sad that makes me.

Growing up, my father was larger than life. He was a tall, formidable man with a deep voice but he was for all intents and purposes, a gentle giant.

Over the past year or so he’s become impatient, occasionally verbally aggressive toward my mom and is forgetting things.  He was diagnosed with mild cognitive impairment last fall but his condition seems to have deteriorated in the last 3 months.  He has a much shorter fuse now and asks my mom to repeat things several times a day.  He denies feeling depressed but we all think he is. Thankfully his family doctor suggested a trial of a low dose antidepressant and he actually agreed.  

He will be having an brain scan soon. I fear it will be normal.  Why? Because the thought of watching him continue down the road of dementia is heartbreaking. It would frankly be much easier if he was diagnosed with a brain tumor. I don’t think I could bear the day he forgets his grandchildren and then me. I don’t think I can watch him become aggressive and angry and frightened at his memory loss.  I see it already happening with my maternal grandmother. 

And there’s the kicker: dementia on both sides of my family? What does that mean for my brother and me? Are we destined for the same end?

We talked about all of it. Dad won’t want to go into a nursing home when the time comes. Will I have to have him declared  incompetent and take over as POA?  If dad moves into a nursing home, mom won’t be able to stay in the condo; will she live with me or my brother or alone in an apartment?  How long are we going to have to watch him deteriorate? He would never want to live like that. I certainly wouldn’t. 

I fear the road ahead. 

#letstalk

I deal with mental illness on a daily basis in my family practice. Having been treated myself for depression and post-partum depression I am well aware of the stigma that still exists. Mental illness is real.

I am not okay.
My life is good.
I have no reason to be depressed.
I feel so alone.
No one understands me.
The voices are so loud.
I think I need help.

Today, let’s talk about mental illness. It’s closer than you think.

Let’s Talk.

Day 28 – January Daily Blog Posting Month

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Today is Bell Let’s Talk day.  It is a yearly campaign to raise awareness and money for mental health initiatives.  Last year, over $5 million dollars was raised.

I’ve been honest here about my struggles with depression and postpartum depression after the birth of my first child.  It was a very dark time for me, one that should have been a happy time.  For the rest of my life, I will remember my first maternity leave, not because I was ecstatic to have my little girl, but because I struggled daily to get out of bed and be happy she was here.

I got better when I finally admitted there was something wrong.  I went through 16 weeks of intense, weekly Interpersonal Therapy and learned a lot about myself as a mother, as a wife, as a physician, as a woman.

In a lot of ways, experiencing PPD was a good thing; for one, it made me a better family doctor.  It allowed me to empathize with the moms in my practice and to recognize the early signs of depression, especially in the postpartum period.

Mental illness is rampant in our society and the stigma is only slowly being lifted.  I hope that more days like today and stories like mine help ease it just a little bit.

 

January blahs.

January has always been a “blah” month for me.  After all the lead-up and hyper over Christmas (especially now having children), January comes with a brutal hangover.   Suddenly, the reality of days on end of eating huge meals, sweets, chocolate, not to mention copious amounts of wine at family functions, catches up to you when you put on your work pants and they are just a bit more snug than they were a week ago.  There’s the task of taking down the Christmas tree, and explaining to the kids why the tree is out on the curb waiting for the garbage man to pick up.  There’s 10 days of having to entertain your child while she is off school.  Really, there is only so much Play-Doh I can handle.  There’s the late, late nights with husband watching Taxi Driver, the entire Lord of the Rings and Alien trilogies, which by the way, is a lot of fun.  Oh, and did I mention I was also working and covering two other practices?  Yeah, so no wonder I greeted January with one measure of fatigue, two measures of new flab and a measure of low mood.

I’ve been quite grumpy for the past week or so, mostly because I don’t know how to say no.  I agreed to cover for my two colleagues during the holidays – paid, of course.  We have an arrangement where we pay each other for lab review and patients seen.  We are all paid a salary, so we get paid whether we see our patients or not.  So, when a colleague is on vacation for 10 days and getting paid for it, I’m at the office seeing their folks.  I agreed to it, so I have no one to blame but myself.  It was busy.  One afternoon, I saw 24 patients (when I usually see that many in a full day), and the other morning I saw 16.  I got tired.  And grumpy.

It’s also winter.  Really?  Yes, it is!   I don’t remember the last time I felt the sun on my face.  Which might also explain the horrific acne these days.  TMI?   So, while at Costco the other day, I decided to finally take some of my own advice and start taking some Vitamin D – you know, just to make sure the advice I’m doling out is actually correct.

Vitamin D is a fat soluble vitamin.  It is present in a few foods, can be synthesized in our skin by natural sunlight, or taken as a supplement.  Vitamin D has to go through certain biochemical processes to become active and useful in our body.  There is some metabolism through the liver and the rest is done through the kidney.   (To read more – go here).  Vitamin D is important in maintaining adequate calcium levels in our body, as well as phosphate.  To put it simply, vitamin D helps make our bones stay strong.   Insufficient levels of vitamin D in children can lead to rickets, and in adults to brittle bones. But vitamin D has other important functions –  these include functions in cell growth and immunity, as well as reducing inflammation.

Many of my patients take vitamin D, for many different reasons.  I recommend it for all the children in my practice as well as the post-menopausal women, and I usually tell the patients who are struggling with depression (especially in the winter) to also take extra vitamin D.   I’m finding more and more people (men and women, alike) are taking vitamin D.  Apparently it’s the go-to supplement these days.  Did you know it can fight 3 different forms of cancer?? <insert eyeroll here>

In any event, I decided it was time to take some of my own advice.  A few days ago I started taking 2000 IU of D3.  To my genuine surprise, I was amazed at how quickly I started to feel better.  Yes, likely a placebo effect, but who cares?  Suddenly, after 10 days or more of darkness and bleak mood, the sunshine is back.

Oh, and did I mention that I am nearing the 10km running milestone?  For a few weeks now, I have been increasing my running distance by 1km per week.  Yesterday, I ran 8.2km.  It felt great.  I’m a little sore today, but it’s that good kind of soreness. Exercise really is nature’s best medicine.  I need to remember that on the dark days.

The “F” word.

Now, now… get your minds outta the gutter.

The “F” word I am referring to is Fibromyalgia.

It’s plagued my office work over the last few weeks.  It’s a diagnosis I hate. It’s difficult to tell a patient they meet the criteria for diagnosis. It’s difficult to manage and impossible to treat (for the most part).

Fibromyalgia (fibromyositis, myositis):Fibromyalgia is a common syndrome in which a person has long-term, body-wide pain and tenderness in the joints, muscles, tendons, and other soft tissues.   Fibromyalgia has also been linked to fatigue, sleep problems, headaches, depression, and anxiety. (Source: PubMed Health)

It’s hard enough treating chronic pain, but treating widespread chronic pain, in mostly women, with our without other psychological issues is a whole entire other matter.  It’s not surprising to me that the recommended treatments include medications which also have some mood stabilizing qualities.  But how to explain that to a patient?  “Hi, you have FM.  I’m going to suggest a medication that has been used in the depressed population.”  Um … say again?  “I’m not depressed, I’m in pain.”  Most patients refuse.  Those that don’t often recognize that there is some element of mental health issue that could be playing a role.  Others are adamant that those medications are not for them and insist on being seen by yet another Rheumatologist, or Neurologist, or “pain specialist”.  These patients often have had every test imaginable – x-rays, EMG, MRI, CT.  And for the most part, the results are normal.  I can understand the patient’s frustration – but imagine what it’s like from my perspective???  I have cost the health care system money in diagnosing that there is no pathological cause of their pain.  Yet, they are still in pain.

What does one do?

Some doctors would just start the narcotics, but that’s a slippery slope and never ends well.

Conservative treatment suggests exercise, healthy diet and OTC analgesics (like Tylenol or Advil).  How does one exercise when they’re in pain?  How do you explain to these patients that their pain will get better with mild-moderate exercise?

The thing that gets me the most with Fibromyalgia is the first thing on the list as possible causes (see also: Mayo Clinic) — physical or emotional stress.   There rarely is an individual whom I’ve seen diagnosed with Fibromyalgia who doesn’t have some emotional/psychological trauma in their past. I believe it’s their subconscious way of coping.  It’s somehow easier to describe (and therefore sometimes treat) physical pain rather than emotional/psychological pain.

I am at a loss most times with how to deal with these patients.  I know they are in pain but my options are limited.  I am already beginning to resent the select few who threaten harm to themselves “if you can’t help me”.  What they fail to realize is that I am trying to help them and that sometimes, thoughts of them keep me  up at night.