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.

#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.

Endless hallways to learning

Day 13. National Blog Posting Month.

Conference centers are like mazes only with poorly designed signage. Seriously this place is so confusing and watching a group of doctors all thinking they know where they are going only to find find out they were supposed to turn left at the fork then right at the double doors then right again is kind of funny.

The morning sessions were pretty good. I got a refresher on the difference between episcleritis and scleritis and learned its never a good idea to prescribe steroid drops for the eye. I also learned that the adolescent brain is very vulnerable to substance use and their neurobiology doesn’t full mature until well into the mid-20s.

I had a very educational 3 hour workshop/course this afternoon. I learned some key tools that I think will go a long way in helping me with some of the more challenging patients I encounter.

Overall it was a great day aside from the ongoing gastro and bronchitis I am still plagued by.

Now to pretend to care about dinner. Honestly, this lack of appetite is getting old.

Movere

To be, to have, to think, to move — which of these verbs is the one you feel most connected to? Or is there another verb that characterizes you better?

http://dailypost.wordpress.com/dp_prompt/verbal-confirmation/

A Mental Game Changer.

I’ve had an epiphany of sorts.

About 4 months ago, I joined a FB running group.  A lot of the runners in this group train regularly for a variety of races.  Yesterday, there was a big race in another city.  A lot of the women I follow were running their first, or third, marathons. It was incredible watching them train and then follow their progress on sportstats.

All day long though, I wanted to go for a run.  The weather was perfect.  We spent a great morning at the park with the kids, flying a kite.  There’s a skateboard park as well and daughter insisted on riding her bike up and down the ramps.  Later in the afternoon, everyone was tired and hot, so we hunkered down in the basement and watched Monsters University.

I couldn’t get the thought of going for a run out of my head.  Seriously. It was like a compulsion.  I knew I shouldn’t go, the left posterior shin was aching a bit after the walk to and from the park and it’s not like it hurt, I could just feel it, you know?  Anyway, I put on my running gear while the kids were brushing their teeth.  I told them a make-up story (Indiana Jones finds a fancy necklace and magical ring).  Once they were tucked in by mommy, their dad went in for a final good night kiss (and probably a better make-up story).

I set up my phone and MapMyRun – I decided it was time to get back to basics.  I set the coaching to 3:1 (run/walk) intervals and I turned off the notifications of how far I’ve gone and how fast.  As I started running, I kept the pace slow and comfortable.  The intervals came fast and during the walk breaks I took time to stretch out my calves and shins.  I decided to take the off-road route and headed to the local trail.  While on the trail, I took in the scenery and realized something.

trail

I’d lost focus along the way these past 4 months.  For some reason, I had become obsessed with increasing my distance and getting faster.  I was sabotaging myself and didn’t even realize it.  Before I got pregnant at the beginning of 2013, I hadn’t had any injuries and was running close to 10km.  For the past 4 months, I’ve been plagued by one injury after another.  Somewhere along the way, I forgot why I started running.

I love the journey that running takes me on.  I love the impact on my fitness, on my endurance, on my physical and mental health.  It’s the easiest form of exercise for me, takes minimal time out of my busy life and doesn’t cost very much.  It got me into the best shape of my life and the pounds melted away until I got pregnant.  My goal isn’t to train for a race, it’s not to win a race or to compete against anyone. My goal is to have fun, stay fit, feel good and look good.  Yes, there’s a bit of vanity here.  Running helps me lose the pregnancy weight, I won’t lie.  I can still eat what I want and don’t have to go on crazy diets to get back in shape.  Running is important to me and I have been causing my injuries by going too fast, too soon, trying to keep up with .. with who?

So, from now on, I am running because I want to.  I won’t care how far I go or how fast I am. All of that will come with time.  If one run is only 3km, that’s okay.  If the next is 6km, that’s okay too.  So long as I am having fun and enjoying it, I will keep going.

I am just going to run because I love it.

 

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.

 

How To Stay Sane During Your Maternity Leave.

Day 15. National Blog Posting Month.

Halfway there!!  Thank you for your continued readership!

Yesterday I took the baby to a movie. (!!!) You might wonder what kind of movie theater would allow someone to bring an infant to a show?  Well, where I live, the major movie theater company runs a weekly program called “Stars & Strollers”.  Maybe you have something similar where you live.  It’s basically a movie showing at 1pm where moms can bring very small children, (ie infants and toddlers) and enjoy an afternoon watching the latest releases.  The volume is turned down, there’s even a change table at the front of the theater!  How awesome is that?

During my first maternity leave, I went to a lot of movies with a friend whose son was born just a few days after my daughter.  We saved each others sanity, I am quite sure.  It was wintertime and the only saving grace (for me at least) were those weekly trips to the movies.  For two hours it was okay if your kid cried.  Everyone in the theater would totally understand.  I remember having to walk up and down the aisles with my daughter because she was freaking out crying, and it was fine because at any given moment there was at least one other mom doing the same.

Remembering that time led me to think about other things that saved my sanity during that particularly difficult maternity leave.

  • Sleep in in the morning.  After the husband leaves to take the kids to school, go back to bed with the baby.
  • Learn how to eat with one hand.  What’s the other hand doing? Balancing the baby on the breast, or on the bottle of formula.
  • If the baby is asleep, and you feel rested and aren’t doing the first thing on this list, go have a shower.  A long, hot shower.  Your boobs will tell you when baby wakes up.  (Seriously, this happens to me all the time.  I start leaking in the shower and if I listen really, really hard, I can hear the baby crying and know that my shower time is up).
  • Go for walks, every day.
  • Eat whatever you want.
  • Drink whatever you want – in fact, a glass of wine or a stout beer will make you feel 100x better.  Scientific fact! (Not really.)
  • Don’t be afraid to give the baby some formula, or expressed breast milk, in a bottle. Let someone else feed the baby so you can go out for an hour or four.
  • Use a soother!!! There’s no reason you need to be the pacifier.
  • Remember: it’s a brief period of time, the sleep deprivation in particular; before you know it, the baby will be a toddler, the toddler a child and you’ll wish you could go back to when they were infants.  No, really, you will.

How did you survive maternity leave?

Getting Old

My 90-year old grandmother was recently moved to a long-term care facility.  She had been on a waiting list for close to 2 years when the room became available.  Prior to the move she was living on her own in an apartment building.  My mom and aunt would take her shopping for food and would help her bathe once a week, but up until about a year ago she was still cooking.

Now, this wouldn’t be a big deal except for the fact that my grandmother has early stages of dementia, or she did a few years ago.  Her disease has progressed in the last year.  Her MMSE (mini-mental status exam) scores have declined.  She scored 28/30 a year ago and 1 month ago her score was 21/30.

Let’s just that she was not impressed with being told she had to move.  In fact, she had forgotten all about it until the day my aunt took her to the home.  Those first few days were really hard, not only on my grandmother but on my aunt in particular.  See, my grandmother also has a vicious streak.  She always has. It’s never been directed towards me or my brother, mostly towards her two daughters (my mom and aunt).   I don’t know what kind of trauma she went through back in the Old Country, but something hardened that woman and she is not an easy person to relate to.  My brother and I learned that very quickly growing up.  She is a very religious woman and when we stopped going to church as kids she never failed to remind us that we were going to hell.  When I didn’t get married in a church, she refused to attend my wedding – a decision she later admitted to regretting.

The sad thing is that I don’t really have any heartwarming memories of being with my grandmother.  Well maybe that’s not true – I do remember her taking me as a child to the local beach, which was always fun. But honestly, that’s about it.  As I mentioned, my grandmother was never really harsh with me, but I witnessed a lot of antagonism between my parents and her growing up.  The relationship between my mom and her mother has always been difficult.  Thankfully, my children will have much fonder memories of their grandparents.

I noticed a significant change in my grandmother’s general demeanor after my first child was born.  It was so profound, it had me in tears.  Never had I seen her so loving, animated, delicate even.  It was astonishing.  Despite everything, I am grateful that my daughter will have some memories of her great-grandmother.  In fact, I think all of my children will remember her – she’s as strong as an ox.  Her memory may not be but her personality and overall general health will certainly make up for it.

Watching my aunt go through this ordeal has prompted my brother to have the discussion with our own parents.  When the time comes, we do not want to go through what my aunt went through.  We’ve made it clear that when it’s no longer safe for them to live independently, they will have to go to a retirement/long-term care facility.  Frankly, it sucks getting old.  Losing one’s independence has to be terrifying, never mind one’s memory.  Alzheimer’s disease has to be the most awful thing a child can witness in a parent.  Short term memory usually goes first, often the first symptoms are relatively mild.  But over time, the person can’t carry on a meaningful conversation anymore.  Confusion sets in, it’s almost like the person become child-like again, they have no memory of their life, of their children or grandchildren.   Heartbreaking, to say the least.

This past weekend, I took my daughter to visit her great-grandmother in her new home.  She looked the best I’ve seen her in a long time.  She’s eating much better and she seemed to really enjoy herself at the activities that were organized for the residents.  It was a good learning experience for my daughter as well.  Getting old is difficult, but it’s important she see that her great-grandmother is happy, safe, and well taken care of.

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 Disordered Personality

So aside from my last post which was inspired by a writing prompt, the proverbial writer’s block hasn’t  lifted.

Normally, the ideas for posts come easily to me, but lately, not so much.  My day job is as interesting as ever, and my kids continue to make me laugh, so there should be plenty to talk about right?  Right.

Problem is, is that my day job has been incredibly draining the last few weeks.  It would seem that all the “crazies” have come back to roost.  It’s the term I lovingly call those patients who suck the life out of a doctor.  There’s another, more appropriate term – the personality disorder patient.  I’m not talking about the Type A or Type B personality traits we all know.  I am talking about the deeply troubled individuals who fall into what the Diagnostic and Statistical Manual for Mental Disorders calls Personality Disorders.

There are six specific personality disorder types:

  • antisocial (the scary dude who has no conscience – think Paul Bernardo)
  • avoidant (the opposite of the dude above, the guy who is meek, shy and afraid to be around others)
  • borderline (the woman with chaotic emotions, unstable relationships, and who makes those around her feel like they are always walking on eggshells)
  • narcissitic (the guy who knows he’s God’s gift to women, and has little capacity for compassion)
  • obsessive-compulsive (the guy who has to have everything in his life be perfect, regardless of what anyone else thinks)
  • schizotypal (the really odd guy who makes everyone around him a little bit nervous)

Dealing with the patient who has a personality disorder is extremely difficult.  As a family doctor, the most common type I see in the office is the borderline patient.  It’s exhausting because on any given visit, I might be her best friend or her worst enemy.  Sometimes I can get a sense of what the visit will be like based on her behaviour in the waiting room.  And other times, she’ll turn on me like a dime and it’s game-over.  Sometimes months will go by and I won’t hear a word from her; other times, she’s in my office on a weekly basis.  It’s definitely a roller-coaster ride.

Lately she’s been in my office on a weekly basis, sometimes twice a week, always in crisis, always on the verge of suicide, always needing help.  She’s never made an attempt on her life, she always scoffs at (what I think are) my helpful suggestions, and she is highly, highly dramatic.  She spends the amount talking at me, asking a series of rhetorical questions yet expecting some miraculous answer.  I can’t tell you how exhausting it is to sit through.

We are taught in medical school that these kinds of patients require boundaries.  Set time for appointments, don’t go past the allotted time; warn the patient they have 5 minutes left, etc.  If the patient arrives early for their appointment, make them wait, do not accommodate them.  If you do it once, they will always expect it.   My patient is unravelling before my very eyes and I feel powerless to help her.  How do you help someone who so desperately can’t help themselves?  How do you change 20, 30, 40 years of behaviour?

I wonder what Barney would say if he were borderline?