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?