Today Is Self Injury Awareness Day

Apolgies for not getting this up sooner--busy day.

Thanks to Deb for posting about this earlier in the week as I knew it was in March but had forgotten the exact date. I do this often. My memory is abysmal.

I know it's hard as there are so many "days" commemorating and promoting this and that. Sometimes with the proliferation of these things it tends to take away the meaning. But I think I will take the time to blog about this one and give it a bit of show.

Now although this day is not formally recognized and is still more of a "grass roots" effort, I found through this site that two states in the US have actually proclaimed it an "official" day: Connecticut and New Mexico. The site offers some form letters if you feel like advocating to your local legislature. Granted, it's all done up for MPs in the UK but it will give you a template. It also offers some literature about self injury that is written by LifeSIGNS, the UK charity that well, basically seems to be managing the site.

Now on a more personal note, if you do not already know this, I am a self injurer. I have been and am a cutter. Please see the link entitled Cutting on the right for previous posts if you are interested. I have also engaged in punching walls, head banging. I have done these as a child and an adult--except the cutting, that came later.

I have been debating about disclosing this for a while but since today seems to be all about awareness, then I suppose it seems an appropriate time. I engaged in a cutting about three weeks ago. It has been about two and a half years since I last cut myself. I'm not even sure why I did it. There were no obvious triggers that day. I'm still not sure.

I do know that my last year has been fraught with tremendous difficulty and it is very surprising that I haven't completely fallen over the edge in dealing with some of the things that have hit me. Perhaps some extremely minor trigger that didn't even register just tipped the balance? Again, I am not sure. I don't know if I ever will be.

Perhaps I just need to have a big Bipolar flip out ever two and a half years!

I mentioned this to my therapist and she (rather glibly in my mind) said, "Well, you can flip out here!" But that is not the point. When you reach that level of crisis, that critical mass in your brain, you can't wait for a therapy session. Especially if you don't even see the oncoming onslaught. I was dissociated. Absolutely. The last thing on my mind was calling up someone, anyone and talking. The only thing I wanted to do was hide away from my partner, use the knife and then quickly try and repair the damage I'd done and hide it all (which was impossible--I'd cut too deeply.) However, not enough to require medical attention as in the past.

So on goes the battle, I suppose. But just remember--be kind and gentle and patient with the self injurers you encounter out there. Don't be scared even if sometimes what we do can seem a little difficult to handle. Believe me, it's difficult for us too.

Police or Paramedics: Who Are Better In Dealing With Psychiatric Crises?

While coming home in the car a while ago, I witnessed a scene outside a shop where two paramedics were painstakingly dealing with a man who was obviously mentally distressed. I only caught a brief glimpse of it all but it took me back to some experiences, some thoughts and discussions I have had with other people who have a veritable cornucopia of disorders. The paramedics were pleading with the man to get in to the ambulance repeatedly or else they would need to call the police.

Now I am not prone to generalizations and am always willing to give everyone the benefit of the doubt but in answer to the question above: Paramedics, absolutely.

In various times of crisis, hospitalization etc..., I have dealt with both individuals in these professions. I have met some decent coppers but at best, they have just done what was needed (save one man) without a modicum of care. The paramedics, on the other hand, have always been the most caring and least judgmental of persons and have always taken such good care of me. Some have even had great senses of humour too.

My most terrrifying experience with the police happened one night after speaking long distance to a friend of mine. I was rather down and had been drinking (or course) and was merely venting. Or so I had thought? My friend had apparently become quite concerned and called 911. As I was getting ready to pad off to bed, there was a knock at the door. I had no idea who it could be; it was quite late (or early...perhaps 0100hrs?) I answered the door and there stood five (yes five) police officers.

Alright. I'm not exactly up on police protocol but I don't think they send that many officers to a domestic disturbance call. And I've never worked as a 911 dispatch operator either but I would assume that they would have asked some pertinent questions like if I was alone in the house?

They asked if they could come in. I was completely stunned. What do you say with five police officers standing in front of you, "No?" So I invited them in and they told me that they had received a call from "a friend" and that I "might be suicidal." I told them that I was not and that I was just getting ready to go to bed. They told me that I would have to come with them to the hospital. I looked at one of the officers who was casually sifting through my mail and some of my writing. I became agitated. I told him to put all of those things down and that he had no right to look at them! I again insisted that I was fine and I needed to go to bed as I had to go to work in the morning! I didn't need to go to the hospital! I told them that this was just a misunderstanding!

At this point, they became increasingly more forceful in their demands and I became more agitated and not combatitive but certainly argumentative. A female officer stepped right up to me, almost into me and threatened me with arrest if I didn't go with them. That was it. No matter how hard I tried to convince them, I couldn't compete with that.

They physically grabbed me by the arm and I told them to let me go as I wanted to put my shoes on. They told me there was no time for that so I ended up leaving the house with one bloody shoe on. Fantastic. They threw me into the back of one of the cruisers (they all still had their lights flashing!) and off we went.

My poor landlords. They were a great couple and didn't even know what to do. They just hid upstairs--I had some serious apologizing to do later.

So we get to the hospital and I am fuming. I had been an inpatient there before and was seeing a psychiatrist there. I explained rather loudly to anyone who would listen how grand a mistake that this was and that I positively needed to get back home to get at least some sleep in order to get to work. My job really depended on it at the time! I could not afford to miss work! I even demanded that they call my psychiatrist at home, wake him up and he would deem me fine. I'm surprised after all the fuss I made they actually didn't hospitalize me. But knowing the hospital as well as I did and knowing I didn't need to be hospitalized I managed to get out of there as the sun was beginning to come up.

By that time, four of the officers had left and one stayed behind to wait with me. He drove me home. I gave him a little piece of my mind on they way and told him that police officers should treat people under such circumstances with a little more decency and respect. I don't know if it made an impact as he simply told me, "We're just doing our job."

EBM: A Balanced Approach?

Okay, I may be making a huge ass out of myself for posting about Evidence Based Medicine but I've been doing some reading and it's kind of bugging me. I'm not a health practictioner (as my blogger name says!) but I am health consumer.

So I've been trying to wrap my head around EBM and all the fuss. I've been reading both sides of the argument and really, I can see where it works in theory but not always in practice?

Of course it's always good to pay attention to studies and be "judicous" in looking at them (that word comes up a lot in EBM) but isn't there more to practising medicine? It's not just about the facts and figures and statistics. I know proponents (or even non-proponents) of EBM may be laughing at me right now, saying that I'm totally taking it out of context and I have no idea what I'm saying?

And yes, there are people out there that claim to be "experts" that do need to be weeded out so yes, cite your references, always. But that's just common sense! If I read someone who claims to be an expert, I want to see their data.

But I think you also need to take into consideration so many other factors that EBM just doesn't allow room for. I'd be an EBM nightmare. Co-morbidities, taking meds off-label--but they work! I'm living proof! But according to EBM, I would not fit the criteria, therefore I may not be able to take my precious Topamax/Topiramate if one of my docs was a real EBM hardass! Well, perhaps I could...if I armwrestled him/her.

I somehow feel that EBM as a "movement" as it has been termed has the capability to go a little too far. From what I gather, they deem what is appropriate in terms of evidence and dictate proper guidelines. It just feels a little too militaristic.

Yes, there are "rules" to science but healing is an art. Let's not lose that in the overall approach to medicine. Let's not completely put the blinders on and have professionals buried in the latest "research" looking only at that (which may only give a partial picture, anyway.) Supposedly, EBM doesn't preclude the patient but it doesn't exactly give me a warm feeling.

Alright, ending this now. I'm just a patient.

Did I Hear That Right?

I forgot about this. I meant to post about it the other night. I was watching Law and Order (too bad Dr. Deb is on vacation, even though it wasn't SVU--I could have ran over to her blog for a quickie on the topic.) Anyway, I wasn't really paying attention. There was too much going on in the house and it was late...anyway, my ears pricked up when I heard that a character died while overdosing on Depaquel(sp?). Huh? They said it was an antipsychotic. And just to be sure that I wasn't hallucinating, they repeated the drug name three times during the episode.

Okay. Now I know that certain drugs can be sold around the world under various generic names but Seroquel is fairly new and I don't know if the patent has run out yet for other companies to start producing it under another name other than the generic Quetiapine. So I was thinking, is this some new hybrid between either Depakote or Depakene and Seroquel? Why anyone would want to do that is beyond me. And you thought Zyprexa would pack on the pounds HA! And speaking of Zyprexa (aka Olanzapine,) it's the only antipsychotic that I know of that has been souped up with another med, an SSRI--Prozac (aka Fluoxetine.) That is Symbyax and I'm sure that was years in the making.

I have yet to hear of any plans to combine anticonvulsants with antipsychotics. To me, it doesn't make any sense. Granted, I'm no psychopharmocologist but anticonvulsants are too hit and miss. And although they may be considered mood stabilizers, technically they are not. They only true mood stabilizer as a class of drug is Lithium. The whole point of Symbyax was to assist with the depressive aspects of bipolar. So far in clinical trials (if memory serves,) the best drug in the anticonvulsant class (and what I've heard anecdotally--see, anticonvulsants are a crap shoot when it comes to treating the depression side of bipolar!) is Lamictal. So maybe the drug in the television show should have been called Lamiquel?

That got me thinking, maybe my spelling was off. Maybe it was Depoquel! That got me going down a whole different pathway. Maybe it was a combination of Depo-Provera (birth control) and Seroquel! Now this makes sense (and the victim of death was female...) This just might be marketable. Sometimes those manic episodes do lead to some pretty bad decisions... Hey, with the *new* "Depoquel" you certainly won't have to worry about racing to get the "Morning After Pill!"

Now I googled every spelling variable possible and I can't find anything. If someone in some country somewhere takes this version of an antipsychotic, please let me know. Nothing makes me angrier than misinformation in the media. I don't know if there was some sort of copyright thing going on but if so, then they could have resorted to good old Haldol/Halperidol and leave it at that.

Cutting: When The Pain Just Can't Get Out

I was thinking about whether or not to put a trigger alert at the beginning of this post as it might be touchy but I could put a trigger alert on this entire blog. So, for what it's worth since some of this might be a bit alarming:

TRIGGER ALERT!

I am a cutter. Or a was a cutter. Have been a cutter. I am a reformed cutter? Once a cutter, always a cutter? Someone early on commented that I am a "label whore" because of all of my diagnoses and that made me laugh. So I guess, I'll simply add to that and say that yes, I am a cutter. I also say this because since I've done it in the past, I know that I am capable of doing it in the future. I think that will always make me a cutter.

Every cutter has a story, as I have learned. I can not speak for everyone so I will simply talk about my own experiences. Some people cut habitually, I on the other hand have only cut impulsively while in the throes of uncontrolled mixed state cycling.

Why? I guess during those moments, the utter pain, despair, frustration and hopelessness was so intense that words could not express what I felt. In a mixed state, you are simultaneously depressed but experiencing manic symptoms so you have the capability to act out violently. While the depression makes you feel so absolutely dead inside, the mania demands that you do something to make yourself feel alive. You cry out to the world to show your pain, to feel it so you reach for a knife and you damn well make it known.

The first time I cut myself I became an amatuer surgeon (albeit, a very bad one.) I severed three-quarters of the left median nerve in my wrist. All the doctors were amazed that I didn't hit any major arteries or veins. I was sent for surgery the next morning and they repaired it but not completely. I still have some numbness in my hand and fingers that will never return.

The second time, I more wrecklessly slashed my forearm deep into several layers of subcutaneous fatty tissue. No serious damage was done and I was stitched up in the ER.

Cutting is serious business. I absolutely loathe the taboo that surrounds it. Most frequently, it is attributed to people with Borderline Personality Disorder but believe me, people with BPD haven't cornered the market on self-injurious behaviour. I am living proof of that. And it works both ways--not all people with BPD harm themselves either.

Not long after the first cutting I spoke to my cousin who is an ER doc. She didn't know about it, just that I was hospitalized for psych reasons (even though I was kept on a surgical floor.) She immediately launched into a tirade about "cutters" and how she couldn't stand them as they were all a bunch of attention seekers, how they just wouldn't stay on their meds and how they never listened and on and on. I was deeply disturbed. I then told her casually the reason for my admission. Oh, she backpedalled hard but she couldn't redeem herself. I had always idolized her but now she really dropped from my esteem. We have since spoken and she seems a bit more sensitive to mentally ill patients. Perhaps she's had some training or grown up a little bit?

I won't argue that it can be difficult to help or treat someone who is a cutter (or who participates in other self-injurious behaviours.) It can be downright disturbing and painful in it's own right to witness it, perhaps even more so if it's habitual. But it doesn't mean that the person deserves less than adequate and/or sensitive care. For someone to get to that point, they are really, really hurting. I know. I never thought I'd find myself there but I did.

Private Health (S)Care?

So I read today that our country's first private health clinic has opened in British Columbia. Huzzah! (sarcasm) Yes, I am a strong supporter of our publicly funded health care system--even if it is in a bit of a shambles right now and sorely in need of some "rehabilitation" and healing in it's own right.

Still, privatization is not the answer. At least not in my opinion. And I think my opinion matters as a patient and health care consumer because in the end, it's us who always end up suffering the brunt of decisions made.

Some people who are onside with, not outright privatization (believe me, I don't think that will ever happen--over certain politician's dead bodies), but maintaining some sort of "two-tiered" approach, think that it will solve some of our current problems with backlogs. They think it will allow for people to seek non-vital services faster. Uh huh. Ah, yes. You have the money, you get to move to the head of the line. But will such "queue jumping" really improve our backlogs? The system is not clogged simply with non-vital services. Oh, take a stroll through the emergency rooms. The "vital" services are looking pretty grim, also.

So here we have this new private clinic that has opened up that treats "vital" or as they say "urgent" services. But wait. According to the article, some vital services are paid for under the public system. This would make the clinic in violation under the Canada Health Act. The doctors there are also working in both systems--private and public so hmmm...dual practice? Conflict of interest? Don't like how slowly things are going at the hospital, well...why don't you come over to the clinic...for a few dollars, we can get you out a lot faster!

So this is that latest in healthcare from our Federal Government. They'll sit and watch this sort of behaviour go on, keep an eye on it and yet they won't actually invest in fixing the problems.

I don't want to be all "Chicken Little" but you know what they say: "Give them an inch..." If one or a few of these start popping up it will turn viral. Maybe the rich don't mind (you'd think they would!) but there are a lot of people that need publicly funded healthcare. We've got a great system. It works. It's just been neglected for way too long by a government that doesn't seem to care.

Finding A New Doctor

In some previous posts I have referred to my "ex-doctor" or my "ex-GP." In life I have also referred to him as "Ding Dong," "Dr. Asshole" and other unflattering terms. Why did I stay with this man for app. six years?

Well, I have "white coat syndrome" for one. I have a strange fear of the Doctor as Authority Figure. I just gave it that name as I don't believe it's really a classified "Capital-S Syndrome." Also, I always likened us to an old married couple. We would argue over my treatment and it was kind of funny. Or not. I mean, it actually bordered on a co-dependent relationship, looking back. But I got away with a lot because I was smart (he bestowed three Ph.D.s on me in our time together) so I could usually get what I wanted out of him.

But he would do a lot of other, what I feel, unprofessional things. He would huff and puff and complain about how busy he was and tell me of his troubles. Um, excuse me, but is this not my appointment for my troubles? Good thing I'm not in the U.S. and I wasn't paying for this! And he would pull this, kind of, passive-aggressive bullshit where he'd get all uppity about something and then say things like, "Oh, you didn't think I'd do that (for you) did you?" or "Oh, you don't think I care, do you?"

I would have to fight a lot to get things done. Like referrals. Sometimes I'd "win," sometimes, I'd lose. This was not about me being a demanding patient. Remember, this was the same man who did not believe I was having seizures. Upon finally seeing a neurologist, the neuro said to me my brain was "screaming" for an EEG and MRI. He wanted to know why on earth I'd never had them done before. I didn't answer.

No, this was because this GP wanted to treat everything himself and things he couldn't treat simply did not exist. Or they were "stress." And because I was too afraid to leave, I just sat there and took it.

Well, over the last few months, it became unbearable that by appointment times, I was either so anxious I could barely stand it and would burst into tears or feel like I was going to ex/implode or I was so angry I wanted to punch him. And I'm pretty passive and non-violent!

Time to find a new doctor?

So off I went. And I wanted a woman haha! I'd only ever seen men and they'd all proven to be trouble. Sorry all you male GPs out there, I don't like to make blanket statements but I've just had no luck with you! I'm sure women physicians can be jerks too but I thought that maybe, just maybe, I'd have better luck with another gal.

Everyone out there, I recommend you interview your prospective GPs! I'd never done it before and boy, did I feel like an ass (I was SO nervous!) but it really makes a difference. These people are responsible for your health! Here is a list of questions that I came up with. Maybe you can think of others that would apply to your situation. I kept these pretty broad:

1. How long have you been in practice?

2. How do you see the role of the patient in your practice?

3. Do you value a collaborative relationship with your patients (eg. valuing my opinions, open to hearing about research/treatments I am interested in?)

4. How would you feel if I brought medical research/information obtained from the internet to an appointment for discussion?

5. What made you want to become a GP?

6. What do you think the role of a GP is?

7. Do you have any personal philosophies concerning treatment?

8. How do you keep abreast of the latest in medical research/trends?

9. What are your feelings about antibiotics? Do you have any other feelings regarding the prescription of any other medications?

10. How would you feel if I did not wish to take a certain medication prescribed?

11. Do you have a specialty?

12. What is your affiliated hospital?

13. Can you refer patients to other practitioners outside of your affiliated hospital?

14. What is your policy/are your feelings about giving referrals?

15. What is your availability, appointment wait times and what is your current patient load?

16. How long do you usually spend with a patient?

17. What is your policy with telephone calls, urgent issues/questions if they arise (i.e. will you speak to me over the telephone, call me back if I leave a message or by appt. only?)

18. Who handles your practice during vacations, leaves of absences etc…?

19. What are your office hours? Is this your only location?

20. How do you handle after hours needs?

21. If lab work needs to be done, where are the tests conducted? How quickly are results usually obtained and how will I be notified?

How did I make out? Well, after almost giving myself an aneurysm (hehe, I know you can't really "do" that to yourself but it sounds fun to say) I finally found someone who I think is good. She seems certainly proficient although a bit distant but we're just getting to know each other. (I talk way too much and I've even prepared long "notes" in Excel/Word for our appointments so maybe she hates me already!) I already have a therapist--it's not like I need her to be my shoulder to cry on. But some level of "humanity" would be good. I don't want to feel like I'm talking to a robot.

Anyway, she's setting up the referrals that I need and we're taking things from there.

Bye bye Dr. Ding Dong Asshole!