Migraine
At the time I wrote my last 'Update' post, I was just starting another migraine after a four day period without one. That migraine lasted 4 days and was mild to moderate without any day having symptoms that would prevent me from working. I then had a five day period without a migraine. I then started the next migraine which has been ongoing for nine days now. The first six days of this migraine were the same mild to moderate without any work prohibitive symptoms.
It occurs to me that I'm not sure if I laid this out, so let me explain what I mean by work prohibitive symptoms. For my migraines I track Pain, light sensitivity, blurry vision, sound sensitivity, and brain fog. these are all on a 0-10 scale with 0 being no symptoms and 10 being the worst I could imagine it. The two main symptoms that I can't work with are the blurry vision and the brain fog, so if they get to 7, I claim that I can't work. The other symptoms suck, but I can work through a lot so they get capped at 8. The only problem with this scaling system is that I'm assessing migraines while I'm in an ideal situation. It's dark, quiet, cool, and low stress. Work is none of those things. But until I get to the point where there are only four or five non work days, I'll keep going with this system.
Okay, so I wrote all that to say that including the previous non migraine period, I went from October 17th to November 4th with no non work days. That's 19 days in a row. And that coincides with re-starting my Wellbutrin on the 17th and starting the Paxil on the 8th. I'm not thinking it's JUST those medications but there might be a critical mass of different medications doing different things to bring the intensity of the migraines down. I haven't had this much optimism about my migraine treatment since I started Nurtec a few years ago (it was the first treatment/medication that ever eliminated an ongoing migraine).
I sent my neurologist an update (as well as updating him on the low dose naltrexone), but he's out of the office until November 11th.
I also contacted the 'new' neurologist's office to see if they were going to set me up with an appointment. They claim they never received a referral from my neurologist and needed one. So, I added the re-request for a referral to my neurologist's note and they faxed it over. That was last Friday and I still haven't heard back so I'll be calling them today.
Now, I mentioned that my streak of being able to work ended on November 4th. On the 5th I was fine on most symptoms, but the pain was really bad. An 8 out of 10. As both the light and sound sensitivity were low, I probably would have tried to work through that. The big change came on the 6th when I had dental work. I'll talk about the dental work itself below in 'other health' but I'll add here that it took a minor migraine that morning into probably the most severe migraine I've had this year. When I left the dentist's office I was at a pain of 9, light sensitivity of 9, with all other symptoms at 8. It was B A D Bad. That extended into yesterday which was exasperated with a trip to my therapist and my first trip to my psych nurse practitioner (more on both of those below).
It's still early in the day, but the migraine is certainly here. Pain and light sensitivity are both present, although the brain fog seems to have evaporated. We'll see how it is later in the day.
Depression/Therapy
It occurs to me that working through my depression, both with medication and therapy, is going to be ongoing and should probably be addressed in its own section of the update posts. At least until I have it better under control.
The short recap is that the continued migraines and the fact that I've had to retreat from almost all aspects of my life really built up about three months ago and started leading me to think more and more about suicide. I wasn't suicidal, but I couldn't stop myself from thinking about how to end this life and how it would be better for myself. So I sought help. The first treatment I had on the books was with my neurologist, so I told him about it. He suggested therapy. I started therapy with a psychologist. In my first visit with my psychologist, he recommended I start an SSRI anti depressant. I continued therapy every other week and saw my general practitioner about the prescription. He immediately got me a referral to behavioral health, as well as starting me on Paxil. As I was already on Wellbutrin, he tapered me off of that. I followed up a couple weeks later with no improvement and he added extended release Wellbutrin back into the medical therapy. As my appointment with behavioral health was in a few weeks, he said they'd be better equipped to manage that side of the treatment and of course said I could see him again if need be.
That's where I left off on the last update. I've had an improvement with the depression and a noticeable sexual side effect.
I'll say this about the actual therapy with my psychologist... I'm not sure what I'm supposed to get out of it. Even though I have a lot of experience helping mental health patients as a nurse, I've never sat in on therapy sessions or discussed them with the therapists. What my psychologist seems to be focusing on is my migraines. I'm not exactly unhappy about that as I'll take any advice about reducing the migraines, especially since the migraines are the main cause of my depression, but I'm not seeing him FOR the migraines.
For example, we worked on a relaxation technique. In short I sit back with my hands on my knees (I generally sit with my hands clasped in my lap). I focus on a sphere in my head, neck, shoulders, elbows, wrists, upper back, lower back, hips, knees, and ankles. I then focus on a relaxing color pouring into the top of my head and washing away any stress. When the stress is washed away I let the relaxing color fill me up. It takes about five minutes. For me there are three color sets. The 'stress' is bright and fiery red and orange. The 'relaxed' color is dark blue and purple. And then there is the migraine pain around the left side of my head and down to my left shoulder and neck. That's bright lightning white. I can 'wash away' all the red and orange and replace it with the blue and purple. The blue and purple though has no effect on the white of the migraine pain. It relaxes me.
On the next visit he suggested I try that multiple times a day, regardless if I'm feeling stressed or that a migraine is coming on or not. I did so. If I'm feeling normal, migraine or no, there is no red or orange. But I still feel more relaxed when I'm filled up with the blue and purple. And that also coincides with the time of my reduced migraine intensity... so maybe it's working?
This last therapy session was bad. We didn't make any progress. I explained how I was feeling on the Paxil/Wellbutrin which is far better than I was. Before, when I was seeking help, I was low. I was bad. I was in the wrong head space. If I put my 'mood' on a 0-10 scale, where 0 is absolutely bottom/suicidal and 10 is as happy as I can imagine, I was hovering around a 2 or 3 all the time with dips to a 1. After the Paxil and Wellbutrin I'd categorize my general mood as a 6 with daily dips down to 1. Not great, but way better than I was. But we discussed what was keeping me thinking negatively and when I looked at it straight on without trying to avoid the thoughts, I had to admit just how bad the migraines were affecting me. They've pulled me from work, from being able to help others, from my social life with my friends and family, from enjoying reading and games and watching TV and movies. They've pulled me away from being myself. And I can't stand that. I can't face that. I can't live like that. It sent my mood immediately down to a 1 and I broke down. It might be the first time I broke down like that in front of another person.
I hate to say it, but I can't remember what he said to try for the next couple weeks. I had a bad migraine at that point and most of the session is just lost.
Later that day, yesterday, I went to my first behavioral health appointment. It's kind of weird to talk about this linguistically because I'm not seeing a psychiatrist. But make no mistake, this is a psychiatric appointment. What's the difference between psychology and psychiatry? Medication. My psychologist is therapy. We talk. We work on relaxation and other techniques to reduce my stress my anxiety and my depression. I see him often. My psychiatric appointments are about my medical treatment of these same issues. We talk about meds, side effects, and overall treatment goals. I see them less often. And while it would be easier to say 'my psychiatrist' as you'd know exactly what I'm talking about, I'm not seeing a psychiatrist. I'm seeing a behavioral health nurse practitioner. I have absolutely no problem seeing a nurse practitioner for this as she's just as qualified as a psychiatrist. She works with a psychiatrist. My mental health condition, major depression, is about as cookie cutter and easy as it comes for mental health professionals. No manic depressive, no bi polar, no personality disorders, no schizophrenia, no hallucinations. This is mostly going to be about getting the right medication or combination of medications that pulls me up and out of the depression while limiting their side effects.
So, I met my NP. I have to start by saying that she's young. My current medical treatment team, my general practitioner, my endocrinologist, my neurologist, and my psychologist, are all near my age or much older than me. They're in their 50s, 60s, or 70s. My NP is either in her 20s or 30s. She's cute and has sleeve tattoos. Again, I have no problem with her being young. To get that position she had to go to school, graduate, take multiple tests (including the same NCLEX that I did), get her license, and has to maintain it. She had to get hired and has to have a psychiatrist over see her work. She's easily qualified. But this is the first time in my life that I've been treated by someone in this position that's been so much younger than me. Nurses and physical therapists? Sure, I've had them be much younger than me. A nurse practitioner, physicians assistant, or physician? Nope.
Anyway, this was our first meeting and it started about how I expected it too. It was a direct assessment of my mental health. It did not assume that I was depressed and depressed only, so it had a lot of questions about other mental health issues including mania, psychosis, and hallucinations. It dealt with alcohol and drug abuse. It dealt with family and sexual abuse. I probably would have found it annoying if I didn't know it was going to happen.
I could feel when she was satisfied with all that and we got down to the depression. Thankfully she was as happy as me that the Paxil/Wellbutrin was doing as well as it was, but she was equally unsatisfied and wanted more. There are a lot of ways to get more effectiveness. There's increasing the Paxil, increasing the Wellbutrin, and even adding another medication. Adding another medication is likely too early as we're nowhere near the upper doses of Paxil and/or Wellbutrin. Adding another medication would just increase the chances of side effects. I'd imagine, from a prescriber's point of view, the best option is to increase the Paxil as it's the newer medication for me.
That's where I had to talk about side effects. And that's where it became more than a little awkward talking to not only a woman, but a young woman. I had to tell her about my sexual side effects. I mean, it sounds so simple. I'm just mentioning side effects to a medical professional. But this is the first time I've met her and these are very personal emotional side effects. In short, I still get mentally aroused but not as much as I used to. When I do get aroused, it's difficult to get an erection. When I do get erect it's difficult, almost impossible, to maintain the erection and have an orgasm.
It makes it even more awkward when talking to a young woman about this as I have to be honest and admit that I don't have sexual partners. That I haven't had sexual partners in a long while. And even saying it in that way, as she surely noticed I'm speaking as much as a nurse as I am a patient, I'm indicating that I'm not entirely or exclusively attracted to female partners. Otherwise I'd say women instead of sexual partners. So, I'm telling a 29 year old, attractive woman, that I'm a 50 year old queer that is having trouble masturbating. Yeah, its more than a little embarrassing. But I did tell her as it is a side effect that I'm concerned about. I also told her that if that was a trade off I had to make, sexual dysfunction for emotional health, I'd take it. I don't want to screw up and get that low again just so I can jack off.
She acknowledged what I said and suggested we increase the extended release Wellbutrin to 300mg daily. That should increase my emotional wellbeing as well as possibly reduce the sexual dysfunction. As it's a higher dose of Wellbutrin than I've been on before, I had to ask about side effects (it's been almost ten years since I looked into the side effects of Wellbutrin!). There are several that I don't care about, but the biggie is possible tremors and possible problems sleeping. My sleep is already all over the place, so that could be a problem.
While I was working I was obviously on 'second shift'. I worked from roughly 2 PM to 10 PM. That meant it was difficult to find time in my work day to take my meds. I took my lunch break between 5 and 7 each day, so I based my medication time around that. 11 AM, 5 PM, 11 PM. When I stopped working, I just kept the same schedule as I didn't see any reason to change it. Well, now I have a reason as my NP suggests taking the Wellbutrin earlier than 11 AM. I've now moved my medication times to 9 AM, 3 PM, and 9 PM.
What really surprised me about my visit with the NP was she went above and beyond the medication. She had two recommendations that I'm taking. First, I told her how I tended to focus on or even obsessively worry. It was honestly just an offhand comment to help her realize why I agreed to take the Paxil in the first place (it helps with obsessive thinking). But she caught onto it and suggested that pushing away worrying thoughts all the time isn't emotionally healthy. Instead, I should take a time each day to specifically allow myself to worry. Just ten or thirty minutes to worry. Then after that, let the worrying just wash away and build up for the next day's scheduled worrying instead of trying to shut it down all the time. I've now booked 12:30 PM, just after lunch, as my 'Worry Time'. I plan to sit at the computer, open up a journal (probably MS Word) and worry.
The other recommendation was an app to help with emotional stability. There are dozens, hundreds, thousands, tens of thousands of apps that say they can help with stuff like this, so I've never paid attention to them. All it takes is some guy who thinks he knows what he's doing to write up an app and it gets uploaded. It doesn't mean its effective or even non-counter productive. But with her recommendation, I've installed Shmoody. I'm still working through it's introductory process which seems like it will take about a week. Not to be suspicious or anything, but it's a paid app that has a one week free trial. In other words, I get introduced to it for free but don't get full use until the trial is up and I have to pay for it. I'd probably toss it aside if my NP hadn't only suggested it but mentioned that she used it herself. Plus it's only $40 for a year. So far it daily tracks my mood, make me write down why I'm feeling that way, and has a pretty extensive AI system to help you track goals and work on emotional health. I like it so far. My only problem is that it has a silly name and it's AI system is a cutesy animated cat. I'd imagine they chose that way to go as its open and warm as opposed to something cold and calculating. I just think the 'cold' also feels 'professional'. But they need to open their net to the widest audience, so be it.
My next appointment with the NP is new year's eve. She actually scheduled it herself and said specifically that there wasn't an earlier appointment. I have to admit I'd rather see her sooner so we can assess the new dose of Wellbutrin earlier, but I know that psychiatric medical providers are rare and overworked, so I can't complain too loudly. She did say that she'd respond to messages sent through the health system's charting, so I can always send her a message or call her office if I'm feeling side effects, or to report less than effective results. Otherwise I'll see her in just under two months.
Other Health
Everything is going fine health wise. I see my doctor next Monday for my wellness visit, my endocrinologist in five weeks for our follow up visit, and my neurologist in April. I should also set up an optometry visit as it's been just about a year... but honestly, it's such a pain to get an eye exam when I have a migraine that I think I'll wait until they contact me.
For my doctor's visit on Monday I have several things on my mind. I know he's going to order some lab work so I can go in fasting and get it done at the same time. I can also get my endocrinologist's lab work at the same time for his upcoming visit. Another thing is wondering about a low dose chest CT. It's become standard practice to have these done for smokers as it's the only way to catch lung cancer early. I asked about it last year, but he said it wasn't recommended until I was 50. Whelp, I'm 50 now. The only other 'maintenance' issues would be immunizations. I know my TD immunization has expired and I wonder if I need to be immunized for shingles. My brother R just got that at his last checkup and I know it's age related, I just don't know what age it's supposed to be given at. R, for reference, was 52 when they started it (it's a two shot system).
Outside of maintenance issues, there's the 'new' issue. I'm still not sure if I want to mention this and it's something that frankly I haven't mentioned here. I've been having trouble urinating for quite some time. Several years. For a long time now, I have dribbles. I 'stop' urinating but have to 'shake it off' for what feels like an extended period. If I don't and only shake it a few times and tuck it back in, I can actually get dribbles down my pants that I can feel. It's not bad when I'm wearing jeans, but I wear scrubs or slacks at work and it actually shows up as a spot in my crotch and even dots down my leg. I figured since there were no other symptoms, and trust me I was really focused on this for awhile when it started, that it was just benign prostate hypertrophy (BPH). Basically my prostate has grown bigger but it's 'benign' or not problematic. They could prescribe some flow max and it would likely take care of it. But that's another medication, more side effects, and for the past few years I'd just rather deal with it than deal with the solution.
But now it's getting worse. I feel that I can't empty my bladder. I feel that I can't maintain a steady stream. It's harder to start urinating. These are all signs of prostate growth. There can be other things, but that would be first on my mind as it can either be BPH... or prostate cancer. What really disturbs me is the way the tests go. First is a prostate exam. I'm sure you know what that is. Bending over the table and having my doctor stick his finger up my butt. Not pleasant for him, me, or anybody. When he does that, I suspect he'll feel an enlarged prostate. The problem is that unless he feels something truly bad (rough gravel like texture to it) it could equally be BPH or prostate cancer. That means further testing. That's a PSA blood test and probable referral to a urologist. A urologist is going to want his own prostate exam (bend over another table, another finger up the butt), and then possibly a prostate biopsy. That's them putting a needle into the prostate and pulling some cells out to look at under a microscope. And that needle either goes in through the rectum (I guess it's better than a finger) or through the skin between the scrotum and the anus. NOT pleasant.
So the question comes to this. How concerned am I about this. I'm at the age where I'll likely need a prostate exam anyway. If he find some growth he might order a PSA and if it shows nothing, I just get some flow max added to my pills and get better urination. Or it could lead down to treating prostate cancer. Prostate cancer is very treatable if found early, but some of the treatments are quite terrible including surgery (I'll let you imagine what type of surgery they do on a prostate and how they 'get in' for the surgery).
I think I'll mention it, but I'm not sure yet.
I went in for my twice annual dental cleaning a couple weeks back. Before I went in I thought about it and figured I'd have to talk to them about future work. In February or March I'm going to lose my COBRA insurance. Right now I pay about $40 a month for dental insurance. That's over paying if I'm just getting the cleanings, but if I have ANY dental work done, it's so worth it. A $1,000 procedure becomes a $50 out of pocket procedure with insurance. And right now my dentist has laid out work on all four quadrants of my mouth including two crowns. I've been pushing off on getting any of that done because getting dental work done with a migraine borders on torture.
Even my dental cleanings, while I'm experiencing a migraine, is bad. Laying back and keeping my neck in that position hurts more when I have a migraine. The sound of the drill hurts. The bright lights that have to be focused on my face hurts. The vibration of the drill that goes through my whole head hurts. That's all in addition to the actual pain caused by the cleaning and/or dental work. I had a filling done awhile back while I had a migraine and vowed it would be the last dental work I had until my migraines were better under control. My dentist was good and understood and each time I see him now for the cleanings, I ask the same thing.... does anything NEED to get done. He knows what I'm asking and answers honestly. So far, it's always been no, nothing NEEDS to get done.
But now, with the knowledge that I'm likely to lose all dental insurance.... well, I'm fucked. Those two crowns could easily get bad enough that they also require root canals. The crowns themselves are around $1,500. Each. The other dental work could easily also end up being around $3,000 (in total). So, I either get this stuff done between now and February, paying several hundred dollars for it all, or skip it, pray that it doesn't get worse and 'only' pay $6,000 for all of it.
I talked it over with the dentist and we decided that one of the crowns was the most important piece of work to be done. I had a tooth removed years ago because of an infection and it's left a whole in my teeth ever since. That was exasperated when I had my wisdom teeth done as it left a single molar on my lower left side all alone. It's solid and still works to chew, but if anything happens to that tooth, I'm screwed. It's the one that needs the crown, so we schedule that.
I knew as soon as I walked in that it was going to be bad. Even though it was at 9 AM, I already had a moderate migraine. I was in that chair for over 90 minutes. Every single symptom of the migraine was at an 8 or 9 with the pain being the worst I've ever experienced. I mean, it was so bad that I'm going to have to re-evaluate my 0-10 scale. I put it as a 9, since I wasn't screaming incoherently (something that I believe is required for a 10 on a pain scale), but it means all previous 9s are now 8s. The migraine remained bad that day, was bad the following day, and is extending into today. In addition to the migraine, there's straight up jaw/dental pain. My gums are swollen and sensitive with the temporary crown in place.
I have an appointment in three weeks to get the permanent crown on. Knowing that I have a LOT of dental work coming up, we agreed to do more at that appointment since I'd already be numbed up. Once the permanent crown is one he'll also take care of a filling I have on my lower left side. That should tidy up that quadrant of my mouth. Assuming I still have some dental insurance available, I'll then schedule another quadrant. If I don't have any dental insurance, I then have to wait until January.
It sucks as I just have to assume that I'm going to go in to get my dental work done and leave with a severe, almost unbearable migraine.
Finances
Nothing new here.
Family/Friends
Nothing new here.
Entertainment
I finished with my scary movie month and overall enjoyed it. I think next year I might take my brother's suggestion and add some of the Netflix scary series to the list like The Haunting of Hill House.
After I was done with the scary movies, I moved on but didn't get back into Billions. R had purchased the 80s Clint Eastwood Movie 'Heartbreak Ridge' while I was in my marathon, so I watched that and enjoyed it. It's not great or anything, but it's a good watch. After that I was in the mood for another military movie and instead of rewatching something like Band of Brothers or Saving Private Ryan, I'd go for something I haven't seen. That made me think of Hacksaw Ridge.
I stayed away from Hacksaw Ridge initially because I didn't like Andrew Garfield and doubted he could do a good job in a serious role. Even after it came out and both he and the movie got rave reviews, I still avoided it. Well, after watching it I have to join the choir and sing it's praise. It's truly a great movie and he nails the role. And knowing that it's not some WWII fantasy and is actually based on a true story... it blows your mind away.
I'm still having trouble getting back to Billions, but it's mainly because I added Top Gear. Surprisingly it makes good watching while I have a migraine. As I have several seasons left and can follow that up with The Grand Tour on Amazon, I think I'll finish this before returning to Billions.
New Tech
I've been a good boy and have avoided any new purchases. I have to say though that my phone's battery seems to be getting shorter and shorter. It's still lasting a full day, but I don't use it all that much. If I take a trip and it ends up not lasing... I might have to replace it sooner rather than later.
Writing
I actually got a chapter of Gamer Gurl out earlier this week. It was right before the migraine ramped up, but I think I was primarily able to get back into writing because of the depression being better managed.
I don't think I'll be able to write more today and tomorrow is football day, but I'm hopeful that I'll be able to write more on Sunday and/or Monday.
An odd aside... I reorganized my porn videos. Not really reorganized but collected the videos that I most often want to see for one reason or another and put them all into a single folder with more easily descriptive titles. It reminded me that I really liked Kaisa Nord and have her in several favorites. And she's the intended model of my secretary story, so watching those videos makes me imagine that specific character which makes me want to write that story. I might transition to that after I finish this part of Gamer Girl.
Michigan Football
Well, Michigan beat up little brother again. Winning over Michigan State always feels good. The victory was marred a bit by some extracurricular activities (fighting) at the end of the game, but it's not as bad as it has been in the past and no one was injured.
We played Oregon and... well, Oregon is elite and Michigan is only marginally good so it went about how you'd expect. Tomorrow is Indiana and no matter how unusual it is to think it or how weird it is to say it, Indiana is going to eat Michigan's lunch money. I'll watch it and root for big blue all game, but I can't even imagine a scenario where Michigan wins.
After that there's a bye week, and then Northwestern. The good thing is that Northwestern is still looking awful beatable and so long as Michigan wins there, they're going to one bowl or another. I honestly don't care about going to some minor bowl, but the extra practices are always worth it.
I almost feel like I should mention that Michigan is doing well on recruiting. They got a great offensive lineman for next year's class and are close to snagging the number one recruit away from his earlier commitment to LSU. But I don't follow recruiting close enough to talk intelligently about it. All I can say is that it makes me happy that Michigan is getting these five stars as they normally didn't.
Layla Review
Another new thing I thought of while driving around in Layla. I'm not sure if this is an actual problem, or just my disappointment sneaking into my everyday experiences with her... but Layla seems quite stupid. She obviously has temperature sensors as she displays the outside temperature and has to have one inside to have the automatic climate control work. The problem is they've both been ridiculously wrong. As in I got into the car when it was clearly chilly out (like in the lower 40s) and the outside temp display shows 67. At the same time it's chilly inside, but the automatic climate control turns on the AC and is blowing cold air.
I'm hoping that's just a problem with this 'in-between' season since I want the temp in the car right around 68 or 69. A very real problem though is the battery. Layla's battery is not long for this world.
With older cars there wasn't much going on once you turned the car off. The battery would shut down and if anything drained it, it was barely a trickle. Newer cars though have far more draining things on the battery when shut off. For example, Isabella, Nina, Tiffany, and Layla all have internal modems and keep a connection to the internet. That's because I can log into the Ford app (or Lincoln App for Tiffany) and find the car, see her odometer, remote start her, unlock the doors, see how much gas is in her, and other things. Maintaining that connection isn't a trickle on the battery, it's a solid sip. It's not a problem at all if you drive it regularly as it easily charges it back up. But I drive Layla once or twice a week. That's not enough to keep up. So now, when I turn her off, the radio immediately shuts down where it would normally stay on for up to 30 minutes. I can turn it on without starting it (putting it in accessory mode) but even then it will only last like 5 minutes instead of 30 before it wants to shut down. And then once I park her and turn her off, I'll get a message in the Ford app about 10 minutes later that remote functions have been turned off to save the battery. No remote start, no checking the gas, nothing.
I don't know if it's weeks or months or years, but I know I'm going to have to replace the battery sooner rather than later.
Ongoing Computer Issues
The God Damned slideshow issue fixed itself again. What the fuck Microsoft!?
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