Tuesday, June 13, 2017

The "Minor" Medication Change that ALMOST Ruined my Goal

(Note: this is a post I wrote for The Mighty, but since their turn around time is 3 weeks I thought y'all deserved the story a lil bit faster.)

In early September of 2016, a friend playfully challenged me to join her for a race on June 11, 2017. She was planning on doing the half marathon (13.1 miles) and assumed I’d be doing the associated 5K (3.1 miles). I had done several 5Ks in the past, and I playfully asked what made her think I too couldn’t do the half marathon. True, I had never done one before, but that’s just a minor detail. A decision was made rather quickly and I paid for registration for the half marathon on September 8, 2016. I started pre-planning to walk/run the race immediately with a goal of just finishing. The plan was to start pre-training in January, then follow a 12-week plan that would start March 20, 2017.

My pre-training didn’t happen due to increased depression through the winter months. When March 20th came around I forced myself to start training, knowing I’d eventually regret it if I didn’t. I did my workouts 3 to 4 days a week out of a 5 day a week training schedule, which my more experienced friends told me was completely fine as long as I didn’t skip my longer distances. I stuck to the plan pretty well for the first eight and a half weeks.

On Thursday of week 9 I saw a new psychiatrist and started a new stimulant (as an adjunct to my antidepressant medication therapy) the next day. The following day (Saturday) I “accidentally” did a half marathon…during a thunderstorm, nonetheless. One might ask how one “accidentally” does a half marathon. Here’s how: I planned to go out for my scheduled 11 mile “long” training walk, the temperature felt good despite/because of rain on the horizon, I brought a rain poncho, I felt good, I kept going until I reached 13.11 miles according to my GPS watch in part because I was able to tune into my audiobook and just keep moving.

The next day (Sunday; day 3 on the new medication) was a MAJOR fundraising event for the non-profit organization I volunteer/work for and for which I was on the organizational committee. There was a ton of work leading up to the event and on the day of the event, but a big part of my job was sending out thank you letters as soon as possible after donations were made. I would only go into the office for a few hours at a time and get a bunch done because I was so intensely focused on the task at hand. I realized that I wasn’t doing my workouts while I was doing this fundraiser “wrap-up” and other social activities that happened to fall into this time frame, but I planned to get back on track as soon as possible.

My breaking point came when, on the 12th day of taking this medication, I started my day at 7am and had a schedule to do “work-related” stuff from 7am to 9pm almost straight through. I only ate half of my breakfast that day because I had no appetite before giving a presentation at 10am, no appetite after, and so much focus on my work after that I just forgot. I had cancelled one thing scheduled from 4pm to 6pm so I could do my workout during that time slot, but when I realized at 4:30 that all I’d had to eat all day up to that point was hash browns at 9am, I decided food was probably a safer idea than a workout. There would be not have been problem with stopping what I was doing at work, getting something to eat, and returning to my work. My boss strongly encourages taking care of myself and I’m not getting paid so it’s not like it would take money away from me or paid time away from my work. I was just so focused on what I was doing that I couldn’t force myself to take a break even to go to the restroom until it was almost too late or get a drink from our mini-fridge on the other side of the room until I was painfully thirsty. I could be either intensely focused or intensely distracted. No in between. Also during the 12 days I was on this medication, I spent almost $1,000 ($957.18 to be exact) on top of paying almost $700 ($698.43) on my “usual” bills, including my credit card which has been maxed out for 2 months. My impulse control was next to non-existent. This might also be a good time to disclose I’m on disability and am on a fixed income of just over $1,000 per month. I had a little extra money from a fender bender which I planned on using to get my car fixed and money in a savings account from my tax return. I pulled some over into my checking account when I realized I would have about $25 in my checking account after my remaining bills alone by the next time I got paid...in 22 days. The worst part: I had worked out 3 times in the 12 days I was on this medication and my half marathon was less than 2 weeks away from the last day I took it.

When I realized all of this it was all at once. It came crashing down on me like a ton of bricks. The realization that the catalyst was this new medication hit me even harder. I called my new psychiatrist the morning after connecting the dots (or rather the dots were connected for me by my boss). I stopped taking the medication immediately and started my old stimulant back up two days after stopping the new one. But I fell into a deep depression. Once I realized how much destruction I caused in my life in so short of a time, I just wanted to cry and sleep all the time. How was I going to get that money back? How was the lack of workouts going to affect my half marathon? Would I even be able to finish it? I couldn’t not try simply because of the time and money I had already invested into it, but failure was also not an option. I had no energy to get back into my workouts. My boss encouraged me take some time off to get myself back into a healthier place mentally and physically, but that had a significant negative impact on the office at a time where the boss herself was having a family issue and couldn’t be there.

I did get back to my workouts. Not as much as I would like to have, but I also could be at risk for overdoing it in the 11 days between stopping the new medication and my half marathon. I worked out 5 times in those 11 days.

This story does come with a happy ending. With the help of my three running groups, my closer running buddies, and my boss, who is also a mentor and friend, I finished my half marathon with a time of 3:59:31.60. Remember that the only goal was to finish before they closed the course after four and a half hours. I started out strong, but since the temperature got up to the mid-80s and it was very sunny with little shade on the course, I got so hot I felt like I couldn’t physically continue. The only things driving me were my friend who was meeting me at set points to refill my drink or help me cool off and my friends at the finish line waiting for me. My boss/mentor/friend sent me a text message saying she was waiting for me. I told her where I was when I was about a mile out, and her response was to remind me of sea turtles. Every move a sea turtle makes, though slow, has purpose and ultimately a lot of power, which is why she uses them to remind her of recovery and life in general. As far as the money goes, I was blessed by an angel of a friend who helped me with some money. Enough that I don’t have to worry about my checking account going into the red before my next pay day and was able to replace the money I took out of savings.

There is a rule in running: nothing new the day of a race. It can be extended into nothing new too close to the day of a race. I now know to take it out even further for myself: no new medications while seriously training for a race.

Due to my ongoing financial situation, I only registered for two races this year: my June half marathon and another in September, with goals of just finishing the June one, then finishing the September one a little quicker. I am scheduled to do my next - second official - half marathon on September 30, 2017. Here’s hoping for better temperatures and better mental health!

(Photo courtesy of Tina A. with backdrop by 131 Event Productions)


Saturday, January 14, 2017

Long Time No Write

I want to start by apologizing for having not written in a very long time. I have been going through a lot of pain and therapy and therapy and therapy.

On August 2, 2016, I was officially diagnosed with tardive dyskinesia, also known as TD. (I give you this link with 2 disclaimers: first, it's Wikipedia, so take everything with a grain of salt; second, my neurologist assured me that even though my symptoms aren't in my face primarily, it is completely normal for a person of my age with TD to have all of the symptoms but not facial involvement.)  Since then I have been doing occupational therapy (ortho and neuro), art therapy, and the individual and group therapies I had previously been doing. I have been evaluated for neurological physical therapy, and though it was found that a weighted vest can help with some of my balance issues, my insurance won't approve me having physical therapy treatment or the vest because I know how to compensate enough to perform the standard tests (namely BERG) flawlessly and never actually fall because I'm a pro at compensatory strategies. The physical therapist did find deficits, and I told her that performing a dynamic gait index would be the ideal way to prove my balance issues, but insurances don't consider that an acceptable test.  I've been trying different medications to make the spasms and pain easier to cope with. Unfortunately while the medications do make it easier to cope with, they don't make it a whole lot easier. And as far as long-term outlook, my neurologist is hopeful and optimistic that I will recover with how young I am. The question of the day, every day, is "when?"

I promised you symptom presentation, but my symptoms change on a regular basis and are complicated at times. The easiest way to explain everything is that my left hand doesn't do exactly what I tell it to do, especially when I tell it to do it. Writing is the most painful and difficult thing for me. Typing is next. With both of those and other than that just using my left hand causes my entire left arm to tighten up. I've developed left shoulder pain from the tightening. My left hand occasionally tremors, too. And did I mention that I'm left-handed? I also have spasms in my right hip, back, and quads. My right hand works pretty well for the most part, but I did develop de Quervain's tendinitis because I had to use my right hand so much all of a sudden. That has gotten better, and my carpal tunnel in both hands has almost entirely resolved. Without surgery, TYVM. I fidget a whole lot. I have to constantly be doing something with my right hand. I even have something I hold on to and fidget with to fall asleep. It was made for infants, but it does the trick.

I have been seeing a pulmonologist and was diagnosed with exercise-induced asthma, which I have probably had all of my life. Unfortunately everything she's done to treat me has not done anything. I actually see a sports medicine doctor on Monday to see if we can stop throwing grenades at something that could probably be hit with a BB gun. I also plan on asking him about my chronic shin pain and recurring toenail bed trauma.

I am currently volunteering for two different nonprofit organizations. I see vocational rehab on Wednesday to see if we can work out getting a paying job where I can do pretty much what I've been doing volunteering. I do a lot of data entry, and I basically get as much done as I can, then based on that decide what I can do next. Some days it means I have to take the next day off. But I frequently do a lot more than is expected, so I'm likely overdoing it. My hope is to find some sort of job I can do from home or from an office, on my own schedule, and get paid for the work that I do instead of the hours that I work. One of my biggest fears is interviewing because due to the TD my body language doesn't reflect my thoughts. I also get really anxious and can't answer questions as intelligently as I would if I felt I had time to think through my answer and my wording. As you can see, I do well if I can type something out, read through it to check the phrasing, rephrase, edit, and send when I'm ready. I don't do nearly as well in person.

As far as running goes, I am signed up for my first 2 half marathons this year. I'm doing the SHE Power Half on June 11, and the Indy Women's Half on September 30. I am still scared out of my mind about these (fear of failure), but I'm doing them anyway. I have been accepted into a group called Achilles International. There are a lot of groups that focus on having runners run on behalf of people with disabilities, like IR4. I run for myself, to prove to people that there are people with disabilities that CAN run and DO, and also to hopefully teach people about TD and mental illness. Achilles International inspires people with disabilities to be active, regardless of how you move. You can run, walk, or push a wheelchair, you just have to cross the finish line.

I'm not sure what else has happened since the last time I blogged because so much has happened and my memory is really not good. It's not that I lose time, like with dissociation, it's that time seems irrelevant. So I could've done something yesterday and thought I did it today, I could've done something six months ago and thought I did yesterday. It's really frustrating. But I think it's something I'm going to have to live with for a while. I tell my doctors about it, but tell them that I'm not really too concerned about it because it doesn't affect a whole lot in my life when I'm not working. When I start working that could be an issue though. My calendar on my phone is my lifeline. I'm forgetting names just as much as usual, though.

I'm going to try to blog more often this year now that I've gotten fairly good at typing with my right hand with my left hand occasionally helping, and I have speech to text software on my computer. I also can and always could do this on my phone, but I don't...because talking about TD is hard for me. I realized that the whole situation, being told that my movement issues were nothing for more than a year, then being told they were something but irrelevant, and now being in near constant pain and unable to do simple things like writing because of the movement issues really traumatized me. On top of that, as I was starting the acceptance process of the diagnosis, I realized that something else that happened over 3 years ago that I thought was irrelevant was actually traumatizing. So I've had a lot to process. But I persevere. My spirit animal for 2017 is the phoenix. I was really inspired by the character Fawkes in the Harry Potter series. He goes up in flames, then is reborn from his own ashes. His tears have healing properties. And he is incredibly strong. How is that not a great representation of my life right now??!!

Like the Phoenix I rise from the ashes of life 
I don't need fortune or fame Just some peace of mind
Like the Phoenix I fly leaving the lies behind
Future's golden for me 
There is no one who can stop me now
"Phoenix" by Stratovarius

This is the year of the phoenix
Let all legends come to life
Turn the silence into thunder
Believe in one more wonder
Out of the old let the new arise
Forged in fire stronger than demise
"Year Of The Phoenix" by Pyramaze 

You've got the heart of a phoenix
So let them see you rise
Let them know that you mean it
Let them see you rise
"Phoenix" by Olivia Holt

I'll be seeing you around!
Twitchy Tina

Wednesday, August 31, 2016

I hate runners...

This post is a response to a FB link to article from Women’s Running Magazine advertised as “4 Reasons Why People Hate On Runners”. You can read it (or just the bullet points if you want) here:

I'll be honest and say that as a "runner" I hate on runners I don’t know and who don't know me because all I see in groups online from them is "I should have gone faster," "I need to go further," and (my personal favorite) "I haven't run in 10 years and just went out and did a marathon in 3 hours!" (The last one is admittedly an exaggeration, but not a big one and by no means fabricated.) I put myself as a runner in quotes because I am technically a run/walker. I consider myself a runner because I do run, but despite my efforts from the last year and some change I cannot actually run for very long and require a long walking period to catch my breath afterward. I discussed it with my family doctor last October and she gave me an inhaler and said "if it doesn't improve I'll send you to a pulmonologist." I used it for a while, then had some medical issues that precluded running and took a break, then worked back into it and am now worse off than when I stopped last year, even after the same amount of training time with more frequent training and use of the inhaler.

On a good day last year I could do a 5k in about 45 minutes; this year my best has been just under 49 minutes. The 45-minute 5k is an almost 15 minute per mile pace and I was miserable most of those 45 minutes. For every 5 minute interval after the first 5 minutes, I was running 3 minutes at 5.1 miles per hour and walking 2 minutes at 3.5 miles per hour. I can't imagine going faster or running longer intervals. I can't imagine maintaining that pace for a longer distance, especially not 26.2 miles (which would take me over 6.5 hours at that pace). That 45 minute 5k was done on a treadmill at 1% incline; I can't imagine doing it on pavement with hills, even on a “flat” course, though I did come close (47 minutes) once in November last year.

True, I could push myself through the discomfort, but between the irrational anxiety of never catching my breath again or potentially passing out from shortness of breath and the pain in my legs, it just doesn't seem feasible or healthy. Most runners say "it gets better." When? I have a runner friend who is not much different than me in age, weight, or story who has spent years trying to finish a half marathon in under 3.7 hours and is hoping this will be the year. She adjusts her training plan based on the previous years’ shortcomings and her body’s needs because prefabricated training plans don’t take her present and known (from experience) abilities into consideration. Even beginner plans typically increase run time per interval by one to two minutes and decrease walk time, but she knows from experience that she cannot do that. She extended her training plan from the beginner’s typical 12 weeks to 16 weeks of serious training after several weeks of not-so-serious training to accommodate her physical needs and schedule conflicts. She looked up the course 3 months in advance. She knew it would be hilly, but now knows exactly what hills to prepare for and does as much hill work as she can in the park where the race is to be held. She is planning on going in as prepared as she can figure, and I hope the best for her this year. I plan to be waiting at the finish line to get a sweaty hug regardless of whether it takes her 3 hours or 10. Good luck LH!

True, I should only compare myself against myself and not other runners, but when you hear over and over again how easy it is for other people you get to wondering "what's wrong with me? What am I doing wrong? Am I the 'normal' one or are they?" (The answer to that last question lies in the fact that "normal" is an idea and a setting on the washing machine, not a reality in human physiology.) I have to take into consideration that I wasn’t able to run for time or distance as a child for the same reasons I can’t run for time or distance today: I feel like I can’t breathe when I run. I can’t count the number of times I went into the locker room in my two semesters of regular high school PE in tears because I couldn’t do the mandatory mile in one class period. I can’t count the number of PE teachers who were just short of yelling in my face, telling me I wasn’t trying hard enough because I couldn’t run one full turn around a quarter mile track. Because of this I was elated the first time I jogged one quarter mile in one go in my entire life, which was just last year. I can’t count the number of times I was treated like dirt by my athletic neighbor or his overzealous dad because I couldn’t keep up with him. I also have to take into consideration that I have a personality disorder that causes me not to know who I am independent of what other people say and so I strive to be what other people expect - or more frequently what I think they expect without them actually saying it. So when runners actually say that their 12-minute mile is slow with an implied “for them,” I hear that as my 15-minute mile that was torture is not good enough and my current average of a 17-minute mile is a waste of time.

True, that is my problem not theirs, but I argue that by expressing your negativity you’re making it someone else’s problem. Maybe not mine, but someone else’s. Here’s how: you run a half marathon and come in second place, but instead of celebrating being faster than 99% of entrants you say “I could have come in first if…” You are also training one of your children to run and hoping to make it a lifelong sport for them. Now imagine that they heard you say “I could have done better…” By a developing mind that already idolizes you that is heard as “second place is not good enough; I must always come in first.” But maybe their physiology is second place at best. They have short legs or fatigue easily because of chronic anemia or whatever. So from that day on they think they are not good enough for you because they just can’t get first place. There are two ways I see this going in the average child: they cheat to get first place or they give up even trying. There is also the possibility for this to morph into a mental illness, but that’s not the angle I’m going for right now. All of that could have been prevented if you just said “I did a great job” and started establishing a strategy for first place based on your shortcomings while staying to cheer for the back of the pack runners like me who know their chance of placing in top three are about as good as winning the lottery, thus showing your child that it doesn’t matter when you cross the finish line, just that you trained and toed the starting line. That’s more than the majority of the world even attempts to do. I would love to say that the beginning of that scenario was entirely fabricated, but unfortunately it was inspired by real life.

So yes, I hate runners (myself included sometimes). Not because they’re arrogant or self-centered. Not because they only talk about running. Not because they’re jerks to other people, but because they’re so mean to themselves individually and as a collective. When they outwardly say “I could have done better” they also say to someone “my barely trying is better than your best effort.” It’s OK to say that when you’re at Olympic level, but have you noticed that Olympians don’t? (I’m looking at you, Meb, you class act.) They say “here’s what worked for me, what got me this far” or “I struggled (not failed) because…I’ll fix it and do better next time.” Not “I could have done better.” You see the difference? It lies entirely in learning from your shortcomings and moving forward, not dwelling on how you could have changed the past.

[You can stop here if you don’t know me and just came for the rant. Or continue. Whatever.]

I do not think my time trying to get back to a 45-minute 5k this year is wasted or regret missing out on training for 6 months and losing the momentum. I see that as a goal I once attained that I’m struggling to get back to and I see the struggle as a lesson. Where I was in my life last year was completely different than where I am now. Yes, I spend more time exercising now than I did last year and not seeing the same or especially a proportionate amount of change causes a lot of frustration, but I have completely different health issues. This time last year my mental illness was a constant battle but physically I was healthier. Now my body is struggling but my coping mechanisms have improved. I have far from given up on my goals. I’ve just shifted them a little. When I had to stop running at the end of last year the goals were to maintain the 45-minute 5k, eventually do a 30-minute 5k, and greater distances are for chumps. Even earlier this year I said greater distances are for chumps! It was actually more like “greater distances will take me too long” after I realized last year that a half marathon would take me 3.5 hours at that hellish 15-minute mile pace. Then I accidentally walked 10k one day this year and productively occupied more than 2 hours I would have otherwise spent watching TV and eating. My only regret was the sunburn caused by poor planning. As of today I will tell you that my goals are to get back to that 45-minute 5k when my body is ready, to run/walk a 10k with consistent intervals (preferably 1:2) throughout sometime during the month of September, and to see a pulmonologist about why breathing while running is so hard for me. It could be entirely psychological, but I won’t know until I try and I’m not willing to try until someone tells me it’s not physical. I have not given up nor do I plan on giving up. I plan on just going with the flow. And that 30-minute 5k is not totally off the table. It’s just filed under a bunch of other things.

Now go for a run and be kind to yourself.

Gentle hugs,

Tina

p.s. If you do figure out how to go back in time and fix mistakes, HMU.

Wednesday, August 10, 2016

A little slightly off-topic RUNNING rant to prove I'm still alive...

I get why road runners call treadmills "dreadmills," but I like treadmills. Roads are nice for constantly changing scenery, but treadmills serve a great purpose for beginners like me. They help me with pacing and they're mostly flat. If I run on a treadmill I can run longer (time-wise) because I'm going a consistent pace on a flat surface. There's also that concern of "if I push myself will I be able to make it home?" Plus, climate control. Need I say more?
That being said...I HATE my home treadmill. The environment isn't great; it's in the basement within snot-rocket distance of two litter boxes. While the basement doesn't have good air flow on its own, I did arrange for a fan to be next to the treadmill and finally got it positioned and angled just right. But the treadmill itself has so many issues. The motor is 1.5 horsepower, which I'm 100% sure is the reason I can't walk fast let alone run on my treadmill. If I have my body weight too far behind my foot when I land, the belt slips forward. So I have to walk with a controlled gait. I've gotten as fast as 3.5mph without it slipping too much, but had to have the incline at 5%. Walking isn't horrible if you have good music or a good book in your ears or something good to read...but the console shakes too much to read a book or magazine while walking. The console also doesn't show the time after you hit stop, so if I want to be sure of my finish time I have to take a picture before I hit stop. The timer only goes to 60 minutes, so the treadmill automatically stops after 60 minutes. These are just the most significant problems...there are more.
I DREAD using THIS treadmill! And my mom says "it was sooooooo expensive." I don't know about that. I just know we selected it instead of an elliptical that I was more interested in because my mom didn't like ellipticals...and yet what is her favorite cardio equipment at the gym? You guessed it, the elliptical. And who is the only person in the family who uses the dreadmill even remotely frequently? Right again! Me. Using this treadmill is a punishment for me for procrastinating my workout until after dark and after the gym closes. Maybe someday I'll learn. Or not.

Sunday, July 24, 2016

BREAKING NEWS

I know I promised to describe my symptoms next, but I have some very important news.

It is with a heavy but slightly joyous heart that I want to announce that I have been approved for Social Security disability benefits.

It's easier to explain why I'm happy: I don't have to worry about money 100% of the time, I will have some income again once everything is arranged and settled (I have to have a feduciary, a.k.a. financial intermediary, which my mom has agreed to). I can decrease the worry time to 75% 😉

I'm sad for at least ten thousand reasons, starting with "I'm too young!" Yes, I am well aware that many people much younger than me are receiving disability benefits. There is also "this could have easily been avoided." Both of those statements have spinoff statements and they're just parts of the tip of the iceberg. I'm not feeling sorry for myself, just stating facts.

I haven't gotten my official notice, don't actually know if I will, but I just boxed up my scrubs (that all still fit or are a little big) and that is definitely symbolically official. I am maintaining my PTA license and my state pharmacy tech certification (the national one is up in the air until it's due for renewal in November). I see the doctor I've been told is a movement disorders specialist on August 2. I'm extremely cautious because I still can't find any information on him on the practice's website, I haven't received any new patient paperwork (I did call and ask, I should get it a week before my appointment and since writing is in the top 3 challenging tasks for me, very possibly #1, it may not get finished), and on my appointment confirmation where my doctor's name is supposed to be is my name.

I need to work on the symptoms list and finish it by August 2 if at all possible, so I will hopefully post it by then.

Sunday, July 10, 2016

Background Part 2: How it all began

I want to tell you how my movement disorder began, but to tell you that I have to give a little more background from before that.  And I apologize in advance for how long this post is.  There is a lot of information contained in it and some of it has been festering in my head for a while.

I was diagnosed with depression in 2000 or 2001 as a senior in high school, but I had symptoms long before that.  I won't go into the gory details, but this information is somewhat relevant.  I started treatment at that time, but as a stubborn teenager I didn't enjoy taking the medication because of the side-effects and decided to stop.  I didn't get treatment again for a while (I honestly can't say how many years).  When I did get treatment again, I found a medication that worked on the first try with minimal side-effects.  I was on it for 6 years, but then it no longer worked for me.  My doctor tried increasing my dose and decreasing my dose, but since she was a family doctor there wasn't much more she could do.  I was already seeing one of her colleagues, Dr. X, for sleep medicine since I have sleep apnea and at that time a sleep/wake disorder called idiopathic hypersomnia.  (The name literally means "I don't know why you're tired all the time" and it is closely related to narcolepsy.  Narcolepsy could not be ruled out at the time because I was on the antidepressant.)  Dr. X also has special training in psychiatry.  He had me try a couple of medications.  I honestly don't remember most of them, but they weren't helping my depression anyway.  One day in 2013 I made a glib remark to my boss about killing myself.  She told me later that day that she was seriously concerned about me and wanted me to get help.  She offered to take me to the ER and have me admitted for suicidal ideation.  After thinking about it for several hours, I told her I was OK with that.  I had thought seriously about killing myself at some point every day for a while prior to that day and I was afraid that I was going to have a moment of weakness and act on those thoughts.  I was admitted to the nearest hospital with psychiatric specialty, which is where I met Dr. S

Dr. S tried a completely different medication regimen with me and said that I didn't just have depression, I also had anxiety and borderline personality disorder.  I was out of there in three days, and saw Dr. X later that week.  All he said was that he wanted me to continue what Dr. S had me start and that he wanted to see me again in four weeks.  Dr. X was very difficult to get an appointment with, so when he said he wanted to see me again in four weeks, the soonest his scheduler could get me in was usually six weeks.  I decided that this arrangement wasn't working for me, especially given the current situation and his lack of action prior to my hospitalization, and called Dr. S's outpatient office to see if he would take me on as an outpatient.  He was willing and available.  I'm not sure how soon thereafter I first saw him.

After I had seen Dr. S a couple of times and had been on his medication regimen for a couple of months, I told him that I was having problems sitting still.  The worst time was when I was in bed at night.  It felt like I couldn't get my legs comfortable.  He said it could be restless leg syndrome (RLS) or extrapyramidal symptoms (EPS).  He gave me a prescription for a medication (a beta blocker, usually taken for high blood pressure) and said that if it helped it was EPS and if it didn't it was probably RLS and I'd have to see my sleep specialist.  The beta blocker did help, so the problem was considered "solved" as long as I kept taking the beta blocker.

The depression continued to be pretty heavy.  Medication doses were increased and other medications were added.  I was admitted to the psychiatric unit a second time because the suicidal ideation was not getting any better.  That was when Dr. S recommended electroconvulsive therapy (ECT, or "shock treatment" as it is colloquially called).  Since I was desperate, I agreed to do it.  After five or six sessions I didn't want to do ECT any more for various reasons.  A little while after I stopped, I noticed that I wasn't thinking of a new way to kill myself every day.  I was still depressed, but not suicidal.  That was a step in the right direction.  I decided to keep going with Dr. S's medication regimen because it seemed that he knew what he was doing.

About a year after starting the medication, I had a new complaint.  When I laid down and closed my eyes, my head would move.  Initially it was just like I was snuggling into the pillow and was pretty controllable, but it got to the point where it wasn't controllable.  You know how it feels when you just can't get your head comfortable on the pillow, so you wiggle it around until you do?  That's what my head did from the time I closed my eyes until I fell asleep.  If I tried to control it, I wouldn't be able to sleep because I was contracting my muscles and straining so much.  If I let it happen, I wouldn't be able to sleep because I was still moving.  And then I would get anxious because I couldn't get to sleep, but that would just make my head move more.  Now I will say that the "wouldn't be able to sleep" part is an exaggeration.  I did get to sleep eventually most nights.  I told Dr. S about it, calling it "restless head" since it felt a lot like the EPS I had in my legs that was similar to RLS.  He didn't do anything about it for the first couple of months that I told him about it.  Finally he tried giving me mild sedatives.  I think I tried two or three mild sedatives before he started giving me "sleeping pills" (hypnotic sedatives).  I actually stayed on one of the mild sedatives for a while because it was a close relative to Benadryl and made my allergies tolerable.  Nothing had any effect on my "restless head" at the time, and everything made me sleepy the next day.  If I took the "sleeping pills," too low of a dose had no effect on helping me get to sleep, and a "therapeutic" dose made it next to impossible to wake up in the morning and then I felt in a fog all day.  I was seeing a different sleep specialist at the time, someone my family doctor insisted I switch to, who was also in her practice.  When I told him about my problems with not being able to get to sleep and not being able to wake up, he diagnosed me with delayed sleep phase syndrome (DSPS) and told me that he wanted me off of some of my psychiatric medications.  He never offered or asked to call Dr. S.  I talked to Dr. S about it and he and I agreed that what we were doing was working better than nothing at all and that a change in my medication regimen was not a good idea at that time.  I went back to the sleep doctor and told him that, but he said again that I need to get off of my psychiatric medications.  I decided I would see a different sleep doctor.  The last time I saw that sleep doctor was early March 2015.  Since he was within the same practice as Dr. W, if I switched to this new guy, I couldn't switch back to Dr. W.  At the time, it sounded like switching to the new guy was not optional.  Now I wish I had stood up for my rights and stayed with Dr. W.  I later found out that Dr. W is one of the only two doctors in central Indiana (maybe all of Indiana) with dual certification in sleep medicine and psychiatry.

Three months later, I had an appointment with a neurologist who "specializes in sleep disorders" (according to her group's website) who came highly recommended from a few friends with narcolepsy, Dr. C.  I told her all the problems I was having, including the "restless head" and subsequent insomnia, and she said that she had a few ideas of what to do but needed to speak with Dr. S first since she wasn't totally familiar with my psychiatric medications.  I was OK with that.  I was scheduled for a follow-up appointment 8 weeks later.  In that time, I had called her office a few times (OK, maybe once or twice a week) to see if she was able to talk to Dr. S and let her know that his schedule is kind of wonky.  He would be in the office for two weeks, but only work in the afternoons in the office (the other half of the day he was at the inpatient unit at the hospital), then the other two weeks he was out of the office completely.  When he was out of the office completely, he didn't check his voicemail, none of his associates took care of his patients, and there was no way for a patient or a doctor to contact him.  I assume he was working somewhere else those two weeks.  I was scheduled to see Dr. S again a couple of weeks before I was schedule to see Dr. C (I think it was late June 2015), but my appointment was cancelled about a week in advance and between his schedule and an insurance issue I had to deal with they wouldn't be able to get me in again until mid-September 2015.  Here's the rub: the office knew at the time that they scheduled my appointment that Dr. S had requested to be on vacation that week, one of his 2 weeks out of the month that he would be in the office.  I had called Dr. S's office several times before my next appointment with Dr. C to tell him that I wasn't able to sleep hardly at all and that I really needed him to either call me or call Dr. C and talk about what to do.  I even said that on the nights I couldn't sleep, especially when there were consecutive nights, I was having suicidal thoughts.  I did not hear back from him.  I finally saw Dr. C's nurse practitioner on my scheduled date.  Nothing had been done regarding my "restless head" or insomnia, so I didn't see a reason to go, but I did go.  At my initial appointment, I had said that I had "dizzy flashes."  I was told that I had vertigo and needed to be tested for it.  That test was finally scheduled after my second appointment (the one with the nurse practitioner) since there was nothing else that could be done about my sleep at that time anyway.  I did have the test and I was diagnosed with unilateral (right) vestibular hypofunction, which just means the balance mechanism in my right ear isn't working as well as the balance mechanism in my left ear (actually it's at 49%) and that was throwing me off balance even when I was sitting still.  I had an MRI to determine if it was due to an infection.  Nothing was determined about my dizziness, but they did find that I have a calcium deposit in my left frontal lobe and said it was most likely due to an old head injury or maybe even just bumping my head really hard.  According to my mom and dad, I never had a head injury as a child and know I haven't had one as long as I can remember.  We will revisit this.  By the way, the "dizzy flashes" went away on their own as my brain learned to adapt to the imbalance.  I have not had a single "dizzy flash" since shortly after that MRI.

I ended up scheduling an appointment with a new psychiatrist, Dr. M, at an office recommended by my therapist for early August 2015.  The night before I went in to see him, I had 5 hours of sleep.  That was considered a "good" night at that time, but I was still a nervous wreck the next day.  When I went in to see him, I was able to hold myself together for about 30 seconds.  Then I was crying inconsolably.  I told him that part of the reason I couldn't sleep was because of anxiety.  He was hesitant to give me anything for anxiety because of my sleep apnea (medications specifically for anxiety can slow the respiratory rate in a regular person; in a person with sleep apnea, it not only could slow my respiratory rate, it could also reduce the signal to my brain to take a breath since that system is already malfunctioning and I could go without breathing long enough to suffocate in my sleep).  He finally ended up calling Dr. C right in front of me to discuss with her what he could give me.  He said he talked with her directly and one of the things she said was "I am not a sleep disorders specialist."  I was put on a trial dose of a medication that is usually given for seizure disorders and nerve pain but has a nasty side-effect of fatigue.  I was to try it in a taper up fashion, meaning that if one 300mg pill every night didn't work after one week I was to try two.  If that still didn't work after another week I was to try three, but I wasn't supposed to go any higher than three pills in one night and I was only supposed to take it at bedtime.  I did as I was instructed.  And the medication did nothing for my sleep.  I was not even groggy the next day.  I stopped taking it.  I forgot to mention that during the time I was under Dr. C's care I started developing what I could only call "restless hands."  For the most part it started like the "restless head."  The movements were somewhat controllable, but there were times I couldn't control it.  In the beginning, if I had to do manual cervical (neck) traction on someone, my fingers would wiggle.  It was almost like I was trying to add a little massage to the grip.  A little while after I started seeing Dr. M, he said something about the "restless head" and "restless hands" being called "akathisia."  I found out that it is a specific EPS and that it was most likely caused by the antipsychotic I was on.  Dr. M started lowering the dose since I was still on all of the medications and dosages that Dr. S had prescribed including maximum dose of the antipsychotic.  I eventually told him that I would like to get off the medication altogether.  I took my final dose in early December 2015 after being on it for about two and a half years.  This is a medication that, when used in short-term situations (about eight weeks) doesn't usually have many significant side-effects, but long-term use is known to have higher incidence of side-effects.  I later found out that "best practice" for this medication is to taper off, discontinue, and find another antipsychotic as soon as movement problems arise.  I was told when I started the medication that, since it was a second-generation (atypical) antipsychotic (SGA), movement disorders were not as common with it as they were with first-generation (typical) antipsychotics (FGAs).  I have since found at least one article that says that the incidence of movement disorders with SGAs is approximately the same as it is with FGAs in long-term studies.

Because Dr. C said she was "not a sleep disorders specialist," I decided to find someone who was.  I asked my narcolepsy group for input again and they suggested someone from another medical group.  I had an appointment to see her in late October 2015.  When I finally saw her I told her about the "restless head" (which had pretty much gone away by that time since the antipsychotic dose was decreased) and "restless hands."  She postulated that it could be due to anemia, since that can cause RLS and there's no reason why it couldn't cause RLS-like symptoms elsewhere in the body, and had me do some blood work.  When I was in the office I was too anxious to tell her that anxiety was part of the reason why I couldn't sleep and that I needed her to talk to Dr. M about putting me on something for anxiety.  Fortunately I was able to email her after I got home.  Dr. M finally wrote a prescription for something for anxiety.  And it turned out that one of my blood iron values, the one that says how much stored iron I have in my body, was ridiculously low.  Everything else was either within normal limits or just a touch low.  So I started taking iron.  None of the "restlessness" was getting any better, though, and one of my signs was causing another problem.  If I wasn't thinking about them, either when sitting quietly or when using them, my wrists would flex significantly.  I started having tingling in my thumb and first two fingers on my right hand and occasional tingling in the same places on my left hand.  I went to my family doctor.  She had me do an in-office test that indicated that I had carpal tunnel.  At first it was mostly in my right hand, but then it went to my left hand.  After I saw her the second time three weeks later, after braces and anti-inflammatories didn't make a difference, she ordered an electromyogram (EMG) of my arms, which tests how fast signal conduction is from the shoulder to the fingertips along certain nerves.  Based on the conduction speed indicated by the test, it turns out that the carpal tunnel in my left hand was "moderately severe" while the carpal tunnel in my right hand was "mildly severe."  I also was discovered to have cubital tunnel in both elbows, but it wasn't enough of an issue to concern my family doctor, especially since I wasn't reporting symptoms.  She recommended that I see a hand surgeon, but I insisted that there was no point to surgery.  If I'm continuing to do the behavior that causes the problem (flexing my wrists) and have no control over it, I see no point to fixing the carpal tunnel, which I see as just a symptom of the problem.  I eventually told her that I would like to see a neurologist to work on the cause of the problem.  I was very reluctant to schedule the first appointment after what I had gone through with Dr. C, but the neurologist who did my EMG seemed like a nice guy, so I wanted to give him a chance.

Since I wasn't working at the time, I saw Dr. W for the EMG the day after my family doctor wrote the referral, but because I was working at the time that I decided to see him for a neurology consult it was three weeks between when the referral was written and when our schedules lined up.  When I finally saw him, I had a hard time explaining the problem to him because doctors make me anxious and after my negative experience with Dr. C I am most anxious around sleep doctors and neurologists.  And at that time I hadn't figured out the term "movement disorder" to explain what was happening.  He agreed that I need to see a hand surgeon, but wasn't entirely sure what to do otherwise.  He prescribed some medication to help with the tingling, which by that time had become painful and is best described by the word "neuropathy" (literally meaning nerve pain).  He said that should help with the uncontrollable movements, too.  It was the same medication that Dr. M put me on to help me sleep that had no effect on me.  Dr. W also said he would do a little research.  Finally, I showed him my MRI report and asked him if the scarring in my brain could be from ECT.  He said that it is possible that I had a minor brain hemorrhage that healed and scarred, but he couldn't say definitively.  I saw him again four weeks later and had no significant improvement.  I had actually declined a little and was better able to describe the problem.  One of the things I described to him was that my left wrist flexes whenever I try to exert a lot of control over it, like when putting tape on a patient or writing.  He actually listened to me and treated me like a partner in my care team instead of an idiot, which is the way I feel doctors treat me in spite of knowing my job title (physical therapist assistant) which is always in the paperwork and I declare in their office when I try to help them solve the problem (a.k.a. tell them my self-diagnosis).  He also admitted that he wasn't entirely sure what was going on.  He thought that it might be a form of dystonia (another EPS).  I told him I would think about it and get back to him, and he said he'd see me again in four weeks.

At that four week follow-up, things were still pretty much the same.  I asked him what he thought about me seeing someone who specializes in dystonia in another practice and he said that he would be OK with that since it wasn't in his wheelhouse.  He asked if I would be willing to see one of his associates, one who knows more about the Botox injections that are standard practice for dystonia.  I was very unhappy to leave this doctor who I had initially feared but grown to like a lot, but agreed to see his associate for a Botox consult.  At the time, I was pretty sure Botox wouldn't do anything for me anyway since my problem wasn't a fixed muscle spasm, but a problem with controlling movement that presented as a "functional" spasm.  When I scheduled the appointment to see the other doctor in his practice, I let the office assistant know that I was very anxious about switching doctors and she reassured me that the other doctor was very nice.  I saw him, and he said it didn't look like anything that could be helped with Botox to him, and said at least three times in my 15 minute visit with him that I MUST have carpal tunnel surgery.  I was incredibly upset when I left my appointment with him.  I was crying so hard that the office assistant knew my visit went very poorly.  That doctor told me to follow up with Dr. W, and so I did as soon as possible.  He and I discussed the pros and cons of doing carpal tunnel surgery and that if I didn't do it and ended up getting worse I could be crippled for life.  I told him that I feel like I already am with the movement disorder.  He said that since we don't even know what the movement disorder is there is a chance it could get better.  I told him that I had been doing some research and that he might as well just slap me with a diagnosis of "tardive dyskinesia" because it's definitely a dyskinesia (which is another specific EPS) and I was on an antipsychotic for over 2 years.  Dr. W said that he did not want to saddle me with that diagnosis because there is no treatment for it and he doesn't want to give up hope.  He also said that I didn't have enough facial tics for it.  He admitted that he had only seen tardive dyskinesia (TD) once when he was in med school, and that the person he saw could hardly control their face.

According to the National Institute of Neurological Disorders and Stroke (NINDS), a division of the National Institutes of Health (NIH), Tardive dyskinesia is a neurological syndrome caused by the long-term use of neuroleptic drugs. Neuroleptic drugs are generally prescribed for psychiatric disorders, as well as for some gastrointestinal and neurological disorders. Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements. Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing, and rapid eye blinking. Rapid movements of the arms, legs, and trunk may also occur. Involuntary movements of the fingers may be present.  (http://www.ninds.nih.gov/disorders/tardive/tardive.htm)  It does not say facial tics are mandatory.  They are considered "normal presentation," but they are not mandatory.  I actually told a few people about his comment.  One person had just graduated from a nurse practitioner program, and when I told her that he said that I don't have enough facial tics she said "like blinking a lot?  Because you do."  I told someone else whose sister has TD and she said "you are pressing your lips together almost constantly."  I realized that Dr. W did not look at me a whole lot when I wasn't talking.  Just like with my hands, my presentation varies based on what I'm doing, how severe my anxiety is, and whether or not it's a "good" day.  I'm not sure how my brain determines what is a "good" day and what is a "bad" day, but consistently Wednesday and/or Thursday are my best days and Monday is one of my worst days, regardless of what I do, employed or unemployed.  I told Dr. W about that at one of the first visits and he said it was totally weird and didn't help him with figuring out the diagnosis.

I am seeing a new neurologist at the beginning of August.  When I originally contacted the medical group that this neurologist is in, I told them that I need to see a movement disorders specialist and asked for the one they had listed on their website.  They said that the person listed on their website is not available but they have someone else available.  They told me his name, and I have looked for him on the medical group's website multiple times and cannot find him.  His name is two first names that are super generic in the US, so just doing a Google search for his name with MD after it yields a lot of results, none of which are those two names combined into one from this medical group or even within my state.  I am afraid that when I get there I will be seeing a "generalist" neurologist, like Dr. W, who will say "I'm not sure what to do," or even worse try to "fix" me based off the symptoms they see and not the root of the problem.  Fortunately and unfortunately, the only movement disorders specialists in my city are in this group.  I really want them to send me for some sort of a functional evaluation.  Something where someone (preferably an occupational therapist) watches me do everyday things like writing, typing, using a mouse, eating, cooking, etc.  And since the cause of the cause of my vertigo was never determined, I want to find out if that could be connected.  But having high expectations with Dr. C is what got me into the most trouble.

I know I haven't talked a whole lot about my full symptom presentation yet.  I actually plan on making that my next post.  I already have a lot of it written out from when I was trying to figure out what to call the stinking thing, all the way back to before when I recognized to call it a "movement disorder."  I just have to update it to include the current symptom presentations.

I want to leave you with a little bit of running wisdom that I came up with that I thought was totally profound and should win me a Nobel Prize (OK, not really).  It was in response to a post from a magazine talking about using running as a defense against depression.  Here goes:
When my demons are threatening to overtake me, I lace up my shoes and try to outrun them. Sometimes I cry on the way to the park. Sometimes my emotions interfere with my ability to push myself to run and I end up walking instead. Sometimes my short, fast workout turns into a long, slow workout. And 90% of the time the demons don't follow me home.

Much love,
Twitchy Tina

Saturday, June 25, 2016

Background Part 1: The Blog

If you've come to this page, chances are you know me somehow.  Most likely it's from Facebook, but it could also be from running, past employment, we could be family, went to church together at some point in time, or maybe went to school together.  Actually, even if you fall into the other categories, we're probably friends on Facebook since that's where I do the majority of my socializing.  In case you don't know me, you'll find out that I'm pretty blunt about everything, but I will frequently try to diffuse tension (my own or perceived from others) with humor.  Sometimes my posts will come across as almost purely informational with no humor.  Sometimes almostly purely with a jocular tone.  You never know what you'll get from me.  I never know what I'll get from me.

This, my inaugural post on this blog, is a background on this blog itself.  As time goes on, I'll give more information on some of the things I mention here.

Why I chose the title "The Trials and Tribulations of Twitchy the Runner"

First of all, let's address the "Twitchy" part.  I am in the process of getting diagnosed with what I am currently calling [an] "unspecified movement disorder."  That means that the two neurologists I have seen since the beginning of this year aren't entirely sure what to call it.  They do agree that it falls within a broad category called "extrapyramidal symptoms," or EPS.  (Here's the link to the Wiki on it, though you shouldn't trust Wiki for research purposes: https://en.wikipedia.org/wiki/Extrapyramidal_symptoms)  The short and dirty on EPSs and me: I was given a generic diagnosis of EPS when I started taking Geodon (ziprasidone) a few years back.  That was a known side-effect and I was given another medication (a beta blocker) to cover it up.  I wasn't "twitchy" as long as I took the beta blocker.  Fast forward two years.  I was having "twitching" so bad that it was interfering with my sleep and work and the beta blocker wasn't doing anything for it.  The psychiatrist who originally put me on the Geodon tried a couple of other medications, but they weren't doing anything for me.  He and I had a falling out and I started seeing a new psychiatrist.  I was given a diagnosis of "akathisia," which is a specific type of EPS.  I found out that it was caused by the Geodon and told my new psychiatrist I wanted off of it.  He was OK with that and I started weaning off of it, which took about 3 months because of how high of a dose of Geodon I was on at the time.  By the middle of December 2015 I was no longer taking Geodon, and a week later I stopped taking the beta blocker.  The "twitches" have just gotten worse since then and I found out through my own research that it is because the Geodon was masking them.  I have also since been diagnosed with "dystonia" and "dyskinesia," both specific types of EPSs, by the aforementioned two neurologists.  There are four specific types of EPSs.  If you've been following along in your playbook, you'll see I've been diagnosed with three of them.  The only one left that I haven't been diagnosed with is "parkinsonism," which is exactly what it sounds like: Parkinson's disease-like movements.

The only way to explain my presentation concisely is that I "twitch."  If you ask me to sit still, I can't.  The harder I try to sit still the more I "twitch."  Sometimes it's minor, like wiggling my fingers.  If I'm laying down my right leg jumps periodically.  But if I'm trying to do something purposeful with my hands, let's say typing, my presentation changes.  That's because purposeful movement requires the motor center of my brain to exert an exorbitant amount of control over my hands so it relinquishes control of the skeletal muscles in parts of the rest of my body.  For example, when I'm typing, certain muscles in my legs contract.  It's not painful.  Just annoying.  What is painful are the contractions in my left arm.  I am putting so much effort into controlling my fingers that I literally have to contract almost every muscle in my left arm.  Outside of typing, frequently my left wrist will flex when I'm trying to just keep it relaxed.  That actually caused carpal tunnel in my left wrist severe enough that three non-orthopedic doctors are insisting I see an orthopedic doctor to discuss carpal tunnel release surgery.  Oh, by the way, I've been left-handed for the last 32 years and now can hardly use the darn thing.

Moving right along, next we'll jump to the "the Runner" part of the title.  I have had to give up almost every hobby I've ever had since my "unspecified movement disorder" has gotten to the point it's at.  I AM a musician, but I can't play any instruments anymore.  I AM a crafter (cross-stitching and crocheting being my most prominent crafts), but if I were to try to do my favorite crafts I wouldn't get very far before getting frustrated by the overflow movements and/or pain.  I do still craft a little when I'm feeling up to it, but nothing that will be a long-term project.  One thing I can and DO do that requires very little use of the hands is running.  I started running toward the end of May or beginning of June of last year and made progress in it but had to stop toward the end of December because of a health problem caused by a medication I was taking.  I've been off that type of medication since April and started running again toward the end of May or beginning of June this year.  There will be stuff about running in this blog because that is one of the few ways I can identify myself other than my movement disorder right now.

Finally, I'll tell you what I mean by "The Trials and Tribulations."  I created this blog because I wanted some place to tell the world at large what I have been going through since I started having my "unspecified movement disorder" problem, including what caused it, some of the effect it's had on my everyday life, the process of diagnosis and application for disability, and so on.  But I will also be breaking up the sob story with positive posts about running (hopefully).  This is NOT a place for me to just complain, though.  That's what I have my friends, Facebook groups, and therapist for.

Parting thoughts for tonight...

I will probably be very sporadic in my posting on this blog because, as I've mentioned, typing is a challenge for me.  I do have voice typing capabilities on my phone, but don't like to use it much unless I'm home alone, plus it's a pain in the butt to edit when you're a grammar nut like me but your hands don't work so well.  I know there is software to do this on my computer, but it goes back to the not wanting to do it unless I'm home alone for psychological comfort reasons.  Generally, especially while I'm just giving background information, my posts will be typed up in the wee hours of the morning.  For some reason, my motor control is generally at its best around 1am, but that only lasts until my brain turns to mush and I have to sleep for 6+ hours.

Feel free to leave comments asking for definitions of anything, especially medical terminology, but I will warn you that I'm just going to give you a link to find more information on it.  You could just as easily Google it yourself and then you'd be saving a poor, ailing woman from having to do it for you.

Lastly, please realize that, though I intend for this blog to be mostly informative, I do still have an emotional disorder that causes me to lose my cool and put my emotions ahead of logic sometimes.  While I have improved at stepping away from the computer and thinking (and overthinking) about what I have typed before I press "send," I am far from perfect, even by human standards.  And if you come across me in person, please realize that one of the reasons I'm creating this blog is because I don't want to talk about this in person.  It makes me very emotional and I am uncomfortable with being emotional, especially in front of people.  If I bring it up it's not such a big deal for me, but I could very easily get to the point of not wanting to talk about it mid-discussion.

Thank you for being supportive of me during this process.  It really means a lot to me.

Much love,
"Twitchy" Tina

Update 7/10/16: I added my Facebook profile photo to this entry today because I'm changing it. I also added tags. That is all.