New Loperamide Article!

Yes, kiddies, the latest-up-to-datest Loperamide Abuse article was just published and added to this site!

Good stuff in here — further indicative of a causal relationship between loperamide abuse and disturbances of the electrical system within the heart. Article is brought to you by the top toxicology experts from Upstate Medical University in Syracuse, Emory University in Atlanta, and Strong Memorial Hospital and University of Rochester Medical Center in Rochester. I’ve read the whole paper (not just the abstract), so I can tell you it’s the most comprehensive paper yet written on the subject.

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loptab3Cardiac conduction disturbance after loperamide abuse

J. M. Marraffa, M. G. Holland, R. W. Sullivan, B. W. Morgan, J. A. Oakes, T. J. Wiegand, and M. J. Hodgman. 1 Department of Emergency Medicine, Upstate Medical University, Syracuse NY, USA. 2 Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, GA, USA. 3 Department of Emergency Medicine, URMC and Strong Memorial Hospital, Rochester NY, USA. 4 URMC and Strong Memorial Hospital, Ruth A. Lawrence Poison and Drug Information Center, Rochester, NY, USA

CLINICAL TOXICOLOGY: November 2014, Vol. 52, No. 9 , Pages 952-957

Conclusion: This case series describes several patients with cardiac conduction abnormalities and life-threatening ventricular arrhythmias temporally related to loperamide abuse. With the recent efforts to restrict the diversion of prescription opioids, increasing abuse of loperamide as an opioid substitute may be seen. Toxicologists should be aware of these risks and we urge all clinicians to report such cases to FDA Medwatch®

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More articles at the Loperamide Medical Clearinghouse

Posted in + recovery, addiction, education, loperamide abuse, sobrietyland | Tagged , , , , , , , , , , , , , | 4 Comments

The dog ate my Fourth Step.

hlnaz

Why so defensive Fräulein? What are you hiding?

The last time I saw the Square-Jawed NP (last Friday), we went over my AA fourth step worksheet that he’d given me a couple weeks earlier.

I was highly resistant to do the work of the fourth step. (Made a searching and fearless moral inventory of ourselves.) I did not want to put down on paper the most horrible things I keep hidden away deep in my heart behind ice and a lead-lined steel door. As far as I’m concerned, those are my issues and nobody’s business. If it doesn’t hurt the other person, it’ll hurt me — again — and I won’t have that.

Luckily for me, NP gave me a form from Hazelden for those with dual disorders, approaching the fourth step (taking a full, honest, and searching moral inventory) from the perspective of assets and liabilities instead of the detailed crap from the AA Big Book. For instance, under assets, one might put “funny”; under liabilities, one might put “impatient”. That was the only reason I agreed to do it. It didn’t seem as scary. Plus, NP said that we would go over it together, and that I didn’t have to share it with my sponsor or any other “normal” person if I didn’t want to — Therapist Barbie would be OK, or I could bring it to a priest, or you know, that sort of thing.

But I still didn’t want to do it.

Despite my calling him a Nazi, I really like NP and enjoy our visits with their banter and sparring. Partly because I like him, I don’t want him peering down the rabbit hole and seeing just how dark and deep it gets.

Remember that NP is only supposed to be “medication management” and nothing more. Any counseling or therapizing he does is brief and bonus.

4thstp

So when I went to the appointment, he asked about the fourth step worksheet. I opened my folder and handed the “final copy” to him. For three weeks, I’d been working through a rough draft that I kept in my purse in case I thought of something on the run, then the night before the appointment, I rewrote it neatly in ink on a clean copy. It was tedious work, but I did it. I found coming up with liabilities was easy and coming up with assets was a lot more work. But no, I didn’t cry, didn’t reveal anything too personal, but referred to all of the weaknesses I could think of.

NP asked me how it was, and I replied, “Oh not that bad. I wasn’t that hard except coming up with assets (insert laughter here).”

NP cocked his eyebrow at me. He flipped through the multi-page worksheet and asked the occasional question which I answered. He got to the section about relationships and said, “This is where it’s usually the most interesting.” He read it and asked a couple of more questions. Then he sat back and asked me, “Did you really put your heart into this?”

I was insulted. “Yes! Of course I did!”

“Really?” NP queried, “You did a fearless and searching moral inventory?”

“I did what you asked. I filled out your form,” I made my case vehemently, “I did exactly what you said to do. I did the form! You said all I had to do was fill out this form, and I did.”

“Wow!” NP exclaimed. “Wow… It’s like this big steel door just slammed shut on me. (He gestures a wall coming down with a stiff, downward motion with his arm in front of his chest.) “Why are you being so defensive?”

“Defensive?!?” I exclaimed, “I’m just defending my work! I did exactly what you asked me to. In fact, I went above and beyond. Look. I wrote two or more items on each line of the form doing two or three times what was asked. I’ve even been carrying around this stupid rough draft (I pull it out of my handbag and wave it in front of him) for three weeks taking notes as I thought of them! I even rewrote everything in ink on a clean sheet so you could read it. I did what you asked and more! Everything on there is what you asked for!”

NP remained stunned, but leaned in to me. “Look at me.” I looked. I was suddenly taken aback by the strange color of his eyes that I’d forgotten about — a steely color, like a dusky blue met with olive green. They were an odd, unusual shade. Because I was distracted, I didn’t hear the first words he said to me, but then I realized I needed to focus and heard him say, “Maggie, I’m not saying you didn’t do a good job. In fact, you did a great job. I can see the work you put into that fourth step. But why are you being so defensive? Why did you slam the wall down?”

“I DON’T KNOW.” I was getting mighty pissed by this point. “What do you want? Do you want me to rewrite everything in essay form?? Just talk to me and tell me what you want!”

NP: “I want you to tell me why you’re being so defensive.”

In fact, I was getting pretty loud. “I DON’T KNOW.”

NP: “Tell me… on a scale of 0 to 100%, how much effort do you think you put into this fourth step sheet.”

Me: “Are you kidding me?” We went back and forth on this a few times, and finally I answered, “100% absolutely”

NP: “Really?”

Me: “Yes.”

NP: “You want to tell me you put in 100% effort on this worksheet.”

Me: “Yes,” I was trying to figure out what he was getting at. Did I forget to fill someting in? Was I expected to approach it differently? Should they have been worded in the form of a question? WHAT? “Yes, in as much as I am able.”

Without skipping a single beat, NP sat back and said, “Now that’s an interesting response.”

A pregnant pause followed.

I was stunned and frustrated and began to plead softly, intimately. “NP, now come on. Why don’t you just ask me what you want to know.” NP sat in silence staring at his wringing hands. So I added, “Just talk to me. What do you want to ask me? Really.”

He grunted and rubbed his head. “We just don’t have time for me to get into this. I wish I was your therapist. This is my specialty.” He has said these things before. “My hands are tied. We just don’t have time.”

I told him that I’d shown the fourth step sheet to Therapist Barbie, so NP asked me how that went. I chuckled and told him that she didn’t know what it was. He chuckled too and shook his head in his hands. “Wow, Barbie really has no idea… she’s got her work cut out for her. She’s really not ready for this.”

I agreed but added, “She’s a nice kid and she’s certainly earnest. But yeah, she really doesn’t get it.” I paused and repeated, “I really don’t know what you want to know, NP. Please won’t you just talk to me and tell me?”

“I want to know why you’re being so defensive. I mean, really, you just slammed down this big wall (he motions again) and shut me out. Tell me why.”

Oh for fuck’s sake. “I don’t know!!” I reiterated.

“You know what? I believe you. I think your subconscious is hiding something it REALLY doesn’t want to get out and…” he grunts again and says more to himself than me, “JEEZ. I don’t have enough time to do this. I just don’t.” He sighed again and resolutely leaned in toward his computer and asked me about my medications. NP looked exhausted. I mentioned that I thought the Wellbutrin should still be increased to 300mg because I still feel like I’m just under the cloud. NP muttered under his breath that this is where therapy is supposed to take over. He let out a long sigh and replied without argument that we’d give it a trial period for a month.

I sat confused. “What, no fight? No resistance? No telling me that you’re worried about polypharmacy so you don’t want to add any more to it? No fights? No arguments?”

Quietly, he responded, “Nope. This isn’t an argument. We don’t fight. Sometimes we… just… disagree and spar a little.” He continued typing in silence, the click-click of the keyboard sending the new prescription to the pharmacy.

Jesus, I thought, I broke him. I actually broke him! What did I do?!? I couldn’t believe I actually won and made him cave in — moreover, somehow that was not a good feeling. It felt as if he’d given up on me. I made him give up. It was an ugly thought.

hans

We have ways of making you talk.

He leaned back in his chair again and said, “I just wish I knew why you were being so defensive. Don’t you see how you just shut me out? Those steel doors slammed and locked fast.”

Me: “So ask me what you want to know? Talk to me. I did the fourth step. That opens a crack in that door, you know.”

Once again he shook his head and grunted. “There’s really just no time for this. I can’t –” His eyes searched for an answer. We sat in silence for a bit — my heart was racing with fear. What had I done to him? Did I really hurt him? And why WAS I being so defensive? Did he have a point? Was my subconscious really hiding something I don’t know about?

Finally he sat forward at the computer keyboard again, moved the mouse around and asked, “What times are you available?”

Huh? I was taken aback. Why did he want to know? What was he scheming? Am I being sent to the looney bin? I was in full suspicion mode.

Me: “Why? What were you thinking?”

“Well, if I can get you in at the end of the day, we would have more time to explore this because I won’t be worried about catching the next appointment. And this is what I used to specialize in. We can get to the bottom of this.”

I was actually touched by the gesture. “Uh… Yeah, that’s fine, but are you sure?” I was worried that maybe he was risking his job by ‘overstepping’ the boundaries of his position. I leaned in to him and spoke softly, “I mean, are you really sure you want to do this?”

“Absolutely.”

I was confused. He was willing to do THAT for ME? Why???

When we walked out, NP directed the receptionist to make sure I got the last appointment of the day in three weeks. She muttered that those appointments are the ones most frequently rescheduled, but he insisted anyway. So October 23rd at 3pm is our next appointment (should it come to fruition).

Until then, I am enrobed in terror. The way I see it, I have three choices. I can, A) Cancel and not go and keep my secrets to myself; B) Go and lie and/or keep that defensive wall up; or C) Go, put on my big girl pants, suck in my lower lip, and let his process happen.

I have no honest idea what to expect. Of course I’m being catastrophic and assuming the worst will be the worst. But maybe I’m not giving him enough credit and it won’t be nearly as bad or humiliating as I think. (As if.)

So I have prepared myself to be numbly clinical about it, be honest, and answer whatever he asks. I don’t want to cry AT ALL. If I can just steel myself to sit calmly through massive humiliation (it may suck beyond all reason, but it won’t kill me). After all, he seems to be going out of his way for me. It sounds like he’s planning to stay and spend more time with me than normal in an effort to break down that steel door. I kinda owe it to him to show up for this mass suckage.

Still, I remain quietly terrified. I feel trapped. It’s like being near a swamp that doesn’t stink until you stir everything up from the bottom — then pour all that foul-smelling, rotting putrification all over yourself.

blueredI’ve also become convinced (catastrophizing again) that NP will give up on me and quit my case. Now, don’t worry, there’s no murder or child touching or anything like that in my past. None of those big things someone might expect. But still, I’m a very private person about my bad shit — and with reason. In the past, for instance, He Who Shall Not Be Named was a person of trust who knew many of my secrets — and eventually he used all my love as a weapon to stab me in the back and send me careening toward ruin. (Okay, to play devil’s advocate for a moment, I had a big part in the ‘careening toward ruin’ part, but he was the catalyst.)

I don’t trust easily or at all. I’m highly suspicious. I worry not only that I’ll be found out, but to be uncovered as a completely pathetic, hopeless loser.

I also fear that NP might come to the conclusion that I’m Borderline and well beyond hope. It’s nice that he’s fighting for me, but he really doesn’t know what he’s in for any more than Therapist Barbie does. The one “Big Bad” secret I know that I hold — which I have never spoken of here or anywhere — is actually pretty lame when you consider other people who had real problems. But it’s uniqueness is what makes it so catastrophic and potentially stunning to the listener. I have to keep it under wraps, but if NP asks… I’ll have to tell.

I think my defensiveness comes more from a lifetime of trust breaches, loss of love, and abandonment issues. I wasn’t necessarily born this way — I was made to have impassible boundaries. Then again…

brfd

First recorded instance of the steel door slamming shut.

My mom once told me a story about a time when I was about 2 or 3 months old. One day, I refused to breastfeed. Every time it was offered, for a couple of days, I continued to refuse, cry, and have a fit. My mom ran to the pediatrician in a panic, and the doc simply shrugged and said, “Obviously she’s done. She’s weaned herself. So try her on baby food and see what she does with it.” I ate baby food just fine. This sounds exactly like me.

Now to truly appreciate why this story is significant, you need to know that my Mom was a chronic alcoholic. If I recall right, her booze of choice at the time was Gin and Tonic, or perhaps Martinis all day long. I was also a colicky baby for the first few months of my life, screaming almost all the time. So it would be a short jump to conclusion that mom’s milk was heavily laden with booze, which was likely the cause of my cramps and probably giving me a massive headache too (as it does even now). So as anyone who knows me well, one day, Little Baby Margaret decided she’d had enough and would rather starve than drink another drop of that poisonous rotgut!

To this day, when I meet my limit (and I have a long fuse), those protective walls slam shut. I’d rather starve — or live alone the rest of my life — than give in to other people’s wishes for me when I don’t agree.

Except… I don’t think that’s working so well for me anymore. And NP would agree.

Given the situation with NP, I feel I need to give him the benefit of the doubt. I have been seeing him for a year now. and we have built a certain amount of rapport and trust. And finally, he is going way out of his way to help me. That’s a presumed gesture of decency I can’t ignore.

It’s incumbent upon me to show up and deal. It’s the best I can do. Even so, I still fear I’ll lose him. He’ll figure out that I’m nothing but a pathetic and worthless, useless creature, hopeless and destined to live a life of misery — all this despite how fun-loving I might be on the surface. And honestly, I’ve prepared myself for that possible outcome. The shrink (or in this case, med-management)-patient relationship is never meant to be permanent anyway, so if I lose him now, hey, at least it won’t be that bad. Especially if I’m prepared. Certainly better than if I spent years seeing the guy and becoming comfortable with him only to be left behind while he, like, moves on to Ohio or something.

The main side effect of my resignation to including him in my dark little world is a dip back into really bad depression. I could barely get out of bed this morning (waiting as long as I possibly could) and couldn’t crack a smile or talk much for most of my morning shift. The increase in Wellbutrin has had minimal-to-no effect at all.

My brain just keeps catastrophizing that the end of the world is nigh. My dreams lately can confirm that (lots of end-of-the-world dreams). No escape. I feel trapped — and for me, that’s a very bad and dangerous place to be.

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“Defensiveness is usually someone silently screaming that they need you to value and respect them in disguise.”― Shannon L. Alder

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Posted in + recovery, AA, addiction, bipolar, depression, Shrinks, sobrietyland, therapy | Tagged , , , , , , , , | 1 Comment

New Adjunct Blog

Sorry I’ve been so remiss in writing. Lots happening, no gumption.

Therapist Barbie gave me an assignment to keep a therapy blog. As if one blog isn’t enough, now I either give her permission to read this one (I don’t wanna since I talk about the two of them here pretty freely), or I create a new one that is similar to, but separate from this one. I chose the latter.

If you want to read along, check out http://madtherapychallenge.wordpress.com/ It’s taken me a week to even begin to attack it because I have no idea how to approach the thing. There’s too much to say really. So I’m winging it — the first real post got really (REALLY) long.

This adjunct blog is set up for my therapist to read. I will continue writing on this blog, don’t worry!  I’m still not sure I’m going to keep the camouflaged names or pictures on the other blog — I prefer to keep the whole matter separate from this blog but changing all the nom-de-plumes and such just gets too confusing — yet I do have to censor certain things or even make the blog private for their own protection (and mine). For now, I’ll leave it as it is and will make the final decision on the confidentiality of the blog before the next time I see her.

Feel free to read the first couple of posts if you wish, but keep in mind the understanding that the dark shit I talk about over there is being read by and helped by professionals. And I may have to privatize the blog if it gets too deep.

Merci beaucoup mon amis.

Posted in sobrietyland | Leave a comment

Militant Vegans and Why I’m No Longer On Facebook

baconI am remiss in discussing my crazy relatives. Today, that changes, and you, dear reader, may have a small glimpse into my little dysfunctional family’s world.

I have one sister and two brothers, all of whom are a full generation older than I am. I was pretty much an only child with 20- and 30-something older relatives floating in and out of my life.

As is well known in my family, my sister is Evil, but my two brothers do not appear to have inherited the evil gene. They’re all still pretty weird though. But for this conversation, we’ll be talking about the Evil Sis’s half of the world. Why do I refer to her as evil? Because she is. She has done many horrible things to me over the years which I will discuss at a later date. For this article, we will discuss just one part of her warped lifestyle. Particularly, her fairly recent conversion to becoming an asshole militant vegan.

Let me preface this article by saying that I don’t have anything against people choosing a vegan diet (in and of itself). Hey, if it works for you, you like it, it makes you feel more healthy, and your body is responding well to it, then please be my guest and enjoy. Those people are not of whom I speak.

I’m talking about the militant vegans. The assholes. The ones who just can’t stop proselytizing about it. The ones who corner you at a party and talk with gushing glee about how they can feel the toxins washing out of their bodies — all because they’ve gone vegan. The same ones who get into fights at those same parties and will drop their friends and relatives because they refuse to go vegan too.

On Atkins, I never proselytize. If someone asks me, I tell them what I know. I include scientific data and answer what questions they have. My choice is mine alone and the last thing I want to do is get into an argument about whether or not what I’m doing is right (or right for them). There’s always someone who is horrified at my dietary choice and queries me if I’ve tried “healthier alternatives” such as vinegar diet, or tried using raspberry ketones, or go on about what weird shit Dr. Oz advertises this week that will help me lose weight — anything but eating those meats and bacon and cheese (and lots of veg). Gasp! Horrors! (Assholes come in many forms.)

But Militant Vegans just can’t keep it to themselves. Just like a recent convert to the religion-of-your-choice, they believe it’s their mission to go out into the world to convert as many lost souls as possible to their one-and-only “right” faith.

One reason I rarely visit my Facebook page anymore is that an unfortunate number of my relatives have gone totally, militaristically, assholey vegan. I can’t bear their posts, well intentioned though they think they are. If it’s true that the last remaining “acceptable” prejudice is against fat people, then they are well on their collective ways to being Supremacists.

Evil Sis and her entire family have gone militant vegan and now my brother’s son and his whole family have gone over to the dark side as well. Like many, my Nephew started off as a non-asshole vegan, able to tolerate other peoples’ choices with the understanding that it’s a free country. Sadly, he has fallen under the spell of my Evil Sister, so he’s become one of those vegans.

Allow me to add, dear reader, that all these people are also wealthy far-right-wing conservatives. Knowing that adds a certain extra level of bizarre to the situation.

His mother, my sister-in-law, was here visiting for a few days about a month ago. She stayed with her son, and sadly it didn’t go well. She and her son got in a huge row over — guess what? — veganism. He’s no longer speaking to her.

So what happened, you might rightfully ask? Something fairly minor actually. Nephew was complaining to his mom that when he and his family visit their in-laws, they don’t serve anything that Nephew and his family can eat. My SIL explained to him that most people don’t necessarily know the specific rules of veganism, and therefore, you should not expect them to accommodate you. So perhaps it would be best if he and his wife brought a dish or two of food that they and their in-laws could enjoy. Nephew took this as a high insult and thus the argument took off running.

Adding to the stress, it turns out, Nephew has also decided to go “minimalist” — has gotten rid of his living room and dining room sets in an effort to own no more than 100 things. He’s also home schooling his kids (he doesn’t want them influenced by ‘liberal’ teachers he says), and is into “attachment” parenting.

SIL knew the rest, but didn’t respond well to this new bit of minimalist insanity since Nephew and his wife have three kids and are planning for more. “You can’t choose weirdness like that if you have kids,” she said. And on the fight went.

Now he’s no longer speaking to his mother or his dad (it’s been over a month, and they used to call a few times a week). Instead, he worships the ground my Evil Sis walks on, and in the process, has broken his mother’s heart. She’s beside herself not knowing what to do.

They are all frickin’ bananas.

But the vegan thing? It all started with my niece, my Evil Sister’s daughter. She’s always had a tender heart when it comes to animals and decided to go vegan after watching some documentary about slaughterhouses. Shortly after that, she attacked me on Facebook for making a comment about how great bacon is. And I mean ATTACKED. Flame war ensued and ended with me de-friending her on Facebook. I don’t need that shit in my life.

My sister verbally eviscerated me about a week later, having chosen to follow her daughter’s example and go vegan herself, and after quite the argument (which included her attacking me personally beyond the vegan thing) we stopped speaking for about two years. Again, I don’t need that shit in my life — I’ve got enough problems. Seriously. We only started ‘speaking’ again after The Incident in 2012, and even that has been minimal contact at best.

But now that she knows I’m back on Atkins? I’m total scum again. She wrote something on Facebook about how Atkins is “ruining so many lives” — whaaaat?

I’ve been doing my best to maintain a relationship with Evil Sis over the last couple of years, despite her evilness, because after all she is my sister. But now that she knows I’m fully supporting the animal slaughter industry and refuse to convert to her lifestyle choice, she’s pretty well cut me off again. Fine by me. As I said — with all that’s on my plate, I don’t need the extra stress. I refuse to bow down to her. She doesn’t own me; never did.

Jeebus! Why can’t we all just get along??

And as I said, Evil Sis’s whole family is now vegan. Evil Sis, her husband, her son and daughter, and all their kids. And now my Nephew, his wife, and all three of their toddlers (and they want more kids too). They won’t have any form of meat or animal product in their houses, so it’s not like I can go to their cookout and bring my own hotdogs or anything. I can’t even go over for coffee since they don’t have cream (or cream-like products). Nope. Coffee black or none at all.

When they had their little family get together over a month ago, I had no choice but to comply and go along with it. I ate a veggie burger and a soy hot dog. They weren’t entirely horrible, but the burger was a little like eating mushy cardboard with fake meat flavoring. The hot dog had a weird, soft texture more akin to tofu than hot dog. Again with the fake flavoring too. Other actual veggie-based food they served were actually quite delicious, but that fake meat had to go. Why even bother? Yuck.

As a person on the Atkins diet, I’m the vegan’s sworn enemy. And Evil Sis and her clan let me know it every chance they get. Nephew recently posted some PSA video on his page that went into gory detail about the obese people who eat all those ‘horrific’ meat products and who are destined to die of heart disease or diabetes. They agreed that despite it’s graphic nature, it’s important for fat people to see this and how much they pity us. (Indirectly pointing at me.) They, of course, like most militant vegans, made sure they congratulated themselves quite thoroughly in the comments for being smarter and more ethical than those horrible Atkins people. (Pointing at me again.)

Let me interrupt this to say, the only reason my Evil Sis is thin at all is she had Gastric Bypass surgery several years back. She was fatter than I was when she chose to have the procedure. At the time, she had tried going raw foods, vegetarian, and even (briefly) vegan and nothing clicked for her to lose weight until she had the surgery. So she has NO room to be snobby or anti-fat.

Another post Nephew had added recently included a pseudo-scientific infographic about how a vegan diet is more satisfying than the Atkins (or Paleo) diet because you can fill your belly with natural vegetables instead of only a tiny amount of meat (measuring calorie for calorie) which, theoretically, means you’ll be full and happy only if you’re vegan. One of Nephew’s quite wise friends commented that the study was bullshit and about as scientific as astrology. After all, the digestive process of those foods — as well as their effect on body hormones (including insulin) — is significantly different than a small piece of meat or fats which actually make you feel more satiated in the long run. This started another flame war between this friend and Evil Sis to which Nephew stepped in and said to his friend not to pick on his “Wonderful Aunt EvilSis”. Barf. I suspect his friend was unamused, but I like the guy whoever he is.

All this said, now consider this: my EvilSis and Nephew have cut their own family members out of their lives based on a dietary choice. True, most vegans also consider it an ethical choice, but if you change religions, do you cut off your family because they’re not converting? And if you do, what does that truly say about your “ethics” or true intentions? You’re choosing a cow over your sister (or mother or father, etc.). How sad is it that what amounts to a lifestyle choice can be the proverbial straw that breaks a family’s back?

After all, if I’m willing to put up with your crazy vegan ass, why can’t you put up with my meat-eating one?

Hah! And to think, I’m the one in therapy.

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I am an only child. I have one sister. — Woody Allen

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Posted in family, memoir, remember when?, weirdness, Who's the bitch? | 2 Comments

Adventures in Intimidation

bullI do not enjoy being a shadow of my former self. The people I know now have no idea how I used to be, they just think I’m just a fat schlub with no talent and no makeup and her hair up in a scrubby ponytail. And the people I used to know can’t reconcile what they see now with what they once knew.

And I never realized how much I relied on codeine and vicodin to give me that extra boost I needed especially when my depression prevented me from getting things done. Now that I’m starting to understand things in that light, I realize how completely far I’ve fallen.

My visit with Square-Jawed NP finally happened last Friday. I really hate the new practice he belongs to. The waiting room was populated by truly crazy people — I was the most normal person in the room. Understanding how overbooked he was (he’s on vacation this week so they crammed everyone in last week at the last minute), I brought a book, my Kindle, and had even downloaded a movie to the Kindle, just in case. The melange of crazy people hadn’t prepared as well and were complaining — loudly.

One particularly agitated person in the waiting room was a mid-twenties African American man adorned in gangsta gear with a handful of similarly dressed friends accompanying him. He was a walk-in on perhaps the worst day of the week for such a thing. He complained ad nauseum how “fucking unfair” it was that he had to wait. That if he didn’t get his medication, he was going to go out and shoot some people because these “assholes” didn’t realize how much he needed his meds.

Lucky for me as I sat there, we lost a few people via attrition, those who had been waiting for two hours and refused to stay a minute longer. One woman was angry and approached the receptionist demanding(!!) to know if NP had snuck out the back to go to lunch or if he was actually in with a patient. The amazingly composed receptionist reassured the woman that, yes, NP was in with a patient and had not dared to ‘sneak out’ for lunch. The crazed woman did not believe her and stormed out.

009-18-gifEventually, NP poked his head out from behind the locked door to call in the next patient and (Surprise!) told me I’d be next after that. The Gangsta guy went ape insisting he needed to see NP right away and calling him a “fucking asshole” and on and on. NP — showing enormous restraint — explained calmly that he would fit Gangsta guy in after my appointment, but that he would have to wait patiently since Gangsta was a walk-in.

I sat there for a bit longer as Gangsta guy threatened to call the county mental health people as well as his lawyer. He was infuriated and was letting everyone know exactly how much.

Not long after that, NP poked his head out again to call me in. THEN the Gangsta guy really went totally apeshit. He stood up and became threatening. The receptionist called for someone to calm the man down. NP stood stone-faced and silent while Gangsta laid into him with every insult in the book. I gathered up my stuff as quickly as I could in order to get behind that locked door myself. NP walked me in.

Finally safe behind the locked door, NP apologized saying, “I’m so sorry you had to put up with that.” And he kept apologizing even though I reassured him it wasn’t his fault. After all, it shouldn’t be surprising to find crazy people at a psych office. I just wished they had a separate room for those of us comparatively ‘normal’ patients!

He had to take a comprehensive history again since this is a new location with all new computer systems and software, incompatible with the records from the old place. I was fine with going over it all over again. My appointment was 45 minutes, so however he wanted to spend that time was fine with me (as long as I wasn’t outside with the nutballs).

wellI discussed my continuing depression with him as we went over my medications. He was concerned that I was on too many different meds and that it might appear to be “poor practice”. I reassured him that I didn’t think it was. After all, I’m still depressed, just not as much. And besides, some depressions (dysthymia in particular) are notoriously stubborn to treat. For now, he wants me on one more medication — non-SSRI Wellbutrin — which I had run out of last month waiting to see him again. We’ll revisit the situation in three weeks after we’ve given the Wellbutrin fair time to take effect. (Honestly, I don’t think the Wellbutrin is doing jack, but I’ll keep taking it just the same.)

singThat being over, I told him about my new voice lessons — something that isn’t going particularly well — but apparently has his full support and encouragement. I explained to him how hard it suddenly is, and how frustrating that I can’t do what I used to so easily. It also allowed me to segue into some funny stories from my “heyday” when I was singing several years back. I even confessed to him that my biggest problem with my voice was always intimidation — brave as I was, and as talented as people told me I was — there was always someone who snuck in and scared the crap out of me. My voice would shut down (just as it is now) and be nothing but a timid squeak, thin and screechy, especially on top. And it feeds on itself — the worse I sound, the more intimidated I become which makes my throat shut down more, making the sound worse and on and on. The vicodin (or even just a few milligrams of codeine) often helped me overcome that. It relaxed my throat and allowed my voice to be free. I told him I’m not sure what’s going to happen now that I don’t have that crutch. He reassured me that I’d figure it out. NP is a lot more confident about it than I am — but I’ll keep going at it. Each lesson gets a little better.

We also talked about my potential return to school, recently approved and now up to me. We discussed old movies and a recent art exhibit at a local museum (which is my assignment — to attend the exhibit and report back in three weeks).

As we finished up, NP apologized again for the behavior of Gangsta guy, and again I told him not to worry, but wished him luck as NP still had to deal with him. “Maybe if I get lucky he’ll have given up and gone home,” he chuckled. I agreed and wished him luck again. NP escorted me to the outgoing receptionist and proceeded to head to the other door. I looked across the glass and didn’t see Gangsta guy or his cronies. Perhaps NP figuratively (and perhaps literally) dodged a bullet, I thought.

gangsWhen I left, it turned out that Gangsta Guy and his friends were out on the street corner having a smoke. I had to pass by them to get to the parking lot, and as I walked by, one of them commented, “Well you sure look happy!” I didn’t realize I was smiling. Then another remarked, “So that’s what he was doing in there. Getting a nooner!” I was mortified — for me and NP — and, I admit, slightly flattered. I guess I look pretty good when I clean up, do my hair, and wear makeup. But yes, I was mostly mortified. And I was worried what Gangsta guy would do or say when he found out that he lost his place in line. Or when he got in to see NP. Good lord. Crazy people. Of course I thought of a lot of snappy comebacks after the fact, but was too flummoxed at the time to come up with anything. Probably for the best. I’m sure that some smartass remark probably wouldn’t have gone well for me.

Since then, I’ve done a lot of thinking about things — life in general. In my voice lessons, the most difficult thing for me at the moment is hitting the top notes without screeching or worse yet — cracking. My voice actually cracks! It CRACKS! What??? Something is desperately wrong. Why can’t I do it? Something is basically wrong. Do I really need vicodin or codeine in order to sing? Was that my secret — or can I sing without it somehow? And if so, HOW? It’s unbelievably frustrating to try to do something you used to do so easily and fail, discovering you’re now encumbered by some mysterious problem you can’t identify.

It comes down to intimidation. My life is full of it now. I can’t speak my mind because I’m dependent on so many people and I’ll lose their support if I get mad. If I told Mrs. H, for instance, to go to hell when she gets pushy or asks too many personal questions, I’d be tossed out on my ear and fired, leaving me broke and without that precious vehicle she lets me borrow on occasion. If I told Auntie and Uncle Crazypants to quit being so freakin’ weird or told Auntie to quit being so damned self-pitying, same thing. Tossed out with no one to rely on.

At work, I’ve learned to swallow my pride and eat a lot of crap. I don’t speak my mind or stand up for things I believe. Someone contradicts me and I just fold and shrug my shoulders. “What difference does it make?” I think — but I never used to be like that. Sad, really. So few situations give me the freedom to speak my mind or feel brave and confident that I think I’ve completely lost touch with that feeling. I feel insecure and scared most of the time. I depend on routine to keep me sane. Any interruption of that routine, and I feel like a shitball.

I’m becoming exhausted from this constant low-level depression. I just want to kick-start my brain, reactivate it, force it to get motivated to do SOMETHING instead of sitting around trying not to run out of the room screaming. I admit, the idea of popping a vicodin, for just one afternoon, is sorely tempting. Instead, I exist from day to day waiting for my brain to do something constructive. NP thinks I’m making such amazing progress, but I told him I wish I could feel that for myself.

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“I don’t think ethical people deal with intimidation as a method to achieve success. Undermining someone’s self-esteem isn’t a method to achieve success.” — Dominique Moceanu

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Posted in + recovery, addiction, bipolar, depression, loperamide abuse, opera, random crap, sobrietyland, therapy, weirdness | Tagged , , , , , , , | Leave a comment

Therapist Barbie and the Long Wait to See the Nazi (aka Bring a Book)

barb4Last Thursday, I finally had my intake appointment and first encounter with Therapist Barbie. I’m happy to report she appears to be quite astute, amazingly. Of course time will tell, but I was surprised by her ability to have solid insight through what little I shared with her during the initial visit which mostly consisted of questions/answers.

As some of you know, I found Therapist Barbie as a result of switching practices in order to follow the Square-Jawed NP, my medication management Nazi who left the old practice.

The new office is stark and uninviting. Located inside a sizable, intimidating business building, the psych office appears to be the poor orphan step-child of the large conglomerate it’s owned by.

rastaOutside, a half-blind Rastafarian homeless man sat leaning against a telephone pole playing an unplugged electric guitar, and acting as welcoming committee, greeted me with a wide, toothless grin and a hearty “Hello!”

Entering through two sets of glass doors, I was then greeted by the stark waiting room, painted plain white and accessorized by cheap chairs, fluorescent lighting, some year-old magazines, informational trifolds about schizophrenia, ADHD, and other mental disorders, and no TV or radio for entertainment. That’s what you get when you have Medicaid, I guess.

The receptionist sitting behind thick glass was at least friendly and gave me all the paperwork I needed to fill out. After that, I had to walk around through the hallway to the next receptionist who took more information and more paperwork.

Once all that was done, I sat in the waiting room again in anticipation of my appointment with Therapist Barbie who would complete the initial intake appointment — basically making sure I’m just crazy enough to qualify for their assistance.

treatQuite a bit different from the psychiatrists’ offices you see in the movies and on television. I’ve been watching the old HBO series “In Treatment”, and their setup couldn’t be any further from TV therapist Paul’s cozy office and couch.

While sitting in the waiting room, I had a few moments to observe some of the other clients as they came and went. One woman who came in was belligerent about not getting an appointment when she wanted. They seemed to know her and go through this with her with some frequency. Another was a father and his teenage daughter, who walked in to see the Square-Jawed NP — former patients of his at the old practice — misinformed that walk-ins were accepted, and were turned away. I felt bad for them because they said they’d just found out about NP switching practices and appeared to be desperate to see him. Popular guy, huh?

Expecting a long wait, I settled into the only corner with an electrical outlet adjacent to the chair and pulled out my Kindle to surf and read. But it wasn’t even a few minutes before Therapist Barbie called my name. I was escorted down a long hall of offices and entered hers. It was a small office, tastefully decorated with a large painting, some inspirational posters, lots of books, and two or three large square chairs opposite her desk.

She proceeded to ask me numerous background questions beginning with “what brings you here today?” Other questions were regarding family history, friendships, relationships, work history, substance abuse, etc. Barbie’s sharp and insightful responses to my answers indicated to me that she wasn’t as dumb as her beauty belied, and she’s well worth my giving her an even chance. I think she may prove interesting. We both agreed that given my increasing depression levels, I needed to get in to see NP for medication management adjustments as soon as possible.

I was also warned about long waits. “How was the scheduling at the previous practice where you used to see NP?” Barbie asked. “Did you have to wait long?”

“No,” I replied, “Sometimes ten or fifteen minutes, but never long.”

“Well,” she laughed a little, “here it’s quite a bit different than that. Bring a book because our waits are usually quite a bit longer than that.”

Uh, wonderful.

The appointment lasted between 45 minutes and an hour, and when I left, I was told to come back and see her in three weeks, and was instructed to see NP as soon as an appointment was available.

Apparently, the main problem in making an appointment is that everyone is going on vacation thanks to the end of the summer season — including NP. Plus, the practice has lost its two other medication management people, and NP’s the only one available for ALL their patients. This complicates matters. The scheduling receptionist appeared to be frustrated by the problem of fitting me in before NP went on vacation. She ended up triple-booking my appointment (after telling me the ones before mine were already double-booked). “That’s the best I can do for you. Bring a book,” she advised.

Again with the bring-a-book thing.

nazihappy

I’m going to make you wait four hours to see me, and see if you’ll actually do it! How dumb are YOU?

My long-awaited appointment with NP is 11:15 tomorrow morning, except since all appointments are double- and triple-booked, I calculated that I’ll be there around 4 hours before getting in to see him. FOUR HOURS. Dudes, I don’t wait four hours for ANYBODY. I wouldn’t wait that long to see the Pope let alone some Nazi who’s gonna harass me about attending stupid AA meetings. Fun as he is, four hours is a long friggin’ time to wait. I’m hoping this kind of ridiculously long wait is more the exception than the rule. If it isn’t, I may have to go back to Milquetoast Guy at the old practice instead.

The one thing I have on my side is patience. If I can position myself in the one corner of the waiting room that has an electrical outlet, I can watch movies on my Kindle while I wait or at least “bring a book” on it.

So why go through all this? Well, for one thing, I’m not a quitter. I’ve been waiting a long time for this, and I’m not giving up just as I’m in the final stretch. It’s rather like playing a video game where you have to kill off all the “little bads” to get to the final round and the “big bad” and win the game.

I intend to win and hopefully when these vacations periods are over, the office will settle into a shorter wait time and seeing NP won’t be so difficult.

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 It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.–  Julius Caesar

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Posted in + recovery, AA, addiction, bipolar, depression, sobrietyland, therapy | Tagged , , , , , , , , , , , | Leave a comment