Welcome to the Pharmaceutical Hassle of Utah's Medicaid

Well, I had my Medicaid orientation last week.

The GREAT news after getting on the horn today with the State Medicaid office is that the retroactive Medicaid cards I was supposed to have gotten, weren't screwed up and I wasn't accidentally applied for not retroactive. They must have gotten lost in the mail. Even better than the 90 days retroactive before my April 13th surgery on my right knee, is that it goes retroactive all the way to January first, which covers the home physical therapy and home rental of the knee machine rental from the FIRST, left knee, surgery, too! I hadn't thought that most of January would be covered! And, after the orientation last week, I had thought that, since I had only received a card for June, it sounded like I might only get the cards for the 90 days prior to JUNE, and not prior to my SURGERY date, and had resigned myself to only getting the last month of my previous surgery's physical therapy paid for, as well as the anesthesia from this surgery, which is the first bill that came through for it and maximized out our deductible . . .

I am also unsure of how to submit pharmacy expenses from earlier in the year, if I even can at all, which I probably can't. That was one thing I forgot to ask the benefits lady at the orientation, but I've got her number, so I can call and ask.

They're sending me new retroactive cards going back to the beginning of the year, but said I can use the number off of June to give to providers. It's a good thing that retroactive expenses do NOT need to be on the provider list with the plan I picked for June and going forward, because the plans they had did NOT have my orthopedic practice (knee, hip doctors), nor my physical therapy place, etc. For retroactive stuff they just pay it straight from the state, without going through a plan.

Anyway, now to the pharmaceutical stuff, which I was looking at today. There was NO NO NO mention in the orientation about something that happened a year ago, in our state legislature, but THAT's no surprise since they are working with printed books that are from 2008!!!! UGH UGH UGH UGH!!!! I mean, REALLY!!!

What happened in 2009, was this:

Preferred Drug List

During the 2007 legislative session, the Utah State Legislature passed Senate Bill 42 allowing Medicaid to adopt a preferred drug list (PDL). During the 2009 legislative session, the State Legislature approved SB 87, which authorizes Utah Medicaid to require a Prior Authorization for non-preferred drugs. The PA requirement became effective May 18, 2009.

Direct from the horse's mouth, as it were. After looking through the two lists, there's only ONE of my medications on the "Preferred" list, and that's generic omeprazole. My other meds are Vyvanse, Geodon (still ramping this up), Lorazepam, topirimate (generic Topamax), and, not prescribed yet by the new psychiatrist but part of an as needed basis prescribed by previous psychiatrists and listed to the new one, and not told to stop, taken as needed when I remember which I usually don't, alprazolam, the generic for Xanax. The Lorazepam is also as needed, which I've only needed it once for agitation in the two and a half weeks I've been on Geodon now, and I suspect that that situation would have aggravated me Geodon or no.

Anyway, so I'm not concerned/worried about the Xanax, since I forget about it most of the time. That leaves four medications for my psychiatrist to get approved by Medicaid. Now, she doesn't TAKE Medicaid so she probably won't be used to this; Medicaid is contracted with Davis Behavioral/Mental Health, in Davis County, where I live.

I wrote once or more about how I had, once upon a time, seen them in the mid-90's for counseling; in fact, the time I tried to kill myself, was the week my counselor went on vacation, although there were MANY other factors at the time as well; THAT, though, was one of them - Having my ear to talk to taken away from me, when I was in the middle of so much . . . but that was a difficult time, when I understood so much LESS . . . I wrote, once or more, about how I had used their services, and then, several years later, tried to turn to Davis Mental Health again, and was told something like, unless you are funded from a certain source (I assumed, Medicaid or Medicare), we can't see you . . . funding cuts . . . They had previously seen me on a sliding scale, but couldn't see me at full price even, at this subsequent time. I then left, disbelieving, that society didn't even care if its citizens had any kind of mental health services . . . .

I eventually related that story, with assurances that I was now currently in treatment with a psychologist and psychiatrist, to my state's then-governor, Jon Huntsman, over the radio, KSL 1160, on a radio call-in show with Doug Wright as the host. I brought the issue of mental health issues and funding up, since it was the fact that the state hadn't picked up the slack in funding brought about by the federal dropping 7 mil in funding; the state had only picked up $2 million of it, and needed to pick up MORE of it, because people like ME had fallen through the cracks, like the story I just illustrated. The responded kindly and nicely and seemed to understand my point. Let me tell you, I was scared to DEATH, lol!

Anyway, back to the stupid Medicaid drug approval process. This is ASININE that it wasn't a part of last week's orientation!!! And then, to have 4 out of 5 medications not on the list? Heck, there wasn't even a category for anti-psychotics, or for mood stabilizers, or for antidepressants, or for ANY kind of mental health medication!!! Probably because of the cost, and probably why they want them approved . . . . stupid bunch of red TAPE!!!

Even though my insurance doesn't run out until the end of July, I'm going to ask her at the early July appt. to work on it; I'll have to print out copies of the form at the library, as our printer recently died. I hope she doesn't say, YOU do it. SHE has to, if you click through at that page and read the form . . . she's supposed to include a copy in my chart, for audit purposes, too. Not that she takes Medicaid, but since I'll be getting the medications using the Medicaid benefit after July, she'd better fill out the forms, I mean, what choice does she have?

I am not sure how I'll pay her after the insurance goes . . . like I say, Medicaid is contracted through Davis, but I'm a little leery, because what if we suddenly don't qualify, like if my husband gets really lucky with the job search on the pay rate? Yeah, one can wish, but maybe the Lord will bless us. What if that happens, and then I'd have to drop THAT psychiatrist, too? So that's why I'm leery, for one reason, to switch, even though I haven't been THAT happy with this new psychiatrist. Plus, we're currently trying a new medication, and I hate to switch in the middle of a trial.

I REALLY hate red tape, though. I do feel for the extra time an already burdened w/paperwork doctor must feel, BUT . . . I don't have a choice, here. Medicaid ain't much fun for the patient, either, people. I feel like a show dog being led around by the nose - go here, do that, get this treat that tastes like crap, go do that, jump through this hoop . . . . yada yada, etc.

PsychoPharmacology: Make It Up As You Go, & Damn the Patient!

You want agitation? You got it!

I want to prove this lady WRONG.

WHY do I keep getting psychiatrists who won't LISTEN?

Even worse, being dismissive of my concerns, is rude, hurtful, potentially medically harmful, and insulting, besides being destructive towards the therapeutic relationship, if it can be said that my psychiatrist and I have much of one.

You don't have to DO what I say, but HEAR me, please! Give me the respect of listening; I thought that was part of your job. When it becomes SO obvious that you AREN'T LISTENING, I just want to tear my hair out!

Okay, so I go in today, and say that I feel less stable since she's had me lower my topirimate (generic for Topamax) dose from 150 to 100mg. She wasn't the original prescriber of this; my last psychiatrist was. I talk about why I feel less stable, and this she listens to.

I tel her I don't seem to be feeling any effect from the Seroquel, which had been upped from 300 to 400mg last time, other than the usual bedtime sleepiness; it is decided that the Seroquel isn't working.

She decides to prescribe Geodon, which is especially good for the manic side of bipolar, I'm not sure if it handles both sides . . . . she lists some of the effects, and side effects, noting that "it helps stop cravings for carbs.". She happens to sub-specialize in nutrional issues, not that I've ever mentioned a carb problem, but I respond with the fact that I have PCOS (Poly-cystic Ovarian Syndrome), which tends to cause its sufferers to crave carbs, and she seems delighted that this little aspect of the medication will be so suited to counter something I have.

Like carbs are a major issue, here. DEFINITELY not a priority, although since we're poor, pasta and rice are often on the menu.

Besides, this medication has the potential to raise my blood sugar, with the potential in some cases for diabetes, I think, as well as it has the potential to cause weight gain (the literature I got listed this weight gain for 7% of the schizophrenic patients and didn't mention anything about it for the bipolar patients, but I doubt the weight gain would discriminate between the two). Now, I may have recently lost some weight, but I weigh enough (around 240, right now) that putting me on a medication with these two potential side effects (which, as a difficulty for the psychiatrist, so many of the bipolar medications seem to have these, which is why I think I've been prescribed such non-traditional mood stabilizers, as a way to avoid those, esp when I was in the 280's and 290's) is a questionable thing to do, in my mind.

Still, I'm not the doctor, and as I mention above, the choices are limited for mood stabilizers that don't have at least one or both of those types of side effects, at least as far as the on-label approved for use goes. The Gabapentin, and then, the topirimate after it, were being used "off-label", ie, the FDA doesn't recognize them for use as mood stabilizers, and, in fact, in Gabapentin's case, I believe had come down on it's manufacturer for trying to promote it as such. I did feel some effect from it though, but topirimate has worked better, I believe.

So, my new psychiatrist prescribes Geodon, and some lorazepam in case I develop agitation on the early, low doses of Geodon, which happens sometime, to counter it.

She told me to stop taking my clonazepam, which makes sense considering she'd just prescribed what I'm guessing is another benzodiazepine, given the "-pam" extension, but it's just a mild sedative, it's not meant for countering the stuff I do when I'm asleep at night.

I asked her, what do I do about THAT? The stuff I do when I'm asleep, like yelling, hitting, etc.?

She said, very dismissively, and in a manner that felt like it was pulled out of thin air, "Up your dose of topirimate to counter that, it will act like the clonazepam did to stop that stuff", or something like that.

I'm assuming she means to up my dose, all at night, right before bed - she wasn't very specific.

I was stunned, though; in my years of taking topirimate, my previous psychiatrist had never mentioned this property, and most psychiatrists don't prescribe clonazepam or any other benzodiazepine casually; of course, he may have been prescribing it additioally for it's anti-anxiety effects, as I was to take a tiny portion in the morning, to help keep a constant level in the blood, and then of course my nighttime dose, but . . . you'd think he would have mentioned that the mood stabilizer I was taking would have substituted for the clonazepam to take care of all the night stuff, if indeed that was one of it's properties.

I absolutely frickin' don't believe it. It's a painkiller, that some people I know take, or took, for migraines; some take as a mood stabilizer, like me, and now it's got an additional property I'd never heard of??

I was just disbelievingly stunned, that she would dismiss my concerns so quickly, with something that sounded like fiction to me. It also sounded like she didn't give a fig what night symptoms I had, either.

Later, it occurred to me, that if I up my dose back to it's mood-stabilizing effective dose of 150, to counter the night stuff (even if it doesn't work for that), then why the hell would I be taking an additional medication to stabilize me? How would I know what effect would be coming from which medication, then? It would be two medications where only one was needed.

This is why I said, at the beginning of the post, you want agitation, you got it! How am I then supposed to tell, as I start taking this medication Geodon, if the agitation is because of IT, or because I'm pissed off at my psychiatrist for being so . . . . . idiotic.

I'm going to take extra topirimate before bed tonight, and hope I have yelling, screaming, kicking nightmares, so I can call her in the morning and tell her how wrong the hell she was, and what now does she recommend?

Cause I'm PISSED, and I can't risk endless nights of possibly punching my recently operated leg (ow), or waking up to it jerking and convulsing, like I did a week after I got out of the hospital (OW), or waking up to me yelling HELP! as if I'm being raped and murdered, liked I believed I was in the nightmare, and then hearing the people in the apartment above wake up and turn over and go deathly still, listening for further signs of attack, me holding my breath against them waking and coming downstairs to pound on the front door, relaxing when they finally relax and turn over back to sleep. I'm hoping I don't throw any left or right hooks though; that behavior seems to be fairly rare, thank goodness, but then I've been on clonazepam for quite some time so who knows how rare it is . . . . . . .

Here's hoping I prove that WOMAN wrong TONIGHT, despite it meaning nasty nightmares for me.

Now, if anyone knows if that med is supposed to have this effect, I'd appreciate a comment, but . . . . yeah, I know it's the internet, grain of salt, not my doctors.

A Quick Call to the Psychiatrist, Regretted

Ooooh, am I so peeved at this woman!

Then again, why WOULD she know who the hell I was, calling, anyway? I'm just a new patient.

Don't put down your cell for pressing matters if you don't want it called. Of course, ones' definition of pressing might differ from someone else's, but it was 9 minutes after her office closed, and the call was 90 seconds or less, so I figured it wasn't a huge bother. It could have been longer, had she not acted the way she did, but she REALLY did not represent herself very well at all. Then again, since she had no idea who the bloody hell was calling her, that's probably partly why I'm pissed off.

Still, all my defenses are going to be UP UP UP like you wouldn't believe, when next I meet with her, and the pressing need behind the call is going to stay buried. From her, at any rate. My psychologist will know, but hell if she will, and I don't give a damn if that means my treatment isn't correct because she needs to damn well earn my trust, and act like a doctor, a psychiatrist with at least a SPECK of empathy, and not a bitch.

Strong language, but the phone call was . . . . jarring. I sincerely regret ever picking up the phone to call that woman. I give her 4 appointments to see if this relationship is workable.

I don't know if I have it in me to seek another psychiatrist, but for my own health I shouldn't give up on psychiatrists entirely, and I know I'm catastrophizing and over-magnifying and blowing things out of proportion, partly because of how infinitely STUPID I feel after that short phone call. All sorts of distorted thinking & thought patterns . . . . it's just, . . . .

I'm like a dry tinderbrush right now, and anything could light me afire at this point. Even the stress of thinking about going to see her, after that stupidness of a phone call. I'm too impulsive, and that call is one impulse I really, really regret. If she's any kind of a psychiatrist at all, she hopefully won't try to make me feel stupid (er) than I already feel about it. If she does, I'll take that as a sign that she's got no sense of empathy or speck of human connectedness about her at all. Which would make me wonder what the heck kind of psychiatrist she is, anyway.

See, though all of this flailing around wondering, spurred on by my embarrassment over a teeny phone call where little was said, is a whole lot of to-do over what is likely nothing. Making straw men out of nothing. Making up potential issues where none may exist.

So we'll see, but as I say, I'm going to have all my armor on because I'm tired of feeling emotionally beaten up or having the rug pulled out from under me and bloody surprised like the way I was at the first appointment; she's got to EARN my trust after THAT stupid maneuver, as well as after her manner with me on the phone, granted that she didn't know I was a patient for half of the very short phone call, though.

Anyway, UGH. Despite the shortcomings of my first two psychiatrists, at least I knew that they genuinely cared for my well-being. Also, neither of them thought I was stupid or annoying, as far as I knew. Well, my first one was sometimes . . . well, it depended. In the end, though, I knew he was sincere.

See, this seeing a woman psychiatrist thing is fraught with a psychological minefield, in addition to all the other problems that have come up. I have plenty of reasons not to trust women.

How It Is, & Thanks Shrink Rap!

Dinah, of the Shrink Rap blog, was true to her word and wrote a post regarding what I described in my previous post here, about my Psychiatry Bait-and-Switch experience, as I title it below. She titles her post, "Hey, What are YOU Doing Here?", and then talks about what her experiences as a psychiatrist have been at different facilities as well as in her own private practice have been in regards to the initial interview and the procedures for it, as well as what the standards are for it as laid out by the American Psychiatric Association (I think).

In the comments, one commenter/psychiatrist brings up sections of the American Medical Association's recommendations & guidelines for practices relating to issues regarding how a psychiatrist should conduct ones' self regarding splitting duties/fees, (at least it is implied that if you are splitting the duties that much, then isn't much of the fee for the session going to the person doing much of the work, thus splitting the fee?) . . . . as well as allowing ones' self, as the psychiatrist, to be used as a figurehead, not being in the patients best interest at all.

I thought those were VERY interesting and informative to read about. Both the post, including the standards from the APA, and in the comments, the further standards and guidelines especially directed towards psychiatrists, from the AMA . . . .

It's an interesting discussion, of which some has spilled over into the comments on my own post, entitled Psychiatry Bait-and-Switch, here on my own blog, from people who followed the link to that post from the Shrink Rap blog. Please feel free to join in the discussion there.

It is heartening to see that there are doctors out there who do not support behavior that is so fringe and will speak up to inform about the profession, and who are embarrassed on behalf of their fellow psychiatrists, and that there are those who care enough to post an informative post for me like that; Dinah, I really appreciate it.

I know it's my own choice about what to do about my own health care, and given everything going on with me, at present I feel that it's best that I'm under a psychiatrist's care, than none at all. That should tell you something, about the pressures I am under. How trapped I feel by circumstances beyond my control.

I added up all the medical expenses from March and expected medical expenses through the end of May and it adds up to $1800 or more, just shy of what we need to hit the deductible - I really don't want to go into surgery without it being met, but it's not like we have $1800 in 2.5 months to meet all these expenses, either, let alone the $2800 the MRI people want. So I'm shutting down, because I can't cope with the reality of the life that is in front of me.

I. Can't. Handle. It.

And.

I am in constant pain, that is wearing me down, and I don't know if I'll have the OOOMPH and the willpower to bull through and do the painful work needed to recover from another surgery, let alone continue with the work needed to continue with my current recovery. I'm feeling so burned out. OUT. OUT OUT OUT.

EMPATHY is NOWHERE TO BE FOUND, and I AM ALONE as if there was NO ONE. ALL. BLOODY. BY. MY. SELF. and it hurts.

I can't think my way out of this one. Money doesn't grow on trees, and recovery doesn't happen overnight.

So, as long as there's no more Energy Healer, and I can scrape up the dough from somewhere for both meds and visits to see her, I'll go to the psychiatrist unless something untoward happens, with constant revisions as time and experience go on, with her. My condition requires being in someone's care, right now. Those are big ifs, though. If I can't afford the care I need, then I'll just have to, well, say that mental health care is unaffordable, both the doctor visits, and the medication. Even if it is essential. Even if this is America, where you aren't supposed to be in danger because you can't afford health care. Who says? That's the way our system is.

I'm tempted to not post this, but I want to lay bare the real truth of how it is, so here's how it is.

Psychiatry Bait-and-Switch

New patient appointments with psychiatrists are usually 90 minute appointments, and subsequent appointments are generally 15 to 20 minutes to deal with medication issues, unless you are also seeing the psychiatrist for your psychotherapy, which many insurance companies don't like anymore.

I do not know if it is an acceptable practice for a psychiatrist to "farm out" part of the initial interview to a colleague at their practice, such as an LCSW (Licensed Clinical Social Worker) or other mental health professional, and then come in for the last 20-25 minutes and be filled in on the most pertinent details (things like family history that I had already addressed in the New Patient Information packet that I had been asked about again in the interview were not brought up in this "fill in the psychiatrist" process, thank goodness; perhaps it was assumed that she had read the history, and that she'd read the interviewer's full notes later) . . . . . .

I do not know if such a thing as this is an acceptable or accepted practice . . . I do not know what my insurance company would say about it, either.

Shockingly, I wasn't interviewed by anyone I'd consider a mental health professional, though I think the people within the group practice there might disagree. I was interviewed by an Energy Healer. AN ENERGY HEALER. Of all the mumbo jumbo hocus pocus crap, pardon my language . . . . . this is fine, for those who believe in it. It is not fine for me, because this is not what I was there for, and despite the fact that her "degree" includes courses in psychology and psychodynamics (when I first went there to fill out the new patient forms, I picked up the business cards of everyone there, and a flyer or two, including the one for this Energy Healer, to take home with me to read, to get a "feel" for this different kind of a place that I'd be going to), I do not consider her a mental health professional.

I also consider it a wasted opportunity on the part of the psychiatrist, because with the limited time we are allowed in subsequent "med check" appointments by the insurance company, she has missed the opportunity allowed in this first, longer appointment in getting to know me that she could have had in interviewing me herself.

Now, if her practice is busy enough that she can't take new patients on without farming part of the interview out to a colleague, then at least do it to one of the LCSW's or PC (personal counselor? professional counselor?) at the practice, and not to the energy healer . . . . .

With as long as it took me to find a psychiatrist last time, and as quickly as I found one this time (although that might be a warning sign, I don't know, although the open philosophy the practice holds would indicate, I HOPE, that they'd not try to force one down a path you aren't comfortable with), I AM happy to have gotten in to a psychiatrist at all, AND the time I DID spend with her (none of it one-on-one, though, the energy healer was still in the room the whole time) I thought she was sharp, in a good way, on the ball, knew her stuff, made a decent impression for the negative impressions that I'd already had going, having been thrown for a loop or two by being farmed out to the energy healer, and a really negative interaction with the office staff at the front desk, which was another throw-me-for-a-loop interaction that is causing a huge amount of anxiety.

The thing is, I cautiously quite like her; the psychiatrist, that is. Based on the little time I had with her.

Counter-balancing that, though, is the resentment at being forced to open up to someone that I'd never have opened up to, had I not been forced to. She's not going to be part of my ongoing visits, as the med checks will be with the psychiatrist herself, but when my arthritis and the prognosis would come up it was assumed that what the doctors had said about my future wasn't really how things had to be, because what the Energy Healer does is supposedly supposed to change that kind of thing. I resent that she or they assumed that I was or would buy into that way of thinking, as well. Although, since that's their worldview, how could they not think that way? It would be like asking them to be something other than who they are, so I suppose I couldn't ask anything else.

At my next appointment, my problem with the staff in the office will be mentioned, unless the anxiety becomes so great that I have to call her and mention it before then (ie, it might prevent me from coming back, and if it does so, I may be done with psychiatrists forever), as well as my resentment at being forced to open up to someone that I was not prepared or expected to open up to, that I would not naturally trust, will also be mentioned. These things are important to maintain a good working, trusting therapeutic relationship between the psychiatrist and myself, although I worry about complaining about the office staff, as well as complaining about the procedures she's established for taking on new patients. I have to counter-balance those worries with how much anxiety the office staff interaction has and is causing me, as well as the amount of resentment caused by the bait-and-switch thing, the amount of resentment caused by the fact that I never would have opened up to this other woman if I hadn't have been forced to.

I still wonder if it makes me a bit of a, pardon my language, bitch, that I had this office staff problem, and problem with the new patient procedure, though. Still, on the latter, I've never HEARD of anything like it, especially involving a non-mental health professional, at least as most of the mainstream world would define the term . . . . .

I was raised to be a bit leery of psychiatry/psychiatrists, and this whole experience just leaves me extremely unsettled, despite the fact that the psychiatrist seemed really good, although I don't have much to go on, there, and I have to make some judgements of her based on more than our interactions; I have to judge her on her intake procedures, office polices, and other things.

She's got me titrating up EXTREMELY QUICKLY on Seroquel, so we'll see how that goes; depending on side effects, we may slow it down a little.

I'm hoping that the peeps over at Shrink Rap see this post, and respond with a post on if they've ever heard of acceptable or not practice of farming out part of the new patient intake interview . . . . whether it be to a more mainstream mental health professional with a lesser degree, or to a more odd "specialty" such as happened to me. Even if it's acceptable within the profession, it's still a missed opportunity on the part of the psychiatrist, as I stated above, to get a good read on the patient.

I see her again in a couple of weeks, on a Saturday morning of all things!

In Which I Go To Church, & Burst Into Tears

Today I went to part of my church's worship service, the main meeting: Sacrament Meeting. The other two parts, well for women, are Relief Society, and Sunday School. For men, depending on which Priesthood one is called to, you go to Elders Quorum, or High Priests'. Then it is Sunday School, along with the women.

Now, some congregations have their Sacrament meeting first, before these other meetings/lessons, and some have them last. Ours has it last. Part of the reason is we meet in our building with several other congregations, or "wards", as our term is, and we have to stagger the schedules. Often, it is felt, that if Sacrament meeting is held last, that some people will feel that they can come to church late, which is not something the leaders want to encourage, and so it is more often practiced, when possible, that Sacrament meeting is first. Still, it is sometimes not possible to always do so.

Anyway, that's more than you likely ever wanted to know about the LDS Sunday Meeting schedule, lol, and that doesn't even take into account the Primary (which is the children) or the Young Women & Young Men's groups, either.

So, today was the first time since surgery that I've been to church. I could have gone back earlier, but I haven't. Going to church is a HUGE anxiety disorder issue for me. I mean HUGE. Being around all those people, ESPECIALLY crossing over the threshold into the chapel . . .

Today, though, my tears had naught to do with the anxiety disorder, at least, not how you might think . . . .

After I'd been sitting on the back bench for a few minutes, right before the meeting was about to start, a familiar feeling in my left leg and knee brought me up short and aware and I looked around at the benches and behind me to the overflow area at the padded folding chairs, and I was filled with horror - every seating surface I could see was angled, with the front edge higher than the rear edge.

If you don't know because you may not have read the posts about earlier in my recovery from this total knee replacement, I have been having an odd side effect that the surgeon has never heard of, which I talked to him about a bit at my recent appointment, just a little. When I sit on chairs or surfaces that are angled upward at the front edge, from the back, ie, the front edge is higher than the back end/edge of the seating surface, something in the way it presses against the back of my leg/thigh somehow causes an escalating pain reacting in the knee that he recently replaced, which is still recovering. I'm guessing there's some nerve(s) or bundle thereof that sends a signal to a bad spot, setting off a chain reaction . . . perhaps it's a quirk of my anatomy, or perhaps when they were cleaning out all the junk in the area when they were getting ready to put stuff in, something wierd happened, I don't know.

But bad things happen, when I sit on surfaces like that, and the longer I sit on them, the worse it gets. Even when it is not a steep angle at all. I certainly hope this is not a permanent condition; I hope it resolves within the year that it takes to recover completely from the surgery. I hate to feel like Goldilocks, complaining about this or that.

When I looked around in horror, realizing that everything around me in the chapel, was constructed in a way that would cause me escalating pain, I burst into tears, even as a song began that entreated one not to despair, and to count one's blessings . . . . and I thought, "How could God do this, how can I come here and be in PAIN, how am I expected to do this, this seems so WRONG . . . .", all the while the verse went on, saying to not discourage, etcetera . . . . . and I was bawling my eyes out.

It was a tough couple of minutes, that. Of course, it isn't God that did it to me, nor even the surgeon, really. It's not like he's ever heard of this happening before, and we'll pray that it doesn't become permanent. It's not as severe as it was at three weeks, although I'm four times as many weeks out now and I still have the effect, so I'm a bit worried . . . . . I also hope it doesn't happen to the other leg; if it does, I'd assume it's a quirk of my particular anatomy, but . . . that would still suck. Again, though, I'm not going to assume it's going to repeat itself. I'm going to assume it resolves before the year is out, but keep an eye on it's progress, because at 6 months if it is still appreciable that will worry me . . . . you don't notice how many seating surfaces fall under this category until you have a problem with them.

I spoke with the Bishop, who is what another type of congregation might call a pastor, except ours is unpaid, and is "called" out of the general population of the ward, generally every five years although the period of service can vary, as seems to be the case with this one, after the meeting, about why I'd burst into tears so suddenly right as the meeting started. I'd noticed the Bishopric's startlement and attention when I'd done so (I did so silently, but they did see and notice, as they are a caring trio), as of course it would have seemed to have come out of the blue for no reason. He said, well, remind me next week, but we don't want you to be in pain; we'll pull in one of the chairs from the foyer (lobby) for you.

I was quite startled by that! These are like soft, wing chairs one might see in a house or a nice waiting area of a reception area of somewhere, and comfortable. You might see these in someone's LIVING ROOM . . . . even more so than where I just said, really. So now I'm worried that people might think, "Who is SHE so special that she gets a special chair, in the Chapel, anyway?". I even said that to somebody, a former Bishop of the ward, and he said, "Nah, we're not like that here, and we wouldn't want you to be in pain; we'll make sure that you are set up just right."

So it sounds like things will be okay, but I'm still going to stick out like a sore thumb, which is going to set off my anxiety disorders like fire alarm bells ringing, despite what the last gentleman said; I'll keep trying to repeat his kind words in my head, but I have a hard enough time with my anxieties and going there, and being in a situation that's going to make me stick out in a way that's going to cause stares and whispers and attention is, um, well . . . for a person like me, it is kind of a nightmare.

Even if he says people aren't like that. People are people, and something so out of the ordinary (and never in the years I was going more regularly did I ever see someone sitting in a soft wing chair in Sacrament Meeting) is going to cause a stir. How to handle it is the problem, and I don't have a session with my psychologist until the Tuesday AFTER next Sunday.

Oh, and to make matters worse, my husband WORKS next Sunday, so I'll be flying solo, so to speak. A neighbor will take my daughter to church for the whole thing, then run back here to get me in time for Sacrament Meeting (as the same angled padded folding chairs are the seats in Relief Society and Sunday School, I'm not sure how to handle the rest of the schedule; I can't expect them to haul around a big 'ole chair around the church just for me, and I know I can't sit on angled chairs for three hours either or I'd be screaming in pain too.)

I didn't think of the seating for the rest of the schedule issue until after we'd left church. I can't begin to impose on anyone for THAT, so I guess I'm stuck for now. We'll see. Sacrament Meeting for now, that's the most important part, being able to partake of the sacrament, anyway.

Well Whadda Ya Know . . .

I've GAINED 1.3 pounds in the last three days! Weighed in on the 23rd, then just a few hours ago, today, the 26th.

Since I had recently been getting very bored of one type of item in my diet, I'd been seeking a change, and been changing some things up the last few days, which led to a variety of other items.

I don't think that those items were necessarily more calories than what I had been tiring of, but . . . . it's one possible factor. It's also potentially the fact that the TYPES and VARIETY . . . . .

It's a good thing I've been keeping a food diary, so I can see the difference between the last three days, and the previous 7-8 days, back to when I had started tracking the food; I can use the differences to mix-and-match some of the different types of stuff from the last few days that weren't in the previous 8 day stretch, and try to come up with a combination that still has me losing weight, but at a modest rate.

There'll likely be ups and downs, but I now don't feel as panicked that things will plummet in a free fall. Still, to do what I've done the last couple of days, is still a pretty big conscious effort to make sure I'm eating as soon as I feel like I've had just enough of a rest from the last meal or mini-meal. Ie, I'm not CONSTANTLY eating, but I can't go longer than 2 hours without trying to figure out what to fix so I get enough either. Depending on the WHAT, as far as content of everything I'm eating (granted, there's been two pieces of cake in the last three days, not huge though) and depending on when I add using the exercise bike to a DAILY regimen instead of it just being every OTHER day (with this walking on my knee, without a cane, AT HOME, being a new stress on the leg, I'm concerned about adding too much, especially since, after 6 days of it, it still doesn't feel stronger, and I get wobbly partway through the day still), adding in that daily exercise bike, will burn more daily calories.

I had REALLY been concerned about adding that daily biking, when I thought I had no way of controlling the rate of weight loss. With that fear beginning to be alleviated, that also alleviates the fear that I won't get the benefit to my leg that doing daily exercise biking will add to it. I'm just not quite sure when to add it. It doesn't really hurt, it's just I wish I felt even a slight difference after almost a week of walking on the leg at home . . . . .

Even with knocking physical therapy down to two days this week, since we have a total gym and the bike (the only other machine used at physical therapy is the knee bender, NOT an aerobic exercise, but painful; extension work is done on a table, and, again, not a calorie burner), I did my squats on the home TG and then used the home exercise bike on Wednesday, since this week we started with the reduced schedule of twice a week physical therapy on Monday and Friday. So I still got the "big" exercises in, although I suppose all the "extra" effort of getting out and going to the physical location would not have been there, taking some calories burned out of the equation, but not a zillion. Still a factor, though.

On another note, I think perhaps that, since I've been living with my bipolar and other mental health diagnoses for so long, that I've forgotten the potential impact that they can have on others, the potential judgment/stigma etc. that they can produce, the potential for a reaction of, "I'm not going near THAT with a ten foot pole . . . ."

Some might say, well, if someone would be like that, you're better off, but . . . it's not that simple. I just forgot myself and rattled off that hey, here's where I blog, to someone from my past, and now I'm worried that, well . . . .

Especially since it's been some time since I used the blog effectively for mental health advocacy, fighting stigma and fostering understanding and hopefully acceptance by showing what MY struggles and experience are like, with my illnesses, tough and harsh though they are at times, especially in the blacker storms, as well as it having been some time since I've used the blog effectively to show WHO I AM, beyond illnesses both physical and mental, although those are both aspects of my life experience, especially recently, in the surgical situation.

Jeez, if that wasn't a run-on paragraph, I don't know WHAT is. I am not doing very well at focusing lately, even ON my medication for that. STILL trying to get the appeal for the MRI claim written, as well as the financial papers for special small payments that are usually unacceptable for such a large balance, for the institution that performed the MRI's, finished and mailed off with associated financial papers. MUST be mailed tomorrow. Even so I don't know how we're gonna scrape up another $50 a month even if they DO accept it . . . . and we have to work out that much of a payment on another medical bill now, too, so . . . blimey.

A Nice Gesture In the Search For a New Psychiatrist

On Tuesday 'round 5pm, I was making a few more calls on psychiatrists. I had started at about quarter 'till . . . why is it I wait until the end of the business day? I'm sure these offices must love this, but apparently at least one clinician takes appointments after five . . . .

One guy, his non-hospital phone number mailbox was full. That doesn't bode well, and I'd guess his practice is full. Upon calling his hospital number, I did get transferred to the floor where he practices and sees patients, but he only sees people ages 55+. I am not sure if that applies to his hospital practice, or to his other address down the street 5 blocks as well . . . .

So my third call, though technically only to the second psychiatrist of the day, was to a man's office - I've never been aware of a woman named "Frederick", although it could happen, I suppose - "Freddie?" anyone? Or perhaps as had happened early in seeing my first psychiatrist, he was either suspended (as in that case) and needed a substitute, or perhaps just on vacation, but . . .

So. I call this Frederick's office, and a nice woman answers the phone. It just seems one of those things that was meant to happen, because no one else was around, and she usually wouldn't have picked it up, because she was in with a patient. I had started to talk before I knew that, but I did not start out with, "Are you accepting new patients?" I had settled, instinctively, on a different approach, which, with the few people I had talked to at the hospital, about the other guy, before I found out about the age thing, it seemed to strike a chord, and even then, they tried to put me through to his hospital voice mail, since they didn't know what kind of patients he saw at the other address.

This approach being, a pretty brief, but emotional, without crying or fakeness, but without hopefully too much desperation, but there's obviously some in my voice, because I don't want to go through 6 months again of a search, . . . I would say something like,

"Well, I'm Sara XYZABCD, and I'm looking for a new psychiatrist. Now, I'm afraid (or, "I fear") you are about to say you aren't taking any (at which point a sound of assent/agreement is usually what I hear), but I will just say that I see a psychologist for therapy, am 37, 8 weeks out from a total knee replacement, have recently lost 13 pounds in 13 days from anxiety, depression, & other reasons and really do not want my physical condition to continue to deteriorate this way, especially after such a major surgery. I see a psychologist for therapy, but my last psychiatrist never called me back when I called him about a potentially life-threatening reaction to a medication. This is also why I am not on an anti-depressant at the moment; too tricky of an issue for my GP.

Now, that right there LOOKS like it takes MUCH longer to say than it actually does. It's pretty quick to say, and even for those who are closed to new patients, they get the gist that I really do need a new psychiatrist, what some of the issues are, it's not assuming failure right off the start like a straight out, "Are you taking new patients?", even though that's sort of in the second phrase of my first sentence in a different form . . .

It's just, from what I can remember of the last search, if you can get a bit of YOU across to the other person, they are much more likely to want to help you, especially if you aren't wasting their time. Especially if you can show that you really are a person in NEED, which I think my little speech shows .

The lady at this Dr. Frederick's ***** office answered the phone, and was apparently in with a patient as I think I may have said, and DID indeed make that sound or word of assent when I got to the part about fearing they were closed to new patients. I went on with the gist of what I had to say, with a little give and take from her, learning she was with someone, not all of what I said above said in that block, and perhaps a little more was said, but I refined it just a little above. She was VERY kind, and sincere in her desire to help. For the second time, she reiterated she was with someone, but that she had two numbers/psychiatrists to refer me to, although she couldn't know if they took my insurance. As she was pulling up the numbers, she encouraged me and said, that if they, too, were closed to new patients, to ask these psychiatrists for referrals, and to keep on going, and to not give up. Some of this was said AFTER she gave me the numbers, as the numbers came up partway through her encouraging me.

She gave me the names and numbers, spelling them out for me as one is an ethnic name, not spelling like it sounded, and then she finished her quick but professional and definitely not brushed off advice about keeping on going - she had learned from me about how it had taken me 6 months last time to find a psychiatrist. We said our final niceties and parted ways, hanging up.

That was the NICEST, most GO OUT OF YOUR WAY for a patient you aren't going to take on, interaction that I've EVER had with a doctor's office of any kind, let alone a psychiatrist's. Based on that alone, I'd recommend, should they ever open up to accepting new patients, this lady highly to anyone. Her manner, and the way she handled things, reminds me of the way that Dinah over at Shrink Rap says she handles things . . . . just the POISE of the lady on the other end, and that little extra something. The whole call was under 3 minutes, and I'm sure she did her best by the patient she had with her. She wasn't even sure why she had picked up the phone . . . . so I'm not sure if it was one of those, "meant to be" kind of things.

I then went on to call and leave a message for the one name of the two she gave me, that is on the list I printed out from my insurance company. I even had it include everybody within 50 miles, although this name isn't that far, it's not as close as I'd hoped; still, doctors tend to refer to those that they've recently known to be accepting patients, although they also know that this status can change.

Or at least I HOPE they refer to those who they know that hey, at Christmas, they told me they were still accepting new patients . . . .

Crossing Fingers! Even if it is an 18 mile drive into the middle of Salt Lake. 7 miles farther than the last one, but beggars can't be choosers. It'd be something, though, if I found one so soon, now, wouldn't it?

Addition before post goes to press, a day after post was written:

Said psychiatrist I was referred to, her office called me back, and she IS taking new patients! Woohoo!!!! They need me to come in to fill out the New Patient Information packet, and copy my Insurance card, and from there they'll make the initial appointment. At first I thought, okay, I think I can get in there in about a week to do that, and told them so. After a few minutes of thought, though, considering that she's currently scheduling appointments into the beginning of March, and I'm not sure what the surgeon is going to recommend (given my recent other health issues I suspect he'd maybe hold off on surgery, even if he ignores the knee degrees), so I thought I'd better try to get in as soon as possible.

First, I called my Mother-in-Law, to see if she could pick me & dd up and head right down there, to arrive when they get back from their lunch break. It's further away than I'd wish, but it beats the pants off of a 6 month search, and it's a sparse market for psychiatrists if you are looking for one that takes insurance, especially YOUR insurance. Psychiatry is one specialty where they tend, apparently, to sometimes or even often practice without taking any insurance at all! Because it's hard to find one, or find one that fits you well, sometimes people DO have to go out of network to find one that works for them, and/or go with one that doesn't take insurance at all and go through a hassle to get some pittance of reimbursement later from their insurance company. I'm glad that it seems I won't have to think about that road, because after having to have probably crossed out a huge chunk of providers that would see my huge MRI bill on their computers and not want to take me on, potentially, and cross off the next biggest block of psychiatrists listed that is apparently a Child & Adolescent practice, and then hitting one who is a Geriatric specialty . . . . aside from the couple of, closed to new patients . . . . well pickings on my 50 mile distance list were looking slim (although the ones over 40 miles I crossed out as too far, anyway; the choices for distance were 25, then 50, so if I wanted to include 30 miles I had to go out to 50 miles).

Not that this prospect is 30 miles out, although round trip is more than, I'll say that much.

My Mother-in-law was free that day to be able to take me and my daughter there at that time, which I am grateful for - I'll have had time to have iced my knee a bit after physical therapy, although my knee is NOT looking forward to the car ride . . . . it's a gonna hurt!!!.

I'm going to attempt to have my list of past psych meds and when and by whom prescribed, typed up - and why they didn't work out, if they didn't . . . . so I can have that handy.

Maybe surgeries too, for the medical history, as a reminder to me. Don't want to get TOO obsessive.

My Blog Post from Monday Sept. 11 2006, as part of the 2996 Bloggers Project

9/11 2,996 Bloggers Tribute - Gricelda E. James

I am still glad that it was Gricelda's name that was given to me to remember. This felt like what I should do today, and I hope her family is doing well.

The link takes you to the blog post where I post about what I found about her and my feelings and remembering her as best as I, a stranger to her but finding we had more in common than I'd know at first, could.

Stuff And Nonsense and No Ooompa Looompah's. Damn It!

I bought a towel today, only because my husband saw it and noted the three smiling dolphins; normally a $20 beach towel, it was on clearance for $6.00. As I am always feeling less than adequately covered by the size of the usual towel, it wasn't a hard decision to grab these smiling faces.

At the moment they are camouflaging the over-the-door shoe holder that is on the back of our front door; I put it over it on a whim, and it almost perfectly covers it. Our living room has ocean, dolphin, and lighthouse-themed items decorating it (well, that's the intended theme, although you'll find Neopets that each of us own, a miniature Star Wars fleet of my husband's, and a MESS of papers; I'm SO bad with papers!) It's a temporary whim, as beach-towel decor is probably not very . . . haute? or whatever the term is. Still, it's near me at my computer desk, and they cheer me up quite nicely, which is quite a thing, these days, and that's no small thing.

I've also recently wiped the C: drive and reinstalled Windows and such, and have not finished reinstalling all my programs; I know there's web apps for fixing graphics, but I just wanted to quickly load it in from the scanner, so crooked is how it remains for now! My computer is still misbehaving though; slowly devolving into a calculator, as I put it.

On another note, today I told my therapist, "Damn you."

Why did I say that, you might ask? Well, I said after a pause, "I come in here all seeing no reason to be or anything, and you somehow find a way to have me all talking about the future again and stuff . . . . . you get to me and help me, darn you!"

We had a good laugh together, because by the end of that, that's how it was. At the beginning of it, it seriously was a reflection on how I had started out the appointment, but was at the 2/3 point through it, and realized the shift, and was like HEY how did this happen???!!!??

Sort of, but really! But not, but it's not like I'm saying therapy is devious, or that the therapist is devious; it's not and he's not. It's just that my mood the last session and this one, well, it's been difficult, to say the least. And then all of a sudden, from my lips sprung, "Damn you, you helped me!!!!" kind of thing, if you know what I mean, kind of!!! Sort of like, despite my less rational self's efforts, the mania I've been having and just things being so fear-filled and other things, that somehow my more rational self was brought out through it, and worked throughout the pain, and the grey, and the pall, and the ineffableness of it all.

It's really hard to explain, especially since I'm not the swearing sort, at least not conversationally. If I stub my toe or bang my leg on the stupid corner of the foot of the bed for the umpteenth time, that's something different (although perhaps a goal to be worked on at some point; I will strive not to judge myself right now because I have other things on my plate at present of higher priority to myself.)

Things have been really, really, REALLY difficult inside, and I can use your thoughts and prayers, or whatever your form of well-wishing may be. I'd surely appreciate it at this time.

Thank you!

Hello Mellow

Maybe all those years of Barry Manilow have finally sunk in?

If I was in an online game right now, I'd do /giggle self . . . . .

I do seem to have been a bit med-focused lately, but it's been sort of our own little medical ward here lately it has felt like.

Like a medical tv show, only more boring.

The panic attack was triggered by a question regarding any conditions I or husband (dd's father) may have, at the end of the Instacare appointment (she was throwing up as he entered the room, thus the history occuring at the end). By this time I had repeated dd's bronchitis story 3+ times in less than an hour so I started mechanically listing stuff off, "Oh geez, let's see - bipolar, OCD, agoraphobia, panic disorder . .. . . " yada yada, more stuff, and then I got to the knee and mentioned that, and the recent arhtroscopy, and the diagnosis, that was said to be because of genetics, and extremely bad, unpredictable, extremely early osteoarthritis, etc.

Anyway, that's pretty much about the gist, maybe not the exact words, but basically what I said, and the quantity thereof, but when I got to the knee part I just started crying; not SOBBING, just tears started rolling as I kept talking, and I became emotional - I was embarrased about that, but kept going with trying to answer his question as briefly as I felt I could. I was pretty brief! And you know how I can go on.

I get overwhelmed easily, though - listing off all my conditions like that, especially after explaining what had been going on with my daughter over, and over, and over . . . . and then at the end, not being able to control my emotion (the doctor was very kind, he was standing actually near me, I was sitting, obviously it's not been a month yet since surgery, although it's getting there) and he put his hand on my shoulder in empathy and understanding - I believe he could tell I was embarrassed about my tears, as well as that obviously I had just seen the results of a difficult diagnosis, seen inside my knee, and all that.

So, he finishes up with a cheery statement about, "But, your daughter is going to be just fine, so that's GREAT!", and gives me an encouraging (but non-patronizing) smile, tells us we're done, can go, reiterates some instructions, and then is gone.

We're quickly back out in the waiting area, waiting for our ride home, and it's been 5 mins or less since the emotions came out, and I have the panic attack. I feel like an idiot about the whole interaction there, at the end of the appointment. Or I felt like it, anyway, to a large degree (I've since discussed it in therapy, as well as having applied some techniques at the time and afterwards to try to counter and cope with the attack, etc.)

All you would have seen is a mother and daughter, the daughter having fun looking at fish, and a stressed out, tired and perhaps pained-looking mom, with tears rolling down her cheeks. Perhaps looking tense or really tense, I am unsure exactly of quite how I looked, but I do know that I was able to "contain the damage", or keep the attack from escalating, in one area, by telling myself that really all I looked like was someone sitting there silently crying.

I just hate that it makes no sense.

Panic attacks, or the "little" "things" one panics over. I'm not a robot tho, nor am I an entirely emotional being, without logic or/nor intellect. Sometimes the conflict between the two can lead to a panic attack. The problem(s) with balance(ing)(es) can and do often lead to panic attack(s) as well.

Balance. Something I've never, ever, EVER been good at.

Guess this post doesn't sound mellow!

I did want to fulfill my promise to talk about the panic attack, though!

I'm si5tting here, with the door open, soaking up the late aftenoon sun, enjoying the day, and just FEELING it, and feeling mellow.

I also had a really good therapy session earlier today. I postponed the appointment from earlier this week due to my daughter's illness. She was asleep with a 104 fever and had recently had medicine to bring it down, and I wasn't going to wake her up to drag her out so's hubby could drop me off for therapy. So I called and canceled, apologizing with a short explanation and asking for a reschedule. Sometimes as a parent you have those choices. Plus I don't have a driver's license, and even if you ignored that, I recently had surgery, so driving wouldn't be a good idea, especially with a stick shift.

Anyway, think of the Sheryl Crow song, "I'm Gonna Soak Up Some Sun" or whatever it's called, and that's what I'm doing, and mellowing out. Oh, and listening to all the hoopla over the American Idol top three finalist, Archuletta (I always mix up his first name w/someone else's) being HERE, in Salt Lake City, today. The kid can sing, that's for sure.

Gonna go read a magazine outside in the sunshine! See ya'll!

Is there a House (M.D.) in the Anesthesiologist?

Yes indeedy.

At my post-op appointment a week after surgery with my orthopaedic surgeon, his first question was "Did you have any problems with the staff?".

I do not know if this is a routine question, but I thought it curious of him to ask that right off the bat . . . . it just so happened that I had had a problem, as several readers may know who attended a Dr. Anonymous BlogTalkRadio Show a few days after my surgery. There's a chat room there associated with the show, and the listeners chat amongst each other as the show goes on, sometimes about things unrelated to the show and of course quite often and most likely about things mentioned in, related to, and/or regarding the show or it's topics, and/or Dr. Anonymous or his guest(s)/caller(s).

Anyway, regarding the Anesthesiologist referred to in the title, and that I had a problem with when I responded to my surgeon's question above, here's what happened that bothered me.

I had been prepped for surgery, and the anesthesiologist came in to the prep area and started his part of things, and started asking questions, his first being, "Did you take your meds this morning?" I responded, "Yes", and he replied with something like, "Good girl. Even the psych meds?" I said, "Yes." He replied, "Good! That's so I can stand to be around you!".

Now, I understand that this MAY have been in jest; earlier, my surgeon had been in, and I had declared my nervousness - he had said, "The good news is, I'm not!" - This made me smile as well as helped relieve my nervousness too! Some joking around and such can be helpful to relieve anxiety and such, and so perhaps the anesthesiologist was just trying to be funny, part of me can see that, and can see that perhaps he just ended up being "funny" in a way that, in the very least, is insensitive, if not outright offensive, judgmental, prejudicial, crass, boorish, cruel, arrogant, and narcissistic, among other things.

The thing is, he repeated that last offensive sentence or its equivalent one more time a few minutes later, and perhaps one more time, before leaving the prep area. I feebly joked about my sleep-punching, I suppose in a passive-aggressive way of trying to sort of "defend" myself from this horrid attack upon myself that I felt. Of course, this man was going to be in charge of me whilst I was under anesthesia, of which I was very aware, so I just did not say much of anything, or tell him what I thought of what he had said to me or of his manner (he seemed to act rather brash, arrogant, and narcissistically with and to the nurses, orderly-types, and other operating-type assistants moving about the prep and operating areas and corriders as well, so while I tried to think the best of him and think it was just an insensitive stumble of a joke, his manner and the repetition of it kind of led me to think otherwise . . .. .)

The man's grandiose manner possibly did not leave room for any awareness on his part that he had caused any offense at all - that possibility I was also aware of. That is okay. Should I have further procedures requiring anesthesia there, I will request, if it is possible to do so beforehand, a different anesthesiologist.

It occurs to me also, though, on the one hand, the most important quality in an anesthesiologist is, well, how good is he or she at anesthesiology? Doesn't matter if his or her personality is as narcisisstic as Narcissus himself (of mythology), or as bland as plain white rice . . . . can they do the job WELL, do they know the unusual rare things that can happen and what to do if so (no one knows everything but to a reasonable degree), do they handle themselves expertly under pressure and emergency, do they handle themselves well with colleagues in the operating environment (which IS where personality would play a role, in a manner, but other people have to obey him, so his arrogance fits there, I suppose . . . . I dunno) . ..

Then again, since I watch the television medical drama House from time to time (not because some of the dreadful things he says are acceptable - the opposite, in fact, is the case - twas unusual from my Mormon perspective to see him have a "go" at a Mormon character - there aren't too many of those on TV, I suspect it was because of the Presidential race - he used comments as unacceptable as those he's used with his Jewish associate(s) or underlings . . . . in a way, he treated them the same across the board, but none of the despicable comments and treatment were acceptable. I think this show tries to SHOW that, in his extreme behavior. I enjoy the medical mysteries, though.

In my answer to my orthopaedic surgeon regarding any problem(s) I'd had with any staff member(s), I replied in the affirmative, he inquired as to who, I replied with the anesthesiologist's name (he did not look surprised), he asked why (although seemed to know before I said anything that it was going to be that the guy was a jerk) and I explained. My phrasing of what the anesthesiologist said is a bit off - it was actually WORSE than what I put above, but as time goes on, I just can't remember - things that send me into a shock of some kind, emotionally at the time, I have a hard time remembering later. I believe PeggiKaye or someone else from Dr. A's show from that week might remember better than I, at this point. I was still in shock, at that point.

I'll update on knee later, let me just say an ultrasound on lower left leg for DVT (blood clot) suspected, turned out negative for any, YAY!!!!

p.s. I could go another decade w/out typing anesthesiologist that's a long word lol w. lots of vowels s's etc. lol. Please chime in with what you think about this.

Just a Quackie

I don't want the kind of hits I'd get if I titled the post something else, so I borrowed Shrink Rap's duck for a few. I don't think they mind . . .

Anyway, perhaps more later, if I haven't lost MY mind first.

Tomorrow's schedule is looking a bit nuts.

8:00 am - psychologist (technically today he is still on vacation, but given the circumstances, he called me back and even would have seen me today but our answering machine light didn't show the new msg so by the time I got his later call it was too late to be seen today - because of extenuating circumstances he was more than willing to get me in as soon as we could. Weds. I'd be groggy and less than 24 hrs since surgery, probably too soon, because here's the next part of the schedule -

8:50-9:00 Finish appt. (Sometimes he gives the extra time, highly likely this time given situation.)

9-10 am run a few last minute errands perhaps, drop state taxes off in the mail (that I'm finishing up in a few minutes from now {today/Monday}, although of course I'll be e-filing the federal}, because I've been afraid to address the stupid out of the normal back pay SSI stuff, broken down into three separate years which I finally have the information regarding the individual amounts by year, received recently.

11:30 - Show up to Ortho Surgical Center (Hopefully be in surgery by 12:30? Not sure how long before I am?)

Not sure what happens next, besides the pain part.

Weds. my parents are up to help, as my hubby has to work. Tues my MIL is there waiting with my hubby as they operate, also one of the two can get dd from school . . . . . Yay for family!!!!

Thursday I have a psychiatrist appointment. That's gonna be fun. More pain. In the knee, I mean, if I wasn't clear.

Lots of appointments! And lots of stuff all at once. I may have more later, maybe.

Making lots o'calls today. Besides thank goodness for family, thank goodness for an empathetic psychologist, who is willing to work with me in an unusual situation at the end of his vacation to get me seen, especially with a lot of potentials for panic attacks ramping up that I've been fighting (have some things/strategies and plans in place and activities and other stuff I might talk about later today, or some other time, about what I have thought through and planned to help fight that panic as I sit there at the clinic, waiting, etc., . . . . hopefully these helps will be helpful!!!!)

TTFN, Perhaps Later.

If I don't "see" you guys again though until after my knee thing, wish me luck (yeah, it's only an arthroscopy, but to me I have this maze of fears and all sorts of things I have to fight and plan out and fight and figure out if I can handle and stuff . . . it's not JUST a routine thing, for me . . . . it's a whole host of a bunch of things I have to deal with, for me. A whole bunch of battles, that I have to face and fight and march through, and fight, and and and etc.

See ya!

Pressure and I, Well, We're Like Matter & AntiMatter . . . .

Put me together with alot of pressure and something is gonna explode, some way, somewhere. I'm not saying that in a way of, oh, it's just gonna happen, I can't help it, but in a, I've fought my whole life, and I REALLY FIGHT HARD when I'm under pressure, but hell when everything's falling to pieces um I'm kinda doing alot trying to grab hold of things already starting to shoot off in different directions already . . . . . dunno if I can keep the lid on, guess we'll see.

Anyway, more tomorrow.

You may not know, but I have an arthroscopy on Tuesday. Not sure what time yet, he does his shoulders (as they put it) first, I'll find out tomorrow what time, and tomorrow we'll work thru about specifics on which of my meds to maybe take and not take (cause, um one of my morning meds is a stimulant, that's not so good for general anesthesia, I'd bet . . . . lol).

Arthroscopy may not sound like much to many of you, but it's alot to me, especially considering what the likely next step will be, etc, although I'm not sure as to the timeline of that "next" step.

Anyway, more tomorrow, lots to do.

LOTS of pressure. lots and lots and lots and lots and lots. I don't do pressure. I try with all my being. EVERY time. Despite the I don't do pressure thing, I still throw mywhole self at it, because that's what I do, and still I . . . well that leads nowhere good, so I'll stop. For now. Psychologically, I'm not in a good place, and I haven't seen the psychologist last week, he was on vacation, and the week before that I hadn't been scheduled for this surgery yet, and now it's scheduled right for when we'd usually meet . . . . so that's all screwed up too . . . (he's very understanding tho, I've left him a message.)

Hopefully I can see him later in the week; I already have a psychiatrist appt. for two days after surgery, that I had long before I knew I'd be having outpatient surgery. The ortho people said it's fine to go out and stuff by then so that's good (except the pain part.)

Ok, ramble over, see ya tomorrow. I'm having a tough time, think, pray, whatever of, about me, whatever, cross fingers, k? I'd appreciate it.

p.s. my word verify is poovil(dh) ha

An Approximation of What My Psychiatrist Looks Like

Mr. & Mrs. Pump
Originally uploaded by David Clow - Maryland

I was browsing through Flickr one day, when I happened upon this fine photo of some "dressed up" gasoline pumps.

Amusing, colorful, bright, and fun, I thought, for such usually mundane objects.

I do not mean any of this to imply that my psychiatrist is gassy, nor full of hot air, although he does tend to go on and on . . . .but that isn't why this photo reminded me of him.

The more prominent gasoline pump, the masculine one, if you will - the one on the left, in the foreground - a closer representation of my psychiatrist in gas station pumpery I daresay you will never find.

Save for the fact that this particular pump is represented in what appears to be a, perhaps, 70's style "leisure suit", which my psychiatrist has not been seen to wear in my presence (I do not think any clothing that even involves the word "suit" has passed his way in quite some time, but then again, I only see him at his office, so how do I know!), it represents him rather well . . . . .

He's kinda hippie-ish, although he doesn't exactly dress like a hippie. His hair kinda fits that, hippie-ish thing, though.

Anyway, if you wanted to know what my psychiatrist looks like, there you go.

Some Lawyers Really SUCK (Sorry Stephen!), and SS Disability Stuff

So, today I finally get around to doing something I've been procrastinating - calling my "good 'ole" disability lawyer's office.

Why, you may be thinking, would I need to call them?

Well, as I've been working on my taxes (this is the latest by far, for as long as I can remember, that we've done our taxes - we usually do them in late January or the first few days of February!

The awarding of SSI, including back pay covering the years 2003 through 2006 (since the regular monthly payments started at the beginning of last year) being paid in two different lump sum installments last year kind of complicates our taxes a bit. I had thought perhaps Social Security would send us some kind of a statement, like my parents get, but they didn't.

So, I thought to call the disability lawyer's office, figuring that if they didn't know how much of the back pay was for each of the "back" years, then they could at least direct me to the appropriate person or sub-department at the local level Social Security offices that they deal with all the time, that have the people who handle the cases like mine on an ongoing basis who could help me with this information.

Apparently, about a month after the Judge made his decision, there was a mailing that was very detailed (yep, aLOT of legalese, and I DID read through it, although I had to take breaks every half-page or so, despite it's being double-spaced, or my head would have exploded, lol!). I knew it was, and would be, VERY important for me to understand what was being said, and what it would mean for me, and what it MEANT.

I do not recall any list or break-down of how the back-pay sum(s) (there were two, one to be paid very early in 2007, the other, later in the year) were made up of the SSI they owed me and were now paying me, from '03, '04, '05, and '06. I did not see any amounts shown by year, like that - just the two back-pay amount installments that were to be paid at two different points in 2007, covering the SSI payments from 2003 through 2006.

Now, reporting these amounts broken out by year shouldn't affect my old taxes, because there's a threshold at which the SSI doesn't get taxed at all, and I'm pretty well certain that it's such a pitiful amount, especially with our very low income, that there's no way it'd be taxed. Then again, when you get into the years when we started getting the EIC . . . who knows. I DO know though, that STILL there is that THRESHOLD that must be gone over first before the social security starts getting taxed, at anywhere from 20% of the amount of it being able to be taxed, to up to 80% of it being able to be taxed.

Anyway, that's a side trip that's not really the point at the moment.

The point is, I called the disability lawyer's office. Over the course of time, especially in the last 6-8 months, I've come to the conclusion that I was not competent to make the decision that I was asked to make at the hearing, that I was under alot of pressure to make, and, (pardon the language here mom, but it fits) as a quote from a movie that fits particularly well here, for anyone who's seen "How to Lose a Man in 10 Days", I Call Bullshit when he says there was no pressure from him. Oh HELL yeah there was, it may have been couched in legalese and with disclaimers of we can go forward and make appeals and of course I am at your service and we don't have to give up your right to appeal and yada yada xyz, (of course, I do understand it's his job to lay things out, and lay things out like, as things stand, with what the judge is saying and has just said, and what the expert has said and has decided, and what they said just now, the only way you will get any money right now would be SSI only, and that only, would be if you give up your right to any appeal, etc. I do understand he had to lay that out, it's his job. There's other stuff about how he was, and crap, that I believe was pressuring. Besides, he's got incentive to be; he doesn't get paid unless we win some sort of monetary award.)

Anyway, I made an OFFHAND remark about how I didn't feel like I was competent to have made that decision and HOO BOY does he go into CYA mode, and BAM the . . .what's the word (major aphasia problems the last few days, as my in-laws and hubby can attest), the word for that ironwork gate that can slam down in the front archway of a castle after you've come over the drawbridge that can be raised and lowered? Ugh, see how long it took to type that, and I STILL can't come up with the word!!!!

Oh, man, does he get so aggress and just start ATTACKING me like I'm some hostile witness on the stand, on Law and Order or something . . . I felt like I was pinned under a fusillade of arrows (see, I can come up with a word like fusillade!!! woot!!!)

I'm still very emotional about it, and crying now . . . geez. He was all like, no one adjudicated you incompentent to make that decision, I didn't adjudicate you incompentent to blah blah whatever . . . . (and I was sitting here stunned, on the other end of the phone . . . . there'd never been any question as to my compentence about going to the hearing or anything . . . of course, I've always known I don't do well under pressure, but this decision, that he asked the judge permission for to take us aside, outside of the formal hearing room for . . . . it was one of those do or die moments, it was one of those . . . um, DAMN HIGH PRESSURE things . . . There was ALOT of pressure, I reiterated to this LAWYER.

Anyway, eventually I said, look. I'm sitting here in alot of pain (because I was, and I am, my knees are killing me, they've almost collapsed under me in non-painful moments recently), there's been several deaths in the family, I've had a new, far-reaching unpleasant diagnosis, I'm NOT mad at you, in fact I think of you fondly (I don't know if that last one is a lie; sometimes my me-ness retreats into the back of my head and I'm not there anymore and the rest of me operates on automatic because I can't cope, I just can't . . .ok, here I go again, tearing up . . . damnit . . .) I just had to get him to stop. I also pictured him working up some paperwork JIC (just in case I should ever decide to sue him for malpractice or something, you could tell he was thinkin it, he was certainly attacking me!!! geez.)

Anyway, I then gave him a compliment of some sort, I can't remember what it was, but all of a sudden he went from this . . . picture a hairy bear of a monster, teeth and claws and impossibly wide tall open devouring mouth like a cavern open to devour and then transformed into a pleasant human being, southern gentleman charm, slight accent and all, like a switch had been flipped; the geniality, the friendliness and cordiality, . . . . . this, too, was jarring and creepy in it's own way, as to how suddenly it was there, although it was soothing as well and I think I kinda unretreated from the back of my head a bit (not sure that's the best description, but then again since I wasn't all there (um, that could probably lead to some jokes, lol) I'm not exactly sure how to describe it anyway.

Part of me understands, that since lawyers are trained in legal stuff, they naturally think defensively, but STILL. I wouldn't sue a fly! Geez. I don't hate the guy, and I think in large part it's the system that has built some incentive into for the disability laywers to have some incentive to act, perhaps unconsciously or not-so unconsciouly depending on the integrity of the lawyer (this one seems to have more than others I've seen advertised, at any rate) in their own interests to some degree - they do NOT get paid unless they win a monetary award of some kind, which, I think, may lead to some compromises that may not always be in the best interests of the client.

Whether or not the compromise in this case was in my best interests . . . . I don't know. I am not sure further appeals would have done any good, although I do know that both the judge and the expert flat-out IGNORED evidence from my family doctor that was BEFORE the dates that ended eligibility for full social security disability . . . . .

Anyway, it's in the past.

Hakuna Matata? That can be a good or a bad phrase, depending on how it's used, when, how, and why, I suppose. In the movie, not so good.

At least my behind, is in my past. Reverse that (channelling my inner Willy Wonka, and the word-mess-ups in this paragraph were all a-purpose, cause I needed some humor!)

Well, I guess this post also had some broader commentary on the Social Security disability application, hearing, adjudication, SSI, payment, and back-pay processes, as well as some more personal discussion of some of my experiences, which I've been meaning to discuss, anyway.

It also occurred to me, as I was typing, that I know it's probably wise to never say never in regards to reserving one's rights to further appeal in legal matters (or perhaps in regards to suing perhaps for the fact that I don't believe I was competent to be forced into making such an on-the-spot decision in such a pressured situation, which is exactly one of the things that sets off some of the mental health problems and disabilities of which they had just been browsing through in all their folders, ugh!!!) that my posting about this stuff could perhaps come back to bite me in the, er, proverbial behind (which is the past, hee hee), should I ever decide to pursue further appeals on the disability front . . . . but the process was so horrific, I can't foresee that.

It still might be unwise of me to post this, and I still feel that I was pressured, but I'm posting anyway.

What I'd like to happen the most out of this is that my experience be of some kind of help to others, whether in just reading about my struggles or in seeing a glimpse of the process, perhaps. I believe that this is far more likely to happen than a suit on the issue of competence or on the right to appeal.

As I say in the sidebar under Noodleheads regarding my friend Stephen of the blog Ethesis, he really does brighten up that whole Lawyer thing. There is hope in the legal world yet! They are not all people who can turn on you one second, and pull a bouquet of sweet-smelling flowers out of their sleeves the next.

The oddness of the call DID remind me of the inhuman jokes regarding lawyers that I'm assuming most people have heard, though. I guess lawyers need to perform in court, and being able to act, being able to turn different aspects of ones' self on and off, would probably be a handy trait to have, but geez, it was unnerving to be on the receiving end of, and I'm still MORE than unsettled by it!

The lawyer is sending me a copy of the paperwork that they say I have, that they say has the breakdown of the back-pay lump sums into year-by-year amounts, but they are sending me the paper anyway.

Yahoo!!!! I did what I've been putting off, and now it is done!

I phoned the knee doc and made an appointment, which is something I've been putting off as well.

Sorry to go on so long. Whew. I'm a bit emotionally wasted, perhaps I'll seek some online gaming out for relaxation . . . . . I'm PROUD AS HELL (sorry moms again . . .) that I came through that lawyer's barrage, even though I apparently checked out, during part of it. Gah, here come the tears! Ok, enough. Talk to you later, and yeah Stephen, I know you guys and gals in your profession aren't all like that.

Would you mind writing a guest post for me sometime? I'd be honored if you would! Your level of writing is just . . . . well, it's quite something, my friend.

*Note: I am not a lawyer, doctor, mental health practitioner or expert in any of those or any field referenced above or anything. Just a person with some troubles, blogging away.

Inspired By Another Blog, Today - "Be Present, Be Here" Blog

Here is a brief partial quote from towards the end of the most recent post of this blog, to give you a taste of what inspired me, of what touched me, and of what runs completely to the heart of me and parts of what my experience in life are, at this time, at this place, at this being-ness, at this state . . . .

the push and pull of life can be exhausting and push me to places and thoughts and fears that i do not want to live inside let alone pass through. yet, i keep going. i begin to . . . . .

Please go HERE for the post & blog I am referring to. Again, the blog is entitled, Be Present, Be Here.

Perhaps Another Part of Luke's Training?

I could have been E.T!....
Originally uploaded by waihey

I betcha there were bits that didn't make the final cut of the movie . . . . . ha ha ha ha ha . . . .

Or maybe he was trying to train Luke to "B Good.".

Anyway, this brought me a smile today, and I thought I'd share the smile, since this Flickr photo is one that it's owner has allowed the "Blog this photo" option on.

Now I've got an urge to "phone home". Do you?

Square Meal, & a Not So "Square" Grandfather

Square food is tasty
Originally uploaded by shookiemookie

I live in a desert, a watermelon could sure qualify as a meal around here, sometimes!

They do have the regular round/oval variety in Japan, but they grow them square for a higher price/ease of shipping/ease of storage/convenience for the consumer, should they want to pay the price.

Sure looks funny, though! I want to know if they grow the yellow innards watermelon square, too? Tastes just like the red, but your eyes keep telling you that you should be tasting something different.

I just thought I should post something, since it's been a stretch.

There's been a couple deaths in the family; my maternal grandfather, and one week later, an uncle of my dad's. Then, a few days ago, word came that my MIL's dad was being life-flighted to the hospital and it didn't look good. He's still here, and doing ok (as far as I know so far), but February was a tough time with the two blows for my parents, and I feel so much for them. I feel for my husband and his family as well.

My mom's dad's passing has brought up a lot of complicated emotions in me. I keep telling myself it was HIM choosing to not be like a grandfather to me; there was nothing wrong with me. Of course, when he goes to my siblings' weddings (the ones that got married) and not mine, it makes me wonder what the hell is so wrong with me . . . . anyway, HE chose to not act as my grandfather. HE chose this. It was about HIM and HIS flaws, not about me. A man can be a coward, despite having served in the Navy during WWII in the Pacific, and in Japan during the Korean War (gee, I bet that last one was dangerous).

My mom is ok with all this talk; I wouldn't disrespect her in her grief; she told me it was ok to type out whatever I wanted here. I may have more, but it's taken me awhile just to get this little bit out.

Not that square watermelons have anything to do with it, but I guess Japan does, kinda . . . ..

It's A-Maze-ing To Me

In a discussion elsewhere, as I was responding to a friend, part of what I said is the following:

I just have a maze of fears I have to navigate in my mind, in order to try to function, and sometimes that comes out in the maze of words and maze of verbal construction that I term/put things in, in order to be able to say it at all.

I thought that a REALLY good explanation of what alot of my struggle is. It uses up ALOT of me, of my energy - even physical, not just mental - as this is very basic to how I interface with the world, kind of like how someone with autism has their own basic things that are on a fundamental level of interfacing with the world.

Different struggles, but in one angle of thinking about it, I thought, HEY, this goes to show to what depth and degree of interference and struggle I'm even starting from, when it comes to doing anything. I thought it a good, though brief, explanation and illustration of the problem, although perhaps it might not make sense to some, or perhaps many.

It's one of the layers of interference that takes effort to push through, to run through that maze in my mind, in my words, in and with my relationships, in and with my feelings and thoughts about those relationships, or about anything; also about, regarding, and involving my actions - actively taking alot of energy to sort, filter, run the maze, etc. mentally, emotionally, spiritually, etc. in thought, word, feeling, and deed.

The title of this post is a play on some of the lyrics in the song, "When You Say Nothing At All", which is kind of funny, because all this effort and energy is being expended even when, and sometimes ESPECIALLY when, I'm saying nothing at all . . . .