Birthday Thoughts

My birthday has been great so far.

I took the day off work which is doubly fun because the last day of the month is always hectic and I end up working way late, and today I would have been stuck in pouring down rain.

I slept in til noon.

I read all my blogs.

I am having time ALL ALONE, a luxury beyond description.

While I slept, my house was cleaned for me. Getting a house cleaner has meant less money for restaurant meals or birthday gifts, but it makes daily life unbelievably better.

I have a deliriously happy life, one that I could never have dreamed could be this happy.

It's not perfect - my mom and my brother Mike and my friend Brandon aren't here to share it, but it's as good as life gets I think.

Even the rain is positive, because it's a glorious spring rain driving away the snow. As good as sunshine, it it's way.

I am blessed.

Social Obesity

As I was discussing addiction with respect to benzodiazepenes with Ed, I stumbled on a great truth that may lead to obesity war success. You see with opiates and benzos and nicotine there are large groups of people who can take them socially and never become addicted. In fact, addiction is very infrequent and there is evidence that some people become addicted more easily than others. And eating food is EXACTLY like abusing nicotine and opiates and benzos. We know that ostracizing people works on addictions, and obesity is simply an ADDICTION TO UNNECESSARY FOOD. Funneling billions into the war on drugs and tobacco has ended addiction in people who matter to politicians. But how can this apply to an EPIDEMIC of obesity?

The war on obesity will make everything okay by eliminating the "socially obese" who are only fat when they go dancing, have surgery or experience panic attacks. The socially obese only gain weight to fit in and be cool. Like the "weekender" cocaine user, they can cut an lean and mean figure in a power suit during the business week, while BALLOONING into fatness for relaxation and fun after work and on weekends. It's scienterrific fact that FAT IS CONTAGIOUS to people who don't live with the obese "index" person, just as influenza is contagious to friends who live across the country but not to members of the "index" person's own household.

The socially obese, like social smokers who can take or leave tobacco products, simply need to be convinced that they can stop eating permanently with the support of medical professionals. And they need motivation. Americans are far too accepting of obesity. We coddle the obese by legalizing businesses that sell them clothing that fits and even food itself. We respect their dignity by never including their faces in photographs of their shameful, disgusting bodies in the media. We protect them from embarrassment by excluding them from the public eye in the movies and especially politics. And the radical "fat acceptance" advocates aren't grateful, even when we make an exception and legitimize their view by letting them debate obesity experts like Meme Roth on national television.

Social obesity must be stopped. People who become obese to fit in need the strongest possible reminders that obesity is a TRAGIC CHOICE taken up to gain social approval. We must emphasize that eating is a choice and they can stop if they really want to, and don't fall for peer pressure to remain obese. Only hatred can improve their health.

Thanks and Update

Thanks to all of you who have given me support online and off. It has cheered me up quite a bit.

I have my disability placard and I'm grateful for it. I only use it if I need to because no other parking spots are reasonably close. I still feel better for the most part fighting the physical decline instead of giving in to it. The fight just keeps getting harder though. As I contemplate possibly not being able to walk anymore I appreciate more than ever the independence it brings and the blessing that it is.

I went to my psych NP and so far the cross taper is going well, although there's no sign that the muscle thing is getting better. Unfortunately, I can't just decide to stay on this class of medicines and be physically disabled, it turns out. J is concerned that they might affect my smooth muscle as well as skeletal. Which includes my heart muscle. :( She did say that it is too soon to tell. At least I've got a proven record of not getting addicted to benzos when I took a modest dose for three years. They didn't prevent anxiety like the atypicals do, but they did treat it effectively.

I'm struggling with doubts that the medication is the real culprit, and wondering what the next step is in searching for a diagnosis. I need to bring up the scooter issue with my PCP, but I'm still afraid that he'll think I'm hypochondriac or lazy because I'm fat. Maybe I'll just have Ed come with me. I hate that I feel like I need someone to vouch for me, but that's the reality. It sure throws my feminism for a loop though. I suppose that if Ed were in the same condition he would want me there. I do think Krista is right that there is medical discrimination toward middle aged women, especially if they are fat.

Tired of pain and fatigue

I haven't written about the muscle pain and immediate fatigue lately, but they haven't gone away either. I just don't like to focus on it. My PCP Dr. Armstrong told me last time I went that we might never know what is causing it. I guess I sort of felt he had given up on me, so I stopped going. He sent me to an neurologist last fall but I had a completely normal exam and the neuro didn't seem to *listen* to me very well. I told him about muscle pain of a seven-of-ten-scale after about two minutes of movement such as walking, carrying, holding or standing, and he suggested a fifteen minute long bicycling test to see if my muscles would act funny. I felt like crying. I was too embarrassed to point out that in this condition I wouldn't be able to tolerate exercising that long. He told me I have an umbellical hernia that needs surgery base on the fact that my muffin toppy belly pooches up when I go from lying to sitting. I can't imagine having a foot long hernia with no pain at any time, it just doesn't make sense.

Anyway, we took a vacation to New Mexico for Christmas and the travel really wiped me out despite the fact that I buckled and asked for wheelchair escorts at each airport. I'm glad I did. I was exhausted during the whole trip, and it took at least a week to recover physically when we returned. I feel like I'm ninety. I worked with a physical therapist for five weeks without improvement.

I feel like I'm in the middle of a fixed delusion about conspiracy and nobody can believe what I say or accept my reality. I've entertained the notion that my pain tolerance is just decreasing with age or fatness, but no other person I know of my weight or age seems to be having these problems. I've asked my NP/Psychiatrist for a disability placard, and she's signing off for one. She thinks it is the risperdal, so I'm switching to seroquel. She doesn't know if this would get better if I stop risperdal, but she thinks it may stop progressing.

So here I am, 18 months after I started having trouble with my 45 minute workouts. At this point I get burning muscle pain and cramping sensations (but not spasms) in my legs and back when standing or walking for over a minute. I get cramping in my arms if I hold the phone, or carry a water bottle or push a grocery cart. Sometimes my legs or feet cramp for a long time after a short walk of maybe thirty yards from the parking lot to my desk. My muscles also get stiff more easily, making it doubly painful to walk after resting. I am often exhausted at the end of the day. I have to sit down to sautee mushrooms because I can't stand for the four minutes it takes without significant pain that forces me off my feet. I have begun sitting in inappropriate social circumstances where everyone else is standing. At the psych hospital's nursing station, or in an AFC home where a client is touring. I'm in enough pain walking that I look longingly at mobility scooters and wheelchairs online.

I'm losing my ability to stand and walk and nobody knows why. It seems to be getting worse again, and I'm starting to fear for my job, which is periodically active. Nobody knows why. None of the tests come back abnormal. All the evidence says that I'm making it up, but I'm not.

It's starting to feel like a slow nightmare I can't wake up from.

I know I sound like a whiney toddler, but sometimes I just have to say it or I'll burst.

Advice to New Case Managers

Documentation of necessity and progress are vital to our continued ability to help our clients. This requires specific description of the psychiatric condition and a complex understanding of progress that is unique to health care. Think in medical terms - progress is not a simple matter of continued improvement, like it is in other endeavors. Compare our work to keeping a person in respiratory distress alive. Interventions promote progress regardless of the severity of the condition or response in the patient. Medical progress is made when the patient is cured (rare), assessed, correctly understood/diagnosed, stabilized, prevented from relapsing, prevented from declining more than they have, recovered from an existing bad outcome, hospitalized for more intense treatment and in the worst case scenario given the best treatment possible until death (rare for us). Our interventions help clients make progress through continued stability at any severity of baseline, mitigation or prevention of symptom or substance abuse relapse, referral to more intense treatment and assistance in recovery from a bad outcome. Progress can be slow and is seldom sudden and earthshaking. Sometimes progress is improvement, yes. But more often it is standing still (maintaining stability) or taking two steps back instead of ten, and sometimes it is falling off the cliff then putting the pieces back together. Suggestions for documenting progress follow.

Opening – What is happening today, with an emphasis on the positive. If you are working on a problem that won’t seem to go away, it’s known as following through. Following through is very esteemed by readers. An intervention is positive when it is presented as identifying improvements to be made, for example. Anything can be phrased positively because you can put a problem in terms of how it is being addressed. You can present a client’s urge toward self harm positively in terms of a worse situation in the past or in terms of what you did to help identify it and act to help them cope or get appropriate inpatient care.

Analysis – Put what is happening now in context of the whole, emphasizing progress made over time. Mention the day’s goal and how it was either met or re-evaluated when surprises cropped up or exchanged for a more pressing goal. Mention the bigger goal that this is part of and pick a time frame that shows progress or work toward solutions. Mention the person centered goal as well and how today’s goal moves you toward it. You determine the time frames and contexts, so you are always able to put this in a positive manner as well. You are never truly stuck because you are always assessing, monitoring, linking to resources or treatment,introducing interventions or building on previous interventions.

Conclusion – How today leads to tomorrow or simplifies the goal or does something to help the client. Once again you choose the details and can direct the focus and attitude. Think of this as the main idea about progress you want the reader to come away with.