Into the system…

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Posts Tagged ‘consultant

Busy, Busy, Busy…

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For someone that doesn’t work I seem to be awfully busy at the moment.

And it seems I won’t be going back to work for a while.

My consultant had been pretty keen for me to contact my employer to try and look for a strategy that would see me getting back to work, or at least to get me back in contact with them a little more. It was suggested that perhaps I could help out with some corporate citizenship work or at least have a contact in the area I could meet up with to discuss work. All of my contact has been with the HR team who are based in London. As I am not allocated to a project I don’t have a manager at the moment, let alone one in the North West. I don’t even have a “Career Counsellor” right now as mine is on maternity leave. So I’ve had very little contact with work and I’ve only been into the office once in the last 18 months (to get my laptop upgraded). The place has become completely alien and the thought of trying to go back is pretty scary. I don’t think Dr M realistically thought I’d be ready to go back in the immediate future, but she wanted me to consider doing something to give me hope of going back.

So I contacted my HR rep to see what she thought. She needed to look into this and wanted me to go see Occupational Health before she made any decisions. She didn’t want to allocate a new Career Counsellor unless I was actually going back, so that wasn’t an option, but she did say she’d look at finding a Manchester contact for me. She wouldn’t agree to the idea of me going into the office or helping out unless there was an OH report which supported this. I suspect their liability insurance wouldn’t be too happy if I was on sick leave, went into the office and then I hurt myself or something.

So I was referred back to Occy Health. An appointment was arranged and I saw Dr R on the 18th. I’d seen him before, 18 months ago. He had been nice last time and had a lot of experience in psychiatry, so I was glad it was him again. He remembered me and I tried to update him on what had happened. I have a document saved on my computer which covers all the main events of my “Mental Health History”, so I took this with me to refer to. I think he was pretty shocked at what had happened since I’d last seen him. At the end of the appointment he said that when he saw me last he’d expected me to have a pretty rough time over the coming year or so, but he’d never expected it to be as bad as it was.

He mentioned a lot of the usual occupational health stuff. Things about how work is generally good for people and that I should be encouraged to go back as soon as possible. He quoted the statistic that 50% of people who are off work for more than 6 months never return (Scarily, 75% of people off for over a year and virtually none of those off for two years or more ever return) and he commented on how long I’d been off. He said he was concerned about my chances, but he was hopeful that at least I have youth on my side.

He seemed genuinely worried that I may be dismissed due to incapacity if I was off much longer. I am worried about this because my Permanent Health Insurance payments would cease if that happens. He said he’d hate to think I’d have a life of benefits ahead of me. Not exactly what someone needs when they are struggling to handle the thought of being alive. He warned that with such a long absence and dismissal for ill health, I would be nigh on unemployable, which is a pretty depressing thought. I should have a great career ahead of me and instead I am dealing with the possibility that is over. I hope not.

We discussed whether or not I could go back to work. I don’t really think I am ready. I’ve only been out of hospital for about a month. My medication is still being adjusted and I am struggling with side effects and anxiety. Things are so unpredictable that I just don’t know how I can plan to go back so soon. I was pretty surprised when Dr M brought up a return to work in the first place, but I understand that I do need to go back as soon as possible and was willing to at least see what could be done.

He agreed with me though. He wants me to be fairly stable for a couple of months before he considers approving a return. He seemed a little surprised that I had even been referred to him so soon after coming out of hospital. He was uncomfortable with pushing me back too soon because there is too much at stake.

If I went back to work for a little while and struggled, ending back on sick leave, then I would not only lose my ESA for 6 months, but I’d probably end up losing my job. They’d be more likely to dismiss me if I failed to complete a phased return. Of course there’s also the very real risk that it would tip me back over the edge and I’d try and kill myself. Not exactly something anyone would want to risk encouraging.

We also discussed the fact I am waiting for therapy and I’m likely to find that pretty hard going. It would not be good for me to go back and then to start therapy. There is good chance that it will make me worse, before it makes me better and we wouldn’t want that to risk my return to work. He’d rather that I knew at least what was happening with my therapy referral before I go back.

He did agree though that we should be doing something to normalise work and the office a bit more. I need to be in contact with HR and I need to go into the office occasionally before I try to go back. At the moment I feel like I don’t belong there and I hardly know anyone. It would be good if I could get used to going in before I try and do any work there. He agreed that helping out with the occasional task might also be helpful and a good way of keeping me in touch with work. The more we can do to convince my company that I do still want to work for them and that there is a good chance that I will again, the better.

So that’s the plan. Try and get more in touch with work, keep myself busy and doing enough work related tasks as possible and lots of hoping that I will get better and stay well long enough for us to consider a return. I will probably see him again in a few months, all being well.

I left fairly pleased with the outcome. Dr R seemed to understand my predicament and agreed that I wasn’t ready to return. I am a lot more worried about my future though. He was genuinely concerned that I will end up jobless and moneyless. At the moment financially we can cope with being on sick leave, but if I lost my PHI payment or ESA then we’d really struggle. I am comfortable with the fact I have a job to go back to with a company that has treated me well. I’m pretty scared that this might change. I don’t know how I’d find a new job and try and get back to work all at the same time.

The report arrived last week and was pretty much as I’d expected. My HR rep seemed fairly happy with the report, although perhaps a little disappointed that I am not ready to return. She called me today to find out if there was anything else she could do to support me. I have been given a contact in the Manchester office now and I’m meant to be talking to her tomorrow. It was suggested that I talk to her about things I can do in the Manchester office to give me something to do and to give me a taste of work. I need to build up my confidence and remind myself that I can actually do that job. I worry that I’ve lost my ability to work. I am not as sharp any more. I’m so slow and unproductive. I struggle to concentrate and think. I worry I will just not be up to the job.

We will see. If I am to get through all of this I need to go back. I loved that job and I want to go back. I just hope that I can. I am very scared that I won’t.

A label…

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Earlier today, I had my second opinion meeting and review with Dr P. I wasn’t given much notice. The ward doctor, Dr C, just said he will be over in a few minutes and fifteen minutes later I was sat in a room with him and Dr C answering questions. It was a bit like the nth degree. My memory is sketchy and I struggled a little, but I gave him an overview of my moods over the past few years. He was keen to find out if I’d had any ‘up’ periods and although I have, I don’t want to exaggerate any of them so didn’t really know what to say. I just tried to explain how I was at various points in time. He had a little bit of knowledge about my history before he started and seemed keen to get an overall picture of my mood cycles. He asked about my agitiation also. It was a different approach to Dr G, who was more keen to get an idea about how I felt and what I thought. They’re polar opposite doctors, but both good at what they do.

Anyway, Dr P eventually said that based on my lack of response to ECT and anti-depressants he believes I have bipolar II disorder and thinks that ADs are not going to be helpful. I hadn’t realised that my lack of response to ECT could be seen as a test for bipolar. If I had recurrent depressive disorder, I’d likely to have had some positive response to the ECT, but because I haven’t, it probably suggests that anti-depressants are not going to work for me. He talked about how some people with bipolar II do not respond to ADs or traditional treatments for depression such as ECT and that was why he was suggesting that diagnosis.

He wants to start me on an old school mood stabiliser, so is putting me on Depakote. I am a little scared as I’ve heard bad thinks about Depakote, but everyone responds differently to different drugs and anything has to be better than the current situation. He is keen to take me off anti-depressants altogether. I’m glad it’s not lithium anyway.

He asked me what I thought and said that he suspected it didn’t really come as much of a surprise. At the time, I said not. I told him I knew a reasonable amount about the condition as I had friends with it and I had in the past suspected that it fitted. Thinking about it since though, it has been a bit of a shock. I’ve been seeking a diagnosis for so long and not received one, so to finally have one is a bit of a shock. It’s an unpleasant surprise too because I know that it can be an awful condition to have and I’m not sure I really want it, even if it does fit. After all, the last year has not exactly been a barrel of fun.

Dr G doesn’t yet know the outcome of the meeting. She isn’t in work today, but she is coming in tomorrow to see another patient so Dr C has written her a letter telling her about the meeting. I may end up seeing her tomorrow to discuss. I’m a little scared about her response to all this as I’m not sure what to expect. I presume she was aware that this was a possibility, because she wouldn’t have got Dr P involved if it wasn’t. Everyone is aware that Dr P is a specialist in mood disorders, especially Bipolar, and if anyone is going to spot it, it will be him.

Generally, I am still absorbing the information. I have suspected I would eventually end up with this label for a while, but it feels weird to finally have it. Dr G has avoided it so far and I wonder why, yet she obviously had her suspicions or she wouldn’t have got Dr P involved. I just hope she agrees with what has been said and is comfortable with it.

I think this has given me a little bit of hope. Things are changing, which is something positive. Hopefully, the new medication regime will improve the situation. I know it isn’t going to change things overnight, but it might pick things up. There is also the fact that this diagnosis should ensure I get more support. The CMHT referral is going through and they are trying to arrange a CPN before I am discharged from The Priory. The bipolar II diagnosis will give that referral more strength and also mean that the NHS pays more attention when I need support.

Aside from that meeting, I also have my GP coming to see me later today. I am a little nervous as there are a lot of things I have to cover with him, but he is lovely and I need to get over that fear. We shall see anyway.

A Second Opinion…

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I went into my ward round this morning with some notes that I’d prepared in advance. I am fed up of going in to see my consultant and not knowing what to say to her. I am fed up of going in to see my consultant and forgetting everything that I want to share with her. I am fed up of the blankness that descends the second I walk into a room with her. So I was prepared. I have been trying to write the notes for a few days and found it quite difficult, but I did get some of it pulled together and managed to get them printed off when I was home yesterday. I handed her the notes as I went in and she read them quickly. I hate that moment. I want the world to swallow me up so I don’t have to sit there as she reads the inner workings of my useless and faulty mind. We get there in the end though and she finishes reading my notes and then begins to answer some of my questions in her usual evasive manner.

She wants me to see one of the other consultants here for a second opinion. I get the impression she is a little flummoxed by me and does not know where to go now. She wants me to see Dr P, who is a specialist in mood disorders, especially bipolar disorder. She warned me he is not in any way shape or form, touchy feely and I’ve heard from others that he is very medication focussed, so will probably listen to me talk for a little while and then dole out meds, but it might be interesting to see what he has to say. I am a little scared though. I hate seeing doctors for the first time.

Aside from the second opinion, she talked about working on my care plan with her on Thursday. The idea is we will work out a plan for when I am out of hospital. She has already contacted my NHS trust with the hope they can provide me some support when I am out of The Priory, but I do not really trust them to be any help. Maybe with a respected psychiatrist or two on my side rather than just a single GP, I might have a bit more luck. We will see I guess.

Finally, she wants to refer me for some long-term psychodynamic therapy. Probably in group format, but she needs to find something suitable to refer me to. I’m a little scared at the prospect and worry that I will dread it in the same way that Alison does, but I think group therapy would be better than one to ones. I find individual therapy a terrifying prospect. I guess we will see what happens.

So.. Despite the fact I was waiting for hours this morning, it was a useful ward round. I just hope Thursday is helpful. We will see I guess…

Written by intothesystem

Tuesday, 14th April 2009 at 4:54 pm

Bad to Worse…

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Last week was tough. I went from bad to worse and the end of the week included a visit to my consultant and a review with my key worker. Both events were guaranteed to increase my anxiety and make things worse.

I saw Dr G on Thursday lunchtime. I’d written some notes beforehand as I am fed up the anxiety that ruins every appointment. I arrive at her office and anxiety grabs me around the throat and renders me speechless. My chest is pummelled by fear and I find myself gasping for breath and flailing hopelessly. She speed-read my notes, punctuated with sharp intakes of breath every few sentences. I hate that waiting whilst she is reading my words, reading my mind. I glance around her consulting rooms looking for things to distract myself with. Reading the titles on her bookshelves. Staring out of the window. Avoiding her eyes.

When she’d finished, she turned to me. As always, she took medication first. She upped my Topiramate. 50mg in the morning and 25mg at night now. No surprises there. I had expected my Venlafaxine to finally get the increase she has been promising since November, but still she holds off.

She suggested that suicidal ideation for me has become an almost habitual response to my depression. She suggested that I use  it as a coping mechanism, like a pressure valve, that if things are getting too much I begin to think of ways to release it and suicidal thinking gives me that. I don’t know how I feel about her suggestion. To a certain degree she may be right, but I feel she almost trivialises it. I found myself almost wanting to prove to her that I was more serious than that. I know how screwed up that sounds, but I know I’m not exactly thinking straight at the moment anyway. I do wonder when the pressure will push the valve though. One day it might just give.

We talked about work. It seems Dr G thinks I should take a slow approach to returning. Just dip my toe in, by getting in touch with some work colleagues and finding out what’s going on from those on the ground. I guess we’ll see about that. I’m not sure who I’d see. My closest work friends have transferred office or been made voluntarily redundant. I don’t know.

Other than that I can’t remember much. Dr G seemed pretty keen for my one-to-ones to start. She seems to pinning all hopes of recovery on them and thinks they may fill the gaps in my treatment.

After groups on Thursday I saw my keyworker for my review. She had some beck inventories for me to fill in. Both anxiety and depression. I think the anxiety was okay, but my depression scores must have been through the roof. I had no idea what to put on my review form. It asked if you felt worse or better than you did 4 weeks ago. I feel so much worse I cannot describe it. I can’t even remember what it felt like 4 weeks ago. I just know it was better than this.

Friday was more of the same. Therapists seemed concerned about me. They kept asking me if there was anything that had triggered the relapse. If there was anything that had made my mood drop. I don’t know. I don’t really know why I am here again. I just know it isn’t fun. I am frustrated of course. I am always frustrated.

This weekend has been okay though. I have just tried to forget the bad week and try to be normal whilst my bloke is around. It’s not been too bad, although last night I thought my head was going to run away, my thoughts were racing so much. I kept wanting to bash my head against my pillow because it was just driving me so mad.  It often happens like that at night. My head feels like it is racing away and I cannot get a hold of it. I lose all concept of size and shape and it just feels so strange.

Tomorrow is another week. A week until I am 23. I cannot believe it is almost my birthday and I am not yet back at work. That is another reason that I feel I have failed. I expected to be back by now. The last thing I expected was to be in this place again. I hate it.

I have to try and see my GP tomorrow. More medication. All I ever do is collect prescriptions and pills. I’m fed up of it.

Slipping Back…

with 7 comments

I realise now that a month ago, I was better than I thought I was. I thought there was no progress and I wasn’t getting any better, but now I realise it wasn’t as bad as I had thought. I was still low and the agitation was a problem, but I was coping then. The improvement on previous months was subtle, but it was there. I just didn’t really know how to see it. When you are depressed it is hard to see the positive amongst all the dark fog.

Now though, I can see. I am worse now. The juxtaposition between now and then makes it clearer. The upheaval of Christmas and New Year has done nothing for my mood. The endless charade of being okay and happy during the festivities is wearing and I’m tired. I find the blackness working its way through my mind and mood. The negative thoughts are relentless. There is a whole army of ants crawling around in there. I don’t have any ant powder. I have been existing for the sake of it for months now and I don’t know why I am still holding on. I keep trying to, but it is getting harder again. I do it for everyone else, not for myself. It is all just wearing. I am still wearing the mask.

I saw my consultant today. That was wearing in itself. I told her this. I told her that I was doing better than I realised, but now I am doing worse. I told her that I can feel myself slipping back and not having the energy to fight. She just said that this will leave me stuck in depression. She didn’t tell me how to stop myself or give me a hand to pull me back up. She just said that dips happen and I just have to keep fighting. I felt like she hadn’t listened and I found that hard. She has done nothing and said nothing today and I don’t know why I bothered to try and tell her how I feel. I am to stick on the same meds and she will review before I go away on holiday. I felt annoyed by her and maybe even let down. I don’t really know.

I am frustrated with myself that I have slipped back. I wonder if it is my fault. My fault for not realising things were improving. My fault for not making the most of that little improvement. My fault for not having faith. My fault for being this way. I doubt myself all the time and I’m punitive. I will wear myself down and beat myself up. I worry over everything. I question everything.

I think Dr G made a mistake today in the way she said that I may be trapping myself in my depression. I don’t know if she meant well or not, but it has upset me and annoyed me. It has not done anything to help me, only make me question myself more. I do not know why I have slipped back. I did not intend to slip back. It has just happened and I need a help out of it, not a knock down back into it. I hope things improve. At the moment it feels as if she is not supporting me or helping me. It almost feels as if she has lost the respect she used to hold for me. It feels unbalanced now. I am scared of her and uncomfortable about seeing her.

I don’t know what is next. I am always looking for answers. I don’t have any and don’t know where I can find them. I want to know when I will get better. I want to know when things will pick up. I want to know that they will pick up. I am looking for questions too. It is hard to find answers when you don’t have the questions. I don’t know what I should be asking of myself. I don’t know what I should be asking of my doctors. I don’t know anything any more. I find it frustrating.

Dr G wants to review before my holiday this month. Then she said we need to think about the future and planning beyond that. I am scared of the future. I am not sure I want a future. I am just trying not to think about it at the moment.

Written by intothesystem

Tuesday, 6th January 2009 at 6:08 pm

Medi-go-up and one-to-ones…

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My Quetiapine (Seroquel) dosage is going up to 400mg. It seems like a lot for someone who is being prescribed off-label and doesn’t have a diagnostic label to match, but nevermind. I saw my consultant again today. It was better than recent visits, perhaps because she has changed something rather than just asking me to wait and be patient, but it is still difficult. I go into my appointments shaking. I seem to lose my tongue and forget what I wanted or needed to say. I forgot to bring up the fact my eyesight has been bad lately and I am still not able to drive, despite knowing I had to. I will have to try and catch her at some point before the Christmas break, but I do not know if she will be in on Friday. She often takes it off.

Anyway, the other revelation of today is that I am being referred for one-to-one therapy at last. I am apprehensive, as I do not know what I am expected to use the therapy for. A few weeks ago, one-to-ones were discussed and it was decided that I wasn’t well enough yet and didn’t really have any key issues that were going to be possible to tackle in one-to-ones. Since then, nothing seems to have changed. I have no idea what I should talk about. I go into group sessions and have no idea what to tackle each week, but I can’t ask for the spotlight to skip to the next person in one-to-ones. I still do not have any answers or even the right questions. I just don’t know where to start. I am lost in this quagmire of shifting moods and negative thoughts. I am still struggling to see much further ahead than the next few hours and I’m still uncertain of what the future brings. I am still depressed more often than anything else and I am still frustrated and agitated. I feel like I am staring at brick walls in all directions and I don’t know which way to turn or how to break through them. I am glad that I am being referred to the therapist that I did my life maps with. I trust her and she seems to understand my frustration and confusion. She understands that I feel trapped in this limbo, not knowing where my diagnosis lies or how to fix the problem. The only problem with this is, I also know she doesn’t know how to fix the problem, so I am unsure of how much use an hour a week with her will be.

I am scared of therapy. It can bring up more things than it solves and it is hard work. I know I need to put the work in if I want to get better and I can’t just wait for medication to do it’s magic, but it is still daunting. Therapy seems to just drag up all these things and makes you question everything. It leaves you sitting in a mess of confusion and not knowing where to start or how to solve it. I don’t know where to begin untying all the mess.

I think most of all I am left feeling frustrated. I am worried that treatment will never work. I only feel that I am more and more confused and the fact that I am doing all the things I am told I need to do to get better and it is not making any bloody difference only adds to the desperation I feel. WHY AM I NOT BETTER!?! IS IT ALL MY FAULT?! WHEN WILL IT BLOODY WORK?!?!!!! WHAT ELSE CAN I DO?! ARRGHHHGHGHGHGHGH!!!

You get the idea.

I…am…fed…up.

Knowing how it feels…

with 5 comments

As Chouette pointed out, it is no secret that I met up with her, Kate, Colouredmind and Eccedentesiat this weekend. It was good to attach real people to the blogs and stories that I read. I enjoyed the meet, however brief for me, but am conscious I was talking far too much. It is a trait that comes from nervousness and agitation, but one I struggle to keep under control. Thanks though. I hope we can do it again.

It was great to just chat about everything and anything. Although we all know how it feels to suffer at the hands of mental illness, it was good that we could be “normal” and talk about other things too. We all know what it is to be students and to live in the city that we met. We all have a life aside from this. I think it is good for all of us to remember that. My partner thinks that I have become too wrapped up in being ill and that I shouldn’t spend all my time with “depressed friends”, but I think doing just that has helped me to remember the other side of life.

That said, I also appreciated being with people that know how it feels. I agree with both Hannah and Chou that we have all lost much to this illness. I too, have a list of wishes and a collection of regrets. I too, wish I didn’t have to take medication to live and sleep, wish I could find enjoyment in things and wish I could erase many things from my memory. I wish I didn’t have to spend days in therapy. I wish I could drive without being a risk to myself or others. I wish I could spend time alone without someone worrying about me. I wish I could turn off the negative thoughts that infiltrate my mind. I wish I could return to the career that I loved and not head straight for a nervous breakdown. I wish I could get on with life and want to live.

I have all these big wishes, but it was weird. The thing that struck me most from Hannah’s post, was the line:

I want to wear my hair parting on the otherside and not have scars to hide underneath my hair

I too wish for this. Worse, I wish I could part my hair anywhere and not show the scars of a lifetime of destruction. This is something I am so ashamed of, yet I still continue to wreak havoc. I have scratched my scalp to the point of bleeding and picked at every scar, every single night, for as long as I can remember. My hair no longer grows in the worst places. Elsewhere, it grows in tufts, as it tries to recover from the abuse. I cannot get a haircut, for fear of what the hairdresser might say when they see the mess that is my head. I am deeply embarrassed by it. My scalp constantly hurts and itches and I can feel the blood in my hair. I hate it, yet I am unable to stop. It is a compulsive act of nervousness, a compulsive act of self-destruction, a compulsive act of distraction. It is worse than ever at the moment. I lie awake at night and give in to the urge to hurt myself., leaving blood on my pillow. I sit in therapy and find my hands wandering. I hope no one notices, but fear that they do. I stand at the mirror and look at the scars. Most of the time I don’t even realise I am doing it, but I am painfully aware of the consequences. I wish that I could stop. I wish that wish was enough and I’d have the willpower. I know that I don’t. It is another one of those wishes, but I think it’s another one that is hopeless.

Yesterday I saw my consultant. I didn’t know what to say to her. I said that I’ve been frustrated that I feel no better. I said that the insomnia has returned. Her only answer was sleeping pills, Phenergan (Promethazine) again. I tried it on the ward and don’t think it helped, but it’s all I can try. I refuse to take Zopiclone, Promazine had no effect on me and Trazodone gave me all the silliness and uncoordination of drinking five pints, then left me with the hangover to match. Diazepam is off limits outside of the ward, as she doesn’t want to leave me with a nice addiction at the end of it all. She looked through her bible of psychotropic drugs at the sleep disorder pages, but didn’t find any other suggestions. Only Mirtazapine, which she discounted with a shake of the head. She went through the sleep hygiene list with me, but she knew better than to push that one. Admittedly, the fact I only had an hour or two’s sleep at most last night, was probably exacerbated by the diet coke I’d been drinking, but nevermind. Anyway, I have a note to give Dr N on Thursday, so my green slip will have the new one on the end.

Back to Dr G. She wants to put up my venlafaxine, but is scared of the consequences. The constant background agitation of the past few weeks makes that seem like a bad idea. She wants to put up my quetiapine, but is scared of the consequences of that too. My chronic apathy and considerable numbness are the issue here. Instead, she has done neither and left me in limbo-land with meds that don’t seem to help. I am fed up of the medi-go-round. I just want them to work. She is waiting and hoping that they kick in soon, but I’ve been on these for over 7 weeks now. Surely if they were going to work, they would be by now? Maybe I need to have more faith. How is the placebo effect going to work if I don’t believe in them? It’s still frustrating though.

She seems to think the way forward for me is therapy though. She isn’t holding out too much hope on the meds front. I wish I had as much faith as she does that splodging some paint around, talking about my life story, or getting annoyed at CBT will do anything to help me. It may be a short term distraction, help me to be more honest with myself and others about how I feel and give me a chance to think about stuff, but at the end of the day I still feel like crap and still battle day in day out with the intrusive thoughts. I don’t know how much “working through my issues” I can take and where it is going to leave me ending up.

I am chronically frustrated with this chronic depression. When will things change? I keep ending up in the same place. I keep waiting for things to improve. I am fed up. I feel like screaming it.