Doctor’s Orders

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If you’re in treatment, there’s a pretty good chance you’ve come into contact with a number of health professionals. With both physical and psychological problems, I’ve been to over a bajillion doctors, pharmacists, nurses, NPs, PAs, specialists, etc, and that’s a conservative number. Some of them have been incredible, amazing people who quite literally have saved my life. I’ve had my therapist since age eight, and I’ve had my psychiatrist for over six years. They are both amazing people, and I can’t imagine how I got along without them. I also have a couple favorite pharmacists, three stomach specialists, an endocrinologist, an OB/GYN, a PCP, and have been to a cardiologist and ENT.

And then there are others that I hope go through the same trauma they put me through. I’ve had an NP try to prescribe me a drug I’m allergic to, someone who never responded to a crisis situation when I had to be hospitalized (my mom had to wait outside his office to even talk to him), an over zealous NP who had me on every medication under the sun, among so many other “professionals” who made my life harder during a time where I was at my worst.

Ok, so what was the point of that story? It can be very difficult to navigate a world of doctors, acronyms, pain, appointments, waiting, medications, and frustration. This becomes even worse when you’re already sick. I have a few things that help me when it comes to the world of healthcare.

1. I take notes on the backs of their business cards. These can be little notes like “friendly,” “kind,” “efficient,” or “cold.” This works especially well with people who I don’t encounter all the time, like pharmacists or people in a practice. This helps me remember which professionals I like and why.

2. I don’t waste time on doctors I don’t like. I’ve spent so much time trying to work with doctors who weren’t willing to work with me. Now, I try to find people who take the time to explain my conditions and treatments. I also look for doctors who aren’t too “gung-ho” about strange tests and treatments.

3. I set aside a lot of “padding” time around appointments. This has saved my ass on a number of occasions. For example, at the last two doctor’s appointments I’ve had, the doctor has been over an hour late. That’s just how it goes. There’s no point in being angry or frustrated about it. However, if I’ve scheduled appointments back-to-back, I’m going to be stressing about being late, and I’ll rush through my appointment. I know that when meeting the doctor, I have to be fully present to take part in my treatment. I need to have the time to ask the right questions and remember the answers. It’s not always easy to find this amount of time, and I’ve had to make sacrifices at work to make sure I have this padding. However, I’ve found that the reduction of time-related stress has been invaluable in the treatment process.

4. Allow yourself to debrief and, if necessary, grieve. There’s a lot of information to take in at appointments. Sometimes you get good news, sometimes you get bad news, and sometimes you’re left with more questions than answers. Whatever the case, I find debriefing very helpful. Sometimes I text my family/friends after my appointment. Sometimes I don’t want to talk to anyone and instead get a coffee by myself. Sometimes I go to back to work. Sometimes I spend an hour wondering how I can have a “pseudo” syndrome.

Sometimes, treatment can be as much of a process as having the illness itself. However, with enough practice, discretion, and luck, it eventually becomes an inconvenient habit.

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Traveling with Baggage

Don’t forget Mr. Carrots!

At the moment, I’m preparing for a long weekend trip. Like many people who suffer from mental illness, I’m not a great traveller. There’s so much instability inside of me that I try to control and stabilize the world around me. However, I’m determined to not be limited, so I do travel quite a bit.

The way I prepare is to treat my trip like I’m traveling with a nervous toddler. Prepare well, keep yourself distracted, and don’t sweat the small stuff.

 

Before the Trip

1. Plan an itinerary. 

Think about it: What does a toddler do during a trip? “Where are we going? How are we going to get there? When are we gonna get there? How long now? What are we doing?”

First, realistically evaluate your destination and transportation options. If you’re still suffering from major symptoms, it’s probably best not to hop on a fifteen hour international flight. Plane trips can be nerve-wracking for anyone, and people have very little tolerance for people acting strangely on airplanes (it’s sad and unfair, but it’s the truth). In addition, international medical emergencies can be confusing, stressful, and expensive.

However, if your symptoms are manageable and you feel you can handle international travel, there’s no reason why you shouldn’t give it a try. If stress is an issue, look for low-key destinations. For example, if you’re not good around crowds, avoid Beijing and look into Bergen. Investigate places where English is a native language or a very common second language. If you’re worried about emergency medical costs, you can investigate buying travel health insurance. Or, you can avoid this in favor of domestic travel. There are so many places to go and so many ways to travel that there’s bound to be something that works for you.

The itinerary doesn’t need to be a blow-by-blow checklist, but planning roughly what you’ll do and where you’ll sleep is a big help. If you know what to expect, you can prepare yourself for the difficult parts of travel, like crowds, bed times, and meals. You can also use the itinerary as a countdown during the difficult parts of your trip. If you know that the plane ride takes three hours, you can reassure yourself that the turbulence won’t last forever. In addition, this makes medication timing a lot easier, especially if you need to coordinate meal times.

 

2. Pack by priority.

Think about it: What would you do if your toddler needed a stuffed animal to sleep, but you left Mr. Carrots at home? You can’t just buy her a new rabbit!

When you pack, there are a lot of things to think about and remember. Clothes, electronic devices, chargers, toiletries… there is just so much stuff! I inevitably forget something. So what do I do? I plan for my forgetfulness. I make a list of everything I need, but I really concentrate on what I can’t replace or do without when I arrive at my destination. For example, I can always buy new socks if I forget those, but forgetting my medication would be a nightmare to fix. I can go without my favorite hand lotion, but I can’t go without my phone.

So, before you start packing, determine what your Mr. Carrots objects are. Mine are:

    • Medication
    • Phone
    • Glasses
    • Credit cards
    • Important documents (driver’s license, passport, tickets, etc)

While it would be nice to remember my Bose earphones, I can always pick up cheap headphones at a Walmart. I also need my Fitbit, but I can even buy a new one if I forgot it. I cannot, however, find a new passport at Walmart (maybe you have better connections that I do). Keep the list as small as possible and know that as long as you remembered that stuff, you’ll be ok.

 

3. Figure out what needs to happen for you to stick to your routine.

Think about it: Have you ever encountered a toddler who missed his nap time? It’s not pretty, and it’s not quiet.

His reaction would be pretty similar to mine if I didn’t take my pills at the right time or didn’t get the right amount of sleep. Before you leave, notice what you do during the day. What time do you wake up? When do you go to bed? At what times do you eat? How much downtime do you need between activities?

Once you’ve noticed your routine, think about ways you might stick to it. For example, if you take a break between work and dinner every day, set aside an hour or two between your museum tour and that restaurant reservation. If you’re hitting up Vegas for a bachelor party, let everyone know you might not be joining them after midnight. These are the small things that make a huge difference once you’re there.

While You’re Traveling

1. Keep yourself distracted.

Think about it: Would you rather sit next to a bored toddler or one who’s busy with a puzzle?

What I’ve found is that the more time you have to think, the worse the traveling process can be. I try listen to music or audiobooks. Sometimes, I grab a magazine or easy book. If you’re traveling with others, you can always play games like Going on a Picnic or the license plate game. Essentially, I try to jam-pack my mind during travel so I can’t think about anything else.

 

While You’re There

1. Treat jet lag as a real trigger.

Think about it: It’s 3am and your toddler is jumping on her bed, wide awake and ready to go. Not a fun time.

If you cross timezones during your trip, jet lag can be a huge concern. You can use these tips from IAMAT to help avoid jet lag. In addition, medication scheduling is important. You can start by using a website like this one. Once you have a basic schedule, run it by your doctor for his/her advice. 

 

2. Do things you enjoy.

Think about it: If Ethan wants to go to Legoland, how much would he really enjoy going with his sister Eloise to the American Girl Doll store

This may seem obvious, but you’d be surprised how easily you can overlook that. Things happen, concessions are made, and suddenly Ethan is busy throwing combs at the wall in the American Girl Hair Salon. If you’re not a fan of walking, I’m willing to bet that you won’t be very happy at the end of an eight hour hike. If you get sea sick, a whale watch might not be the best idea. If your days are filled with hikes you don’t want to take and whale watches you don’t want to go on, travel won’t be a very good experience.

If you and your fellow travelers enjoy doing the same things, that’s great! If you don’t, try finding an activity with which you’re both comfortable. If Eloise hates Legos and Ethan hates dolls, try visiting Disney instead. I aim for activities that are slow-paced, interesting, and have opportunities to leave if I get nervous.

 

3. Know your limits.

Think about it: Your best friend Elliot really wants to go to a midnight parade. It might be fun, but you know it’s loud, intense, and way past your daughter Eve’s bed time. How would that night be for Eve? How would the next day go?

These are critical moments. That parade might sound incredible, but if loud noises, late nights, and crowds are big triggers for you, you might want to sit that one out and settle for the pictures. It might not seem like a big deal at the time, but stretching way beyond your comfort zone could ruin your trip and even have lasting effects.

These are just a few tips to get you started. If you’re curious to know more or actively planning a vacation, check out the resources below. Bon voyage!

WHO Recommendations

Making a Medical Portfolio

IAMAT Resources

 

Drug Scheduling

Note: This information is only valid in the United States. In addition, I’m not a doctor, lawyer, or have any sort of important credentials. Always check with an authority in your area if you have any questions.

Today, I want to talk about controlled substances and drug scheduling. Like many with mental illness, I take a few controlled substances. I take both a stimulant for ADHD (Schedule II) and a sedative (Schedule IV) for anxiety. Both drugs are highly regulated, which makes it hard to obtain them (even legally!). In addition, there are a lot of special rules surrounding scheduled drugs.

So, what are these classifications? This is from the DEA’s website:

 

Schedule I

Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Schedule I drugs are the most dangerous drugs of all the drug schedules with potentially severe psychological or physical dependence.

Some examples of Schedule I drugs are:

    • Heroin
    • LSD
    • Marijuana (cannabis)
    • MDMA
    • Peyote

 

Schedule II

Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, less abuse potential than Schedule I drugs, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous.

Some examples of Schedule II drugs are:

    • Cocaine
    • Methamphetamine
    • Methadone
    • Demerol
    • OxyContin
    • Fentanyl
    • Adderall & Ritalin

 

Schedule III

Schedule III drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV.

Some examples of Schedule III drugs are:

    • Vicodin
    • Tylenol with codeine
    • Ketamine
    • Anabolic Steroids
    • Testosterone

 

Schedule IV

Schedule IV drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence.

Some examples of Schedule IV drugs are:

    • Xanax
    • Soma
    • Darvon
    • Darvocet
    • Valium
    • Ativan
    • Ambien

Schedule V

Schedule V drugs, substances, or chemicals are defined as drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes.

Some examples of Schedule V drugs are:

    • Robitussin AC
    • Lomotil
    • Motofen
    • Lyrica
    • Parepectolin

 

Travel

States have their own laws about handling controlled substances, including filling the prescriptions, driving with them on your person, and traveling. For example, if you’re in New York, you must have your medication in its original container. In Texas, there have even been accounts of people being questioned and arrested for having unmarked medication. In other states, all you need is proof of a prescription.

So what should you do? Well, the safest thing would be to always keep it in its original container. I would also recommend that process if you’re traveling by airplane, especially internationally. While the TSA doesn’t mandate this, other countries might. In addition, you should obtain proof of your prescription and a valid ID (driver’s license, passport, military ID, etc).

But is this practical? For me, no. I take many pills a day, and I’d have to constantly carry a backpack if I needed them all in their original containers (granted, this is really only important for narcotics, but I like to exaggerate). When I travel, I keep my controlled substances in their original containers. I only have three, so it’s not a big deal. For the others, I keep them in a day-by-day pill box. I’ve never had any problems, and I’ve flown both domestically and internationally.

 

At Home

Generally, I just keep everything I need during the day in a pillbox in my purse. If I don’t need it during the day or in an emergency, I leave it at home. Every Sunday, I sort all of my pills into my pill boxes. If I empty a pill bottle, I disguise the name and Rx on the bottle using a security stamp like this one. Then, I recycle the bottles. When it comes to controlled substances, you definitely want to protect your identity. One, people can steal your identity, and two, they know that you have narcotics in your house and might try to rob you.

 

Around Friends

I try not to make it a point to discuss what meds I take. For one, it tends to alienate others, and for two, I’d rather not put people in the position that they know what medication I take. For example, my friend has bipolar disorder, and she takes a mild sedative. She had previously told people that she was prescribed that particular medication. Later, she found that someone had gone through her purse and stolen most of the pills from her pill bottle. You never know what people are going to do, so it’s probably best not to tempt them.

So, what can you do? Well, try to keep your pills as close to your as possible when you go out. You could also lock them in a small bag. Or, disguise them in a container that doesn’t look like a pill bottle (I use a contact lens case). Note: You probably shouldn’t do this if you live in NY. If you live in a group setting, such as a dorm room, hide them somewhere or invest in a small safe or lockable toolbox.

 

Using ASL

Clean Brains ASL ChartSometimes, I find myself unable to communicate or find words. For some reason, however, I can still use sign language. It might just be me, but in any event, I suggest it because you might find it useful as well. You can learn a few signs (such as the ones for medicine, emergency, hungry, thirsty, help, etc.) and teach them to people in your support network. That way, you can communicate without having to physically speak.

I’ve created a printable chart of the basic fingerspelling signs and the signs I feel are most helpful. You can print these papers and give them to friends and family as quick references. You can also buy the book The Perigee Visual Dictionary of Signing by Rod R. Butterworth. It’s the one that I personally find most useful (and believe me- I’ve seen a lot of them!).

Download Clean Brains ASL Chart

Download Clean Brains ASL Fingerspelling

Tune It Out

If you work in an office building (or if you’re in school), invest in a good set of headphones or ear plugs. This is critical if you easily get distracted. You can also ask coworkers to email you rather than drop by your work space. This way, you can address issues on your own time rather than being interrupted and find yourself unable to return to your previous task. You also have a written record of the conversation in case you need to consult it later. If you’re at school, you might be able to ask for this accommodation.

Surprise Visitors

Have an emergency box for visitors. Don’t use the contents unless you absolutely must and, if so, replace them. It can be awkward and embarrassing when people drop by and you have to basically tell them, “Sorry, I have nothing to offer you.”

Examples:

  • Samples of good quality tea, both normal and herbal. These can often be picked up at hospitals/hotels, etc. Or, when round at your parents’ or friends’ homes, comment that the tea they served was fantastic and ask if it would be ok to take two or three bags. If they are foil sealed, wonderful. If not, cover in foil or put in zip lock bag.
  • Smallest bottle possible of a decent instant coffee (Starbucks Via isn’t bad, and it looks fancy.)
  • Long life milk/unrefrigerated soy or nut milk.
  • Individual samples. You can generally get these for free at restaurants, coffee shops, etc. Individual packets are generally more shelf-stable so you won’t have to use/throw out a whole bottle of something. I try to find:

 

Sugar/Sweeteners/Honey Ketchup, Mayo, Mustard, Relish
Dipping Sauce (BBQ, Honey Mustard) Dairy Creamers
Salad Dressing Jams/Jellies/Marmalades/Syrups
Hot Sauce Soy Sauce

 

If you don’t want to take these for free, you can pick them up online as well.

  • A nice, clean set of dishes (so you don’t have to scramble to clean anything). You can also get a decent set of disposable dishes as  well.
  • A packet of decent cookies, crackers, or chips
  • Frozen finger food that can be heated within 15 minutes in your disposable oven tray and served up in a disposable bowl. French fries are good for this. If you need something fancier, the Archer Farms brand at Target has some decent frozen appetizers.
  • Another winner is to have a packet of corn tortilla chips, jar of salsa, and shredded cheese (stored in the freezer). Bang it all together on a large disposal plate pop in microwave and within three minutes – simple but delicious nachos. You can always add a tin of jalapeños or canned chili (I like Amy’s brand) for bulk.
  • Microwavable popcorn

That “Lived In” Aroma

When surprise visitors drop by, if you have put in place the “bin in every room” hack, then all it takes is about three minutes to collect and deposit all of them in the council bin. Your house may need vacuuming or dusting, but it won’t be littered with rubbish. Have some cheap but pleasant incense or aerosol/spray bottle essential oils to remove that “lived in” aroma within seconds.

Social Sidelines

I always seem to be dodging social events and invitations. I like to go out, but it’s not always feasible. While my closest friends and family know about my struggles and I’m honest with them, I don’t always want to share this information with acquaintances or strangers. For this reason, I have a mental list of polite declines for invitations. These are my best ones:

  • “I think I caught a bug. I don’t want to get you sick!” This also works with food poisoning. Anything with bodily fluids, really.
  • “My parents won’t let me go.” A great fallback if you’re young.
  • “I can’t find a babysitter.” Great if you have kids.
  • “Sorry, I already have plans.” It’s even better if you can get a friend on-board with it. My boyfriend usually doesn’t mind covering for me.
  • “I have an appointment, and it’s really hard to get an appointment at that place!”

The possibilities are endless.

Pro Tip: Don’t update social media or talk to other friends while you’re dodging the invite. It’s really easy for that information to get back to the person/people you’re trying to avoid. You don’t want to ruin a friendship.

The Cellphone Save

If you find yourself in an anxious group situation (such as a family get-together or meeting), set an alarm on your phone that will go off a minute after you set it. Make sure this alarm has the same sound as your ring tone. When the alarm rings, look at your phone and remark, “Sorry, guys, I have to take this.” This will allow you to leave the room for awhile to collect your thoughts. It also won’t draw the same concern as an extended bathroom break might.

If you have a psychiatric service dog, you can also train your dog to provide an out, too.

There’s Always a Way Out

When you enter a room, always look for a way out. Stare at it and lock it in your head. This way, you can quickly duck out in an emergency or if you need to catch your breath. There’s nothing worse than getting lost among a crowd of people when you’re having a panic attack.

Similarly, I try to avoid situations where there is no “out.” I tend to avoid boats, trains, busses, and airplanes. This isn’t always an option, but every little bit helps.