Let's try that again...

I was back at the GP today, after last week's utter failure of an appointment. I started crying almost as soon as I sat down, and still had trouble finding words, but it was better than last week's.

I finally agreed with her on raising my Mirtazapine (anti-depressant) dosage, from 45mg to 60mg. She's been suggesting it for a while, but I've been putting it off. I've been on the same dosage for over two years now, 45mg is usually as high as it goes, and I guess I just haven't seen it as necessary.

She kept asking questions like "Do you think we should try a higher dose?". All I could do was cry in frustration "I don't know", because I honestly have no idea when my meds need adjusting. 

"But do you think it'd help?"

"I don't know!" 

After talking around in circles for a while, she said I should at least trial it, especially given the recent decline. She gave me a new script, so we'll see how it goes. After all, what have I got left to lose?

As for exercise, her opinion is that it's really up to the dietician. She sees where the physician is coming from with wanting me to exercise, and why it's complicated for me, but the dietician gets the final say. The big risk is being unable to make up for the energy deficit, especially if I overdo it. So when the dietician is happy with my intake and it wouldn't cause my weight to drop, then I can exercise.

She asked how I'm going with smoking, if cutting back's still working, though by this point I'd fallen back to wordlessness and tears. On the plus side, she got a good feedback letter from the physician, so apparently he's happy with how things are going. 

"He's a very good physician," she says "and he's looking at the big picture of your health. You're lucky to have him, because you do have a permanent illness that will require monitoring."

I still cringe whenever the seriousness of COPD is mentioned. 

She gave me some more ointment for my skin, the wounds that itch and never heal. She also took bloods, and wrote me a slip for a bone density scan which has been on the 'to do' list for months.

Not much news from the last week... No dietician appointment, which is always strange, but she's back this Tuesday. I've been doing a little sewing these past few days, a skirt, after weeks of not working on anything. It's slow going due to my lack of motivation, but I'm trying to do a little most days to help fill the time, and hopefully find a sense of achievement.

Today's been full of stress, and I'm exhausted, so I'm about to defrost some soup for dinner (lamb, lentils, barley, peas, carrot, potato, onion) and call it a day. With any luck, I'll have something to say in the next week or so that isn't appointment or depression related. 

xxBella

The Non-Appointment

The appointment with my GP was a total loss. The appointment you have when you're not really having an appointment. I was feeling so flat and down, I couldn't bring myself to talk. I slumped in my chair, stared straight down and fought off tears the entire time.

She asked about the physician, smoking, exercise, self harm, medication, even things like sewing. I couldn't say more than one or two words answers. It's not that I didn't have anything to contribute. I had things I needed to say, but I just couldn't talk. Mum answered some things for me, but I can barely remember what either of them said, and I couldn't give my input, so I won't bother trying to recall any of it here.

Near the end she asked if I was tired, or upset with her, or what was going on. I shrugged, and could feel the tears about to leak out. She said it was the quietest she's seen me, not that I'm usually overly chatty anyway. I made it out to the car and broke down into fat, sobbing tears. We got home, and I still couldn't stop crying. I told mum that I just couldn't talk, that I just felt so low, I couldn't talk. It sounds so stupid, I know, but that's all it was. I got nothing out of the appointment, it's like I didn't even go, and I feel awful for wasting my GP's time. We called and booked another appointment this Friday for a do-over.

The appointment is a prime example of what my week's been like. Few words, lots of tears.

I don't even have much to say about my intake. It's so routine, eating mechanically, and with Ensure I'm hitting my goal most days. I've had one day this week fall significantly short at 700 cals. The rest have been in the 900-1,050 range, and nothing much to talk about. Dinner is still the only variable, and that's only some nights, my other meals haven't changed at all. I'm cooking (and eating) family dinners maybe 3 nights a week now, the other nights I just pull soup out of the freezer.

Since I'm struggling for words, have some pictures. This is a stir-fry I made for the family last night. Chicken breast, carrots, green beans, red bell pepper/capsicum, onion, sauces and an impressively tiny 2 grams of olive oil to cook it all in. It was so bright and colorful. We were a little short on beans, but oh well. 

xxBella

Isolation

I saw the dietician on Tuesday, as usual, and the focus of conversation this week was my increasing isolation. 

She asked if I've been leaving the house, going to the supermarket, things like that. I nearly laughed as I said 'no'. I think I last went grocery shopping sometime back in February, maybe March, whereas I used to go every morning. I don't go for walks, I don't go shopping, I don't go into town. Sometimes I go out in the car with mum, but I never get out of the car except for appointments. I just don't go out, and I don't particularly want to. I'm terrified by the world, and everything in it.

Between this apparent agoraphobia, anxieties and other contributing factors, I've completely isolated myself, lost contact with every single one of my local friends. The last time I spent time with a friend was back in December, and I had maybe four social encounters in the whole of 2012. Socializing has always been difficult and anxiety-ridden, but now I don't even talk to anyone locally. I wouldn't know what to say or how to talk to them, and that's a scary thought. I'd really be lost without this blogging community, I can't say it enough. 

The dietician suggested that mum and I go on a day trip, something to change up the routine and get me out for a few hours. Just to go for a drive to another town, have lunch, and come back home, even if I don't get out of the car. So we're planning on doing that sometime soon, and we'll see how it goes.

Walking down the hall to be weighed, she asked what do I hope happens on the scales these days. I paused, and said I hope it stays the same. 

At the scales, step on sideways, stare at my feet. 

"You've got what you hoped for."

Exactly the same. That makes three weeks in a row.

Back in her office, she asked what my reaction would be had I gained. I said I'd be a little upset, and not see a reason to raise my intake if I was gaining, though I know now that one fluctuation doesn't mean I'll gain 'real' weight.

"You know you can't afford to lose anymore."

"I know." I sigh.

She talks about weight gain, says something about not having any weight to spare if I become sick with the flu, gastro, or even a cold. I tune out.

Next week the dietician is away for a conference, so I'll be next seeing her in two weeks. She offered me an appointment with her colleague just to be weighed, as she does on weeks away, though I don't think it's a good idea to be weighed without support available. Until then, she wants me to keep aiming for the 1,000-1,100 calorie range. 

Tomorrow I'm off to the GP, and will get her opinion on the exercise issue. On the plus side, I don't think my meds need to be changed around at the moment, but we'll see how it goes.

xxBella

All the Wrong Reasons

There are times that I forget why I'm doing this. Times that I reconsider raising my intake and working towards maintaining, or feel guilty for doing so. I have to stop and remind myself: it's okay, it's not recovery. It's not letting go of my eating disorder, but holding on to it. I know it sounds awful, but it does make me feel a little better. I'm doing this to avoid A&E, the horrible psychiatrist, sections, inpatient admissions. It's to keep me stable enough to not have anyone intervene. It's because I'd rather slowly raise my intake to maintain, than be forced onto 3,000 calories a day to gain weight that wouldn't stick.

When I remind myself of these things, it gives me motivation to try for the 1,000 cals a day. It makes it a little easier to drink the Ensures, and takes some of the guilt away. I need to remember that the alternative to maintaining isn't losing more weight, it's gaining. Obviously there's much more to it than calories and weight, it's never that shallow, though I'm trying to avoid even thinking about the big picture of my mental health. It's too distressing. As long as the eating disorder takes centre stage, my other mental health issues don't have to be faced.

I don't really have much to say at the moment, without getting into the over-emotional ramblings that I'm trying so desperately to avoid. I'm at a point where I'm really just waiting for my days to pass, and precious little else. Everything is very still, quiet, empty, and I'm lost for words.

My intake's been unremarkable this week. The stir-fry I made on Wednesday went down well, definitely a new family favorite there. Apart from that, I haven't really broken my routine, and have been relying more on Ensure. I made individual Beef Wellingtons (complete with mashed potatoes and tarragon-red wine gravy) for my family on Friday, which they loved, though I had no intention of joining and had soup instead. Made another batch of my 'go-to dinner' stew yesterday. But so far I've only had one day this week fall significantly short of 1,000 cals, most days I've pushed through 900+, so that's something. 

Well, that seems to be all the words I can summon for now. Have the best week you can everyone!

xxBella

The Dietician

I had my appointment with the dietician yesterday, and most of it was spent discussing the issue of exercise. I told her that the thoracic physician wants me to start exercising, and that I wasn't totally comfortable with the idea because of my history with compulsive overexercising.

"What does he mean by 'exercise'? Walking?"

"Yeah... But when I said that I don't leave the house, he asked if I had an exercise bike or a treadmill."

Her face dropped "Oh."

She asked what I'd said to him about the overexercising, and I'd said nothing. I doubt he'd have understood. 

She thinks that while exercising may help my lungs, it'd be detrimental to my health in the bigger picture. I need to be able to make up for the calorie deficit, and at the moment I just can't do that. My weight would drop further if I start exercising, and it'd cause more harm than good. She wants me to be eating at least 1,500 (*gasp*) calories before I can exercise at all, and even then it'd need to be heavily supervised. She's going to discuss it with my GP to get her opinion too, and then the GP will discuss it with the physician, but it's not looking likely. 

As for my intake, it was a bit better this week with the help of Ensure. Some days I drank it, some days I just couldn't. Overall I had three days at 1,000 calories, and the other days were between 600-900. She weighed me, and I'd maintained. Back in her office she started talking about how my weight needs to be going up, though I'm still avoiding that like the plague. Little steps.

I'm still struggling to have much variety in my foods. I'm in a routine, and the world of food is just so daunting. I eat the same meals everyday, though I've been attempting to challenge myself once a day, usually dinner, with mixed success. Last night I joined in pasta, and I also had a glass of wine. Tonight I'm cooking dinner for mum and I; a stir-fry with chicken, green beans, carrot, red capsicum (bell pepper) and onion, served with rice. Simple, fresh, easy to weigh and measure. It's not enough to not need Ensure, but it's a start.

Next week I'm back to the GP. I think the higher Seroquel dosage is actually starting to help. I don't feel great, but I feel different, like the mania's finally drawn to a close. Something's changed. 

Thank you to everyone who's been reading and commenting. You guys are seriously amazing for putting up with me and my ramblings.

xxBella

Smoking, Exercise and Lung Function

I had my check-up with the thoracic physician yesterday.

For a quick refresher: Three months ago, just a week after my 20th birthday, I was diagnosed with Chronic Obstructive Pulmonary Disease (COPD) and Bronchiolitis. At that point, I was told I had to quit smoking, that any irritants would worsen my condition. My lungs functioned at around 30% when I was admitted to hospital, and my oxygen saturation would dip to dangerous levels. Basically, at the grand old age of 20, I've caused permanent damage to my lungs from smoking.

So, I had my second check-up yesterday. We sit down in his office. My leg swings violently, my hands clawing at each other, staring at the floor with my eyes occasionally darting up to meet his.

"How've things been going?"

I mumble "I haven't quit smoking yet, but I've been cutting back. I'm down to about half a gram of weed a day,"

"Good!"

"...though my cigarettes have gone up to 30-40 a day."

"Why'd you do that?"

As if it was a conscious decision. Maybe because I've cut back on the green stuff so dramatically?

"Have you been exercising? Going for walks?"

Immense guilt hits. "...no."

"Not leaving the house much?"

*shakes head*

"Do you have an exercise bike at home? A treadmill?"

"...yes..."

"Do you use it?"

Cringe. "Not at the moment."

"Why not?"

"It's just... Umm... It's not..."

I decide to not go there, and fall into a silence.

"What does your GP say about the smoking?"

"We don't really talk about it that much."

"How often do you see her?"

"It's not really regular... Maybe every few weeks."

"Are you seeing anyone else?"

I know he means psychiatrists. He thinks I need lorazepam for my anxiety, though my GP won't prescribe it. 

"I see a dietician once a week."

"And how're things going with your weight?"

"...it's okay, evening out, staying the same."

At my last check-up, his technician weighed me on the spot. Thankfully they didn't this time, and took my word for it.

After a physical check over, he tells me my lungs are functioning at about 70%, which is a slight improvement on my last check-up, though obviously much better than 30% during the flare-up. My bronchioles have also improved, though they're still very narrowed. Apparently this is as good as it'll get, and now it's up to me to slow further damage. Keep on cutting back, work towards quitting. He reminds me that there is no better or worse with tobacco and marijuana, that they're just as damaging as each other. He says I've done well, to keep up the good work, and I take a sigh of relief. 

The first thing I say to mum when we leave is "Guess whose fat ass needs to get back on the elliptical?"

Ugh. I'm going to ask the dietician about it next week, and see what she has to say about it. She says I need to be resting, conserving energy, sitting down as much as possible and asking mum to get my coffees for me. He says I should be exercising, going for walks, moving around as much as possible. The guilt is massive. I know it's about making breathing easier, and nothing else, but it won't stay that way. There's no such thing as 'go for a half hour walk, three times a week' in my mind. It's all or nothing, and when I start I can't stop until I've burnt every calorie that enters my body.

My next check-up is in three months, and hopefully by then I'll have mustered up the motivation to quit smoking. For now though, it's just about making it through each day.

One thing at a time. 

xxBella

The Dress Disappointment

The dietician was lovely this morning, as always. She's far too kind and patient with me. I reached the 1,000 calories goal one day this week. Every other day was between 600-750.

On Saturday I planned my meals with mum, and ate 1,020 calories. It was too much to handle, mentally and physically, and the next day my intake was back down. The dietician asked what was making it so hard, and I don't really know. I just don't have any motivation to eat outside of my routine, and even that's too much to handle some days. She knows I'm not in a good place mentally, asked if I'm still taking my meds, reminded me I can come back on Thursdays if my intake's failing. 

She's given me another week with the same goal, 1,000 calories minimum each day, though a new approach. It's time to dig out the tin of Ensure powder. There's no excuses for not reaching 1,000 this week, and if I don't, I don't know what else to do. 

She weighed me right at the end, and I was exactly the same as last week. Which begs the question: why the hell do I need to eat more if I'm already maintaining? I know there's more to it than that, and that my weight doesn't maintain long term on this intake, but it's still set a doubt in my mind. 

I finished sewing my dress yesterday. It's beautiful. Why are there no pictures, you ask? Because it doesn't fucking fit. It's an inch or two too big. It's enough that it looks and feels obviously too big on me. Now, I had the same problem with my coat, but at least I can wear layers under it, and it still squished onto my dress form because of the looser fit. But this dress? It's too big for me, too small for my dress form.

It's a size 6 AU. There are a few patterns available in size 4 (which I'm still yet to see in shops)... maybe 0.5% of the catalogue, and they're all very basic, but I refuse to sew another size 6. It's frustrating to put so much time, effort and money into a project just to have it not fit, when that's the whole reason I started sewing again.

Now I'm looking into buying a smaller dress form, since the one I have is currently useless to me (size 8+). Mum suggested I could simply gain enough weight to wear the dress, hah. No. Even if/when I do gain, I doubt I'd wear it anyway, because I'd have to keep gaining past a size 6. One day it'd fit me, the next it wouldn't, and that's just depressing. 

xxBella

Overwhelmed

Everything is too much. Not just food. Everything is too much. 

The pressure just keeps building. It's a bubbling irritation, filling up my body, about to burst.

Meltdowns occur once or twice a day. The pressure builds, and I start to snap back whenever spoken to, swear like a sailor, or start ranting. Then comes the self-harm, in an explosive burst. I'm littered with bruises, bumps and various open wounds. I start to vocalize the negative talk that swims around in my head, raving in an endless circle. Sometimes a few tears leak out alongside, and if they do, good luck trying to stop crying.

My mood is shit, obviously. My intake is shit. I've been between 600-750 calories so far this week. So much for "not a single day under 1,000". Mum wants to be more involved in my meal planning, so she knows what I have to eat at each meal to get to 1,000. She also suggested we start planning a dinner I'm comfortable with earlier in the day, because I keep refusing to eat what's on the menu and having my stew or soup instead.

I'm dreading my appointments next week. I don't want to see the dietician after yet another week of failing to reach calorie goals. I don't want to see the thoracic physician, three months later and I'm still smoking like a train (though less weed, more tobacco). Mum says both are understandable, that I can't make any real progress with eating or smoking while my head's such a wreck. "One thing at a time" she says, "you can't be so hard on yourself", but all I see is failure. 

As for my foot, I went back to the GP on Thursday, and showed her my impressive bruise. It seems I've sprained my arch, not my ankle, quite badly. She sent me to get an x-ray, and thankfully they came back fine. No breaks, just a helluvalot of bruising. Now I'm just waiting on her to sort out what's going on with my meds, and then hopefully things'll start to improve. 

Sorry for so much negativity lately. On the bright side, I've nearly finished sewing my dress, so hopefully I'll have pictures up in the next few days. 

xxBella