Tuesday 28 July 2015

Deteriorate

I saw my GP last week. Everything is such a mess right now, it's not even funny.

I was a bit of a wreck at the appointment, and I'm not even 100% sure why. I think it worried her a bit. Normally, I never let her see me cry, but this time there was no holding back.

She took my blood pressure so many times I lost count. The cuff stayed on for the whole appointment, and every now and then she'd reach for my wrist to double-check my pulse. Up until the last appointment, my blood pressure had mostly been fine, although my pulse always sits near 100. When I looked up at the screen as she typed in one of the readings, it said 96/83, pulse 127.

Printing out another blood test, she asked
    "Can you get these done today?"
    "Can it wait until Tuesday?"
First thing in the morning, straight after the dietician, is the safest/quietest time.
    "It depends on your blood pressure."
But thankfully by the end of the appointment, she let it slide.

Then the appointment took a turn for the worse.

She said she's worried my condition has deteriorated over the past few months, and dependant on my bloods, may need a 'short admission' for refeeding.
PANIC.

She's already said, not that long ago, that she doesn't think inpatient would help at this point. And if we're talking about just refeeding - not weight gain - there's nothing good IP can do for me that I can't do at home with the dietician and GP (and medical admissions, if necessary).

   "We'll see what your bloods say, but I think we're close to needing to weigh you."
I told her it's fine, I'm fine, I don't need to be weighed. I actually told her exactly how much I'd lost since the dietician last weighed me, which was 1.5-2kg, as much as I hated saying it (I'm still only weighing in on the Wii, deliberately so I don't know an accurate weight but can tell when it changes).
    "Well, I don't know if our scales would say that... but talk it through with the dietician and see what she thinks."

It's just all so fucked up. I don't know where this sudden burst of worry-panic-urgency came from. That's what I get for being so teary instead of just holding it in.


Obviously the mental health nurse was going to come up, and I had no idea what to say. We hadn't spoken about it since I was supposed to make an appointment, the MHN called to make one, but I couldn't bring myself to.

She asked if things with mum were still stressing me out, in particular the fact she's refusing to come to appointments.
    "I was actually talking to the MHN about it the other day, since you're obviously having trouble getting back. She agrees it was too sudden a change, and needs to be worked toward slowly and gradually. It was one of the first things she wanted to work with you on."
    "It doesn't matter. She won't listen."

We spoke a bit about my not going back to see her. It's too overwhelming, especially after so long, especially by myself, even if gong back could help. The last thing I want is to go back to see her and have her go on and on about what she meant by the 'mum's tired of you' thing. And I know she wants to explain what she meant, but I honestly cannot cope with that right now.

I can't even remember the outcome of the conversation. The gist was that I'm still expected to go back, but I don't think she told me to make an appointment. It was all just too much and my head was not coping.

She asked if maybe my mood has gotten worse since stopping Mirtazapine, but I really don't think it has. If anything, they're just seeing it more because I feel without outlet at home. To be honest, I'm just glad to not be putting that crap into my body any more.
    "What would your thoughts be on starting a new antidepressant?"
    "I don't know. I really don't think they'll help."

She gave me the name of a new pill, saying it had only been around for a few years but was showing promising results.
    "Can I at least come off the Gabapentin first? I really don't think it's changed anything and I don't feel comfortable taking pills that don't do anything."

She wrote me up a 3-week plan to cut back the Gabapentin from 3-a-day to 0, and start this new pill at week 3. At least I didn't have to take myself off it unsupported like the Mirtazapine.

This will be antidepressant #7. I haven't even read into it yet, but when I do I'll let you all know what it is. Normally, I'd be straight on it, but it's just too much so I'm trying to forget about it for the next 3 weeks.

I really don't think they'll work, but what does not taking them get me?


As we were finishing up, she asked if I'd had my scripts filled yet. I hadn't. They'd all been sitting on the garage floor for nearly a month, along with the forms. I don't want to even think about it, let alone touch them.

She started going on about how she'd need to legally involve mum in my care if I couldn't ask her to get the scripts filled, saying she'd go get her from the waiting room, and would I prefer to leave while they talk. I talked her into leaving it and told her I'd get them filled, but ugh. It was all just such a fucking mess.

Walking out, she says
    "I'm only pushing because I care, you know."
    "I know."

I tried to get an appointment with the dietician later that day, but she was booked out. I was just a wreck and needed to talk to someone and have it not end in disaster. Instead I sat in the car in the garage with my pipe and cried until I fell asleep.


This morning I got my bloods done, saw the dietician. It was so good to just talk to her about all the crap from the GP appointment after holding it in all week. She seems to agree that hospital is not the ideal situation given my emotional state. I told her it seemed a bit over the top. She's much more relaxed and less panicky about this stuff than the GP.

She does want me to think about starting regular weigh-ins again, but only every six weeks to start with. She suggested blind weighs, just so there's a number on the computer for the GP, and I just keep going by the Wii. I don't know. I'm still kinda bitter when it comes to the scales. Not getting weighed is more of a 'fuck you' than trying to hide anything.


As far as leaving the house goes... yeah, no. After this week, I feel less able to than I have in a long time, if ever. I don't have the energy to get into it right now, but things are not good. I just want to block everything out and have everyone leave me alone (not you guys - don't worry <3).


xxBella

Saturday 25 July 2015

Notebooks

For something a bit different, today I thought I'd show you all some of my notebooks.

I am obsessed with notes, journals, getting my thoughts down on paper and out of my head, and have stacks of notebooks in their own specific places around the house.
So for today, I thought I'd Show & Tell you about some of my most used ones.

Last week, when the dietician got back from her vacation, I'd been telling her about some of my different notebooks and how they all work, mainly my Intake book.

I routinely start new Intake books every six months, just to keep things neat and tidy. In her absence, I had filled book one of 2015, and was telling her about my monthly/6-monthly/yearly total/average intakes/burns/nets, and she asked me to bring them in.

So this week I went into our appointment with a pile of 5 identical notebooks, dating back three years (minus the one I've only just started).

I mentioned in my last post that I was nervous about showing them to her, although I did want to. I had butterflies in the morning, and even though I stacked the notebooks next to my armchair early that morning, I still got halfway to the garage before mum called out
    "Don't forget your notebooks!"

She laid them all open on her desk, eyes darting as she flipped through random days, comparing and pointing out patterns in my monthly/6-monthly/yearly total/average intakes/burns/nets.
(Seriously - every combination is accounted for, plus more)

She turned to a page from early 2013, where half of the page was stained with red wine.
    "It even has a sense of authenticity to it!" she laughed
That was just after Silky died. I was drinking nearly a bottle every night for a while there.

She noted things like my low-cal baking, and even asked about the stew I posted a recipe for a few weeks back. I had listed
"beef & vegetable stew w/ wholemeal toast"
and I think the calories were somewhere in the 150 range.
    "That can't have been much."
So I proudly announced that it was 150-ish a cup, and usually have around 200g. My bread is 40-50 cal per slice, depending on weight, though sometimes I'll just have half.

She asked if my intake book was it, or if I did more tracking elsewhere.
    "No. I've been using MyFitnessPal for nearly five years."
She nearly fell out of her chair when I told her about my 'days-in-a-row' streak. As of today, I'm at exactly 1,650.

Closing the books, she shook her head and said
    "You even used the same pen the whole way through..."

It was putting myself in a really vulnerable position, but I think it was worth it. It's something I've wanted to share for a while, but I just haven't had the guts.

    "You've given me a lot of insight."


And now, without further ado, I present some of my, Intake and non-Intake, notebooks.
Please excuse my atrocious handwriting.


Intake

I started these three years ago because I wanted a more visual overview of my intake than MFP could provide, and to be able to track times. The detail is kept for the app - in here I like to keep it simple with just the time, what I ate, and the calories. There's also a note on my phone simply listing my intake each day since I started seeing the dietician.

Both my Intake and Smoking books cover 6 months each. Each December for the last two years, I've sat and spent hours, days, writing the date at the corner of every single page and writing up the summary pages up the back.


99% of my notebooks are Marbig ColourHides


Smoking

I started keeping a closer eye on my smoking after being diagnosed with COPD and Bronchiolitis Obliterans in 2013. Even if I'm not actively cutting back, I'm always hyper-aware of it, and that has to count for something.




Journal

Pretty self-explanatory. I've been keeping journals since 9th December 2012, a few months after I first noticed ED behaviours. Top left is 2012, bottom right is 2015. I'd show you more, but that really is a whole 'nother post.




Daily Plans

I've been keeping these since last November. They're now bursting a lever-arch folder. There are 15 minute slots throughout the day. In the left column, I plan things in advance, and on the right, I record what I've done. The next morning, I highlight it into categories of how I've spent my time. 

Yellow = food & drink
Green = writing, blogging, notes, journaling 
Blue = relaxing, reading, watching movies
Orange = health, appointments, breakdowns
Pink = self-care, hygiene 
Purple = sewing, creativity
Red = exercise, cleaning, physical activity

Sorry for the vague picture, but most sheets have details like names and locations that I'd rather keep quiet. 




Pan and Crockery Weights

This little notepad lives on the windowsill by the scales, alongside another notepad for scribbling down weights and numbers. It has the weights of all the pots, pans and other dishes, plus my safe bowls, plates, etc..




Note Notebook
This has everything from word prompts to 'to do' lists to recipes and reminders and times and fragments of journal/blog entries. It's where some notes land before ending up in their proper place. I always need it with me.
This, like my smoking book and daily plans, may be bit too personally revealing to show photos of though.


I also have other, less-mentionable notebooks. 
There's a Food Cost one where I keep all of my receipts, and write a list of how much food I buy total each fortnight (hint: half of it goes on soda).
There's my OBs book.
My Self Harm Journal.
A BM chart (Am I the only person under the age of 80 who does this? Really?)

Not to even mention the endless, constantly-updated library of notes and to-do lists on my phone...

The box of notebooks in my wardrobe


xxBella

Monday 20 July 2015

Paralyzed with Anxiety

Today we have some tradies around the house. Something to do with the roof, I think.

As we all know, proven by the last batch of handiwork we needed done, I do not cope well at all with having people in the house.

I've been stressing over it ever since mum called them. On Friday, they said they'd be here this morning, 'before eight'. Now, I'm an early bird, so that aspect didn't bother me (I was up freezing my butt off at 3:45 this morning), but the impreciseness meant I felt I had to be ready to bolt inside from the porch from 6am onward, and every noise had me on edge.

He got here at 7:50.

So today I am hiding in the lounge room, curtains drawn. The entire contents of my study, furniture and all, is currently in my bedroom in preparation for painting (out of necessity - my GP's 'redecorate' speech has not impacted me), meaning both rooms are currently out of order. Going out to the hallway or kitchen or study means windows, and potentially someone on the other side. I can't.

I've been utterly frozen all day. Not just from the weather, although it did get down to -1.4°c this morning (what???), but mentally. I can hear the tiler banging and clanging outside and thumping over the roof. And I am stuck. Staring at the wall. I can't do anything. It's taken me until 3pm to even pick up my laptop.

Paralyzed with anxiety.


I did see the GP last week to fill out those bloody forms.

I told her I didn't want to even look at them, and she thought that was probably a good idea. Although I normally enjoy perusing her answers, this one was so in depth, and at the moment I really don't need any more triggers. She did ask a few questions, but most of my history she just looked up. As soon as she was done, I crammed the papers in the envelope and sealed it before temptation could get the better of me.

The dietician and/or mental health nurse must've talked to her, because she said she was still listing the MHN as part of my current treatment team even though I haven't been seeing her. She didn't push it or ask about it though. I guess she's saving that for the double this Thursday.

And, amazingly enough, despite taking them nightly she gave me another script for temazepam, though she said to keep taking breaks occasionally, and to use them as a 'treat' rather than a nightly thing.

I still haven't filled in my half of those forms. They're due in on Friday so I might be able to get my GP to help on Thursday, if mum can take them into town instead of posting them. Sigh. Currently they're sitting spread out on the garage floor from a post-appointment breakdown. I don't even want to pick them up.


Thank you guys for your feedback on my recent posts. Sorry for being so negative all the time lately. On the bright side, yesterday I dyed my hair and tomorrow I'm going to paint my nails, then I'm going to try to get out after this week's appointments.


xxBella

Tuesday 14 July 2015

The Dietician Returns, and the "Don't Think" Daze

It's Tuesday. The dietician is back from her holidays, and I saw her this morning for the first time in a month.

As good as it was to see her, part of me didn't even want to go, so I could just continue in my recent 'block it out' daze.

My GP must've made a note, because the first thing she asked about was the fact I haven't been seeing the new Mental Health Nurse. So I filled her in on my last appointment with the GP (we talked about it and she was going to call the MHN, and asked me to make another appointment), then her office calling wanting to make an appointment with both mum & I, when I panicked and said hell no.

I still haven't even made an appointment. I don't even want to think about it, let alone initiate a conversation, and mum hasn't mentioned it since so I just... haven't. Whenever we do talk about appointments and such now, it only ends in tragedy anyway.

Then last week, I got a letter in the mail regarding my pension. There are a heap of forms they want me to fill out, and I need to see my GP to do that, but I haven't even made the appointment yet. Again; do not want to even think about it. I'm not 100% yet on why, but it's another medical check on top of the regular one my GP filled out only a couple of months back, and it's even more invasive.

They want a complete list of diagnoses, whether they're presumptive or confirmed by a specialist, details of past, present and future treatment, they want names, they want dates (that's over 10 years since my first diagnoses of depression and anxiety), they want to know about my level of compliance, how each diagnosis specifically effects my daily functioning...

It's pretty horrifying.

Needless to say, this all led to a major freakout, panic, tears. I feel like I'm in trouble, although I know there's no reason to feel that way. The thought of possibly having to work terrifies me - not so much the 'work' factor itself. It's having to be a part of the world. in a way I can't explain.

It's just all too much and I don't even want to think about it, let alone do it. I want to shred the forms, burn the remains, and bury the ashes deep at the bottom of the garbage bin (one copy of the forms - they sent two - may have gotten torn up during the initial breakdown).

So I've been sticking my head in the sand. I don't want to see the GP because it's been nearly a month and I still haven't even made an appointment to see the MHN, and I'm afraid to tell her, more so now because I'm worried it'll look bad on this form. And I haven't been able to talk about any of it so it's been going no where.

So today we spent most of the appointment figuring out how to deal with his GP-MHN-Paperwork mess. I swear she'd be a better MHN than my current MHN. I think it helped just to talk about it and have someone to bounce things off.

We decided I should see my GP first to get this paperwork sorted out first, since there's kind of a deadline on that (oops), and then we can deal with what's going on with the MHN. I told her I'd try to get an appointment later this week. To make the whole situation a tiny bit less rough, I think I'm going to ask my GP to seal the forms in the envelope, instead of letting me peruse them when I get home. Some of the questions - or answers more to the point - can be triggering as hell, and I really don't need that right now.


My intake dropped when she was gone, but that's to be expected. In the end I've only a kilo to report. I've also not really been exercising this month except for some cleaning/moving furniture and a couple of stints on the step. I just have no energy, no motivation, and it was having bugger all effect on the scales anyway.

And I've only just remembered that my GP was going to leave the dietician a message regarding my electrolyte and iron labs and blood pressure/hydration, but it didn't come up. If it had, it would've been the same conversation as always, and the same supplements sitting unopened on the shelf.

We were discussing exercise and estimates for calories burned, and I mentioned that in her absence, I'd finished my first 6-month intake journal for 2015. On top of MyFitnessPal, which dates back further, for the past three years I've also used notebooks. Each is evenly split into 6 months, and up the back is a summary of my intakes for each month, monthly/6-monthly/yearly totals and averages for intake, calories burned and net, everything.

So she's asked me to bring them in next week because she'd loved to see them (oh, I was so hoping she'd say that!!!). She said she doesn't know anyone who take as many notes as me, but she doesn't even know the half of it. So be prepared, guys. There's probably going to be a big notebook post coming up.

I have to admit, it feels very vulnerable to let someone see every detail of my intake, even though she is a dietician. In the three years I've been seeing her, I'v never let her in so far. To show someone my intakes and weights and numbers, or my total calorie intake for a calendar year... It feels like I'm letting someone see my DNA, to see what makes me, me.

But it was so good to see her again, Despite our rocky patch earlier this year, we've come out of it stronger, I think. Regardless, a whole month without appointments is far too long. I hadn't seen anyone since I saw the GP on the 25th. As much as I've enjoyed the break and wish I could keep my head in the sand, it'll be good to have some structure back in my week. I just feel so lost and stuck. But this post is long enough already.

Now I have to face the music of the GP-MHN-Paperwork fiasco...


xxBella

Thursday 9 July 2015

The Walls are Closing In

Over the last few months I feel like my agoraphobia's been getting worse.

I've been in serious hibernation mode this year. I don't think it's really been that intentional. I just don't often think about going out. I was aiming for the same goal as last year, to try to go out once every month, but after I failed the first few months of the year I lost motivation and abandoned the goal.

So far this year, the only time I've gone out was my trip to Warrnambool for my birthday, plus a visit to a friend's house and quickly popping into my brother's girlfriend's house to play with a kitten. For some reason, going to familiar houses isn't as scary as going out in public (much like my familiar clinic being safe, vs other clinics).


Agoraphobia isn't black and white. It wasn't a sudden change, but a gradual thing that gets worse over time.

It's been an issue for a while now. When a psych first attached the term to me, it wasn't 'that bad'. I was 16 when I was diagnosed, but I was no where near as restricted as I've been the last couple of years.

At first, long before diagnosis, I think it was being afraid to go to certain places, but at the time I just linked it with other anxiety issues. I could still function like a semi-normal person when I was diagnosed. But over time that list became bigger, and I only went to 'safe' places. I stopped catching buses and trains, and could only go places if driven to the door. The last place I could go on a regular basis, except for the clinic, was the supermarket. Even that faded away slowly, and I haven't even been there since January '13.

Mum seems to link it to when a lady approached me in the meat section, on one of my last trips there, and started squealing -
    "Oh my gawd! You're like a model! You're so tall, you're so thin, I wish I looked like you. Honey, come look at this girl..."

I suppose in the big picture, it did escalate quickly at the start. By the time I was 17, nearly 18, the supermarket, appointments, and occasionally shopping at other safe places had pretty much become my limit, up until the time I stopped even going to the supermarket.


Since then, I've been limited to going to appointments, going for drives without getting out of the car, and sitting outside on the back porch, which is okay because it's so closed in.

I've written about most of the times I've gone out in the last couple of years, and kept track of locations and dates in a list. Last year, when I first set a goal of leaving the house once every month, I had a total of nine outings. In 2013, after I stopped going to the supermarket, I only went out three more times.


But things are still getting harder.

I have trouble even getting through the backyard these days, especially the second, more-open half toward the safety of the garage.
If the car's parked out on the street, there's not a hope in hell of me getting there.

I'm feeling more and more anxious in my own backyard and on the back porch, which is problematic as I usually spend the bulk of my day out there in my armchair. It's the worst of a night, when I wake up and go out to have a smoke. Every little noise plays on my mind, and if I hear a car pull up or people's voices or someone driving down the laneway, I can't stay outside.

I'm scared to sit in the car while mum goes into shops, ever since that guy peed next to my car door a few months ago (and no, there's no way he didn't know I was there). It really shook me, and it's just icky and no. I'm paranoid about the headlights being left on, because a few months ago, a guy came up and knocked on my window to tell me the lights were on, and obviously I went into a total panic.

I can't even go out for drives everyday like I used to.

It all sounds so irrational, but it terrifies me.

I had been planning to get out again before the end of June, though obviously it didn't eventuate. Then at the end of the month, the school holidays started, which means a flood of people everywhere. I will never ever go out in school holidays.

After the dietician gets back next week and the school holidays are over, I'm going to start trying again. I'm just conflicted.
I want to go out for a walk. I want to go to the zoo. I want to go op-shopping.
But I don't.
I can't.

    "It's like your Basic Freedoms are becoming less and less."
    -- Mum

And she is so right.

***

On the upside, temazepam has been working amazingly (temazingly?). Even though the first night was disappointing, they've proven their worth since. I don't think I've woken up more than once or twice a night, although a solid 8 hours still eludes me.

Kinda worried about talking to my GP about it. I know you shouldn't take sleepers every night or on a long-term basis... but in my head, it's kind of normal to (my mum's taken sleepers every night for as long as I can remember).
    "Don't take it every night - just when you've had a few sleepless nights, then maybe have one.", said my GP
Fuck that. I've had enough sleepless nights.


xxBella

Monday 6 July 2015

Recipe: Beef & Veggie Stew

It's been a while since I posted a recipe, but with winter well set in down here, I thought it'd be the perfect time to share my favourite stew recipe. It's whole, warm, and is a definite comfort food. In fact, before I made it into a safe food, it was a huge fear food. But, with a few adjustments over time, I now can't go without having a batch stashed in the freezer. 


The great thing about stew is how versatile it is. I'm not a big meat eater, so you might prefer a higher ratio of meat - or different proportions of veggies, or different veggies altogether. My mum and brother both eat it regularly, but with more meat, and a traditional roux base instead of cheating with gravy flour/semolina. The beauty is in it's simplicity.

I'll try to keep this concise, but I want to explain a little about what changes made it safe; apart from customizing the ratios of meat:vege.

I actually don't brown the meat any more, which means I eliminate the need for oil, but it turns out beautifully tender anyway. These days, I just put the pan on the scales next to the chopping board and put it all in together, except for the flour, which only comes in toward the end. Everything lands in a 16-cup boiler, and pretty much takes care of itself.

I've mentioned this 'gravy flour' at least once before, namely in this post, which I will update later. Basically, it's a very fine flour that allows you to thicken sauces without using butter or oils in a roux - another key ingredient for an oil-free stew.

But I've recently learnt more about this wonderful thing. A few weeks ago, after I could no longer find gravy flour in stores, I had a closer read of the last container, and realised it's nothing more than semolina (a form of wheat flour, like you use to make pasta or cous cous), which I already had a big bag of in the cupboard! On inspection, the grains are ever so slightly larger than the bought gravy flour, but I've since filled a proper shaker with semolina and it works just the same.


When it comes to safe hot meals, I do like to cook in bulk, and so this recipe makes about 16 cups. I keep my freezer drawer stuffed with portions of homemade stew, soups, mashed potato, etc.; anything that can freeze and reheat.

My dietician actually asked about how I weigh cooked foods, family dinners and the like, just before she went on holiday, and I realised I don't know if I've ever written about it here.
Not only the ingredients, but all of my pots and pans are weighed. I know the most-used off by heart. Once it's finished cooking, I can pop the pan on the scales, subtract the weight of the pan alone, and have a result accurate enough to calm my head.



It's really a very simple recipe, so I won't complicate it here. I use rump steak, which I think you Americans would call sirloin, but any cut will do.


Beef & Vegetable Stew

Makes 16 cups (4,000g)

Ingredients

   -- 750g beef, trimmed and diced
   -- 6 large potatoes (1kg), diced
   -- 5 large carrots (350g), sliced
   -- 2 large onions (250g), diced
   -- 800g can diced tomatoes
   -- 4 cups beef stock
   -- 55g gravy flour (or semolina)
   -- Thyme and oregano (or your preferred choice of herbs)
   -- Salt and pepper to taste




I started with 1.4kg before I ruthlessly trimmed it of fat




First, get everything sliced and diced.

I like to puree the onions and tomatoes with an immersion blender. I think it adds a lot of flavour to the sauce, but leaving them diced is fine too.














Like I said above, everything except the flour all goes in to the pan straight away - the meat, veggies, stock, seasonings...

Top up with water to ensure everything's covered.

Bring to the boil, then reduce heat to low and let simmer for an hour, or until the beef and vegetables are cooked, adding more water as needed.

(Note: Both meat and vegetables will become more tender as it's cooled and re-heated)











Once cooked, lightly sprinkle some gravy flour/semolina over the stew in batches, stirring well each time.

Sprinkle Lightly and Stir Well - the #1 rule of gravy flour.

You can generally guess this by eye, although the scales are handy. Just keep in mind it will thicken up more as it cools.

Leave on heat for at least 10 minutes to allow flour to cook, but not so long that it sticks and burns in its oil-less glory.








Dinner!


And because I just had to...

Nutritional info, courtesy of MFP.
(per cup / 250g)


(calculated using weights listed in Ingredients, to make 16 cups)


I hope you guys enjoy this recipe if any of you try it. 

I'll write a proper update soon. Right now my head needs a break.


xxBella