Medication and Obligations

I had an appointment with my GP yesterday for the first time in two months. 

Part of me had hoped she'd forgotten about it, but the first thing she asked was if I'd made an appointment with the mental health nurse yet. She reminded me that last year I said I'd see the nurse, that she had me on contract and I need the extra support. I cringed. I'm being backed into a corner and I don't like it.

We talk about days and times, and she asks me to make an appointment for sometime before Easter. She wants me to meet the MH nurse briefly at first and then to have monthly appointments, working towards fortnightly and eventually weekly. She tells me they work at my clinic two days a week, or could also visit me at home if I'd prefer (I think not). I start wringing my hands and shifting in my chair.

'I'm just letting you know what your choices are.'

'It's not really a choice though, is it?'

'No.'

She checked my arms and legs for self-harm, and the only wounds were some scratches, a little burn on my finger and a lot of mozzie bites. I've still been self-harming, but it's not several times a day like it was even a month ago, and generally I don't leave marks.

I told her that I've been taking lorazepam since just before Christmas, hence the decrease in self-harm. When I initially mentioned it, she asked where I got it, forgetting she herself had prescribed it back in May (where did she think I got it?!).

She asked if it'd helped with my anxiety at all, and asked mum if she'd noticed a change too. She had, quite dramatically. It's no longer a daily occurrence for me to spend several hours straight in hysterics, crying and panicking and breaking down over the smallest things. I mean, my mood hasn't particularly improved, mornings are difficult and I still have episodes, but they're no longer a constant and they usually don't last as long.

She agreed to keep me on it, much to my relief, but she can't raise the dose, which is fine. It's the most useful thing I've been prescribed in a long time.

As for the antidepressants... It looks like I'm stuck with Zyban for a while longer, even though it hasn't really helped at all. My insurance pays back a certain amount per year, but not enough for it to be affordable for longterm treatment as my pension no longer covers it. Mum said she was willing to pay for it, but it's just not practical for longterm treatment, especially for when I move out, and I couldn't carry the guilt.

But my GP won't take me off them. She and mum talked numbers and insurance and pensions and rebates, and it all went over my head. Long story short, I can get them at a reasonable price for the next 3-6 months, then she'll review them.

But here's the problem. No matter what, I won't be taking them in six months time. Even if they did eventually help, they're too expensive to be a viable option for longterm treatment. I don't see why I have to keep taking them, especially when they aren't helping. No matter what, I'll need to be on another antidepressant in six months time.

I'd barely been speaking but at this point I just gave up, feeling that my voice wasn't being heard anyway. She tried to ask about my weight and exercise, but my only response was nodding when she asked if I was exercising. She said we'd talk about it next time as I obviously wasn't in a talking mood today. I was quiet to the point that we wrapped up my double-appointment markedly early.

Just before I left, she asked if there was anything else I wanted to mention to her. I had a list running through my mind but I just shook my head and pushed out the words 'I just don't want to take Zyban anymore'. She insists.

Once in the safety of the car with mum, I broke down into tears and rambles that continued for hours.

I don't know what to do. 

I don't want to keep taking these antidepressants. 

I don't want to talk to this mental health nurse. 

I don't want to work forwards with my dietician. 

I don't want to deal with any of this.

I don't want to do anything.

I just want to hide away from the world for a little while. 

And I'm doubting myself more than ever.

xxBella

Spiraling Downward and Slipping Away

I'm slowly trying to come to terms with raising my intake and maintaining my weight again. It's not going to be easy, but I know I don't have much choice. 

I need to eat a little more to avoid having to eat a lot more. I need to maintain to avoid gaining. I need to keep away from hospital to keep anorexia close.

I have been pushing myself to eat something a little more 'substantial' each day, but it never adds more than 50-150 cal compared to the 'safe' options. My intake's been sitting anywhere between 350-700 cal for the past week or two and it all feels like too much. A couple of days pushed into the 900s, and I wanted to tear my stomach off.

The dietician asked me to have an Ensure everyday this week. Hah. To be honest, I haven't had any. I know that if I drink the Ensure, I'll just eat fewer calories from actual food. I don't work well with such variable goals. This is why I've always had calorie-based goals with my dietician, like "950-1,000 calories a day, eat what you can and top the rest up with Ensure". Otherwise I play with the numbers and twist the goals to keep my calorie intake lower.

I haven't been feeling too great the past few days. I've got an annoying little headache and a touch of fever, and enough phlegm that I practically wake up choking on it (gross, I know). On the plus side, it's helping me keep my exercise capped at one hour. I've been smoking like a train again which I'm sure hasn't helped. I'm back up to 40-50 cigarettes a day after getting down to ~35, and I'm smoking more of them, *ahem*, 'other stuff' than I have for months. 

I crashed in a heap after spending all weekend hunched over my sewing machine. My motivation has been sapped and I feel utterly useless. I do my step aerobics in the morning, and I do obligatory food prep throughout the day, but most of my time is spent chain-smoking in my armchair, still. Lorazepam is actually keeping me relatively docile. I'm self-harming less, and my panic attacks and breakdowns have reduced dramatically since I started taking it.

Speaking of, I see the GP next Thursday. I have to tell her that I've been taking lorazepam everyday since just before Christmas, despite her telling me it was a once-off prescription when she gave it to me back in May. I also need her to find another bloody antidepressant for me to try. Zyban was covered by my pension for two months as a 'quit smoking aid' (hah) and she was hoping my insurance would cover it afterwards, but they won't. I think this is the first time my health insurance has ever failed me.

Also, I'm pretty sure it'll be the last appointment before she corners me into seeing the Mental Health Nurse, so I can start panicking about that again. Yay.

I did mess around with a little sewing on Wednesday/Thursday. I made this little patchwork pin cushion wristband one day, and the big heavy pin cushion and scraps bag in the background the next. It was nice to have a quick no-pattern-required project to distract me as a break from the frustratingly precise dress.

xxBella

Rainy Days and Ruffle Skirts

It's been nearly a week since I last posted. I don't know where the time goes. Days just keep disappearing.

I saw the dietician on Tuesday. She asked how the last two weeks have been, and I didn't know where to start, so I just awkwardly blurted out that I'd weighed myself that morning. She asked why I decided to, and how I felt about it, but I honestly didn't know. I still haven't fully processed it.

The first week she was away, my intake was between 450-600 calories. In the second week, it became more like 300-500. Most days, my intake has been dictated by my calorie burn. Most days, that means burning more than I eat.

She said that something has to change in the next few weeks if I want to keep away from hospital. At the moment I don't really see it as being a real risk, but as something I can avoid inevitably, though I know that's not true.

Apples, salad and rice have been making up the bulk of my diet, with little bits of bread and yoghurt here and there. This week, she wants me to try for either a more 'substantial' lunch, or to join in a family dinner, or to have a snack that isn't sugar-free jelly. Otherwise, a 200 calorie Ensure.

On Tuesday night I stayed up late drinking Black Russians made on Coke Zero. A little serve of stir-fry with my rice one night. Animal cookies another. A cheese and Vegemite sandwich. 

I think the thing I'm dreading most about raising my intake, apart from the obvious, is probably the amount of thought, time, effort and stress that goes into planning, anticipating and preparing meals. It's been so simple to just grab an apple for lunch, or to reheat rice for dinner and drip on soy sauce. I haven't had to think too much about it, and it's taken a lot of stress off.

The dietician asked again if there was anything I wanted to talk about, if I knew why my intake has dropped so far. I just said that I feel very low. I didn't know what else to say. I can't find words when someone asks 'how do you feel?'.

Yesterday was strange. Mum was away for the night, and I spent about eight hours sewing in a near-manic state, trying to keep myself away from the more self-destructive distractions that've been filling my week. It worked for most of the day, at least.

On a positive note, I've finished the first half of the 1880s polonaise and walking skirt pattern that I've been working on for the last two and a half months. I can't even begin to calculate how many hours I've put into this, how many things I've had to go back and re-do because it wasn't perfect enough. There are so many details that are hard to show in photos, like the intricate facings, the precise pleats, or the amount of hand-sewing that gives it such a neat finish. I'll get better photos once it's complete. There are 23 meters (76 feet!) of ruffles, all hemmed and evenly placed. I've gotta say, I'm pretty happy with it so far.

Yes, shock horror, it's not black. I'm making it for the purpose of educating myself, improving my skill and building my portfolio, so it's not something I'll be wearing. White shows the details better, and is more appropriate anyway. 

xxBella

12.6

It was the longest five minutes.

I jumped up at my 5am alarm. I dashed down the hallway, went to the toilet, then lit a cigarette. 

I never could weigh myself without a smoke first.

The familiar white box peeked out from under the counter. Mum had pulled it out of hiding yesterday. 

I strip and rest my cigarette down on the counter. 

I step on the scales. 

Once. 

Twice. 

Thrice. 

43.7, 43.7, 43.7

Too much.

I don't much like to weigh myself these days. It does nothing but make me want for the number to be lower. I can run through it in my head without even stepping on the scales. 43 becomes 41, becomes 39, 37, 35, 34, 32, 30, 29... It's all a numbers game, and I know I can't win. It will never be enough. I will always need to be less. I will always be too much.

This is the first time I've weighed myself at home, first thing in the morning, looking at the number, properly weighed myself, for 18 months.

After so long of being kept up to date by my dietician, wearing the same weight of clothes and drinking the same amount of fluid every Tuesday morning for nearly two years. Though there's always room for error, I estimated I'd be around 43-45kg, so I wasn't far off. 'You've lost Xkg since June 2012' just wasn't doing it for me anymore. I needed a true update. I've tried to weigh myself several times over the last 18 months, but every time I chickened out, scared of what I'd see.

It's been a while since I've posted body-checking photos, though I still take them nearly everyday. I think it's because there've been no drastic changes to my weight for the last two years. But, since I'm updating on my weight and measurements, it seems like an appropriate time to post some.

An interesting note is that my bust measurement has gone up 1.5" in less than a year, even though my bra size and weight has gone down. It's the only measurement that's larger, most have gone down 0.5-1". I'm 99.9% sure that it's because of my lung disease, that I'm getting a barrel chest. 

(The rest of my measurements are updated here)

It's now 7am. I'm going to see the dietician in an hour. Then, I'll have to figure out the answer to the tough question. 

Where to from here?

I don't know. 

I just don't know.

xxBella

Why do I do this to myself?

I had my first outing of the year on Sunday, and went shopping. Part of the whole 'leave the house once a month' goal I set for myself this year.

I spent hours talking myself into it, out of it, and back into it again. I spoke softly and told mum that I was scared, that I didn't know what to do. We needed to go pick up an electric blanket I'd ordered, an hour's drive to the outer suburbs of Melbourne. I could've stayed in the car, but it'd be quiet being a Sunday morning, and I didn't have any appointments this week which made it slightly less daunting. Plus, I really needed to go shopping for new bras.

I don't know why I thought it was a good idea. It never ends well.

I sat in the car while mum got the blanket, and then we ventured into Target. I felt horribly self-conscious. It wasn't busy, but there were people. People were looking. People could see me. I hugged my arms across my chest in an attempt to hide. I wanted to shrink into the ground and disappear.

For the last few years it's been near-impossible to find bras in my size that don't have padding or underwires. But in the 'My First Bra' section, there was one style that fit the bill. I can't normally buy children's clothes because of my height, so this was my first purchase from the children's section. I felt like a bit of a creep buying kids' undies to be honest, but I'm just glad to have something that fits. I came home with three new 10AA bras. The funny thing is, they're smaller than my actual first bra was. Before I developed Anorexia, at my natural weight, I wore a 12G.

After we paid, I darted for the car. I felt sick to my stomach and started hyperventilating. Tears started to leak out, and I took the backup lorazepam mum had packed. 

I'd already had one earlier that day. 

I pulled out my notebooks and scribbled my thoughts in an attempt to calm myself. I folded my legs up and drifted in and out of sleep as we made the drive home. 

I'm conflicted. Part of me knows that I need to start leaving the house, especially if I want to stand a chance of moving out this year. But the rest of me just feels so... negative about it all. I don't have any positive feelings about having left the house. I know I need to and should leave the house, but I don't want to.

I feel overwhelmed, afraid, anxious, embarrassed, hurting, stressed, exposed, defeated, hopeless, guilty, ashamed, sad... I don't know how to explain it. It's just all too much. It's everything I was already feeling, amplified, intensified. I feel like an idiot for choosing to go out and bringing all this extra negativity upon myself when I'm struggling enough as it is.

The next day was when it really hit me. I felt horribly low. The entire day was spent 'processing' the day before, with near-constant tears, two hours on the step, an intake of 350 and entirely too many cigarettes. Today hasn't been much better. I haven't cried like this for weeks.

I'll never leave the house on a daily basis again, I swear. The more I go out, the less I want to go out.

Summer is well and truly here. We've got five days straight of extreme heat at the moment; today is 43°c (110°f). I'm barricaded inside with the aircon and my water bottle, only ducking outside to smoke, in a bid to avoid heat-related illness. Evidently I won't need my new electric blanket this week. 

Mum also picked up some new tiny cookware for me. Two more 'one egg' frying pans (12cm) and another saucepan (375ml). I'm building a whole collection of tiny kitchenware. I love it. 

xxBella

Silence is Safer than Speech

I don't know what to say. I don't have words anymore. 

Mum keeps asking why. Why my mood is so low, why I keep breaking down, why everything's just getting harder, why I feel like I'm giving up, but I can't answer. There are no words. 

The dietician asks the same. 

'There's obviously something going on for you that made you drop your intake.'

Silence.

It feels stupid that I can't give a crystal-clear reason for why. It's everything that keeps building and bubbling inside. I think it was PTSD stuff that tipped me over the edge, but I don't want to pin it all on that, and I don't even know how to talk about that. Sometimes it's easier to just stay silent. 

Everything is too much. I can't seem to express much more than that. 

My blood sugars have kept slipping and dipping over the last couple of weeks. Silly as it sounds, I didn't even consider that I'd need to eat more to be able to exercise. Most days, I still eat around 100-105 grams of carb most days, which has always been the 'safe minimum'.

I asked the dietician's advice when I saw her yesterday. She said that since I'm exercising so much, I probably need closer to 150g. My plan for now is to aim for 110-120g of carbs a day, which I can still do for under 600 calories, and go from there. There's no way I can jump straight to 150g, and hopefully it won't need to be quite that high. 

I try to avoid testing my sugars, but I have been this week. It's triggering in a similar way to weighing myself; it gives numerical feedback on how much I've eaten, and impacts how much more I'll eat. If they're 5.0, for example, I obviously don't need to eat for a while. If they're under 4.0, yeah, maybe I should eat a little more. 

Now I've got two weeks without appointments. She asked that I please keep an eye on my blood sugars, that she doesn't want me to end up in the Emergency room. I nearly laughed, saying that's not going to happen. I've worked damn hard for the last two years to keep myself away from hospitals and psychiatrists and everything involved with that, and keeping my sugars stable is a big part of it. I'm not about to let my sugars slip to dangerous lows.

I am trying to rein back the exercise a little, given the impact it has on my sugar levels and therefor my intake. I have to do at least one hour, but I'm trying not to force myself to do extra. If I do anything over an hour, I want it to be because I really want to. I'm finding exercise has become compulsive again, even though I'm not particularly overdoing it. 

This morning I was exhausted, but I pushed through a half hour on the step, telling myself I could stop there and take it easy. Afterwards, the stress kept building and I felt incredibly guilty for doing any less than a full hour. I couldn't leave it there. After some fruit for lunch, I forced myself back on the step, and did a full hour for a total of 90 minutes. And I felt a little better.

I've spent nearly all day trying to put this post together, so I'll leave it here. Thank you to everyone who left comments and support on my last post. It means the world to me to know that there are people who care. Apologies that I just don't have much to say right now. 

xxBella

Colder

The first day of 2014 came and went just like any other. I saw in the New Year quietly; no shenanigans for this little black duck. One glass of red, two Black Russians, asleep by 10 o'clock.

I've officially continued my streak of losing weight over Christmas, for every year since the start of my ED. This was the fourth. 

After two days of being slack with where my calories came from, my blood sugars had dropped by Saturday morning. I struggled on the step, stumbling and dragging my feet. I felt cold and nauseated, unable to breathe, about to pass out. My heart rate went through the roof, and I gave up after a pathetic 10 minutes; 90 minutes less than I'd managed the day before. I struggled to keep my eyes open all day, but pushed to get my sugars stable again, resulting in an intake of 800. With exception of that, and New Year's Eve drinks, my intake seems to've settled around 450-600 calories. 

The dietician will be working next week after all, even though she'll be halfway through a family camping trip at the beach. Thankfully that means there'll only be two weeks without appointments, which is slightly less daunting. 

I'm struggling for words again. I'm currently getting through the days with step aerobics filling the morning, leaning on lorazepam to zombie through the afternoon, smoking the green stuff after dinner and taking my night meds as early as is reasonable. But hey, whatever works. 

Lorazepam is new to me. My GP gave me a box of 50 back in May, after the Lung Doctor Man recommended I should be on them. She wasn't too keen on the idea, but gave me the one prescription, warning there'd be no more after that. I hadn't taken any yet, aware they're a precious commodity. I started taking them just after Christmas, in a desperate attempt to lessen the breakdowns, the debilitating panic attacks, the 4-hour episodes of nonstop hysterics.  

Everything is too overwhelming, too painful, too much. I'm managing little bits of sewing here and there, but that's about it. Except for Christmas, I haven't even cooked for three weeks.

I am self-destructing. 

I am falling apart. 

"I would say happy new year, but it's not happy; it's exactly the same as last year except colder."

  - Robert Clark

xxBella