Tag Archives: psych

Of Psychiatry and Surgery

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Nearly two weeks ago I had my last appointment with my psychiatrist. In it, we discussed where I’m at and where I’m going. There wasn’t much to the appointment, really. He determined that my dose on the sleeping pill was so low that it wasn’t actually doing anything and I should stop taking them when I felt I was okay to (most likely after my surgery). He also felt that the hallucinations I experienced were likely caused by my lack of sleep over a year and a half ago and that now that I’m sleeping properly, I shouldn’t need the antipsychotics. He suggested that once things are stable (so likely after my surgery), I should try going off the antipsychotics and see if the hallucinations come back. We were to discuss my sleep study as well, but the clinic didn’t fax the information over. As of now, I still haven’t heard anything, which probably means it found nothing of note, so don’t worry. The milestone I reached with this appointment is that it was my final one with a psychiatrist for the forseeable future. I’ve been determined to be stable, and in good mental health. There’s no need to continue to see a psychiatrist, though a therapist or counselor wouldn’t hurt.

Five days ago, I stopped the sleeping pills. The first night was okay. I had two rough nights, and the last two nights have been good. I think he was right and I don’t need them. Which is awesome because I’d rather avoid taking medication if at all possible. One down one to go.

Now we move into other territory:
Immediately before that psychiatry appointment, I called the office of my surgeon (for top surgery as the next step in my medical transition to manhood). I wasn’t expecting anything beyond knowing where I was on the waitlist. Instead I was given a surgery date: May 3rd.

At first I was excited. I told everyone. It was awesome, finally have a date! No more waiting! Once the initial excitement wore off, I got nervous and scared and started second guessing myself. I realized that the bulk of the excitement was for the fact that I’m finally able to move forward with my life, since surgery’s put my life on hold for so long. I realized I wasn’t sure my exact reasons for wanting top surgery other than knowing that it was the next step in transition. I also realized that I wanted to breastfeed my kids, which isn’t possible after the kind of surgery I’ll be getting. I freaked out.

I talked to a few select people who generally seem to think if I’m freaking out this much, I shouldn’t have the surgery. To better get a grip on where my head’s at, I scheduled an appointment with a (trans community recommended) counselor, a friend who is a counselor and trans, and the surgeon to see about getting a reduction instead of a full double mastectomy and still have it covered. These appointments are all within the next week and a half, so hopefully I’ll have a better sense of things by then.

I do know, that now that I’ve had a bit of time to think about it, I’m more used to the idea of getting surgery and am kind of looking forward to it again. I still talk like I’m going to get it and the more often I say “surgery’s in two months” the more used to the idea I am. Maybe it was just jitters, but better to get some handle on my thinking before I do it anyway.

I imagine, unless something radical happens, from this point forward this blog will follow my mental health in association with transition and living life. It’s good to know that my brief touch with mental illness was not a step on the true descent to madness.

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First Diagnosis

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It’s been a while and there’s things to update.

After seeing my new psychiatrist a few times, he was prepared to make a diagnosis. I’ve been diagnosed with Hallucinations NOS or nonspecified hallucinations. That means that I hallucinate with no known cause. It’s not linked to any other mental illness. It just appears independently. While I’m happy to have a diagnosis (and am glad that there’s not some greater mental illness), I’m disappointed that there’s no known cause. Maybe that will come with more time and conversations with therapists.

At my last appointment, I brought up the fact that I stopped sleeping and my psychiatrist decided he would start investigating. It’s been a year and a half since I stopped sleeping and finally one of my doctors is asking why. I’m so happy about it. The first step in that is a sleep study that will be done later this month.

At my second appointment with my psychiatrist, I got put on Latuda (instead of Risperidone). Within a week, I noticed a marked difference. I was connecting with the world significantly better. I was feeling more emotions. Customers were responding to me more positively. My coworkers commented on me being more positive and outgoing, so did my mom. It was incredible. I had no idea how disconnected I’d been, how distanced from the world I’d been, until I started to reconnect with it. Now I know, and I hope to never experience that again.

Unfortunately, Latuda isn’t covered by my insurance, so I had to change the meds again. This happened at my last appointment (a week ago) where I was put on Abilify. It’s too soon to tell how much it will impact me, but from what I’ve read of other’s use of it, it seems to work well.

In the non-mental health side of things, I’m still waiting on the CT scan of my pituitary gland to find out why I’m lactating. There’s still no word as to when it will be. I hope it’s soon.

In terms of transition, well, I found out that the three to four months until surgery after consult that I was quoted was wrong. It’s actually closer to nine to twelve months. So, instead of being at a point where I have less than a month until surgery, I’m waiting at least five more months. I’m disappointed, but I should have known better than to hope it would be so fast. Maybe there’ll be a cancellation. I do know that I have enough money saved up now to cover my expenses for two months off work, so that’s a stress off my mind.

In general, currently, I’m doing okay, a mix of good and bad. I officially dropped out of university. The program I was in just wasn’t a good fit for me and I failed both classes. I also realized that the work I want to do doesn’t require a degree, so why am I shelling out the money for the degree? I cancelled my loans for the second semester and am just waiting on hearing about repayment to find out what it’s going to cost me each month. Hopefully not much as it was a fairly small loan. My brother and sister in law got me colouring books for Christmas and I’ve been slowly working my way through them. I find it relaxing and engaging and it’s nice to do something other than just staring at my screen all the time. On the down side, I’ve lost a lot of motivation to do anything. I’m finding it very hard to convince myself to do anything and am not even getting out of bed until the last possible minute before I have to go to work. I’m not going out to meet with friends (not helped by my work schedule where I’m scheduled to work the only two days anything happens with my friends). And I’m not going out of the house to do anything except buy the necessities, go to work, and go to the doctor. I’m trying to find something more to do with my time, but I don’t even know where to start. I’m hoping the colouring will at least help. Part of the lack of motivation to do anything is impacting my sleep as I’ve lost the motivation to go to bed. I still don’t get tired, so it’s hard to convince myself that I need to go to bed. I’m finding more and more that I’ll only actually go to bed when I get bored with what I’m doing on the computer. In the last week, I’ve had 3 sleeps. I know it’s not good, and not healthy, but I can’t seem to convince myself otherwise. I’d rather stay up and actually do things than go to bed where I’ll stay until I absolutely need to get up, sometimes twelve or fourteen hours later.

Here’s to hoping things will improve.

Time Flies

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I suppose I should update, since it’s been a while.

I got in to see the counselors at the university, specifically, the counselor that was recommended by my counselor at the college. He’s a great guy, listens well, helped me get in a good headspace. I saw him twice before I realized I probably don’t actually need counselling right now. I’m in a pretty good space right now and don’t feel the need to work through anything.

I also got in to see a psychiatrist at the university. Finally. The appointment was over an hour and a half long and went through my entire mental health history. He actually read my files going back years. He took me seriously. I recognized my need for a diagnosis and is working with me on that. He gave three preliminary names of what I might have, but he wants more information before he actually gives a diagnosis. Schizoaffective disorder, borderline personality disorder, and Asperger’s (high functioning autism). He gave me a printout to have my parents fill out and they went over it when I was up to see them for Thanksgiving. Hopefully that will give him some clues. I’m ready to be armed with a diagnosis that will help me find ways to cope and make things better.

In a non-mental health vein, something happened with my physical health that has been weighing on my mind as well. A couple months ago, I started lactating. I saw a walk-in doctor first and she ordered a battery of bloodwork. I saw my GP a week later and he didn’t see anything alarming in the bloodwork but suggested I talk to my endocrinologist (who I’m working with through my gender transition because I’m on hormones). I saw him a couple weeks later and he was concerned by my bloodwork. My prolactin level was 99, normal is 25. He didn’t seem to think that it was because of my being on testosterone (though that’s a common problem) and ordered a CT Scan and some more bloodwork. I’m still waiting on the scan, but it should happen soon. He said that the scan would look for a growth on the pituitary gland which would cause the spike in prolactin. My research has found that the growths are fairly common and mostly benign, but I’m still worried. What if it isn’t?

In terms of transition, everything’s on track. I got in for my consult for top surgery a couple weeks ago, which means the surgery itself will be in three to four months, a lot faster than it was originally going to be. I’m excited and more than a little nervous. Part of the nerves come from wondering if I’m going to have enough funds saved up to make it through the two month recovery. I hope so.

I think that’s everything of note.

Counselors

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I’ve continued working with my sleep counselor at the college. She currently has me not reading in bed and getting up at 11am every day. At least, that’s what’s supposed to happen. It takes longer to fall asleep if I don’t read in bed, and I can’t seem to convince myself to get out of bed in the morning, even if I’m wide awake. I see the counselor again this Thursday and that’s the last time I’m going to see her. It just doesn’t seem like there’s anything else she can help me with. She has spoken with my GP and he’s going to investigate my potentially having restless leg syndrome and maybe send me to the sleep clinic to have an evaluation and see if there’s anything else going on. Beyond that, I don’t know what to do about sleep. Everything seems to circle back to it being a problem.

I saw my regular counselor at the college last Thursday. That was my last appointment with her. She’s given me the name of a counselor at the university (where I start in the fall) and I’m to make an appointment with him. She also agrees that I need to get in to see a psychiatrist. (I had a friend/coordinator helping me with that and he got nowhere with general psychiatry, same as I got nowhere with them.) The counselor reminded me that there’s psychiatrists at the university for students and suggested I get on with one of them. I’ll have to go to their doctor’s office and get a referral through them, but it should work and I should get in to see someone fairly soon, at least reasonably soon.

Other than that, nothing’s really been going on in my life. I need more going on in my life, but I don’t know where to start, especially since I’m not getting up in the morning. Maybe that’ll change with time though… maybe.

prescriptions and consultations

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A week after I went to the hospital, I saw my GP. He decided to up my dose again. I’m now on 3mg of risperidone. He prescribed me three months worth of that and the sleeping pills and had me book a followup in August.

I heard from general psych a month and a half after I got the referral from the hospital. They referred me to the gender psychiatrist I saw and refuse to talk to me further about the problems with that referral. I have yet to hear from the psychiatrist, so we’ll see how that goes.

A week ago, I had an appointment with one of my therapists at the college. She’s the one who specializes in sleep. She has me doing another 2 week sleep log to see what it looks like with me on my meds. So far, it doesn’t look that bad, except I’m sleeping too long and not getting out of bed after I wake up in the morning. She seems to think that I might have restless leg syndrome, which is contributing to my inability to sleep. I don’t disagree. In order to get a diagnosis, though, I need to do a sleep study. In the meantime, the sleep therapist wants me to try sleep training a bit to get into better sleep habits. This means she wants me to stop reading in bed. Reading’s the only thing that gets me to sleep. I’ve tried reading then going to bed and I just lay awake for hours on end. I see her again in a week.

Today, I got the news that I have a consultation for top surgery (breast removal for female to male transgender) in January. I’m very excited about that and can hardly wait.

Over the last few months, I’ve seen my mom a fair bit and every time she’s said she thinks I look spacey and seem flat. I agree that I’ve been flat. I don’t know what the trigger was for that change, but it was worse than ever before. One of my customers even mentioned it to me. It’s gotten better in the last couple weeks and I’ve been excited and happy, smiling and joking again, so I think I’m on the mend from that bout of depression?

During that same time, I was experiencing heightened anxiety, specifically around going to work. The way my coworkers were acting towards me was making me anxious. I got talked to about my own behaviour at work and how I contributed on a shift, which really didn’t help any. Our store moved though, and since the move, things have slowly been getting better. I’m less anxious now than I was a few weeks ago, which is really helpful for the rest of feeling better.

Other than that, I seem to be doing okay. As far as I know, I’m not hallucinating, though I suspect I’m seeing flies that aren’t there, but can’t confirm. I’ve been eating decently, not great. I’ve also been more active riding my bike. Riding the bike is tough, especially with the sleep schedule, but I’m working on it and getting better at just doing it. I want to be in better shape, not just in general, but specifically for top surgery.

I think that’s it.

Of Hospitals and Dosing

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Last Wednesday, I decided to take myself to the hospital again.

Over the preceeding several days, I’d been having increasing paranoid type thoughts and increasing self harm thoughts. To be sure, the self harm thoughts weren’t new, but they were getting into the realm of encouraging me to do some serious damage including taking a knife to my arms and legs and slamming my head into the cement sidewalk and walking into traffic. I’ve self harmed in the past and know when I’m close to giving in to my thoughts and actually following through.

On Wednesday, I called my mom to ask her advice. She had none but to call the crisis line, which I did. They advised me to go to the hospital. I called my mom and told her that was going to happen on Thursday.

Thursday was my day off. I figured I could get up early and take myself, but as the night wore on, and the thoughts tumbled through my head, I knew I would harm if I went home. I asked my coworker, a friend of mine, if he’d be able to drive me to the hospital, on the other side of the city, after we closed the store. Amazing friend he is, he agreed to. (I don’t know what I did to get such great friends, but they’re awesome. I bought this one a craft beer he had his eye on the next time I saw him in thanks, since he refused gas money.) We stopped by my house and grabbed a few things (change my shirt, grab my meds and a soft cover book) and then drove to the hospital.

I checked in at midnight. It was a busy night, so I didn’t see the ER doctor until 5am. Since I hadn’t seen the ER doctor yet, they wouldn’t give me my meds, which meant I didn’t sleep. I stayed up the whole night just reading that soft cover book I thought to bring. The morning was entertaining as the other patients got up. I talked to a few of them and found out that most of them were waiting for beds in the long term ward. By 11 I saw the Psychiatrist.

She talked to me for a bit. Her assessment was that my dose was too low on the antipsychotics. They’re now adjusted permanently up to 2mg, at least for the time being. She seems to think that the dose was lowered too soon. She also put in a referral for me to general psych, as opposed to the emergency psych that I’d been referred to by my GP and had seen previously after the last time I was at the hospital. I think that general psych was where I was originally referred that took forever to look at my file and lead to me going to the hospital in the first place, but I could be wrong.

Time will tell, but, for now at least, I’m stable.

Inching Toward Answers

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A week ago, I saw the psychiatrist and therapist at the same time. Together we talked about things like my transition, my general mood, where things are going, and how things have been.

The hallucinations have officially stopped. I’m grateful for that, but I can’t help but keep wondering when they’re going to show up again. Generally, I have to say that things have improved. I’m sleeping better (though it’s taking me a couple hours to fall asleep again, up from 20 minutes or so when I first went on the meds). I don’t have any compulsions right now, so that’s good. When we discussed those, the psych seemed to agree that they were OCD like. She encouraged me, next time I notice one, to push past the anxiety and let the anxiety happen until it goes away.

My mood has been, well, flat. My mom first identified it over the phone the night before the appointment. I repeated it to the therapist and then again to the psych and we talked about what that meant. I’m not excited, can’t get happy or feel sad, and generally don’t really care. I want to care and be excited and eager and all that, but I can’t. The big word that popped up here is depression.

I’ve known that depression is a possibility, but it felt so real for them to say it. Thinking about it later, it made sense. The psych wants to wait and see what’s happening, give it time to manifest or whatever and decide on medication when I see her again in a month.

On the note of medication, she also wanted to reduce the dose of the antipsychotic. I was taking 2mg of risperidone at bedtime every day. She bumped me down to 1.5mg. Since doing that, I’ve noticed no change, so I’m going to stick with it.

The psych also wanted to talk about my transition a bit. She wanted to know why I wanted to transition and how I saw that working. I talked about how I’ve always felt, how I’ve always leaned towards the masculine and roleplayed the boy in games. How I always picked boys clothes first and fought wearing the dresses. I talked about feeling okay about myself, but uncomfortable wearing flattering clothing anyway. About how I’ve always been more comfortable when perceived male. I mentioned that I wanted to have a baby or two later down the line and that’d be okay. And I talked about being excited for top surgery (getting rid of my breasts) which should happen in the next year and a half. I don’t know what she thought of it all, but I’m glad I got it out.

Today, I had another appointment with the therapist. We continued the conversation from last week, going more into the flatness and general emotion state. I talked about how I haven’t done the dishes or cleaned the living room in a while and that’s a problem. We talked about how I’m always well groomed when I go out (and I do shower regularly even without expectations from somewhere else), but my house is a mess. We talked more about how sleep is an issue and I’m sleeping more but it’s harder to fall asleep and I’m still tired all the time.

She wanted to know about my plans for having a baby and how they fit in with my transition. She had no idea anything related to transgender care, so I’m happy to educate. I told her about the possibility of birth defects if you get pregnant while on testosterone. I talked about the wait time between going off the hormones and trying to get pregnant. I talked about how I’m really after the secondary sex characteristics (facial hair, deeper voice, no chest) that stick around after hormones have stopped, so stopping them will be no problem for me. Having a baby is something I’m excited about, it’s something I look forward to. I’m sad I won’t be able to breastfeed, but I know it’ll be okay anyway.

We also talked a lot about my future, what I want to be doing and where I want to go. She asked me, if I could wave a magic wand, what would it fix. I told her I wouldn’t have any more issues with money. Money seems to be a big issue. Last month I was playing “pick two” where the three I had to pick from where meds, rent, and food. I’m still really tight on my budget and not sure how I’m going to make ends meet properly with enough to spare to save for the vacations I really want to go on, but I’m sure I’ll figure something out.

The therapist says there’s lots of stressors, lots of reasons to be feeling anxiety between work and school and future plans and transitioning. My life’s in turmoil right now and it makes sense for me to be in turmoil mentally.

She gave me homework, and I’ll have to think about it. She wants me to write out (since writing comes easier than speaking) what I want out of life, where I want to be.

This afternoon, I saw the counselor at the college. I gave her a brief overview of how things have been going with mental health and the psych and therapist and where we’re at there. Then we got into the meat of her appointment.

We started where we left off last time, with the “addiction” to the internet and how that’s an issue. I said it wasn’t really an issue anymore. It isn’t, really. I can stop any time I want, I’m just not motivated to do anything else. And really motivation is the big problem. We talked a lot about motivation, that was the big heart of what we talked about.

Right now, I’m really externally motivated. I do my homework because it’s for a team project and if I don’t do my part, others suffer. I go to work because my manager and coworkers expect me there. I go to class because there’s a team meeting every class. I go to appointments because the person I made the appointment with expects me there. I’m not motivated to do anything for me.

We talked about the self care issues that I’ve got, with the apartment a complete disaster and mold growing in the dishes. It’s completely not healthy to be living like that. I’m not motivated to cook for myself when it’s like that because it requires too much effort. If it were like that and someone were to come over, I’d spend the time to clean up in preparation. I’d clean up and do the work to make meals for someone else, but not for me.

I want to want to care, but I don’t.

After a lot of back and forth, the counselor narrowed it down to the idea that I don’t think I deserve the best of care. She said, if I were a nanny for myself, I’d be fired. It’s true, I would. But what I need to do is start treating myself as I would someone I were caring for, or like a team project. A team project with me, myself, and I is a good analogy. I’s the slacker, always making excuses. “I don’t care,” “I don’t want to make the effort,” “I don’t want to,” “I can’t be bothered.” If me and myself can make it work despite the I, maybe eventually, we’ll get I on board.

My homework from her is to start telling myself “I deserve the very best of care.” I’m to start thinking about providing that care, but the important thing first is to make sure I know that I deserve it. Right now the phrase seems awkward and uncomfortable, maybe that will change.

I feel like I’m on the right track with all this. I’m going to see the counselor again and keep working on things with her. Because I seem to be working on different things with the counselor from the therapist and psych, I don’t mind continuing to see them both. It kind of makes sense. I’m still overwhelmed by everything, anxious about how things are going, are they going fast enough or too fast. I wish I wasn’t so flat right now, I want to get excited again. We’ll see, I guess, maybe things will get better.