Tag Archives: seeing things

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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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.

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.

“They’re” a problem

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“Get the infection out of my face, the infection they put there.”

The last few months have been productive and things have moved forward, and not. I’ve graduated from Business Administration (official ceremony is in June, but I’m officially done). I went to all my appointments with mental health (the therapist and the psych). I’ve been released from them and will have to get a new referral in order to see a psych again if I need to. I’ve continued to see the counselor at my college, though because I’ve graduated, I won’t be able to continue to see her for much longer.

There was no diagnosis of anything and only vague assumptions as to what might be wrong with me. I’m not pleased with that and want better answers.

My risperidone (the antipsychotic) has been reduced down to 0.5mg, the lowest dose I can be on without going off it entirely. I’m still on the amitriptyline (sleeping pill) and that was increased to 20mg (2 pills, double the original dose).

I’m working with my counselor at the college to connect with a counselor at the university as I should be attending there in the fall for a new degree. I’m also working with one more counselor at the college specifically on sleep. We’re not making much progress and I don’t really want to push it right now.

I see my GP on Thursday and want to ask to go off the antipsychotic. My logic? The hallucinations came all at once and I went on the sleeping pills and the antipsychotic at roughly the same time. There wasn’t a chance to see what hallucinations were caused by the inability to sleep and what were caused by anything else. I want to find out what hallucinations I have that are not related to sleep problems. I also want to see if there are any other symptoms of note. I have nothing really happening this summer beyond a few family things and work. I would rather have another mental breakdown, or whatever you want to call it, this summer when things are relatively calm than in the fall or winter when I’m back in school. I’d also like to have a diagnosis, or a partial diagnosis so that there’s something to work off of if things go south down the line. I’ve told a few people that this is what I’m going to ask for when I see my GP and they all seem to agree that it’s a good idea and that they’ll be there for me if/when things start going south.

The last few days I’ve noticed something new that really has me worried. I’ve started getting intrusive paranoid type thoughts. Like the one at the beginning of this post. “They put an infection in my face and I have to get it out.” (zits) “It’s their fault.” (I slept late.) I don’t know who “they” are, but the thoughts pop up whenever I get thinking about something that’s happened or is happening. I stop and logically work through where fault really lies and what’s really going on, but the thoughts keep popping up and I don’t like them.

The paranoid thoughts are new, not something I’ve ever experienced before. I really think they’re a part of everything else that’s going on and I should probably mention them to my GP when I see him, if I remember.

I keep getting stuck in circles of thought being anxious about my future and what it holds for me. The degree I’m hoping to start in the fall is Child and Youth Care. This is something I’m really passionate about and really look forward to. I love working directly with kids and helping them grow. I worry that whatever diagnosis I wind up getting will be something that inhibits me from working directly with kids on a regular basis and will force me to rethink my career choice. I really want this, but health and safety come first.

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.

Baby Steps

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I saw my therapist on Thursday and talked to her about a lot of things including the anxiety that I’ve been feeling.

I’ll catch you up because I haven’t fully talked about it here yet. When I get anxious, it’s because I’m worried about doing something wrong, usually something that affects other people. When I’m alone or in certain situations, especially situations where I’ve done something wrong in the past, I find myself looping through what I did wrong. Example: At work a couple weeks ago, I was told that some of my coworkers thought I was making up rules and I needed to stop. I wasn’t making up rules, but was communicating ineffectively. Now, when I’m at work or thinking about work, I think about all the things I’ve said and done that might be construed as rules and how they’re wrong and made up. Getting out of the loop is hard and usually takes a lot of effort and focusing on something else, even if I remind myself that the damage is done and it’s in the past and there’s nothing more I can do.

Non obvious signs of this anxiety (that I’ve had for a long time) include OCD type behaviors. When I was a child and young adult, this included organizing the book shelves by author’s last name. I would spend hours on this one task and it would require taking the whole bookshelf down if someone put one book in the wrong spot. Another behavior was dishwashing. It would take more than three hours to wash the dishes for a simple dinner for three people; something that should take 20 minutes. Other ones that have shown up include an obsessive need to always wear a hat and to not step on sidewalk cracks. These behaviors come and go and it’s hard to describe the feelings driving the needs to do these things, they just need to be done. Right now, I don’t have any that I can pinpoint.

So, I talked to my therapist about the anxiety and the behaviors and she thought there was a link to OCD and anxiety. I see both her and the psych this coming Thursday. The therapist wanted my permission to talk to the psych about all that I’ve talked to her about and I gave it, gladly. I want the psych to know everything too, how else to get a diagnosis and proper treatment, but with the no words day last time I saw her, it was hard to explain what I could to the therapist.

I personally think that the hallucinations were triggered by the complete lack of sleep, and the insomnia by the anxiety. Anxiety might also explain why the sleeping pills weren’t working.

The hallucinations are essentially gone. I’m attributing that to the risperidone and am truly grateful. They were more than scary. Unfortunately, I’ve noticed in the last week or so that I’ve not been getting as much sleep. It’s been harder and harder to fall asleep (taking upwards of 2 hours or more some nights) and in the last few days, I’ve been waking earlier. I’m still getting 5 hours on a bad night and 8 on a good one, but there’s fewer good nights and more bad nights now. (Note, the numbers are down from 7 on a bad night and 11 on a good night a few weeks ago.)

So, I see this as baby steps forward. Hopefully the therapist and psych will have a good long chat together and find some answers together before we meet next week.

Also, about the nanny job, I just got a reply back from the agency and they’re apparently not taking any new nannies on just now. Frustrating, but not the end of the world.

Doctors Without Answers

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I’ve had two doctors appointments since I last posted. Let’s start with last week.

On the 8th, I saw the psychologist. She had with her that day a resident training to be a family doctor. That made me less comfortable than I already was. The appointment followed the same track as the one with the therapist and it felt like she hadn’t read my file to understand my background. I don’t know the reasons specifically, but I was having a no-words morning, where it was hard for me to get anything out of my mouth, let alone the details and explanations that the psych needed. It wound up being an hour long waste of time, basically. She had notes that anxiety and hallucinations are the two big issues. She said there was no real indication that my symptoms were part of some diagnosis yet, so we have to just keep an eye on things and see what happens. She told me to stay on the risperidone and come back in a month.

Following the appointment with the psych, I did some thinking and was able to pinpoint what my anxiety is rooted in: the fear of doing something wrong with consequences for other people. I like to live without regrets, like, mistakes are lessons to learn and you can only regret until you learn the lesson. So I’ve made a lot of mistakes with consequences for other people; I learn the lesson and try not to make the mistake again. The problem comes when I get thinking or the thoughts just pop in my head. I start thinking about what I did wrong and what the consequences were and what I might do wrong and what the consequences might be. I get into loops of this where it’s hard to step out and get away from them. I usually remind myself of how the problems or mistakes were fixed and what the lesson was and the fact that there’s nothing more I can do about it. Usually that works. Failing that, I try to distract myself.

Yesterday, the 15th, I saw my GP. Except I didn’t see him, I saw his resident who is practicing to become a family doctor. We covered what’s happened in the last month, what’s changed, and where I’d like to go from there. He taught me a technique for getting out of the anxiety loops: focus on each of the five senses and recognize what those senses are doing and feeling at that moment. I asked him about drinking, something I like to do socially. I was told that I’m allowed one drink, socially, not allowed to get tipsy or drunk. He told me I risk passing out for multiple days and stopping breathing if I decide to get drunk. So, I guess I don’t drink while on risperidone. I also mentioned the blurred vision. He talked me through what it actually was like and confirmed with my GP. They agree that it’s probably a side effect of the drug, something to keep an eye on, but he didn’t recommend a visit to the optometrist.

Other than that, life has been fairly normal. I started my last class of my program. It’s Thursday nights, all group work to keep me accountable, and looks like it will be interesting. I’m eating homemade food a bit more often. I’m starting to really notice how well I’m sleeping and wishing for a more consistent schedule so I wouldn’t have to wake up early for day shift or go to bed at midnight every day for the one night shift so I can take the pills consistently.

I see the therapist next Thursday and the psych again the following Thursday. The appointments are scheduled for later in the day, so hopefully I’ll be able to speak properly at them and get across what I need to get across.