Day 86, Part Two: This Time, It's Personal

Phone appointment this morning with regular doctor went well. She is upping my Seroquel (sleep med) to 75 mg with optional 5 mg Ambien chaser if I wake up and can't go back to sleep during the night.

"Has it changed your mood?" she wanted to know.

"To what?" I answered. No, my mood pretty much stays at half-mast, Doc; I just want to sleep. I am having one of those puffy-eyed, flat-affect kind of days as it is. We debated about eventually changing the Lexapro, but when she consulted my chart notes she discovered I have already tried every freakin' antidepressant that was ever so much as a glimmer in Eli Lilly or GlaxoSmithKline's eye.

We talked about the sleep apnea, and she wants me to see the specialty dentist to get the mouth guard made ASAP. I have to see if I can get it covered first; they are not cheap. If I have to have another sleep study, I will straight-up plotz. She is willing to write me authorization letters for everything. I heart my doctor.

(A side note/update about Fun With Insurance Coverage--insurance still has not settled on my psych eval charges. They continue to debate back and forth with the provider's office as of 11:30 this morning. The date of service was January 16.)

*****

Next up: the nutritionist.

I weigh in. I have gained a couple of pounds. I am two pounds less than I was on the first appointment. This is not a shock. I am rather grateful I didn't gain more.

We procceed to Talk Seriously about What I Think Happened. What I think happened is as follows: I am not feeling motivated, I am sick of the BS, I have a hitch in my gitalong, I am discouraged. I have gone out to eat and I wanted a cocktail. I have gone out to eat and split dessert with Mr. Salted. I have gone out to eat and felt like crying because I'm not going to be able to enjoy food as I once did. I have eaten chocolate because it remains the most reliable source of pleasure on the planet. So sue me. I am still writing every blessed thing I eat down (give or take a Hershey's Kiss here and there), complete with calorie counts and protein content. I am exercising roughly half the time. I am not a complete and total screw-up; if it was Pass/Fail, I'd get a Pass. (I think. If I smiled a lot. Probably.)

I tell her I'm looking into getting counseling authorized by insurance and--DA DA DUM!!!!! turns out the wellness center is hosting a support group. It isn't free, but the cost isn't outrageous. It starts tomorrow night, goes until June 3. The flyers says, "help break the cycle of food addiction and emotional eating." It's facilitated by a nutritionist/counselor and there will be no more than eight members, which sounds like a good size. Support, therapy, reading, assignments, etc. I bit the bullet and took the money out of the tax-return/pipe-dream-of-further-education fund, which is flying out of the bank to pay this bill and that anyway. I really need to talk to some other people who are dealing with the same stuff; I think it could really benefit me. (Since I coughed up the actual cash, I know that I will not run screaming into the night; once I part with any money, to run screaming ceases to be my way. My way is, "I will get everything out of this that I possibly can, dammit.") I participated in a similar group fifteen years ago, and although it was not about food issues, it was extremely helpful. The book they are going to use in this group is called "Anatomy of a Food Addiction". It discusses brain chemistry and other contributing factors.

I have never talked about my food issues in a group of people I didn't know. I barely talk about them with people I do know. I wonder if I will be the fattest (SHALLOW!), and I wonder if there will be any men there. (It would be really interesting to talk to an acknowledged male food addict.)

I am feeling some (inevitable) dread, but also that this is a positive step in the right direction.

How I can end up spending the better part of a day on the phone with insurance and the doctor's office

The past week has been incredibly frustrating. I was turned down for three of the five jobs I'd applied for; I didn't hear anything on the other two. My sleep continues to be on and off, which can make a person a little crazy all by itself. I tried to force sleep a couple of nights by taking two Benadryl, which resulted in grogginess the entire day after and still waking up every couple of hours. I took a generic version of Unisom tonight and was (am) up after 2 hours.

My primary-care doctor is about three hours away and so I conduct a lot of business with her via e-mail. My husband's insurance has been hounding me to get all my medications via their mail-order program, so I have been trying to transition them all. There are seven or eight of them. The health insurance took so long to process the initial switch that I ran out of everything for several days, requiring several frantic phone calls back and forth with insurance and the doctor's office, paying almost $20 to have overnight delivery, etc., and after all that neither my antidepressant nor my sleep medication were included. I've emailed my doctor two or three times in the last couple of weeks to have those things transitioned as well. Of course, the emails were never answered and I found myself playing the call-everyone-involved-two-or-three-times game a couple of days ago to try to get those medications transferred to the mail order pharmacy program before I ran out of them, having to request expensive overnight delivery again. My doctor and I have had a long-standing relationship, and she has never had a problem changing a medication for me. Unfortunately, I think her staff is getting their signals crossed now; I haven't had any direct communication with her at all on this issue, and after thinking all was said and done and the medications were ordered, I get a call yesterday from her staff saying I had never gotten the new sleep medication from her previously and that they were just going to discard the request from insurance to fill it--because insurance had referred to it as "a refill". (I had made it clear to insurance that it was a new medication.) Of course, this was left on my voicemail at home while I was out; of course, I received it after their office had been closed on Friday afternoon; and of course, they acted annoyed, like I was trying to put something shady past them, sounding rather indignant with me on the message they left. And of COURSE, the sleep medication is the one being disputed.

Doubly frustrating is the fact that I tried repeatedly to get the fax number for the doctor to send a request for the new medication to insurance, but insurance would not give it to me, preferring instead to fax something to the doctor and have her fax it back to them. If they had simply given me their fax number in the first place, I seriously doubt this would have played out the way it did. I left a frustrated message on the doctor's office voicemail in which I doubtless sound like a total freaking loon, telling the entire story for what felt like the 500th time and trying desperately to say the right polite words at proper intervals.

"How do you not go mental?" a friend asked me not long ago. I chuckled somewhat ruefully; I think it's too late to refer to it as "going" mental at this point.

Not much to report

Have not felt like writing much the past few days. My sleep is still all over the place. I notice I crash after 2 days without it; last night I took a couple of Benadryl to help it along, and it did the trick.

I have spent most of today on the phone with doctors and insurance, trying to get new sleep medication ordered, and then a "health advisor" from insurance called and advised me to check in regarding the appeals process. So I did, and as I thought, I don't have a leg to stand on without that 6 months of documentation, which I am in the process of obtaining.

I see the nutritionist Monday, and I have a lot of questions for her. A friend recommended the South Beach Diet, or at least many of their recipes, so I've been reading the book. It seems like a reasonable diet in the 3rd phase, but Phase 1 throws me into a panic. I don't think I feasibly can go to that extreme, and I hope I don't need to--just being able to have some sugar-free pudding or Crystal Light helps tremendously with curbing my appetite for sweets.

I have gotten a couple of hip-hop and salsa dance-based workout DVDs that I am enjoying and alternating with the t'ai chi. I don't look as cute doing salsa dance steps as the instructor, but thankfully, there is no one here to see me trying to learn them but the cats.

I've also been applying for a lot of jobs.

Going off Ambien CR

I decided this evening that I am just going to quit taking Ambien. I forgot to bring any with me when I went to visit my friends out of town last night, just toughed it out and tried to doze a bit with the Ipod on my special insomnia/quiet playlist. I didn't sleep all night.

When I got home today, I thought: why am I taking this stuff? I've been taking it for years, and it's not helping me much. I'm eating in the middle of the night, and I definitely don't need THAT. (I can imagine the complications that could cause over and above potential weight gain, particularly post-op when some foods are going to make me sick--I'm going to want to remember what they are so I don't eat them again.)

So, I'm awake for the second night in a row. I'd rather just stop taking Ambien and have a bad day or two, not have it in my body, and not pay for it--even with insurance, it is not cheap. I was also reading online tonight about some of the side effects others have had with it, both while taking it and while trying to discontinue its use. I have escaped unscathed compared to many of these folks.

I just hope I will be able to sleep at some point before too much longer.

Sleep or lack thereof

My sleep has been really, really bad lately. It has never been good, not since I can remember. I'm a lifetime insomniac, since I was a young teenager anyway; I also have PTSD (post-traumatic stress disorder). The PTSD has improved drastically over the years, since I am no longer attacked while sleeping or awakened to the sound of violence and haven't been for decades. I've also been taking medication to help me sleep for the last ten years. My current fears involve possible intrusions from the outside world, and I do have them sometimes to an irrational degree. ("Did you lock the door? Are you sure? Well, I'm going to go look.") Unfortunately, I don't think this will never leave me completely, but I do the best I can. I would feel better with more locks on the doors (like about ten) and a really large, protective dog that loves me best. A razor-wire electric fence around my house and an armed guard might be nice, too. (I wish I was kidding.) A doctor looked at me once and said, "You have sleep apnea AND insomnia?" and I could tell he was thinking, Well, you're screwed.

Part of the problem with waking up often during the night--at least while I've been on Ambien/Ambien CR--is nocturnal eating. I've found wrappers and crumbs in different places in the house the next day and had no memory of eating anything or even being there. I have tried and rejected several sleep drugs over the years, and am about to try a new one. The only one that worked for me was Remeron, which provided the loveliest, most restful sleep of my life. I gained fifty pounds on it (one of the side effects is increased appetite), so I had to discontinue its use. (I managed to lose half of the fifty pounds I gained and keep it off, but at this point, who's counting?)

The other I wrote something weird in my food journal when I had a middle-of-the-night snack. Of course, I didn't remember eating or writing. That assignment was to write down why I was eating, what, what time, whether it was need-based or for some other reason. I wrote was "3:00 AM, 2 cookies. Want or love?" It creeped me out, and, taken literally, probably revealed more than I wanted it to--even to myself.

I have also been having nightmares, which isn't unusual for me, but some are easier to shake off than others. Like any nightmares, it feels as if my subconscious took a laxative and what comes out comes out. Last night's involved having to watch a dog be burned alive as part of some twisted ritual I wasn't part of but couldn't escape. The night before that, it was about being in the hospital with my mind alert, but unable to communicate with anyone, and being wheeled around on a gurney. I could feel the wheels wobbling under me.

These two examples are upsetting to me, but actually quite mild as my nightmares go. My dreams in general tend to be vivid and involved, like movies, with people I don't know taking part and plot twists aplenty. In the past, have had PTSD flashbacks manifest themselves as dreams, and we've all had those anxiety-based "naked in high school" dreams. I know a lot of dreams are symbolic, but I try not to spend a lot of time analyzing them, just chalking them up to the aforementioned laxative of the subconscious processing everyday life.

People are asking me lately if I am scared about having this surgery. The answer is, of course I am. But I've had several surgeries in the past few years, and this one is a lot less invasive than most of them. This one also has the capacity to really be a tool to help me improve my life. Yes, I could die, but anyone can die from any surgery. If my number is up, I have no control over that, so I don't see the point in fussing about that aspect of it. I'm more focused on the ways my life has to change and determined to make the most of what this could do for me.