Thursday, October 21, 2010

Depression, Doctors, Society and Me

I just watched a program on PBS from WGBH Boston called "Depression: Out of the Shadows" that was excellent. Afterward though I started to get frustrated and angry about so many things.

As I watched this program, like all the others that I've seen over the years so much of what I see & hear hits home for me and yet so much of it leaves me angry.

Many of the things that get me angry are related to the situation I find myself in here in Concord, New Hampshire. When I hear about people trying several medications before they find the one that works best for them, I wonder why when I asked my present primary care physician about the possibility of trying alternatives or additional medications that are available to address some of the symptoms that I have he simply said "no".

In addition to that, when I hear about people actually being given a diagnosis for what they're experiencing I ask myself why I was refused that same thing when I told the doctor I'd been seeing that I wanted to be evaluated and 'diagnosed'. He also said "no". Not only did he say he couldn't/wouldn't be able to diagnose me, he stated that 'it isn't going to do any good for you to come in here and tell your stories' (or something to that effect). Note: He has since denied saying that after I mentioned it to others in the same facility (though I assumed was in confidence when I did). He also nearly fell asleep (he got that glazed eye, disinterested look as I was going over the results of the task he gave me during the previous visit) during what I decided was our final session.

At this point I should provide some background history.. I'm living on Social Security Disability and have been for around 10 years. As such my choices for healthcare are quite limited and my services are provided by the Family Health Center at Concord Hospital. For the first several years all the doctors I had were in their final year of their residencies and as such they changed about every year and a half. The level of care they provided was very good but over time became disjointed. I also had a deep sense of loss when they left and I had to develop trust in someone new knowing that they too would leave all too soon. I eventually voiced my concerns about this and a year or so my 'new' doctor was an established middle-aged physician.

At first I was hopeful, thinking that I would now have some continuity in my care. I prepared for my first visit assuming that he would have looked over my medical history and have some kind of 'Care Plan' in mind. I'd recently turned 50 a while back and assumed that among other things he'd bring up the usual tests appropriate for men that age (especially since my father had prostate cancer and heart disease). Well it quickly became apparent that he wasn't aware of my health history (so much so that I asked him if he'd even looked at it) and one of the first things he asked was how I'd feel about him taking me off my antidepressant medication!

It hasn't gotten any better since then. When I mentioned that I bought a home automatic blood pressure unit (the kind with an electric pump) he pooh-poohed the idea saying that it would just make me get too fixated on the readings. On another occasion when I asked him if I would benefit from getting out in the sun more (I rarely leave my apartment and would obviously benefit from some sunlight & fresh air) he said it wasn't a good idea citing the dangers of over-exposure.. And one other incident I need to mention is when I went to see him about an embarrassing hemorrhoid issue (after discussing my need for a prostate exam during the previous visit that I'd been avoiding), I was there, pants-down and bent over the examining table (what better time to do the prostate exam?) but he said no, he'd do that at another time.... he hasn't mentioned the exam since and I'm now 53. I guess he's waiting for me to 'present' symptoms before he finally gets to it?

It seems like every time I did something that a well-informed patient is encouraged to be/do it was met with the same attitude of  'I'm the doctor', don't challenge my authority or have any ideas of your own.
So what I'm getting at is while I'm doing my part in being a responsible patient he's meeting that with what I can only describe as an air of disdain or doctor's aloofness? I haven't had an actual 'physical' examination for 5-10 years, and  many of the symptoms I've mentioned during visits over those years read like a pamphlet for the early warning signs of diabetes (lower leg pain/pressure, light headedness, frequent urination, excessive thirst, numbness in the toes and then frostbite-like symptoms one winter). Nothing was done about them or the borderline A1c test back when action could have been taken to perhaps prevent full-blown diabetes, which I was recently diagnosed with earlier this year.

Without health insurance I can't simply 'find another doctor', and the psychiatrist I spoke of there at Family Health only took me back as a patient because there weren't any others there available to see me (I was told). So I feel stuck with a doctor who I don't feel does his job well and a therapist who seems disinterested at best.

Now I haven't even mentioned the issue of my chronic depression and related issues (that I need to have diagnosed once and for all so they can be addressed and properly treated) and the issue of a 'Permanent Disability' form for Sallie Mae that's supposed to be filled out by my 'Primary Care Physician'. But guess what? My doctor says he doesn't feel like he's qualified to fill it out despite the fact that it states on the form 'To be filled out by your Primary Care Physician'. He wants it filled out by the psychiatrist.... yeah, the same one that doesn't see the point in me 'just coming in and telling my stories' (aka Talk therapy). The result is that Sallie Mae is calling sometimes 8 times a day and I'm not answering the calls because I have no news for them, and besides that they've hung up on me, they call again the same day that I just called them and talked to them, one caller doesn't seem to know that any of the others already spoke to me, and every time I have to go through the SAME information!

Now there's so much 'background' information to all of this that I can't include it here, but I was 'recruited' by the Art Institute of Fort Lauderdale back in 1993-4 back when I had a decent job working for a great family printing company. Unfortunately the economy and the company's business were both slowing down and we had to accept a pay cut. My brother and his family lived in Ft. Lauderdale and he encouraged me to come stay with them while studying photography (my lifelong dream) at the Art Institute. The recruiter promised quick job placement upon graduation so I signed all the loan papers and started the 2-year program. I loved it and soon I was getting listed in some college directory for students (I wish I could recall the name) with GPAs in the highest levels. I was photographing Olympic divers, pro boxers and learning from some excellent 'teaching pros'. I was competing with other students some of whom were young with wealthy parents and had the best equipment & could afford the costs of all the 'extras' associated with studying photography in So. Florida.

Then one day I went to the financial aid dept. to pick up my regular financial aid check and was informed "The last check you received was supposed to last for 2 quarters" (this was the first I'd heard about that). When I went to my financial aid person they didn't know anything about it. Some time after that about 1 year into the program all financial aid stopped and no one could even tell me why! Around this same time the school was going through the process of improving their status so that credits earned would be transferable to other institutions which resulted in a loss of many excellent teachers because they didn't have the appropriate degrees. One of the impacts on my class was that an outstanding portrait photography teacher was let go and temporarily replaced by the head of the photography department who proceeded to teach the class mainly through the use of photocopied materials. Let's just say the cost of this program charged to students wasn't reflected by the quality of what we received in the classes..

I tried to earn money for school but it wasn't enough (and the job listings provided by the school's job placement office weren't nearly what was advertised by the recruiter) and eventually the fact that I'd given up my job in New Hampshire to follow my dream and having that pulled out from under me (financially) with absolutely no explanation, sent me into a deep depression that eventually prompted my brother to ask me to leave. My father who lived here in New Hampshire was suffering from heart failure and cancer at that time also so I moved back to be available to help him while he recovered.

At this point I'm going to end this long ramble and pick it up in another post.... - 'till then..

Tuesday, October 05, 2010

Oh yeah, I'm "Still Alive and Well ..."

Yes I'm still here.. Despite the recent diagnosis of diabetes mellitus (type 2), the finger pricking, the insulin injections (& medication Metformin), and the associated change in lifestyle, I'm adapting .... slowly.

From a starting point of my 'A1C' at 15% and a blood glucose of 586, I'm now down to 8.2% (A1C) and my morning/fasting glucose measurements averaging 110. In fact just recently I had my first *low* fasting measurement of 67 (which I quickly got to 100 with a small glass of grapefruit juice).

The [hyperglycemic] effects on my brain & eyes have returned to "normal" (a matter of  opinion, I know..), and that's a relief! For a while I couldn't see well enough to do much of anything, and my brain was so *fuzzy* that I didn't feel like doing anything anyway. I've even regained some color in my toes although they're still constantly cold and cramp all the time (btw, is there such a thing as an electric blanket for just the foot of the bed?). I don't like wearing socks when I sleep, but I don't want to use a full-sized electric blanket.

I've just recently started to get back to checking my Twitter feed and posting comments occasionally but I'm finding that keeping up with email, Facebook, Twitter, Blogs, News etc. in addition to the new health maintenance tasks is often too much. Energy is one thing that's in short supply but I'm taking advantage of it when it's available.

I have grown to appreciate & rely on some of the many 'reminder' utilities available for the computer to keep track of bills, appointments and the like. Multiple alarm clocks help too.

One of the things I pictured in my mind when I was told that I'd have to take insulin was filling a syringe from a bottle of insulin kept in the fridge. Thankfully I was started on something called a "Flexpen", which is a pen-like device prefilled with insulin. All I have to do is screw on a tiny disposable needle and set the dosage! It's really simple. The hardest part was choosing an 'injection site' and remembering where the previous one was until I made myself a chart/grid and numbered the different locations so I could enter the location into a log.

On a less positive note, once I started researching diabetes (and my other issues like hypertension and family history of [that], depression, and Alzheimer's/dementia), the clinical research paints a fairly bleak & uncertain future. The combined 'risk factors' I have are all interconnected it seems.
I'm thinking that I definitely want to get as much accomplished as I can, while I can.. That'll be a challenge for a serious procrastinator like me! 

Thankfully my father had a saying that I've been able to embrace, especially since he passed away. "Keep smiling" (whether you feel like or not..) was something he always told me when I left his home. That and the ability to laugh at myself are so helpful in my solitary existence (and I've given myself plenty to laugh at lately).

I truly wish that the feeling of community and compassion that existed all too briefly after the attacks on 9/11 could be regained. The divisiveness and polarizing atmosphere that just seems to have grown exponentially over the years since then thanks in part to the extremists on the right and fanned by insensitive, dishonest & dangerous rhetoric spewed by the likes of Fox News-(in name only), Rush Limbaugh, Michael Savage, the GOP, et al..

And I'll finish that thought with the failure of (the majority of) the 'media' to have the guts to truly do their job and point out the fraud & lies from the right instead of claiming some kind of  'equivalency' between the left and right messages. Bob Cesca says it well in his "Killing the False Equivalency 'Both Sides' Meme".