Unexpected Day Off.

•December 6, 2012 • 3 Comments

I really ought to……fill in that blank. Literally. As I even read that sentence, I recognize that my life is filled with blanks that I have never filled in. There are things I have never done and wanted to do. There are the things that I “should” be doing to improve myself and my situation. The problem is, with the way my mind works lately, I can’t seem to focus on any one thing on my endless “to do” lists, even on the fun stuff. I had several cancellations today, so I had a day almost entirely freed up. I caught up a bit on Facebook, and that I don’t think of as a waste of time because I have made some great friends there and learned a lot from other people. But, when I’m reading the same posts over and over because I can’t figure out what to do next, well, that’s a problem.

One thing on my to do list is to keep up with my blog. I wanted to really get into writing, at least when I started this thing. I thought I could maybe take it and do “something” with it, but I think that my enthusiasm has waned. I don’t seem to feel as confident. I don’t feel like what I have to say will really be interesting or make any sort of difference.

I recognize that as my depression. It’s so insidious. It seems to steal the joy out of the simplest things, like an unexpected “free day.” I instead feel guilty and angst ridden. Now, to be honest, I would probably do a bit of the angst thing even when not in a true-blue depression. But, the whole no confidence thing? That part is newer. I’m trying to move into new areas with my business in the next year and in my life. I’m pulling in information and am just overloaded right now. I need to sort through it all. But, with this impetus to do something new, to make the changes I’ve wanted to make all my life, I am sunk down in the mud of a depression. Not now, I want to cry out. I can’t be bothered with depression. I have things to do! I have a life I want to live, to fully live! Yet, that depression is still there. It’s really caused me to doubt myself.

I have friends who tell me I can do amazing things, that I am talented and capable. But, I don’t see it right now. I don’t feel it right now. I feel like I’m running out of words, and I never run out of words. There don’t seem to be words to really express what I feel. I feel like I am not only lost but a loser, someone who hasn’t earned her way into anything important, someone who doesn’t have what it takes.

I’m so tired. I’m trying a new medicine. Well, revisiting an old one actually. I feel a bit different, but the depression hasn’t really lifted yet. I’m a bit lighter, but I’m more out of sorts and feel more disconnected to myself and my life.

And, I just write today because I have today. I promised myself I’d start to write, that I’d even write about the depression. Maybe knowing what it’s like on the inside can help someone.

I know what my patients feel when they are depressed. The hard thing is, sometimes I can almost feel it with them.

This sucks. This….this entry. It’s no good. But, it’s done. So, there. I did do something today. Fuck off, stupid annoying thoughts about how imperfect I am……..

Dear DeDe is Grateful!

•November 19, 2012 • Leave a Comment

Dear DeDe is Grateful!. Just want to share a blog by my friend, Rumpy, who is, yes, a dog. How we treat and care for animals, especially our companion animals, is a topic that is more than a little dear to my heart. Because of this, I want to share Rumpy’s blog with you.

Weeping in the morning.

•November 19, 2012 • 2 Comments

There is a passage in Christian scripture about how weeping may endure for the night but that joy comes in the morning.

I have been weeping in the morning. I don’t weep. I don’t sob. I may cry a bit here and there, but I have avoided serious weeping and sobbing much of my life. I couldn’t stand to be that broken. I learned to not do it, to stop it. So, when I have really needed the cleansing that can come from deeply mourning some true loss, I haven’t even been able to do it.

I remember my brother telling about sobbing in his wife’s arms the night after our mother died. I remember feeling that sense of disconnect when I heard it. I didn’t know how to mourn for my mother. I didn’t have any arms into which to cry.

This has been the case with my life for a very long time. I have also had depression for a long time. It has been held in check a lot of the time, possibly by medication or possibly by the weird chemistry that is the human brain. But, I know I am in a full blown depression right now. I have had moments when it’s been loosened a bit, when I could feel other things, but most of the time lately I have just had a sense of numbness, dread, disconnect all at once. I don’t feel like much of anything is even real.

I look at my life. It has been a mess for a long time, and I have felt like I was scrambling to try to bring some order to it for many years. There have been years when all I seemed to do was work to survive and just try to pull on through. It has left me so empty.

The other morning when I finally wept, I just sobbed and sobbed on my bed. I had my dogs there, but I didn’t worry about being heard. There was no one to hear me anyway. I wept for my mother, for the father who never was there, for the broken hearts I’ve had, for the losses I’ve experienced, for the times I’ve been treated badly, for the loss of dreams. I wept for the child I’d never have. I wept for the dreams that seem so far out of reach, that maybe I’ve lost for good because it’s too late. I wept for the loss of self.

I didn’t know if the tears would help me heal or would just drag me deeper into my pain. I still don’t know. I tried to let go and weep. But, at some point, the alarm went off and I had to face the day. There were three patients to see. I had to drive to their homes, put myself aside, and try to be there for them. I had a call with a woman who is an executive coach who was kind enough to offer to talk to me. I had to be coherent for that, too. The wheels are coming off of my practice because I’m not getting paid. There are so many problems mounting. They’ve been there all along in some cases, but there are new ones piled on that, and it’s just scary as hell. I wanted to talk to the woman to try to explore a different path for myself.

I’m trying to be there for my patients, trying to resurrect my business, trying to figure out what I want to do and who I want to be. I’m trying to make enough money to feed the dogs, pay for the car, keep the house, stay afloat. I’m not even trying to deal with the other looming problems and debts, just the survival ones.

I feel like long ago I shattered, and many of the pieces were just swept away or crushed underfoot. I almost feel I don’t exist anymore. I’m shards of glass, a figurine not completely broken, but on the verge of disintegrating.

I’m at a loss for words. I wrote this blog entry once already, and through the magic of computers it was lost. It just disappeared. It wasn’t that it was that good, but, much like me, it just was so much nothing. No trace. I don’t feel there is much of a trace of me left anymore.

I joined a church today. I’m not sure why. The dogs led me there in an odd way. But, I don’t feel God is necessarily the answer. People say to trust God. But, he won’t do the billing. He won’t argue with the insurance companies. He won’t make sure there is dog food and that the property taxes get paid. He won’t even sweep in and fix the bigger problems. Are they all financial? No. There’s the filthy, falling down house. Money would help, but it’s not the complete answer. Energy and physical health would help, but they won’t solve it all, either. I cannot turn back the clock. I cannot become me again. I cannot pick up the lost threads of my life. Much like a lost blog entry, that is gone.

I cannot tell you the answer because I don’t know it. I can tell you the experience, but only in faulty words. I’m supposed to be the healer, and I’m the broken one. There is no one to go to, no place to rest. There is no sabbatical for the self-employed therapist. Hell, there is no sabbatical for any therapist who doesn’t have a lot of their own money to pay for it. I need solace. I need a place and a way to heal. But, I can’t see how that can happen.

I weep for what I’ve become. I am ashamed of who I am in so many ways. I weep for what I lost, what I let pass me by, what I never got to be or to experience. I weep for my life. I weep for it all.

And, then like something crazed, I stop up the tears. I get dressed, I work, listening to others’ problems when I feel so completely disconnected to myself, to the world.

I’ve been lucky this time around. I have had moments, just a few, where I felt an easing of the depression. It’s been rare, but it’s been there. It almost makes me want to weep more because I know there is such a thing as a life without this weight, without this depression.

My weeping comes in the morning, when I first wake up, when my guard is down. And, then instead of being able to cry all my tears and rest, I have to go to work. There are no arms to hold me, no one to watch over me while I fall apart. Yes. Thank God. There are my dogs, but I worry more about whether or not I’m taking care of them. But, they are there. Tears. No tears. Walks. No walks. They are a presence, the only constant in my life. But, there is no safe place for me really. When that clear light of morning breaks me from sleep, all there is is a broken woman.

I have no ending for this story at this point. I have just the sorrow, and the expectation that tomorrow will be another day. Perhaps I’ll weep. Perhaps that will help me heal or that will wound me further. Perhaps I won’t weep, but will feel the call of the tears like the distant roar of the ocean. I’ll feed the dogs. I’ll get dressed. I’ll see patients. I’ll try so hard to “be” the therapist and care about their concerns. I’ll make efforts to solve the most pressing problems, but my mind won’t be tamed or easily focused. I’ll scramble. This is my life right now.

Can this depression be lifted? Depression always has its times and seasons. It does go into at least some level of remission eventually. Maybe another medication can work. But, another chunk of my life is gone, given over to this illness. More time passes me by, more people and relationships and things I wanted and dreams and…….more me……is lost.

This is living with depression. I’ve done it long enough that I am not shocked by it. I do what I can to function in the world, but I don’t feel at all part of that world. I feel locked in my own hell. I know all about depression and how it works. I know what I’d tell my patients to do. I’m trying to do those things that I think will help. But, the clock ticks and more of my life is gone.

Does joy really come in the morning? Damn. I’m waiting for that morning.

Hello Again, Blog. Hello Again, Depression.

•October 30, 2012 • 2 Comments

I’ve been gone for a long time. I just read the blog I posted in February. I was struggling then with an ever encroaching depression. I think it started perhaps right after my car wreck last November, but I remember times of feeling “happy” and of really having “fun,” you know, where the laugh actually goes all the way down, at least through Christmas. I enjoyed my visit to see family during the Christmas holidays, but I also remember a phone call from a patient that was just wearing and then the death of my friend’s father coming right at the end of the time I took off for Christmas. I felt like I didn’t have much “Christmas” time during the holidays themselves, and the 12 Days of Christmas have always been important for me. I know that by New Year’s Eve, I just didn’t quite have as much fun listening to my band as usual. My Achilles began giving me more and more problems, and I really could not ignore it anymore. I was getting treatment for pain related to the accident, but something just wasn’t “right.” By the time I wrote the last blog entry in February, a true depression was brewing.

Let me clarify a bit. I have what they call “double depression.” Whenever a depression lifts, I never get technically into what they call full remission. Some diagnose this as “double depression” because dysthymia is always there with episodes of full-blown depression interspersed. Dysthymia is a diagnosis given when someone does not meet full criteria of depression, but when it lasts for over two years. Think of it as the low-grade fever of depression. It’s not the full-blown flu, but it lingers and depletes energy over time. Dysthymia is the low-grade fever of the depressive spectrum. I often feel like depression is lingering around the edges of my life, sort of like an old picture fading around the outside. However, there are times when the depression “meets full criteria” and when it is a “full-blown.” It’s been a while since I’ve been here. Medication has kept the “full-blown” version at bay to some extent, but meds just weren’t working that well and were really expensive. I’ve played around with different meds, trying something cheaper when it seemed like the more expensive version wasn’t as effective anymore. I even tried a medication used in Europe for depression but used here only for fibromyalgia. I thought that maybe, somewhat like Cymbalta is supposed to do, this medication would give me some relief from both. Cymbalta had failed to do that and was very expensive for someone with no insurance like me. So, that is where I was from a clinical perspective when this depression just began to build and build.

By February, it was waiting in the wings for sure. I got extremely overwhelmed by all the requirements of the different insurance companies, by a reduction in pay once about six of my patients moved from being in foster care to being adopted, and by a huge upcoming change in how Medicaid would be managed for all the new adult patients I was taking on trying to make up for the loss in revenue from that change. This big change that was looming in Medicaid management was confusing, and I got different versions of what was going to happen depending on who I talked to, and all the people I was able to talk to had a vested interest in what I chose to do. Well, at least one really did, and he was the rudest. I decided that they were not telling me the entire truth because of how they acted and did not believe that my patients would be forced to change from their existing plan. And, if some did change, I would be able to bill as an out-of-network provider although I’d get a bit less. I figured at that time I could become a provider if I needed to, but that I’d be able to bill for out-of-network. Somehow, having not dealt directly with insurance other than the two companies that managed Medicaid, one for foster care and one for everyone else, I didn’t know anything about being out-of-network. I just thought that meant quite literally that you would be out of their network and billing them. I didn’t realize that even to be an out-of-network provider, one has to do a HUGE amount of paperwork and be approved to provide services. I thought that the massive paperwork was only required to become an in-network provider. I made a big mistake. It’s hard for me to estimate even how much money this has now cost me.

Back to my story…….I got overwhelmed. I decided not to go to a training provided by the “new” insurance companies that were going to “manage” Medicaid because I was overwhelmed and just scheduled patients and kept on seeing them. I went on with my life, my practice, trying to figure out how to get paid for two patients that I had that had other insurance, and the like. (I’d been led to believe they were simple Medicaid patients, but they had other insurance I learned after I’d started seeing them.) I knew those insurances would pay reasonably well if I could get in with them (didn’t know the part about Tricare requiring a doctor’s referral for an LPC, for most insurance companies that went out about 15-20 years ago), so I wanted to hire an assistant to help me figure out all the massive paperwork.

The assistant search story could go on and be about as boring as the details about insurance have been, so I’ll spare you a lot of the details. Someone suggested I have her granddaughter do it when I asked her for a suggestion. I knew that wasn’t going to work, but I gave it a try. I felt I owed it to the grandmother. I gave a very organized, paperwork “maven” friend a shot, too. It took me a very long time to find anyone who could make any progress. There were lots of dead ends and lots of different trails that were quite ridiculous. For BlueCross/BlueShield, you needed to be registered with something called CAQH, a sort of database for credentialing providers, but to get in with CAQH, you needed a “secret code” from an insurance company. It was a catch-22. (We’ve finally gotten through that, I think.)

I tried to work through some of my issues at a Dance Workshop at the end of February. It was in one of those workshops that I finally mentally broke free from my former job and decided to go into private practice. I’d played around with the idea for a long time, but I was mired in just feeling bad about the current job I had then and the problems relating to my bosses. I just didn’t “get” why they always seemed so disappointed in me, and I was frustrated. At that workshop all those years ago, I was able to get clear about what I wanted to do. It was also when I decided that it would be important for me to work towards leaving on the best terms I could. It took me months to do it, and I worked hard before (and after) I left to make sure I left on good terms. I worked on some new things that I thought were real improvements. I gave 4 months notice. I came back to work, for free, after I’d left and the new person took over to help her get started. I’d had no one to teach me the job when I came in, so I wanted her to have all the support she could have. What I had decided to do at that workshop set a blueprint for me that I followed and that made me feel proud. I hoped to do the same thing at the workshop at the end of February. I was struggling with fatigue and with an injury to my Achilles tendon. I was having trouble really dancing down into my feelings. Usually, that type of dance is a format where I can really tap into what is going on inside of me, but it often takes a full three-day workshop to get the benefits. We work through different things over the three days, but there is an arc to the workshops that leads us through to a place where we can get really quiet inside and be able to hear what we really need to hear. Whether that is from the inner self or from God, it’s a mystery to me. But, it’s on that last day that I usually get freed up and get some clarity. I screwed up. I didn’t make it to that last day. I was just too tired and in too much pain to drive down to Austin one more time. I regret that now. I might have had that “moment of clarity” that I needed to lead me in the upcoming months.

So, then comes March. By the end of March, I realized I was NOT beating back that creeping depression. It wasn’t creeping as much as it was reaching fingers into every crevice of my being. I decided that even though I couldn’t yet get health insurance, I was going to pay out of pocket to see a psychiatrist. My therapist indicated that there weren’t any in the area that he’d even recommend anymore. I went over an hour away to see one. We decided to try Abilify. It would be an adjunct to the other med I was on for both depression and fibro. It has had good results with some patients. I hoped I’d be one of them. At first, it seemed like I was getting some good results, but not quite where I wanted to be. March, April, May came along. I tried varying dosages. I wasn’t getting the results I’d hoped for, but I so wanted to see improvement that I kept on trying.

May came. My 50th birthday. I had EXTREME anxiety about that date, about that number, about what that meant for my life, about if that meant I even had a life. At the same time, in fact, a few days before my birthday, my therapist of about 16 years let me know he was retiring. Interestingly, he told me that right after I told him about one of my worst birthdays when my boyfriend, then fiance, now former fiance, pretended to leave the evening before my birthday and how that upset me. Oops. Bad therapist. Actually, he’s been really good, but THAT was some uncharacteristically bad timing on his part. So, I was a bit stressed.

Ended up with an AMAZING birthday, and perhaps I’ll tell that story another day. But, it was good. It was a great day. There was a lot of reflection, along with a lot of partying. It surprised me how good it ended up being.

But, then back to the stress. Had to finish a bunch of CEUs to keep my license by the end of that month. Then, a notice from the one Medicaid company that they would not pay me until they had a copy of my new license. Oops. I sent in the stuff to renew right before it expired, and it took weeks to get a copy back. So, it took a few weeks to get that into that company and be able to bill and get paid. I wasn’t too worried, just a bit irritated. I had gotten a settlement, finally, from my car wreck. I knew I could make it through. I started making some progress on the forms for insurance for the few patients who had other insurances as their primary carriers. I had found someone to be an assistant for me! She made progress in just a few weeks that others had not been able to make in months, and I was working like crazy trying to fill in the blanks of the paperwork that she couldn’t do and to get it in. I was making progress!

Then, BAM! I was able to get it all settled and found out that I WASN’T getting paid, starting at different times, for almost half my caseload. They’d been switched to a new insurance. Remember that February blog and what I said about it above? Yeah. This is when it bit in the butt. I wasn’t getting paid for them AT ALL! I scrambled, my assistant scrambled. We had to get all sorts of paperwork done. I got to be an out-of-network provider because I did what was called a “case agreement,” and it was retroactive. We worked like crazy to get the actual contract done so I could eventually be an in-network provider. I had to write, for each patient, a request for more services. I had to bill as if the first time I saw them under their new insurance was like an initial evaluation even if I’d seen them for years. Then, I had to fill out a form for each to prove they needed more services. They didn’t receive them or answer my faxes, so I had to refax them to some big muckety-muck who’d helped me with the “case agreement” and the contract. It was this long, grueling process. And, I didn’t know if I’d ever get paid. I billed and waited. I’m still working on the billing from before I became in-network. I’m still getting dribbles of pay and more denials than anything.

I billed for about $3,700 on one report I got back. I expected to get paid about $1,200 because of how little they pay in percentage of what is the actual going rate. And, I got paid about $500 after all their denials. Whether I ever even get what the cut-rate amounts owed to me is anyone’s guess.

So, this all sounds like it’s been about work for the most part. It has been a huge component of what I’ve been going through. I’ve been trying to keep on moving in other areas of my life. I had friends helping me trying to fix up my home which is not only in bad repair, but looks like a hoarder’s mess since I developed fibromyalgia and tried to start a private practice at about the same time. I wanted to make some progress on it and felt that might lift my spirits. Usually, with mounting depression, I would not have been able to do much. But, my best friend and some other friends really pulled me along. I also just kept fighting, kept hoping that the depression was not going to overwhelm me.

I kept on with that medication change, too. That, as it turned out, was maybe not the best idea. At one point, I had a bad reaction from the medication. When the dose got higher, I developed severe anxiety. I was anxious all the time. There was that churning in my gut all the time. I woke up with it. I went to sleep with it. I sat and tried to calm it while I worked with my own patients. I could keep it at a dull roar at times when working with patients, but it was still there. I tried so hard to listen, to be present, but I’d catch myself watching my watch more and more. I woke up early, which is not good for me. I had more problems with my Achilles, so exercising to calm myself was not as much of an option. I was crawling out of my skin. I backed off the dosage, and I had a little relief. However, it as if once that switch was flipped, I really could not get back to not being so anxious.

It was then that the depression really began to sweep in.

Then, one other thing happened. Some of my patients had been adopted by people I thought were wonderful people. I kept seeing the kids, and they were some of the patients for whom I worked on BlueCross/BlueShield. I really thought highly of these people and was continuing to work with the kids as they transitioned into their adoptive home. And, then I noticed the dogs were missing. I asked about the dogs. They had taken them to the pound. The pound! The dogs had been digging out of the yard, and they just didn’t want them to get hit by a car. They’d tried a kennel, but the dogs had dug under it. (They had NOT tried paying the dogs any attention.) I was frantic. These were dogs I knew, and now they were very likely to be killed. Dogs do NOT often make it out of the pound alive. I became obsessed. I posted their pictures everywhere and contacted every rescue I could. I thought I had a rescue lined up two different times. I ended up getting the dogs out of the pound on my own, signed out to me. I later got a local rescue to take us on, to take official custody of them, as long as I’d be their foster because they had no room. I didn’t plan on having two big extra dogs. I knew I couldn’t afford it. (The local shelter/rescue is at least paying the medical bills, but one still needs something done to help her back legs.) I didn’t plan for my own dog, who is 14, to get a severe ear infection that cost me about $500 so far. I knew my other dog would not like having them here. He’s had some problems with other dogs in the past, and I don’t know how he would act if left out with them for any real length of time. He’s extremely anxious, and he could get to where he just got aggressive because he is so anxious. I just don’t know. what he might do. (He just was barking outside. I called him in. He didn’t want to come in through the dog door because “they” were in here. I called him in anyway. He got spooked because there was no room around them and because my exercise ball was in the way. I had to grab his collar and make him run the “gauntlet” through the “other” dogs, past the exercise ball, and on into the back room. He’s a HUGE dog. He wanted to just turn around and run outside again, but I’m pretty sure he was barking because he’d rather be inside.) Oh, and my two lovely foster dogs? Escape artists. They dug out of their former backyard, so that had been a factor in addition to my dog (and the rules of fostering given by the rescue/shelter) that makes me crate them when I’m at work and at night. (I have to fight one of them to get her in the crate. She has broken out of other crates several times and out of the garage once.) So, I have had a lot of dog worries, to say the least. My dogs are my family. I am a staunch believer that dogs are family and should be treated as such. I have little patience for anyone who does not think of a dog as a life-long commitment.

So, here I am with these people I really used to respect whose dogs I now have. They have lost my respect, but I still work with their kids. Because the dogs stayed local and might be at local adoption events, possibly with me, I felt I had to tell them that I had the dogs. Even if I hadn’t, I would feel very uncomfortable. The little girl still plays with her two stuffed dogs when we do play therapy. She calls them Dixie and Coco. That’s the names of the actual dogs. How they thought it wouldn’t impact her, I don’t know. But, she was very worried for a long time about the dogs. I have a feeling that for as long as she lives, the fact that they suddenly got rid of the dogs will always make her wonder if they won’t suddenly get rid of her. How could they be so cruel to the dogs, and how could they be so stupid about children? They also have a teen who plans to become a vet someday. Why she didn’t speak up makes me really question her. I stood up to my mom when we took in a dog that we did not know was pregnant and she wanted to put the puppies to sleep. I don’t believe that girl has “always” cared about animals and wanted to be a vet. Either that, or she is really ignorant of what happens at the pound. Anyway, how do you not speak up when your parents take away your dogs, you’re a huge animal lover/vet-wannabe, and the dogs are going to the POUND???? I wonder if it will matter to her when she learns how animals often die of illnesses caught in the pound, how some pound use gas chambers, how even if they use “euthanasia” in a pound that they don’t give the pain-killer before administering that drug like they do when they use it on someone’s sick or elderly pet at the vet? How will either of those kids feel? Their irresponsible parents won’t be liars when they say that the dogs were not “put to sleep” in the pound. They have a home. Hopefully, they will have either the same home or two different homes that will be “forever” soon.

If my stress level was not enough with these two dogs, I had ANOTHER foster family who took their dogs to the pound. The mom had been out of the country, the dad had not made sure that they adult foster girls had cleaned up after the dogs, the mom heard through her bio daughter that the house smelled bad, she was afraid that “the state” would find out and remove her foster girls, she didn’t feel she could expect her husband to make the girls clean up, so she had him take the dogs to the pound. She said she’d had good results having dogs get adopted out of the pound. REALLY???? Like hell. My respect for her is so low now. I used to think of foster parents more like colleagues than as parents of patients. So, they were a bit closer to friends, people I often respected. I know not everyone takes care of animals the same. There are people who think I’m terrible for crating the dogs during the day. (Heck, I think it’s pretty horrible for now, too, and I hope they get a home where it’s not needed soon.) I have another family that I love and even think of as “my” family who do not take care of animals the same way I do. But, they’ve never disappointed me like these two families have. Not to this extent.

I had a patient who “had” to get rid of her dog, who she should never have gotten, when she had a baby because her lazy-ass husband never came home to let the dog out or clean up after the dog. Now, they have given the baby up for adoption. I thought they gave the dog to a friend and had been told she was doing well. Something went awry, and the friend gave her away again. She ended up at a shelter. They got a call about her. They could have gone to get her even if it would have cost them $25. She could still be there! But, my patient has talked about getting a puppy because she’s lonely now at home. She talks about all she wants for her upcoming birthday. When I point out that her dog, the dog she still says she “loves” and still calls her “baby” might yet be alive, she says she might call about her. But, then she points out how much it would be to get her out. Really?!!! I KNOW this is a (supposedly) “mentally retarded” person. I know this is someone with her own history of abuse. I know this is someone who is mentally ill. But, REALLY?!!! What the fuck!

I’ve run out of patience with people. I am so literally sick about all these dogs, dogs I have petted and held on my lap and played with when I’ve done therapy, being just thrown away that I cannot stand it. My trust in people is at an all time low. My trust in my own judgment of people is pretty bad, too. I know that someday one of my patients or one of the parents or someone else may come across my blog and be able to tell what I wrote. I have some of this shielded on FB, but that won’t keep it completely from being seen or heard. If they found out now, I could lose a patient or two. I haven’t told anything too personal about the people, so ethically I think I’m ok. Unless you know my caseload, you can’t even guess at identifying who I’m talking about. Well, unless you happen to know someone who has done something as abhorrent as I’m talking about……If someone stumbles across my blog and actually reads this particular entry, this long and overwrought entry, and figures out I was talking about them, well, maybe it’s good they know how much my trust and respect in them plummeted. And, that even goes for the actual patient. I’m sick of this much lack of concern for other creatures. We wonder why there is such widespread cruelty against animals and even against children. It’s because “good people” don’t care or don’t want to know. I do some bad things. I do some things that are wrong or even illegal. I’m sure people can, and do, judge me based on these things. I judge me, too. But, we’re talking about other living creatures here. I am just sick since these things have happened.

So, take some genetics and a history of depression. Take the fact that past depressions tend to indicate the increased likelihood of subsequent depressions. It’s like the brain chemistry getting into a rut, or a groove like on an old record when it skipped. (Remember records?) Take some overall financial problems and add to that just not getting paid. Add to that some huge scrambling to do paperwork and get one’s “ducks in a row.” Take questions about the future of a practice, an increased workload and decreased compensation, farther distances driving to see patients. Take a failed med trial that not only led to deflated hope but to a real increased anxiety. Take the usual ongoing struggles of life with fibromyalgia and trying to break free from its grip. Take a big birthday and some need to figure out where life goes from here. Take the impending loss of an important, long-term, supportive relationship. Take the added stress of two extra dogs in a home and how that stress multiplied for the human as it impacted the resident dogs. Take an obsessive and exhausting fight to help those dogs and now the difficulty of having to place them for adoption when one has lost trust in people. Just take it all. Now. Full blown depression.

I want to re-engineer my career and make it work. That’s a hard thing. I don’t know for sure where to start, my confidence is not that great given all I’ve been through lately (and getting routinely underpaid by insurance companies has not really helped that I realize), and I am very uncomfortable and leery of marketing. I don’t trust myself in hiring people to help because most of the times that has not worked out well. Having lost trust in people in general lately does not make that easier. I’m trying to push on ahead and just do “the next thing,” even though at times I don’t have a clue what that is. But, I need a viable work life. That is part of overall healing because I not only can’t afford treatment without it, I can’t handle the ongoing stress and hope to get well. I don’t want to work for someone else necessarily. (Oh, forgot the whole stress of applying for and interviewing for another job that I felt I might HAVE to take but didn’t really want to take. Was all “green lighted,” but the requisite huge amount of paperwork has not shown up, so maybe that’s a good thing.)

I decided to work last week rather than try the psychiatrist again last week. I recognize meds will probably be part of the overall process of getting out of this depression, but I am not sure that they are the first thing that needs to happen now. There seem to be more pressing issues. I know that with the right meds, with some relief of the depression, I might be better able to create that life I want. But, money took precedent for now. And, I needed a bit of a break from trying meds. I felt so deflated when they didn’t work.

I’m trying to function. I’m doing things I normally do. My best friend helped me put up Halloween decorations in spite of my not really feeling like doing it. It’s been a big tradition for me and for the neighborhood. I’ll be in costume as will my personal dogs (the fosters would try to escape every time I opened the door) and giving out candy. It’s not a fun and happy Halloween like last year was. We seemed to celebrate fall and Halloween for about two months last year. There were all sorts of activities and events we did. It was a grand time. It was right before the depression started to creep in, and it was an especially good time. I’m glad I had that before the descent. But, now, a year later, I’m just trying to keep moving. I’ll do as much of the “normal” things I can as this season proceeds.

You’re probably not all caught up, but it’s a start. There’s been a lot that has happened since I wrote my last blog. If you made it to this point, I congratulate you. I’m actually astonished. I don’t think I’d read anyone’s blog if it was this long! But, it fills in the blanks. I haven’t written because of life events, but more than that, I haven’t written because of an increasing and deepening depression. That’s a shame in a way because the whole point of this blog is to chronicle the experiences of dealing with mental illness and a chronic illness while actually working as a mental health therapist. It’s supposed to be about what it’s like to life with such an illness while trying to treat it at the same time. And, I stopped writing the blog as it got worse. I have written a lot on FB. I have needed that immediate response, but I have neglected my own blog. And, I believed that this was valuable not only for myself but perhaps for others along the way. I let myself down and let down anyone who might want to follow my journey. I needed to try to catch you, and myself, up. I needed to give this blog something by way of explanation.

Something about my depression this time, I’ve gotten very wordy when I write. I’m not so good at listening, not just to my patients, but even to my best friend. I don’t always even want to talk. But, I write. I should have been writing here. I hope I can bring myself back to this page because perhaps this, too, will be part of my healing. And, perhaps it will lead to things I’ve never imagined, positive things I hope.

So, dear reader, I wish you well. If you are on a journey that includes mental health issues, chronic health issues, or even if you are just working on treating those or living with those struggling with those issues, I hope this lends some light on the subject.

Is this what crazy feels like?

•February 16, 2012 • 1 Comment

My body aches, tension just moving from place to place. My heart rate races. My stomach churns a bit. My brain, well, it’s moving like you cannot imagine. Unless you happen to have anxiety or whatever it is that seems to be rampaging through my mind.

There are so many things I need to do for work. I don’t know how to do a lot of those things, and there isn’t anyone to ask. I’ve asked my own therapist how he learned all the business stuff for his practice, and he’s indicated that it was from making a lot of calls to insurance companies and making a lot of mistakes. Well, it seems I’ve done some of that. Just not enough. I have to figure out how to work through all these systems and companies and agencies, all these government entities with their contractors and subcontractors and subsubcontractors. It makes no sense. They rattle off terms and words and acronyms. They don’t explain any of it when I talk to them, but I honestly don’t think any of them know more than their little piece of the puzzle. Well, except for maybe the guy I suspect outright lied to me today, stating that ALL my Medicaid patients were going to be forced to pick an insurance company soon. When I call whoever it is that I bill for them now (is it a private company or some government thing? Not a clue. Truly.), they take a list of my patients’ Medicaid numbers and say that, for most of them, they won’t be switching. Well, unless they call and ask to have change. Changing program or whatever does not really change benefits. If they do, I have to be a provider for that company. I might not even know which company until after I’ve seen them, so more free sessions for Medicaid. It won’t change their services nor will it change what I get paid, but it will require a huge amount of mystery paperwork.

That’s the problem. The mystery paperwork. It’s on a “to do” list, but it’s not something I really know how to do. I don’t know who to ask. I don’t know how to start. I’m going to try having an assistant, but I don’t know whether finding out all those types of answers is something that someone without a lot of experience can do.

Then, there is the “grow your business” crap. I need to figure out how to fix some student loan stuff so I can go back to get certified to be a Life Coach. What do I need to do? It’s a letter to someone about something. Then, find a program or a class or something. Oh, and figure out if I can do therapy online. Is it ethical? Well, I know it is. But, will my licensing board allow me to do it? How about phone counseling? I know it’s effective, but can I do it? How do I go about doing it?

How do I get credentialed to be a provider from other insurance companies? What about the people I see that were supposed to be just Medicaid but that I never get paid for seeing because they have other insurance? I can’t drop them for ethical reasons, and I’m scrambling to try to find a way to get all that set up so I can get paid. I need to call them, fill out more paperwork, etc.

How do I get Dragon set up on my computer? There isn’t enough room. Will it work on an external hard drive? I need to do this because I have to be able to do my notes more effectively. I am late with notes again. I need to get stuff for a judge. I need to call a teacher. I need to ……fill in the blank.

Personal? I have a house that is a wreck. I’m trying to buy a bed. I need to fix up a bedroom and stop sleeping in the living room on an air mattress. I need to find a way to get money so Lilith can get acupuncture. I need to be writing in my Daily Pages everyday and working on the two different self-help books that I have prioritized.

I worry about my family and how they have such disconnected relationships. I worry about my friends. I worry about every person I know on FB and every dog I see that comes across the screen. I worry about big political issues and environmental issues and hurting the feelings of my friends when I don’t do things they suggest.

I want to be different. I think about how I wanted to change things about myself. I wanted to be a better person. I still do.

I’m tired of not being healthy. I’m tired of being a mess. I’m tired of me.

Now, for the brain part. All this. All this, and so, so much more is going through my head. People tell me to do one thing at a time, but I can’t. I can’t choose. I forget important things. I have small and huge “to-do” lists. I try to pick one thing to do, but it’s hard to know which is most important. One thing will make a difference, maybe, to a family of four small children, and it needs to be done now. One thing will get me authorization to see a patient, to get paid maybe. Another thing will enable me to bill over time. Another thing will help me lose the weight I want to lose and maybe help me be healthier. I can’t choose.

I took a couple of those interesting “tests” online a few years back. It was about attention and focus. I can pay attention to something, give it my all. In fact, I love doing that. I do it when I have a great project. As long as it doesn’t go too far, it can even be a good thing for me. But, I can’t figure out where my attention needs to go. That’s what the test said.

That’s because it needs to go EVERYWHERE! How will I ever BE anything or DO anything if I don’t do all this and much, much more? I feared getting “old” when I was 12 and thought I was running out of time to be a child. It panicked me. I had an anxiety attack thinking about it. Now, age is even a bigger factor. It’s a big birthday this year, and I don’t want the rest of my life to be characterized by the same mistakes and crap that the first part has been. I feel the time crunch even more.

I remember this “anxious” feeling often as a child. I remember feeling it, sitting in the car, on the way to ballet. I remember it when family came to visit. I feel so disconnected right now. I talk to people, people I love and enjoy, and I almost feel as if I can’t “touch” them. I laugh, but not all the way. I try to fake it through.

All the while, this prattle in my head. Throw in all sorts of odd facts and “interesting” information about, well, pick a topic. It just goes on and on.

Is this anxiety?

My therapist often says if I had 20 fewer IQ points, I’d be happier. I tell him I’ll try to get “dumb” really quickly. It might be part of what goes on. I have a very active mind. I would have that anyway. I want it to stay that way, but not to the point that it is out of control. I want an active, thoughtful mind. But, this goes so far beyond that. It goes to the point of being just crazy.

This is annoying to write about. I just want to give you a glimpse, a very tiny glimpse, of what it’s like to live inside my head. My very noisy head. I know that it’s the anxiety and the depression. I know that the “fibro fog” makes it all so much worse. It makes it even harder to make decisions, to remember important things, to think through things.

I need to be myself, but I need to be a healthy self. I love my friends, my chiropractor, everyone for their suggestions. They want me to “do one thing at a time.” They try to help me realize I don’t have to do it all, but I do. It’s my only life, and only I can make it better. Only I can change it all. Isn’t that what we’re told? If I want to be a different, a better person, I better get on it. If I want all those dreams, those really big ones, the ones I barely even tell anyone about, to come true, I HAVE to change, and change quickly. I don’t know how to quiet the noise in my head. I don’t know how to stop my body from aching and twitching and hurting as ripples of tension run through my nerves, my muscles, further making my health a problem.

Live in my head for a moment. Or, maybe you already do. It feels like there could be an entire world in there, rattling around, telling me what to do. But, I only hear part of what they say. I can’t get it all in. I can’t get all the information together. I want to be…….me. Whoever that is. I want to be active and healthy and happy and whole. I want to contribute to the world and have relationships and experience love. I want to have quiet in my head, at least for a time. Even my dreams make me crazy. I wake up, full of information about the dreams. Not necessarily bad, but exhausting. The dreams make me tired. They don’t resolve anything. It all just continues to spin.

I can’t even shut it off when I write. I can’t wrap it all up in a neat package.

Anxiety. An overly busy mind that isn’t busy in a productive way, but just spins out of control.

Then, I go to work. I have to quiet the noise, at least a bit. I used to be able to do it at other times, now it seems I can only really do it with my patients. I put the rattling of my mind to the side, and I pick up theirs. I listen, letting my “crap” fall away as I pick up the “crap” from my patients. I try to think how to help them. I try to listen. I usually remember all sorts of little details from things they’ve said and done, even years ago. I try to exhibit being “present” and really paying attention. Do I fail at times? Of course. And, some patients are much more difficult than others. But, when I walk in their door, I tell myself to focus on them. I whisper a prayer. I often do turn off, or at least down, the chatter. However, I carry their “stuff” with me. I can remember the name of some kid’s boyfriend or someone’s childhood cat or notice that they avoid certain subjects all the time. I remember and process things in their life, but it seem to take up space needed for my own life. That’s why I need an assistant of some sort. But, they are going to have to do some mind-reading of their own. They are going to have to be able to anticipate what I need. They are going to have to be pro-active. That’s going to be the hard part.

So, when you tell me to “do one thing at a time,” it’s like that doesn’t register for me. It makes no sense. I’ve too often done more than one thing at a time, and I used to be good at it. Now, with that life clock ticking away, it’s hard to allow myself the luxury of slowing down, and yet it’s as if I’m just spinning in the mud and muck of my life.

I don’t have a solution right now. Better meds? That would maybe help. But, that gets into the lack of insurance and the need to find a new psychiatrist, probably a decent drive away because not many good ones seem to be around here. That alone is a huge hill to climb. How to find one, know that they will be good and not waste my time and my money? How to afford one?

I need some help. I had a good friend pray with me about this, but that peace that seems to come to her seems to elude me. Elude me entirely. I don’t “get” that peace. I don’t know that I ever have. I don’t think I had it even as a child. My head was pretty full then. At times, I remember depression and anxiety. There were other times when my head was clearer and when I could accomplish soooo much. I was a rock star at times. I was amazing. How I did all that, I don’t know.

Maybe I can sleep. Maybe this helped get a bit of it out of my head. Maybe. Just a little. I want to be. To BE. To BECOME someone, myself, someone I’d be proud of. How to get there? The simple, and good, advice I’m given doesn’t work easily with my crazy head. I don’t comprehend it. I don’t know how to pick the one thing to do. And, what if I’m wrong? What if I pick the wrong thing?

Lucan and Cheryl

•February 15, 2012 • Leave a Comment

I first wrote this October 17, 2009. I’m including it today because I’m celebrating Lucan’s 7th birthday today. I love my boy! And, Cheryl, you are always missed. Thank you for guiding him my way, somehow.

Four years ago today, I brought home a gangly, huge puppy and named him Lucan. He was scared of everything. I had to drag him, literally, in the house as Lilith ran out to meet us. I’d seen a picture of him that my former boss kept sending me, and I’d spent six hours online trying to find a Celtic name that would fit him and go with Lilith’s name. She’s black, and one meaing of hers is “queen of darkness.” He’s a big yellow/white lab/Pyrenees mix. His name means “bringer of the dawn.”

Lilith came into my life at a crisis point and in many ways saved it. Lucan, too, came at a critical point and in an amazing way.

Four years ago this past March, my sister-in-law, Cheryl, died. She was one of those people who never failed to send a card for holidays, remembered birthdays, and would call just to check on me. I’d been her flower girl when I was around 8.

Cheryl had an actual phobia about dogs. It carried over to things like cats and rabbits, but interestingly, not so much to bears or horses or sharks. Since my family is very much an animal family, especially a dog family, this was always hard for her. My nephews did not grow up with dogs, but they always wanted them. They loved to visit me and my mom since we had a bunch. When they went to college, they of course whined to different girlfriends and came home with at least 4 different dogs. Cheryl always babied her boys. They’re grown, but they’ll admit it. She did not ever get over her fear and was so proud when she got up the nerve to pour water into their bowls through the sliding glass door. But, she made sure that they were cared for when my brother went off with the scouts or on his various adventures. And, she became very understanding of me and my dogs over the years. She became more understanding even when she saw how Lilith helped me and how Willie helped my nephew, Travis. But, the fear remained.

In the last few weeks of her life, she and her nurse went shopping. She had to get me a Valentine’s Day card, and she wanted it to have a dog on it. They found a cute card with a little yellow lab type puppy on the front of it. It was the last thing she ever gave me, and the last coherent conversation I had with her was about that card. She told me how she picked it out and how she made sure to find one with a dog, just for me.

When she died, weird as it sounds, one of my first thoughts was that now she wasn’t afraid of dogs anymore. And, for some reason, that thought comforted me greatly.

Strange thing is, around the time she was picking out that card is when Lucan must have been born. He was just a stray in the country who my boss took in when he was about 8 months old or so. He couldn’t keep him, and after he kept sending me pics of him and telling me when he was taking him to the pound, I decided I had to get him.

And then I realized that the puppy who looked a lot like the one on that Valentine card came home the day after Cheryl’s first birthday not afraid of dogs.

Even in the Bible, there are instances where animals served as messengers. I often look at my two dogs, knowing how and when they entered my life, and stare just a bit harder to see if there aren’t some wings beneath that muddy fur. If I’ve entertained “angels unaware” it would not surprise me to learn that they came in a canine form…..

Happy Anniversary, Lucan.

Kiss of Ice and Fire

•February 12, 2012 • 1 Comment

I had given up hope of seeing your face until the wheel turned yet again, oh goddess. I awoke today to a different world, and you had painted it with your palette. I walked into the day, guardians of Light and Dark at either side, forever companions. I felt your icy tears fall upon my cheeks, a mother’s kiss. You wrapped me in your soft arms, and I entered that luminous space where you exist. Cold. Silent. Brilliant. Crystalline. Each tear was a unique blessing, different than the others. In that silent walk, I heard my own heart and the whisper of your strength. I felt my heart both calm and surge at the same time, knowing that you had gifted me with the ability to see between the worlds for a moment.

Others trudge through the wintery mess, seeing it not quite snow and not quite rain. A muddy mess. The need to bundle up. But, they miss that sense of beauty, the contrast that even the simplest things bring. That contrast between the icy droplets on the face, that slight pinging sound, and the feeling of being wrapped in layers of loving warmth and moving through a quiet day. How can they not see what I see? How do they not know what I know?

I suppose it is because their mother is not the queen who resides in the northern reaches. They don’t wait for her to visit, longing and yearning for her touch, for her blessing. They were not given life by the cold wind and the amazing silence where one can hear her own thoughts. Not the nagging thoughts that paralyze daily life. The thoughts that speak of deeper truths, of the fire that burns in the hearth of the heart.

To me, it is essential that I walk amidst the dancing dreams of the goddess, that float as if without gravity, gracing the cheek, glittering on the fur of the black one walking by my side.

It is in that space with no gravity, where sound moves in different ways, where warmth and icy cold meet that I feel alive. It is what carries me through days when it is too hot to breath. It is actually what ignites the fires within. I hear her whisper of who I truly am. I am reminded that I am but a visitor here. I am not the broken down shadow of a person that I often feel I am. I am reminded that I inherit the strength of my mother, the winter, the goddess. She is soft, but when she needs to be, she is unyielding. Her strength comes in silence, but she is capable of breaking the largest trees and changing the landscape in a day. She can drift in the wind or build herself into something solid. Creative potential. She is there for a moment, only a breath. It’s true especially here, where the heat can be so brutal. But, she comes into my life for those moments, reminding me that I, too, am fey. I am not of this world. I am a warrior, goddess, priestess, maiden, vestal virgin, the Morgaine, the woman who waits for a love that is worthy of her strength and her softness and her intuition and her knowledge of the “other.”

And, so today, I thank you, Mother, for reminding me who I am. Thank you for my guides and guardians, those creatures of Light and Dark, who walk beside me not just on their leashes out in public, but through every day. They watch over me. My boy will always be by my side. He is my heart. My girl, well, she knows me, understands my love of a visit from this winter goddess. She is my soul. Angels, but not unawares. I know who they are. I can, after all, see between the worlds on rare occasions.

I will go forward, with the memory of a gentle kiss of icy tears on my cheeks, Softness and strength. An ice to ignite my fire.