Medical Service Appointment

The worst part is over now that the appointment with the medical service is behind me. It went by no means great, but at least I did not cry afterwards like last time.

The physician took a little more time to ask questions, about 15 minutes, which was the one positive aspect of the appointment. On the negative side weighs in that she tried putting phrases in my mouth that I didn’t mean to say, kept interrupting me, and generally had a brash demeanour.

I wasn’t feeling my best to begin with: slept badly the night before because of anxiety about the appointment; kept confusing words; couldn’t remember which dosage of escitalopram I take, etc. And the doctor’s behaviour made everything even worse.

For example, I had tried to explain why I had not gone back to psychotherapy – that I want(ed) to, but for reasons already discussed on this blog haven’t. She tried to twist it into me saying that because I’d had such a positive experience with my first therapy, I was resisting seeing someone else now and idealising the first treatment. Absolutely not true. If health insurance wouldn’t limit the number of sessions I could have, I’d be way more willing to try things out. And even if, ultimately it was my psychiatrist who suggested to wait with that – and she knows me a helluva lot better than someone who judges me based on a 15-minute-meeting.

The doctor also had never heard of CBASP and when I said that the general consensus is that chronic depression is largely treatment-resistant with standard behavioural therapy, she called bullshit. Whatever, I don’t really care. It’s what the scientific papers say, not my personal opinion. Not trying to convert anyone, least of all her.

Also, she said I was “talking in diagnoses”, not how I felt. Well, last time I tried that with her colleague, he wouldn’t even let me finish. Also, it’s really hard for me to open up to strangers about such personal stuff. There’s a reason why my therapy sessions worked out so well, and that is that he took the time to make me comfortable. I realise the medical service was never meant for that kind of in-depth, trust-gaining discussion, but I had told her half a minute earlier that I suffered from social anxiety, and how at uni I would devote 75% of my energy to not freaking out and 25% to following lectures. It’s kind of a low blow to hold “talking diagnoses” against me after I just divulged that strangers freak me out.

Seven hours since I got out of there, and the knot of anxiety in my stomach only slowly starts dissolving.

Misfortunes Never Come Singly

Over the past few days, I’ve had to deal with a number of frustrations and disappointments.

The aquafit class got cancelled after local authorities closed the pool and adjoining gym. Apparently there’s fault with the ventilation system, and fixing it will be so extensive that it won’t re-open before summer 2017. A number of schools and seven different sports clubs have now suddenly lost their training locations.
As for the group I was part of, any vacancies at aquafit classes held at different pools are first going to those who joined as part of their physical rehab. Anything that’s still available afterwards will be offered to the “prevention group”, or you can simply get your money back.
Financially it’s no loss, but I was so happy with everything concerning this: the group, the instructor, the time slot, the uncomplicated drive… On Friday I’ll find out if I can at least finish the last four weeks before the summer break.

Then, we are having jobcenter problems. My husband has a fixed salary per hour, but there are additional boni for night shift, Saturday or Sunday work. So he never gets paid the same and the difference can be several hundred euros in extreme cases.
As I mentioned before, welfare is slowly phasing out; we are still approved until the end of September and only get substituted right now to make up the difference between the threshold-income and his actual income. We have to hand in a copy of his payslip every month to prove how much he made.
Well, the first month, when my husband’s actual income after taxes was still lower than what we got from the jobcenter, they paid us too little and the missing rest came three weeks later. The second and third month, they paid us too much (way too much this month) – which wouldn’t be such a big problem if we wouldn’t get into trouble for that down the road. We basically have money sitting in the bank that isn’t ours, that we can’t touch because they might ask it back at any given time, and all attempts to contact them have been fruitless so far. They don’t react to emails, phone calls end in the holding line…

On top of all of this, the jobcenter ordered me in Friday morning to discuss my medical report. It makes me nervous as hell, because I don’t know the result and what they want to do with me. Worst case scenario, we would have the means to terminate welfare support on the spot. Last month we were just 60€ below the threshold and this month we’ll be over it, so the jobcenter would have (or should, at least) stopped giving us money anyway – we only wanted to stay until September because we could have used the “mobile pass” still, which gives you percentages off public transport fares, and as a security net until my husband’s probational period at the new job ends at the beginning of September. Last but not least, terminating now would be a nightmare of bureaucracy, whereas just waiting until it runs out does not require anything other than NOT requesting a renewal.

Logically, I am aware that no matter what they are going to say on Friday, they can’t do anything to me. I could just walk out saying “So long, suckers!” if shit hit the fan. But being the unconfrontational person that I am, it already stresses me out.

To Sum Up My Diet…

https://www.tumblr.com/upandoutcomic/144671044321/im-hopeless-when-it-comes-to-those-badboy-carbs

http://upandoutcomic.tumblr.com/post/144671044321/im-hopeless-when-it-comes-to-those-badboy-carbs

One Pound At A Time

As I am typing these lines, I am 100 g or 3.5 oz away from reaching the weight that has been my target for the past 15 years. When I do – and since the aquafitness class starts this week, I have no doubt that I will – it means that I have successfully lost all of my excess university weight. It’s been my goal for such a long time that I don’t even know what the next one should be. Most likely, I’ll just try to lose another 5 kg / 11 lbs and take it from there – but I am also aware that muscles are heavier than fat, so my short-term goal is losing visible belly fat rather than a certain number on the scale.

There’s a certain genetic predisposition for weight gain coming from my maternal family’s side. Even on the oldest family pictures we own, that pre-date the First World War, my ancestors appear stocky and rotund. The only difference between them and me is that I am quite a bit taller than they were.

I was born a chubby baby, and never lost that appearance. Robust build, strong muscles; not fast, but good stamina; extracting every last calorie from a meal. Genetically designed for foraging or farm work. But unlike during prehistory (and most of history), I don’t have to actually find or grow my own food. There are no famines anymore in my part of the world where those “genetic gifts” would have made the difference between life and death.

Without the thyroid problems, I still would have been overweight. No illusions about that. They pushed me firmly into obesity territory, though, and ever since I have been struggling to leave it. Every ounce lost is the result of great effort, as if my body was desperately trying to hold on to the weight.

My husband, who easily eats twice as much as I do, has a different kind of metabolism. He used to be skinny, and even though he isn’t anymore, all it takes for him to lose some pounds is to exercise more. Within two weeks of starting his new job (where he’s on his feet all the time) he began looking visibly slimmer. If he put his mind to it, in a few short weeks he’d probably lose the 8 kg it took me over a year to get rid of.

I’m really hoping that the exercise will make the difference. My eating habits are pretty good – not perfect, but I very rarely exceed my calorie limit. Anything excessive makes me sick quite quickly anyway – fast food or junk food usually results in digestive problems. The only time when I can’t seem to go without it is when PMSing…

My ambition is not to become thin; that would be unrealistic. I never was, never will be. Sometimes, I wonder what that would be like. Would I carry myself differently? Would it influence my behaviour? Because being large has certainly left its mark on my psyche – I had my fair share of ridicule from strangers, and criticism from relatives. I never forget that I am fat, not even when alone. I wonder whether there is a certain point where I would?

The Year Wasted On Venlafaxine

The venlafaxine debacle certainly deserves more attention than just the few lines I’ve allotted to it so far.

The first few days have been chronicled by this blog, but fact is that the side-effects never got significantly better. Nausea, headaches, muscle pain, and paraesthesia became my steady companions. Very often, it made me so sick that I had to lie down two or three times during the day. At every appointment I told the psychiatrist about it: he would either dismiss my complaints as “I’ve never heard about anyone having this problem with venlafaxine before”, or claim that those were not side-effects, but withdrawal symptoms because my dosage was still too low to last all day.

About fifteen months down the road, he finally cranked the dosage up – and that is where the heart problems started. Actually, I was in the early stages of serotonin syndrome, and it felt like I was on the verge of a heart attack. Before the next appointment was up, I had to lower my dosage again without even consulting him, because I just could not take it anymore. Finally he decided that maybe venlafaxine wasn’t for me and that I should try escitalopram instead.

The idea was that I would reduce venlafaxine over the course of three weeks and then start escitalopram. The withdrawal was so terrible that even though I gave myself six weeks instead, I still became bed-ridden. Other than expected, the most difficult part was not when I first started lowering the dosage, but the second to last step, which made me hallucinate.

Imagine lying in bed, sweating, your heart beating fast. Your head hurts, your teeth hurt, your back, your legs… every single muscle is in pain. Lights are too bright, sounds too loud, everything you eat makes you queasy. Your thoughts race and you cannot do anything to calm them down. And just when you think it cannot possibly get worse, you start hallucinating that the walls of your bedroom, the furniture around you, the ceiling above you are pulsating, bending in and out as if they are breathing.
I knew it was the withdrawal – that it wasn’t real – but that didn’t make it any less unpleasant. I cried like a little child: “I want it to stop! I can’t take it anymore!”

I do not want to badmouth venlafaxine, since there are many people who take it with few or no problems. I wasn’t one of them. By now, I am aware that I have problems with every drug that influences the noradrenaline (norepinephrine) cycle; that I am genetically predisposed to react that heavily to them.

However, I harbour resentments against the psychiatrist for letting me go through this for such a long time. He was friendly, but I feel like he did not take me or my complaints seriously – whatever it was, you don’t drag out a treatment that doesn’t help and causes so many problems for a year and a half. And I was too afraid that I wouldn’t get my sick note for the jobcenter if I complained too much, so I didn’t dare protesting too loudly. Even when giving the drug the benefit of the doubt, he should have stopped after six month. Instead, I wasted a whole year of my life on top of that trial period.

Coincidentally, just as I made the transition from venlafaxine to escitalopram, the practice was also taken over by a new psychiatrist. The options were to either stay at the old location and get a new caregiver, or migrate to the new location and stay with the old psychiatrist. I chose the former, and have been very happy since with the lady who took over. She’s friendly, competent, seems to genuinely care about her patients, and I find it easier to talk to her than her predecessor.

Escitalopram is a walk in the park in comparison. It really helps with the anxiety, and also has reduced the depression by 80%. What was left fell into three categories:
– problems falling / staying asleep
– lack of energy
– lack of motivation.

The psychiatrist’s suggestion was to try a second antidepressant as a booster. Initially I was very hesitant to even consider this option, because I did not want to go through an ordeal like the venlafaxine-regimen again. She promised that if it didn’t work, I could stop any time, and so I started with bupropion – which is how we discovered that I cannot take any SNRIs. It basically felt like a toned-down variety of venlafaxine to me. After three weeks I stopped.

The second booster I tried is valdoxan (agomelatine), which comes with zero side-effects. It’s slower to show results than other antidepressants I’ve taken, but after five months and experimenting with the dosage there is a definite positive trend: fewer days with sleeping problems, gradually increasing productivity, more motivation. There’s still room for improvement, but I am feeling better than I have in over a decade.

To Hell And Back Again

After the last post, I fell into a really dark hole. For every problem solved there appeared to arise two new ones, and between a lack of energy (which was bordering on apathy) and near-despair, I had some really horrible weeks. None of the bills due June had yet been paid, and I’d really had more than enough of those troubles over the last months: we got threatened with having the gas / electricity switched off twice and had to borrow money from a friend to pay those bills. I had my bank account terminated because I accidentally went over the credit limit and (thanks to being preoccupied with the side-effects of venlafaxine) didn’t notice immediately, so I ended up being blacklisted as a “financial offender” for the next three years – it will be as good as impossible to get any kind of loan, and I had to go begging at the bank to be granted another bank account, and on top of everything else I will have to pay off almost 1250.- Euros for the old account and in penalty fees. I tried explaining my situation on the phone, but first I had to wait three weeks for a call-back since the people holding the decision power were always busy, and when they finally did get back at me, the lady berated me for it “being all my fault”.
We just about managed to pay for my husband’s German classes and get some food on the table, even though the latter was perilously close to uncertainty at two times at least. There was one day when we had all but € 9.- between the two of us, and all that was left to eat was a bit of frozen vegetables, half a jar of jam, pasta and potatoes. No bread, fruit, rice, cheese, meat, fish, butter, milk or soy drink or whatever we usually eat. Our options were plain potatoes or plain pasta, with a bit of spinach or peas. Nothing you’d traditionally serve for breakfast – and having just asked a friend to help us out with money so we wouldn’t have the gas / electricity cut off, I didn’t want to go begging again. My mother-in-law unwittingly saved us from this by sending some money, and my friend scolded me for not telling her earlier when I related the story to her… All I can say is that there’s a difference between having to ask for help once, because you got into a tight spot, and having to do it again and again, week after week or month after month. It wears you out mentally.
I believe my husband became more worried about me and my state of mind than about the money, because even though I was not entertaining thoughts of suicide, he made me promise I wouldn’t do anything to myself. Nevertheless, even getting dressed became an almost insurmountable obstacle, and I oscillated between apathy and fits of crying. I felt like I had nothing left in me: no energy, no fight, no will. And even though I had successfully fought off the denial of the application in April, nothing appeared to move forward in that regard ever since – until the beginning of June.

The money came in about three weeks ago, and despite the fact that we didn’t get approved for March (when I was still officially a university student and not available for welfare), we got monthly allowances retroactively from April 1st on. We could pay our bills, and get rid of the debts with the health insurance and the energy provider. I made a payment plan with the collection agency to pay off my old bank account in rates, paid off my sister since she had covered the contents insurance of our worldly possessions earlier this year, and gave two months’ worth of rent to my mother, as a thank you for supporting us when my parents were on a budget themselves.
Having this existential problem lifted off our shoulders has done more for my mental health than any other measure taken during the last months. For the first time in years, I go to bed without being afraid of what the next day is going to bring: even though I still get a fright when one of those “official-looking” letters comes in, I can immediately remind myself that we have the money to take care of whatever is heading our way.
The German welfare system is far from perfect and much criticized, but compared to our situation during the last year – and especially the last couple of months – we are doing peachy right now. Of course, we are not eating steak and lobster, but I can buy everything we need and some more, whereas before I would have to prioritize and calculate whether I had enough money to buy some yoghurt, for example, or whether it had to wait until the next time since it was not strictly necessary.
There was one day when I went to the neighbouring town for shopping, since the local supermarket had some offers which justified spending money on a tram ticket as we would still save compared to buying the same products in our hometown – and I made a mistake when calculating the expense. It was just a minor figure I was off, about 50 cents, but I ended up those 50 cents short for buying the tram ticket back home. I did not dare taking the tram without a valid ticket because of the € 60.- fine if I got caught, so I had no choice but walking home. It was a relatively warm day and I was dragging / carrying about 30 kg (roughly 65 pounds) of bottles and groceries in my shopping trolley and two bags. I had called my husband to meet me halfway, but by the time we got home, I was completely exhausted.
That is only one story out of many about how destitute we were. I walked around in jeans ripped from wear and tear for over a month, because I could not find a pair cheap enough in my size. When I finally found one, it had a bad, unflattering cut and I didn’t like the colour, but at least the prize was very low and the fabric not torn, so I bought it anyway. After just a few short weeks, the pull tab of the zipper broke – cheap material, I guess – so I had to put a safety-pin through the eye of the slider for using the zipper: the result was that every time I went to the toilet or got (un-)dressed, the safety-pin popped open and stung me in the finger. At that point, I made such a pitiful figure that my mother and sister gave me a part of my birthday present, two pairs of jeans, about ten days early.

Maybe that gives a little insight into why I have not been blogging. At some point, I just got too exhausted – all my mental energy went into making sure we would get on state support. And I wanted to escape from the daily struggles, not reflect on them.

At War With The Job Centre

Dear Mrs […],

hereby I lodge an objection to your refusal of my application for welfare.

On Tuesday, April 2nd, 2013 at 3.51 PM, I received a phone call by a job center staff member (phone number: […]), informing me that the appointment for Friday, April 5th, at 9 AM, had to be cancelled because you had become sick. When I asked when my alternative appointment would be, he informed me that you would get in contact as soon as you recovered and returned to your work place. This did not happen.
My husband, Mr Layara, and I had two appointments at 8 respectively 8.30 AM for that very same Friday with the employment agency in the same building, which we attended; there was absolutely no reason we would have missed the appointment at 9 AM with you had we been informed that it was on again. During the entire time, you could have reached me via mobile phone and mail.

The incoming phone call from April 2nd, 2013, is being archived in my mobile phone for the duration of one month and can thus be proven.

Kind regards,
Layara

On Tuesday I got a letter from the job centre, informing me that I had missed my appointment, when it clearly had been cancelled, and as a result – because I neglected my cooperation duties despite having been lectured about the legal consequences, and because I “refused cooperation” and made it “excessively difficult” (WTF?) to come to a resolution of the case – my application for welfare would be refused. I would have one month to hand in written protest.
Since the job centre is closed to the public on Wednesdays, I went there this morning and left the letter which I have translated above; trying to call the lady in question remained fruitless as she didn’t pick up the phone either on Tuesday or Wednesday.

After receiving the letter, I got initially so mad that I wanted to punch someone in the face. I had not done anything wrong, but merely acted according to what I had been told by representatives of the job centre, and yet I was the one who had the hassle of proving my innocence even though the error was clearly on the side of the staff – due to poor internal communication at best, or simple incompetence on their side. As if I did not struggle enough with fulfilling my daily tasks already…

I’m Going To Quit University

Instead, I will enroll at the only state-maintained German distance teaching extramural university, starting next autumn. The idea was actually proposed to me by my mother and sister, because my sister is considering doing the same, and they thought it might make studying easier for me. I also discussed this with my husband, and slept over it, so while this was a relatively sudden decision, it’s not a rash one.

Arguments in favour of the change:

• You study online and out of books. Apart from the written tests, there are only two weekends during the entire Bachelor’s programme where you have to attend a seminar in person – and one of the study centres where you can do so is easily accessible to me, even without a car. Since I waste about 75 % of my energy in class on fighting off depression and only the remaining 25 % on taking notes or studying, I believe I will actually be able to study more effectively that way. You receive the materials and literature lists via mail, and you send in your homework and term papers online. There also are video streams of lectures and special software programmes for learning. At any time, you can contact qualified docents if you need additional help, and should you need to see someone face to face, you can also visit the study centres.
• It’s cheaper than a regular uni. Money is always a factor for me. And you pay for the classes you take only, not a fixed sum regardless of whether you actually take any classes at all. So, if shit hits the fan and I have to take a sabbatical (which I hope never happens, but we are talking eventualities here) again, I don’t have to pay just for staying enrolled in the programme.
• It’s more time flexible. I can adjust the learning to my personal schedule, because nobody cares whether I study something on Tuesday morning or Thursday afternoon or Sunday night, as long as I send in my homework punctually.
• Academically, it’s worth just as much as a degree from a regular uni.

Arguments against the change:

• I’ll not have a semester ticket for public transportation anymore. But: With the money I’m saving every semester on fees, I can buy a good number of tram tickets if needed…
• It sets me back to square one. But: I only took 6 hours per week last semester, and the next one would have been the same – I might actually be able to take more classes than that and thus eventually make up for “lost” time.
• They have a limited offer of subjects you can study only. And geosciences is not one of them. That is, in the end, the only heavy argument against it, in my opinion – and the reason why I never thought about making this step before. It would mean changing my major again. But: You can study psychology with them, and that is something I would be really interested in.

In the end, I believe the scale tips in favour of going ahead and doing this, because there are also arguments which fall outside of the pro-and-con-scheme listed above. The days of fantasizing about becoming a world-famous archaeologist are long over, and I don’t see myself crawling through the Andes or Alps, looking for rare minerals, either. What I want above everything else is to finally have some kind of degree and become employable; I’ll happily work as a secretary or a boring office job afterwards. The pipe dreams of glory are firmly buried.

And there are some obstacles in my current university course which did not occur to me when I had to make a quick decision in August 2011, and which I pushed into a remote corner of my mind afterwards: field trips abroad. I can’t do them – it would be ok if I got my own private hotel room at the end of the day, but going abroad and sharing a cabin with people who are essentially strangers for two weeks horrifies me to no end. I have worked really hard on my social phobia, but that is a problem I don’t think can be “treated out of my system”. On top of that, you also have to pay for those trips and all the equipment needed for it in addition to the semester fee, which runs up sums of several hundreds of euros every time, and I just cannot afford that.
Finally, seeing how the current semester ends on Sunday, I could actually apply for welfare myself instead of hoping some cryptic system where I take over from my husband works out – I haven’t been able to pay for the next semester yet, so all it needs is a phone call that I won’t be returning and I’m out.

Maybe it makes me look fickle in the eyes of some, but over the course of the last three semesters I realized that most of my problems with uni stem from the system itself, and I genuinely believe that my mental health would profit both from taking a break until October and even more so from getting out of that system. I love learning and writing papers and all of that, and I want to focus on this instead of how to effectively hold back tears in a classroom.

The Status Quo: March 2013

1.) Long dark winter: Germany experiences an average of 160 hours of sunshine in the period defined as the meteorological winter – December, January, February. This year, we stayed well below the statistical mean with only 96 hours of sunshine in those three months, and I certainly felt it. Day after day of dreary grey; snow and rain and drizzle and sleet. I can cope with periods of bad weather, but this winter does not seem to end.
All of a sudden, there was a spring intermezzo last week. The sun came out and we had a few nice days in a row – only to go back to freezing temperatures and snow.

2.) The welfare process still makes no progress: The only thing missing is my therapist’s statement, so I could go back and officially apply. The psychologist couldn’t tell how long it’s going to take; when I asked her, she said, “it’s difficult”. I feel awful for even having to bother him (and her) about this, but unless someone’s going to donate me money to tide over the months until he can work again, what am I supposed to do? I wish I didn’t have to ask for that and could just let him recover…

3.) I still miss having a car: The supermarket closest to home is about ten minutes away by foot, but is too expensive for me to shop there regularly. The one I used to like best and frequented the most is about 30 – 40 minutes away by foot – one trip. So just the physical act of getting there and back takes at least an hour. Not to mention the physical limitations of how much I can carry; a few times I had to call my husband to meet me halfway because I had underestimated the combined weight of all articles. Sometimes I take the shopping trolley, but that is tedious and brings its own problems, like when the tram was so full that I couldn’t enter it with the trolley, leaving me with no choice but to wait for the next tram in the cold.
Last week, I borrowed my sister’s old bike for shopping (I don’t have one of my own anymore since selling it for making some money), but discovered that while I could get to my destination in about half the time, it really did not make much of a difference regarding how much I could bring home. Also, for at least ten years prior to this, I had ridden a bike exclusively when on vacations at the North Sea – in a car-free environment. I got so scared on my way to the supermarket that I rode on the sidewalk for about half the distance… On top of everything else, the bike is actually too small for me, so that I cannot stretch my legs properly, and I found the whole process actually more exhausting than walking the distance.

4.) The insomnia is under control: I still have problems falling asleep, but at least it’s restful slumber once I dozed off. No more waking up every hour.

Help Me, Zopiclone

I did not think it was possible, but the last night was almost worse than the one before. It started promising: Got tired and went to bed at 10.20 PM, read for half an hour and switched the lights off at 10.50 PM. Fifteen minutes later, I was asleep – until 1 AM, when I woke up and was so alert that I could not force myself back into the realm of dreams. Got out of bed for a couple of hours, then back into bed, where I read until 6 AM. Lay awake for another hour and finally dozed off just after 7 AM again.

At least I did not cry this time, but it was even more confusing than simply staying awake. So for tonight, I asked my sister for one of the zopiclone pills she got prescribed for her insomnia last autumn. A definite first, as I never took any kind of hypnotic agent before, but I just cannot go on like this. I have tried everything to rectify my sleeping cycle and it only got worse, and even though I am generally not keen on using pills, I feel like I am going to lose my mind if I don’t get back to normal hours soon.

In other news, I have an appointment with the psychiatrist in four weeks. As the psychotherapy is covered by the fundings of the clinical trial, he has pretty much free reign to do with me whatever he deems fit, because with the exception of the citalopram two years ago, the health insurance did not have to pay for anything yet.
I’m not quite sure how I feel about all of this yet. I would have prefered to see my therapist as the psychiatrist as well, because nobody else knows my mental health history as well as he does, and quite frankly it would save me the hassle of having to get to used to another “stranger”. However, I have hardly any right to complain, and maybe it will even be good for something to keep the two treatment fields separated.