a busy past few days

A busy past few days

I have a busy week with a lot of appointments. I had two today, back to back. Tomorrow I see my pcp to discuss my cardiac markers and a BP med. I am hoping she listens to me and puts me back on labetalol rather than another med. But if she isn’t open to it, then I will go on what she suggests.

I saw my TG doc today. She had a fellow interview me first. Things went well. The fellow tried to get me a 5mL vial of T but the pharmacy just filled a 1mL vial. I have enough T to last me the next few injections. She also referred me to plastic surgery so I could get a top surgery consult started. I am glad because my pcp never responded to my request from last week. The fellow also answered my concern about whether T had caused the dislocation in my shoulder. It didn’t. I am glad. She did say that because I had removal of my ovaries, I have to be concerned about my bone health. But I am still young enough that I don’t have to go for a bone scan. The only bone scan I want to do is on my shin to see if the CRPS has spread to it. I have been having severe pain for no reason and it is worrying me.

After my TG appointment, I had the chronic pain group, which had already started. I was about fifteen minutes late but they accepted me anyways. We had a good chat about families not getting our disabilities and I told them how rough it was living with my sister who triggers my PTSD often. I also came out to them as transgender and they didn’t seem to care, which I was glad about. We also talked about how our families don’t believe our pain and disability. It was a good group. I did talk about how my therapy session went and got support around it. There maybe future discussions about CBT.

I had therapy yesterday and we talked about my ED visit went. I told her I was freaking out over my lab results, thinking I was having a heart attack. Tomorrow when I see my pcp I am going to discuss what the lab values mean as having this marker in the blood indicates some kind of cardiac injury. I also asked my therapist if we could role play a bit about me asking for the blood pressure medication that I want so that I don’t get turned down. I didn’t want to come off as obstinate but I really think this med will be better as I have been on it before and had little to no side effects from it. We talked for more than a few minutes about it and I wrote down how to approach my pcp on this issue. I just hope I remember.

We then talked about how I feel we are divided and not on the same page about things. That is when she said to me “take the reins”. I was like what? She repeated what she said, adding that I was in charge. I was flustered. I couldn’t believe what she had said so I got my journal that has the notes to the bCBT book and shared with her what a structured session looks like. It had listed “agenda” and then went on to list other things. I asked the author of the book what is meant by this and he gave me a more descriptive outline of what the session looks like. I think there should have been an “:” to indicate this. So I went to my blog for the crisis response plan (Suicide Crisis Response Plan – midnightdemons7). This needs to be reviewed. In it, it said that if I get specific I should contact my therapist or psychiatrist. I should ask them if this is right or if I should just go to the psych ED. My therapist might not be available but I will bring it up with her when I meet with her next as that is when we will start with the new sessions I guess. She agreed to allow a new skill to be introduced and to practice it while in session. I think this is going to work out now as this seems more collaborative than what it was in the past where I spent the time just talking or not talking during session. I asked her if she was more DBT oriented or CBT. She said she was CBT so that will help a lot during the next few weeks. I am glad this is happening because I really felt like we were going on different directions. It just seemed like we would talk about stuff and then she would ask what is helpful but never follow up on what was helpful during the week or if I had practiced or done what was helpful. Mostly that meant me reading this manual for discussion. I felt like I was alone in reading it but it not going anywhere. I also felt like it was pointless to read if I couldn’t share what I was reading.

I have a busy week. Tomorrow I see my pcp and that is going to take a lot of energy. I wanted to get my hair trimmed but my barber had a death in the family. I contacted him today and he said his sister died. Her breast cancer had come back and it wasn’t a good prognosis. I am surprised she last this long. It was more than a year since she was diagnosed with this. I set up an appointment with him for Sat. Fri I plan on making his favorite dish, chili cornbread. I just have to get the ingredients. I will Thurs after my session with my psychiatrist. I will also ask him if I can contact him in an emergency as we have never discuss this before. There wasn’t really a need to as I really haven’t been in crisis since he became my psychopharmacologist.

By Sunday, I am just going to rest as I will need it. I don’t know when I will be able to read. I got hit with a flare up and couldn’t finish this blog yesterday. The flare was so bad that the bones in my foot and leg were aching very deeply and intensely. The pain in my leg is higher than it was and I fear that the CRPS is spreading. I want to contact my neuro and see if I can get a bone scan to see if it is CRPS or something else. I don’t think an X-ray will show anything as It only hurts when my ankle or foot is flared up and when I am resting on my bed. It doesn’t hurt when I put weight on it or walk on it. It is a very unusual type of pain when it comes on. I am feeling better because I got some sleep. I woke up around 0030 and had something to eat as I was hungry. I had honey nut cheerios. I emptied my bladder because it had been more than five hours since I last emptied it. I probably will have to go again as I drank the milk in the cereal and had some water afterwards. It’s 0130 now and I am not so tired. I might read the book for a bit until I am tired and can get back to sleep. My pain has finally settled down.

About Magnesium

I finally found the article about magnesium for those that are interested in reading it. I do not take credit for writing it.

About magnesium

Archived columns by Leo Galland M.D., F.A.C.N.

Magnesium is the fourth most abundant mineral in your body, a necessary co-factor for hundreds of enzymes, and the most critical mineral of all for coping with stress. Stress-related diseases, which run rampant through modern society, like heart attacks and high blood pressure, are often accompanied by magnesium deficiency. Unfortunately, most Americans consume diets that fail to meet the government’s RDA for magnesium, and magnesium intake is even lower than average among people who develop heart disease.
The best food sources of magnesium are vegetables like buckwheat (kasha), mature lima beans, navy beans, kidney beans, green beans, soy beans (including tofu), black-eyed peas, broccoli, spinach, Swiss chard, oats, whole barley, millet, bananas, blackberries, dates, dried figs, mangoes, watermelon, almonds, Brazil nuts, cashews, hazel nuts, shrimp, and tuna.
When you are chronically stressed, you can become magnesium deficient even if you eat these foods regularly. The complex relationship between magnesium and stress explains why many of the patients I see require magnesium supplements, because even a nutritious diet does not correct their magnesium deficiency.
If you are like most people, when you are exposed to the stress of continuous loud noise, for example, you become irritable, easily fatigued and lose concentration. Your blood pressure may increase as the level of adrenalin, a stress hormone, in-creases in your blood. Under conditions of mental or physical stress, magnesium is released from your blood cells and goes into the blood plasma, from where it is excreted into the urine. Chronic stress depletes your body of magnesium. The more stressed you are, the greater the loss of magnesium. The lower your magnesium level to begin with, the more reactive to stress you become and the higher your level of adrenalin in stressful situations. Higher adrenalin causes greater loss of magnesium from cells. Administering magnesium as a nutritional supplement breaks this vicious cycle by raising blood magnesium levels and buffering the response to stress, building your resistance.
Personality has a marked effect on the stress-magnesium cycle. A study done in Paris found that stress-induced depletion of magnesium was much greater for people who show the “Type A”, competitive, heart-disease prone behavior pattern than for their less competitive colleagues. Dr. Bella Altura, a physiologist at the State University of New York, has proposed that depletion of magnesium among Type A individuals is the main reason why Type A individuals are at increased risk of heart attacks.
It appears that the body’s magnesium economy is an integral part of the stress response system. When stressed for any reason, the body’s hormonal response causes an outpouring of magnesium from cells into plasma. This outpouring is a bit like taking magnesium by injection, except the source is internal. The effect of the sudden increase in magnesium is both energizing and calming. Magnesium is needed to burn sugar for energy; it also calms the excitation of cells produced by the stress-induced release of calcium. If there is insufficient dietary magnesium, or if there is insufficient rest in between episodes of stress, the body’s magnesium stores are slowly depleted. The hormonal response to stress disintegrates. The plasma magnesium does not elevate in response to stress, as it should, so that the energizing/calming effect of magnesium is not present to counter the nerve-jangling effects of adrenalin and other stress hormones. Consequently, the disorganizing effects of stress are intensified and coping is impaired. Higher blood pressure, abnormalities of your heartbeat and an increased risk of heart attacks or of angina (cardiac pain) may be one result.
Laboratory tests for magnesium are often misleading in evaluating your need for magnesium, because blood magnesium levels fluctuate, depending upon where you are in the cycle of stress responses and magnesium depletion. Your symptoms are a better guide. Muscle tension, spasm and twitching are the most characteristic symptoms of magnesium depletion, followed by palpitation and breathlessness. Irritability, fatigue, trouble falling asleep and hypersensitivity to loud noises are also common. The presence of migraine or tension headache, unexplained chest pain, strange sensations of the skin (like insects crawling) and abdominal pain or constipation are further indications of magnesium deficiency. If you are suffer from any of these symptoms, or if you are being treated for heart disease or high blood pressure, you may need a magnesium supplement.
The best dietary supplements are the acid salts of magnesium like magnesium chloride, citrate, gluconate or glycinate. The dose needed varies from one hundred milligrams to about five hundred milligrams per day of elemental magnesium. Too much magnesium can cause diarrhea. Magnesium taken by mouth is very safe, except in people who suffer from kidney disease or are severely dehydrated. These people may develop levels of magnesium in blood that are too high; they should only take magnesium supplements under strict medical supervision. Just as magnesium taken at bedtime can induce sleep, so high blood levels of magnesium may cause drowsiness and lethargy.
Much has been written about the need to balance the calcium/magnesium ratio when taking supplements. This notion is based upon the known interactions between magnesium and calcium in cells. Calcium freely dissolved in the fluid of each cell has a stimulating effect that leads to rapid contraction of muscle cells and excitation of nerve cells. These cellular effects of calcium result in muscle spasm, poor circulation, and rapid heart beat. Magnesium in the cells of your body is nature’s calcium blocker and many of its protective benefits result from blocking these undesirable effects of calcium, reducing high blood pressure and stopping palpitations. No dietary formula can balance calcium and magnesium in the cells, however. Only your body can do it. Your job is to give your body enough magnesium and enough calcium so it can get the job done right.
People who take magnesium supplements do not automatically require extra calcium. In France, where therapy with magnesium pills has been widespread for thirty years, calcium is rarely given in conjunction with magnesium. There is also no evidence that magnesium and calcium interfere with each other’s absorption. Calcium and magnesium are absorbed into the body by distinct and separate mechanisms. Similarly, people who benefit from calcium supplements do not always have to take extra magnesium, although many women who are taking calcium for preventing osteoporosis may well need magnesium in addition. There is a growing body of evidence that magnesium in the diet is as important for prevention of osteoporosis as is calcium.

sense of sensing–proprioception

Proprioception

Proprioception (  /ˌprpri.ɵˈsɛpʃən/ pro-pree-osep-shən), from Latin proprius, meaning “one’s own”, “individual” and perception, is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement.[1] It is distinguished from exteroception, by which one perceives the outside world, and interoception, by which one perceives pain, hunger, etc., and the movement of internal organs. (wkipedia 9-27-12)

We take this for granted until you get hit with Cauda Equina Syndrome.  Cauda equina syndrome is a particularly serious type of nerve root problem that can be caused by a prolapsed disc. This is a rare disorder where the nerves at the very bottom of the spinal cord are pressed on. This syndrome can cause low back pain plus: problems with bowel and bladder function (usually unable to pass urine), numbness in the saddle area (around the anus), and weakness in one or both legs. This syndrome needs urgent treatment to preserve the nerves to the bladder and bowel from becoming permanently damaged. I took a bad fall a few months ago and could not figure out for the life of me why I fell. I was trying to enter a cab and missed it by a foot. I just suddenly dropped with no awareness as to what the hell happened. I almost took another header the other day and realized I was tired and my proprioception was off. Usually I know where my feet are. When I lost this function back in 2001, I always made a mental note of all times of where my feet were so I wouldn’t trip over them. This vanishes when you become fatigued, mentally and physically. Then your feet can cause you trouble. I realized this painfully when I fell and nearly broke my arm and sprained my good ankle, again, when I fell a few months ago. I am sure that most people are saying what the hell is it I am talking about and it is complicated to explain. How can I not know where my feet are? It is because the nerves that tell me where they are has been damaged so I no longer have the sense of where they are. A couple of years ago, while exiting work in the garage, my car would stop and I had no idea what was wrong as I was hitting the “gas”. I looked down and found that my foot was really on the brake. Thank goodness or I would have been speeding around in the garage and god knows what kind of trouble I would have gone into. The few times this has happened was again due to fatigue and less awareness, a type of mindfulness, if I dare use the word, that has dissipated as I become tired.

To lose this ability is frightening. Not knowing where your feet are is a dangerous thing. I thought that after 10+ years I had developed the sense back but my fall can tell you I have compensated for it pretty well, that is until I become fatigued. Lately I have been more fatigued but thankfully I have not had any falls or trips. Sometimes if my leg is really tired, it will drag. I just cannot bring it up to where it should be while I walk. The AFO (ankle foot orthotic) has made things easier for me to get around but it still doesn’t help with the swelling and pain that I experience every day. Today I went to my monthly pain management appt with my primary doc. I asked him what I can do about the swelling other than elevating and icing like I have been doing. He says to wear a light compression stocking to see if that helps. Problem is that they are like $40 a pair and when you have a limited budget, it is difficult to spare that kind of cash. He also just advised to keep doing what I have been doing but to try and lose weight. I was like are you fucking kidding me? I can barely walk most days and you want me to keep moving? I love to walk but I get so damn tired that it is hard to do and with my ankle swelling up on me, I don’t think I can walk more than a few blocks without pain. I have tried. I hurt and then trying to get the pain under control just about kills me afterwards. It takes me at least twenty-four hours to recover and I hate spending time in bed doing nothing but keeping my foot elevated. I am glad I bought this trapezoid sized foam elevator thingy to raise my legs to where they should be. I can get very comfortable in bed now except I cannot sleep on my back. I am a side sleeper so the elevator ends up kicked to the floor or the foot of my bed most nights.

So I had planned on going on a diet anyways. A slimfast diet. Except I can’t keep my appetite controlled. I want to eat food not liquid. So I have tried eating smaller portions. Fail. Tomorrow a friend is taking me out for dinner to a restaurant. Now I need to watch the fatty foods and salt that goes into it. I really just want to lose the weight without having to think about it but that is wishful thinking. I have always been heavy. Started in gaining weight in 3rd grade and then when I got on psych meds, I just ballooned out because the side effects of the meds make you hungry. I find that the nerve pain med I take, neurontin, will triple fold my appetite. The hungry horrors come out the next day and all I do is eat. So I limit my nerve pain med to when the pain is so bad I cannot sleep, which is usually when I take it. So far my nerve pain has not been so bad. But then I have not been standing too long on my feet for some time now. Usually if I have a day of standing too long my feet will burn and have shock pains.

Spoon Theory Explained

I had someone in my support group share  Christine Miserandino’s story of her “Spoon Theory”(http://www.butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/) and I have then passed on this theory to my countless friends and support groups to pass on the message, “but you don’t look sick”. I have shared this with my therapist and for the past three years, she has given me a starbucks mug filled with spoons because she knows there are days that I do not have enough.

The story that Christine portrays is simple. Every time you do a task that a healthy person that does not suffer from chronic pain or major illness, such as arthritis or mental illness, such as depression, a spoon is taken away. You are given 10 spoons I believe. So taking a shower, lose a spoon, getting dressed, lose a spoon, etc until by the time you have done your daily living activities, you should have a spoon or two left, sometimes not if you are in pain.  For me, just waking up requires a spoon. I wake up most mornings and the first thought I have is to kill myself. The next thing I do is I have to stand and then go down the stairs to the bathroom. These days this would require 2 spoons as just standing causes me pain. I often have no choice but to bear it and go down the flight of stairs to the bathroom to do my bodily functional duties. So this requires another spoon. Going back up the stairs to my room requires another spoon. So before I have even brushed my teeth, made breakfast, or showered/dressed for the day, I have used three spoons. I think you know where this is going. By the time I have my sneakers on and am ready to leave the house, I barely have any spoons left and you cannot borrow anymore for the day.

My days are mostly grin and bare it. I am currently out of work so that takes the trouble out of getting dressed out most days I do not leave the house unless I am really in the mood for a coffee at my Starbucks.  But even on the days I am just lying in the house I am bored and like I have said, even before I get back to my room after going to the bathroom, I am already 3 spoons down for the day.  Getting dressed and deciding what to wear takes extra effort. What normally took me 10 mins now takes me 20 mins to do. Twenty minutes to decide what to wear when looking at a pile of clothes. All I need to do is pick one pair of shorts or jeans and put them on but that decision is agonizing.  After choosing which one I will wear, I then struggle to put them on. I think that is the reason why it is so difficult to decide because some jeans are easier than others to put on and others you just have to struggle with but when you have a foot that doesn’t have normal range of motion, you are often balancing on your good foot for a while struggling to place the bad foot into the damn pant leg. While this might be seen as funny it is not. The potential for a fall is great and that would not be funny. I am glad I only have two pairs of sneakers to wear, those for my brace and those without.  The pair without I sometimes have to give my ankle a rest as the brace irritates me and walking consecutive days can lead to ulcers or other irritations on my already numb sore ankle.

So now I am dressed and all I want to do is go back to bed but I want my coffee so it’s off to the bus stop. I make sure I have my phone, headphones, watch, journal, pen, and keys which makes up another spoon for remembering all this because if I forget, it is multiple trips up and downstairs until I have these four items.  Walking to the bus stop is another spoon. Waiting doesn’t really count as I can usually sit and wait as there is a bench there or stairs on the neighboring house I can sit at. Provided the bus isn’t late, the latest I am waiting is twenty minutes as I usually get there early to make sure I don’t miss the bus should it leave early or be on time.  I’m usually listening to my music, what ever I am in the mood to listen to which is usually country, unless I need something a little bit with an edge, then it is rock.

When I arrive at my destination, another spoon is taken as I need to walk to my coffee house. By this time I am really tired and need a nap but you have coffee to wake you up so I go. If I am really restless, I go back to the bus stop to go home. I might go to CVS to get something like powerade or something to eat. If I’m not restless, I will stay while I drink my coffee and write in my journal or write something about how my day is going so far. If it has been more than a few days I try to give a recap of my activities so that I know what transpired.

By the time I am on my way back to the bus stop, my ankle is usually really hurting by now. If I have a pain pill I usually take it but most often I forget to bring it with me and have to wait till I get home to take it. Another spoon. Then it’s the walk home and by the time I reach my door, I am beyond tired and need a nap and meds. Yet I haven’t done anything except get a cup of coffee. This is what I go through on a daily basis. This is what my life has come down to, to use my energy to get a cup of coffee or stay home and do nothing but play my facebook games and maybe write something in my journal. I keep two. I don’t know why I do. One stays in my room and the other travels with me to the places I go. I used to write all the time but now my writing is limited by how much energy I can put into it. And by the time I am back up in my room, I think I am in the minus category of spoons…