Black Dog Days – I still have depression

It’s been 13 months since my last post. When I realised this, I initially thought “That’s because I’ve been feeling so crap.” That’s just not true though. I have been feeling crap, but not for 13 months. Not as bad as I currently do anyway.  If I’m totally honest, I don’t think my depression and anxiety ever really went away, but life’s been good and I’ve been symptom free.  I don’t think they ever will go away. This sounds like I’ve given up. Given up on ever being well again. I haven’t. I’m just starting to accept that I’ll always have to live with my mental illness.  Sometimes it’ll be well controlled and sometimes it won’t.

My mobility has been affected by my diabetes. Chieroarthropathy, foot pain, shoulder pain and pins and needles in my left hand after a failed carpal tunnel syndrome op. I used to run. I loved to run. I was never fantastic or about to run an ultr-marathon, but it was good for me.  It kept my weight under control. It made me sensitive to insulin. It was time on my own with my thoughts. It was my way of pounding the shit out of things that were stressing me or getting me down. Then there were the endorphins, oh those lovely endorphins. This has been affecting my mood for the last 3 or 4 years.

I found myself in a perfect storm of chronic pain, drugs for my physical symptoms making me feel dopey and thick headed and their interactions with my anti-depressant meds making me sleep for up to 20 hours a day. Something slipped.  I went from I’m ok. I can do this. To thinking I can’t do this anymore. I’m just not physically capable of doing everything I need to do in a day. I became more and more anxious about work. About being dad. About my relationship. About my ‘worsening’ health. About the future. About everything ad infinitum. Enter big black worst case scenarios around every corner.

This was the worst I’ve felt since 2003. I was having chest pain in the car on my way to work. I felt hopeless and started having suicidal thoughts. I’ve been there before and didn’t want to go back. I spoke to my partner about how bad I was feeling and made an appointment for my GP. I should have gone months before.  A quick review of my meds and a reassuringly thorough assessment of my symptoms and I left with new anti-depressants and a referral to the Primary Care Mental Health Team.

It’s been nearly 3 months since I first saw my GP and I’m slowly getting better.  Starting the new meds was tough, as were subsequent increases in dose. I couldn’t face anyone and answering my phone was a no-no. Thankfully I can see recovery coming.

Things that have helped:

  • Getting away. We had booked our holiday before this all came to a head, and it was great to just go away and not think about anything more than what we were having for lunch and where we would go the next day.
  • Anti-depressants. This should probably have been at the top of the list. I know they’re not for everyone but they definitely helped. Initially they made me feel flat. Flat isn’t great, but its way better than anxious, hopeless and crying at the drop of a hat.
  • Walking. I know some folk don’t agree about physical activity helping your mental health but I found it useful. Big walks and little ones. I’ve bagged a couple of Munro’s and a few sub 3,000 feet hills. The little ones have been mostly around where we live and have just been at times that I’ve felt agitated or just needed something to distract me.
  • Pokemon Go. On days when I really didn’t feel capable of doing anything with The Boy Pokemon Go was a lifesaver. Either walking or on our bikes if there were eggs to hatch. It was great to have something we could do together that didn’t need any prep or have any stress attached to it.
  • My bike.
  • Stop, breathe & think. My CPN recommended this fantastic little app to me. It asks you to input how you’re feeling when you open it up and then suggests guided meditations based on how you are at the time. Most of the meditations it has suggested for me are between 5 and 10 minutes. I’ve found it really helpful and a really quick way to calm myself down if I’m starting to feel anxious or agitated.
  • Cheer Up Love by Susan Calman. I bought this on Audiobook and there are some good tips and tricks in it.  It’s also entertaining.  After listening to it, I’ve stopped apologising to my partner when I’m having a meltdown and now thank him instead when he helps me out.
  • Social media (Twitter). Facebook has been unhelpful in equal measure and I’m seriously thinking of divorce. The #GBDOC has been good for sharing as there are a few of us who know that Diabetes and Depression often go hand in hand.Like all social media, it can have it’s moments, but they’re generally a good bunch and if someone has been out of order or inadvertently upset things they generally sort themselves out quickly.

I got a card from the guys at work the other day which said no matter how big the storm gets, the sun always comes out.  I’m glad to say it’s still a bit cloudy, but the storms on it’s way out.

If you are having suicidal thoughts, or thoughts of harming yourself, please speak to your GP or CPN. Tell a friend or relative how you are feeling.

Contact the Samaritans, free from any phone, on 116 123 (UK & ROI)

In Scotland you can contact NHS24 on 111 or Breathing Space on 0800 83 85 87

Return of the absentee blogger (again). Elsie and I, day #548

It’s been ages since I took some time out to write on here.  It’s been a busy year so far, and to be honest its been good, after a shaky start.

I had my left Carpal Tunnel and trigger finger (middle) operated on a few weeks before Christmas 2014 and it was a bit of a disaster.  I ended up back in hospital with infection and had to have washout of my wounds and IV antibiotics, with another two trips to theatre and General Anaesthetics over the Christmas holiday.

I wasn’t a happy Boylie.  On top of all of this, my joints were pretty stiff and sore and I was getting depressed and frustrated with the lack of progress, or any sort of diagnosis. Thankfully my hands are better, with a combination of meds, lots of physio and steroid injectionns. This has made a huge difference to my mood – the pain and constant pins and needles I was experiencing were really getting me down.

6 months of duloxetine (prescribed for the pins and needles) also helped my mood.  I know it’s not for everyone, and I had quie a few of the unpleasant side effects.  (Dizzines, insomnia, difficulty passing urine). It also made me feel pretty flat for the first few months.  I’m not sure if ths was a bad thing though.  It certainly helped with the feelings of hopelessness I was getting at the start of the year.

The pain and the pns and needles were driving me round the bend.  I couldn’t sleep and I felt like noone had any answers to my questions.  I was beginning to imagine a future of increasing immobility and pain. It looked pretty bleak to me. Until mid 2014, I was regularly running 10k’s. Worst of all, the hand pain was making it impossible to play the piano. I’m no concert pianist, but I can play a tune or two, and I really missed being able to play.

I’m not 100% sure when I started to feel better. I’m also not 100% sure exactly what made the biggest difference.  Looking back on it, I was clearly clinically depressed. I never told my GP how bad I was feeling at the time and I know this was wrong. I did know though, that I could get a prescription for Duloxetine because the pns and needles were so bad. At the time I didn’t want to talk about my feelings to my GP, but I knew I needed some sort of treatment.  I’d had duloxetine before (when I had surgery on my right hand and wrist) and I responded well to it.

This coincided with a diagnosis of Diabetic Cheiroarthropathy and limited joint mobility and some slightly frustrating physiotherapy.  In the end I got some very good advice from the diabetes team about keeping mobile and reducing the pain in my joints and feet.

I’ve accepted that I’ll probably never run another road race, but I also realise that I need to keep moving.  I had gotten into a cylce of doing less because I was sore, which was in turn making me more stiff and sore.

I’ve swapped running for cycling – nothing too dramatic, just nice easy rides along the canal towpath or the local disused railway path, with the occasional ride to and from work.  I’m slowly increasing my distances and the sweet spot where the endorphins kick in (that was so easy to achieve when running) is just around the corner. I’m graduallyy losing weight too. This can only be good and will certainly help the sore joints.

Numbers have been pretty good (considering my diet) and I’m dabbling with the Freestyle Libre again. I can’t afford to use it constantly, but every now and then is great for adjusting basal rates and I’ll hopefully get that elusive HbA1c of <7%. I’m hovering between 7.1% and 7.3%. The exercise is helping with insulin sensitivity. If I could just stop eating cake. Then again, 7.1% is acceptable.

Return of the absentee blogger. Elsie and I, day #252

Day 252! Its been 164 days since I last blogged. Lots has happened. Run of the mill stuff, but busy nonetheless. The Boy has been doing great since his diagnosis in May. Going live on his pump has been fantastic for him and I’m glad to say that he’s taken to it like a duck to water. I honestly can’t remember what it was like after I was just diagnosed. I vaguely remember being hungry, mostly, and there being lots of hypos, but that could have been all of my teens and my twenties if I’m honest. Not really much to report about The Boy’s progress, other than it’s been generally good. He had a school trip – 3 days and nights away, that passed without event. Lots of credit needs to be given to the Teachers and to the DSN’s who supported them and wrote a minute by minute plan of how to manage all of the activities that were scheduled over the weekend.

I’ve been getting on ok with Elsie and seem to have settled into a routine that’s generally working. I use different profiles for different shifts, which is working well. I’m still having a few more spikes than I’d prefer, but that’s more down to the choices I’ve made, than issues with the pump or my ratios.

I’ve made no secret of the fact that I’m addicted to carbs. I love them. Bread, cakes, biscuits and anything else you care to put on a plate. I’m not going to beat myself up about this. Food is to be enjoyed. Too much diabetes education, for far too long, was about what you can and can’t eat. This as left many of us with a negative relationship with food. It’s taken me a long time to not feel guilty about what I eat. This is no mean feat given that I’m a nurse. Many of my colleagues (some of whom were trained by Florence Nightingale) still question me about what I’m eating and if diabetics “are allowed that?” DAFNE and New Deal for Diabetes have come a long way, but the rest of the NHS is sadly still very much in the dark about managing diabetes.

What I do need to do, is take responsibility for managing what I eat. I’ve found generally that pre-bolusing for all, or a rough estimate of the carbs I’m eating in a meal by 30-45 minutes is making a huge difference. Saturday’s tea was vegetable soup with home baked bread and chicken pie (homemade too) for the main course. I estimated this to be around 140g carbs and bolused for 80g of these 35 minutes before we sat down to eat. No prebolusing for the boy – he’s so sensitive to his insulin theres no need. 2 hours after eating (and taking the remaining insulin for the meal) my blood glucose had risen by 0.1 mmol/L. I’d love to say that I’m this successful every time I try to do this, but sadly it’s not the case.

Going low carb a couple of days a week has been good. 2 or 3 days is acahievable and seems to work well on the days I’m working. I don’t fancy it full time though. It would be dire to never have a slice of pizza or some cake if I fancied it.

I’m due a review in a few weeks and am really keen to find out if my A1c has dropped. My last one was improved dramatically since sarting the pump. and if I’m totally honest I’ll not be disappointed if it doesn’t drop. 7.1% is still far better than it’s been for years.

I’ve got loads more I want to blether on about including the Freestyle Libre. I got very excited about this and have at times been crowing all over Twitter about it. Abbott were being very vague about availability and I decided to put my savings down on a new car. Turns out it’s been available for over a week and everyone else in the #GBdoc has beaten me to it. I’ll just have to wait a few more days until payday before I order one.

Elsie and I, day #49

Day 49 already.  There’s been a bit of a hiatus. For around 8 weeks I’ve been getting chest pain and shortness of breath. This has more or less since I got Elsie – a few weeks before going live.  After 3 hospital admissions – one rather disastrous and two extremely efficient, I now know for certain that I don’t have coronary artery disease. This is good news, given that I’ve been Type 1 for almost 30 years. I saw the evidence myself on a screen at the Royal Infirmary of Edinburgh after having an angiogram on Friday.

I’d been prepped for this by lots of people telling me it would be a relatively straightforward procedure – which it was and that as a Type 1 of 30 years, I could expect to see some narrowing and this would be sorted out there and then by a Stent being put in. Thankfully this wasn’t needed. The last few weeks have been pretty stressful to say the least, but I reckon Elsie and I have managed ok. I’m still having pain but at least its not my heart.

In the middle of all of this, I kinda lost the impetus to get on top of the diabetes, but Elsie has been there, quietly reminding me to test and sort out the highs – of which there have been a few.  On the particularly stressful days I found a temp basal of 140% seemed to do the trick.

Despite this, I’ve made a few changes in relation to my overnight basal in an attempt to sort out the Dawn Phenomenon.  I had a bit of a crisis of confidence when my beta-blocker was increased and I lost my hypo symptoms for a few days.  I was convinced the long feared night hypos were going to come back and slashed my overnight basal rates in a blind panic.  I’m slowly sorting this out but could do with another increase in my rate around 6.00am. Time to set that alarm again.

Things that are going well: Huge drop in the number of hypos. Basal rate getting there.

Things to work on: Low Carb, post meal highs and dual/square bolus.

Last 14 day averages: CHO – 276g, BG: 11.5 mmol/L (207 mg/dL), Tests per day: 6.64.