Hibernating

I'm sorry I have been AWOL the last few weeks, this usually happens to me about this time of the year. I have depression but about mid October it gets a lot worse. And this year I mean about ten fold. The doctor's call it seasonal depression in addition to the severe depression I already have, but it's not really. It's not the holidays. It begins right before my birthday or right after, depending sometimes. And then it starts. You see from end of October till mid January is the anniversaries of literally all the deaths of people I have been close to that have passed away, and also their birthdays. This may sound strange to say but not a month after our wedding my husband's step father passed away, the beginning of December. I seriously thought I had brought my family's curse with me, and the curse was spreading to my new family also. I know that is ridiculous but 4 years ago we lost my Grandma Oct 30, and this Christmas Day it will be two years since we lost my husband's Grandma. It seems it's about every two years we lose someone. My Dad and Grandma were the two most important people in my life. I am missing them this year more than ever, lots and lots of tears almost everyday. 
I realized a few years ago how down I get this time of the year, my Dr always gave me xanax to help me get through. Even before I realized though I would become very down about mid November till mid January. After Grandma passed the period got lengthened to mid October - mid January. Then a few days after Grandma's birthday in January I am miraculously better. Used to be back to my happy go lucky self. 
I wonder does bipolar change? I mean I used to be mostly up with some shorter periods of depression (not including the 3 month "seasonal" depression). Now (before the seasonal kicked in), I am down most of the time with few up times, and those up times are usually pretty recognizable as hypermania, because they are short lived periods (a day or two) of extreme energy and creativity.
My real point of all this was to apologize to anyone who reads my ramblings regularly (thank you by the way) for my disappearance. I will try to be a little better, but it is going to be pretty rough for me for a little over two more months. Just hang in there with me, I'm holding on by a thread, hold on too. Thanks. love from chele

Ups and Downs

I think this moodiness may just kill me. I have been so moody lately. My husband is really a dream, works 10-14 hrs a day then comes home and does the dishes or whatever else I need and lately I have just been so bitchy. I hate being that way, reminds me of my mother, but I can't control it. Like right now it is 3 am I am sitting here with tears streaming down my face. I have no idea why. Well, maybe exhaustion. I overdid it Thursday helping my friend with her computer, which I really wanted to do for her I just don't think either of us expected setting up her new computer to take so long. It wasn't the physical stuff that took so long, although I was laying on my stomach under the desk at one time folding cords up and tying each individual one up with a velcro strip. The other stuff, setting the actual pc up. First we couldn't get the cable modem to work. I spent 20 mins on the phone with someone out of country, finally he says "I am going to give you a ticket number because when I reset your modem we will lose the call. Resetting the modem should fix the problem but if it doesn't just call back and give the ticket number". So I wait the three minutes, call back give the ticket number and the new representative says to me right away "did you try the standby button? press and hold it for three seconds and then try the internet". Fixed. Geez. One thing our cable company offers is a free antivirus software called CA Internet Suite that I really think is fantastic so why should she have to pay for Norton? No reason, so I uninstalled Norton and downloaded the CA. Downloaded Picasa. If you haven't discovered Picasa yet it is another free program this time by Google. It is for photos. When I changed from my laptop to my new PC (thank you again Marty, I love u little bro) I uploaded all my photos to web albums on Picasa and then downloaded what I wanted to back onto my PC. All the others are still on my private, unlisted, web albums where I can access them any time I want but they aren't clogging up my computer.
So back to my moods, sorry I tend to digress at 4 am. I feel like I went through the entire range of emotions in less than 12 hours, happy, excited, angry, royally pissed off (same thing?? I don't know, not in this case), insulted, and then just exhausted, in pain, and crying. I took two xanax so I am starting to feel calm and hopefully sleep will come soon. I really must make an appointment to go back to my primary care doctor to see about a mood stabilizer, I feel like I am all over the place. I have been told this is quite normal for bipolar. I'm not sure. Ideas? Comments?

Kim's Pink Kiss Cookies (meringue)

These are my sister in law, Kim's recipe. However, when I made them I used 3/4 cup of splenda instead of sugar and sugar free jello. Also, I tried to make them the regular way with sugar first, but the egg whites wouldn't thicken enough. My friend, Ronnee, told me to chill the bowl, and it worked!!!! oh, and I skipped the chocolate chips cause I forgot them. Also, I had to cook them for about an extra 45 minutes, seriously. Must \ be the crazy humidity here, I had looked at a few recipes online that said that could happen. I ate one after 30 mins and tasted like a big marshmallow. Probably not so great to eat uncooked egg whites, oops!

3 egg whites (let eggs come to room temperature)

1/8tsp salt
3/4 c sugar
1 1/2 tblsp strawberry jello
1/2 c chocolate chips

Beat egg whites and salt til fluffy. Add sugar and jello, beat til stiff. The mixing process must add LOTS of air or it will not work. No kitchen aid mixers.

Fold in chocolate chips. Drop with spoon onto lightly greased then floured pans.

Bake at 250 degrees for roughly 25 -30 minutes. Observe for pink chalky color.

Crippling pain ... Fibromyalgia

denylady: I was diagnosed with Fibromyalgia a few years ago, but no doctor explained to me how ill this makes you. Even if I do too much house work or try to do something a bit strenuous it can put me to bed for a couple of days as I become so ill.

My feet are the worst thing, the pain on the bottom of my feet is awful. I can only walk short distances, when I tell doctors they just look confused and can't seem to give me any advice.
Can you shed some light on this illness for me as I get so depressed as I feel no one understands how I feel?

Dr Carol Cooper: You're right - nobody really knows how or why fibromyalgia makes you feel ill, or even exactly what it is.
On the whole, one of the best treatments is to pace yourself and gradually increase your activities till you get back to near-normal levels.
Strenuous activity, as you've learned, is counter-productive because you pay for it afterwards.
If you're depressed, an antidepressant and/or counselling might be an idea. Even if you're not depressed, antidepressants can help - it's been discovered that in small doses (too small to work against depression), some antidepressants help all sorts of chronic pain. If you haven't talked it over with your GP, that should probably be your next step.

And have you had a look at the useful site www.ukfibromyalgia.com?
p.s. For those of you who don't know fibromyalgia sufferers have decreased levels of seratonin, which is why antidepressants tend to help, they increase levels of seratonin in the blood (so does chocolate!).

Admiration of Strength and Courage

My cousin is a fighter. That I have always known. She's the oldest of seven kids. was a second mother to all of them. I think all but two have lived with her at some point including me. She's worked two or three jobs when she's had to in order to support her family.

She's five foot tall and has never been afraid to tell someone how it is even if they are six foot 250 pounds. I used to make her crazy. I was the kid who was so shy I sat off by myself while the other kids played kickball at recess. I would never stand up for myself, which is what made her crazy. She taught me how when I lived with her. For which I will be eternally grateful (although others who find my bluntness rude may disagree).

In some ways we are so much alike. Neither of us have ever been able to hide our dislike of someone. Both of us count loyalty as one of the top traits we both admire and expect in a person. In some ways we are not alike. Nine months ago she had a car accident. She has a dislocated jaw she was supposed to have surgery on today (postponed due to more problems with...), she has swelling of the brain, she is having some kind of problem with all the discs in her back from top to bottom that I don't understand, neuropathy of the brain stem, some kind of eyesight problems, including temporary blindness at times. and the list goes on.

I thought I knew pain. I can not begin to fathom the pain she is in. But she still works at least weekends as a waitress. I don't understand how she does it. I can't help but compare our situations and find hers extremely worse, yet she has the steel to still work, as a waitress nonetheless. On her feet probably 8 hours a day. This blows my mind. I think I am green with envy. I have to say that today, my cousin is the person I admire most. For she makes me look inward, find myself lacking in steel, and determined to do better. 

Strenth and Courage author unkown

It takes strength to fit in.

It takes courage to stand out.

It takes strength to feel a friend's pain.
It takes courage to feel your own pain.

It takes strength to hide your own pains.
It takes courage to show them.

It takes strength to endure abuse.
It takes courage to stop it.

It takes strength to stand alone.
It takes courage to lean on another.

It takes strength to love.
It takes courage to be loved.

It takes strength to survive.
It takes courage to live.

~~ Author Unknown ~~

The Job Quest Part I

There are people who have worse physical disabilities than me. In fact, there are millions of people who have worst disabilities than me. I see actor Christopher Reeves directing films, it's inspirational. I watch So You Think You Can Dance and there is a woman trying out who lost her arm, but still dances, another dancer who is dancing in spite of not being able to hear the music. But, I am not these people. I list the types of jobs I've had in the past:

• permitter (drove 300-500 miles a day to building departments all over the state). Obviously this is impossible because I can't drive anymore due to the peripheral neuropathy in my hands.
• convention & meeting coordinator / party planner. Wow, I was so good at this job. I'm not just saying that I am incredibly creative and we through some fantastic parties for some fantastic people. But this job is out too, it requires 18 hour days that include lifting, climbing, and even creativity such as floral arrangements and other arts & crafts type that I love. The whole of this job just eliminates itself as a possibility.
• Working at Disney booking hotel reservations. My favorite job ever. Talking to guests on the phone 8 hours a day and typing information into the computer that long also. Sitting 8 hours a day is impossible given the muscle spasms in my shoulders, neck, and head. Plus, I am unable to do the typing. I could use my voice recognition software to type for me, but the problem with that is I can't talk to the customer and talk to the voice recognition program at the same time. Someone or something would certainly end up confused!

I want to be Christopher Reeves, the girl who dances in spite of not being able to hear the music. I want to be that inspirational. For now I struggle. I write my blog. I get letters from people that tell me I am inspirational and I have helped them. And that feels so incredible I can not describe it. Yet, to be inspirational and to help people does not help my husband move us above poverty, keep a roof over our head, food in our mouths.
I consider the perfect jobs:

• being paid to blog. I can do it from home in my pajamas. I can do it if I am in the worst flare. My hands can look and feel like I spent the afternoon punching a wall. I can toss my cookies all day, and I don't need someone to drive me there.
• Walmart greeter!! I'm pleasant, oh, but I can't stand more than a few minutes, let alone hours. Damn.
• job sharing like an administrative assistant position, or even a sales position. But, the location would have to be somewhere I can get to on the handy bus, and I need to be able to use the Dragon Naturally Speaking program for typing. Which means my cubicle would have to be pretty sound proof so as not to drive other employees nuts.

Now what I need is a plan who to talk to, what organizations can help me.
This I will leave for part 2.

Neuropathy Quiz By Patrick Lowe, D.C.

 Rank Each Question 1-10

1 means it rarely happens or is very very mild

10 means it is Severe or Constant

___My hands feel like I am wearing invisible gloves on them or my feet feel like I am wearing invisible socks on them.

___I feel like someone is stabbing me with a thousand pins or needles.

___I am sensitive to being touched, causing sensations of burning, freezing or electric shocks.

___I am tormented by numbness, tingling or loss of feeling in my arms, hands or legs

___My hands go weak, I drop things.

_____ Total Score


Single question scoring

1 to 5 in any question you probably have mild to moderate neuropathy

5 to 10 in any question you probably have moderate to severe neuropathy

Total Scores

2 to 5 may indicate mild neuropathy

6 to 15 may indicate moderate neuropathy

15 or higher may be considered severe neuropathy

Diabetes Friendly Double Chocolate Cheesecake

Ingredients:
24 sugar-fre Oreo cookies (about a pack and a half) crushed
1/4 cup butter or margarine melted
4 packages, 8 ounce each, cream cheese, softened
1 cup Splenda
2 tablespoon flour
1 teaspoon vanilla
1 package, eight squares, bakers semi sweet chocolate melted and cooled
4 eggs

Instructions:
Heat oven to 325°F. Mix crumbs and butter, press onto bottom of a 13 x 9 pan. Bake for 10 minutes. Beat cream cheese, flour, and vanilla with mixer until blended. Add chocolate, mix well. Add eggs one at a time, mixing on low after each just until blended. Pour over crust. Bake 45 minutes or until center is almost set. Cool completely. Refrigerate four hours. Serve with fresh berries if desired.

My Breasts Are Lumpy: What Does It Mean?

I have fibrocystic breasts. I am also at high risk for breast cancer, as there have been multiple relatives with both of breast and other types of cancer on both sides of my family I have a micro-cluster of calcifications that I'm told is precancerous yes if I think about this, it does worry me some. My problem is with the fibrocystic breasts they are lumpy. According to the Mayo Clinic fibrocystic breast disease is a very common noncancerous benign condition the cause of the condition is unknown. However, it is thought to be associated with the change in hormones in premenopausal women. It is also associated with the hormone fluctuations during a woman's menstrual cycle.
Fibrocystic breast syndrome may or may not come with pain . The pain can be intense and is generally in the upper outer quadrant of the breast. Moist heat, a reduction in your intake of caffeine and a good support bra may help relieve your symptoms. According to Dr. John Lee's book, "What Your Doctor May Not Tell You About Premenopause," natural progesterone cream applied at a dose of "15 to 20 mg per day from ovulation until a day or two before your period returns will usually result in a return to normal breast tissue in three to four months." Dr. Lee further advises that once the desired results have been obtained that you should taper your dose of natural progesterone down until you have reached the minimum dosage required for you to maintain your results. Dr. Lee , also recommends the use of Vitamin E, in doses ranging from 400 IU to 600 IU per day, to reduce symptoms associated with fibrocystic breast changes. Other vitamin suggestions include Vitamin B6, a B complex, and magnesium.

What to Do When You Find a Lump in Your Breast

First, don't panic. Calmly call your physician to schedule an appointment and ask yourself the following questions:

• What is the date of your last period?
• When did you discover the lump?
• Is there a family history of breast problems?
• Have you had any previous breast problems?
• Have you had a previous breast biopsy or other breast surgery?
• How does the lump feel? Is it hard or soft? Does it feel grainy?
• How big is the lump and has is grown larger or smaller since you discovered it?
• Do you have any nipple discharge?
• Are you taking any medications?

Managing Chronic Pain: 10 Steps from Patient to Person

Making the journey from patient to person takes time. The isolation and fear that can overwhelm a person with chronic pain grows over time. And the return to a fuller, more rewarding life also takes time.

It’s a journey with many phases. The ACPA describes these phases as Ten Steps.

The ACPA’s Ten Steps For Moving From Patient To Person.

STEP 1: Accept the Pain
Learn all you can about your physical condition. Understand that there may be no current cure and accept that you will need to deal with the fact of pain in your life.

STEP 2: Get Involved
Take an active role in your own recovery. Follow your doctor's advice and ask what you can do to move from a passive role into one of partnership in your own health care.

STEP 3: Learn to Set Priorities
Look beyond your pain to the things that are important in your life. List the things that you would like to do. Setting priorities can help you find a starting point to lead you back into a more active life.

STEP 4: Set Realistic Goals
We all walk before we run. Set goals that are within your power to accomplish or break a larger goal down into manageable steps. And take time to enjoy your successes.

STEP 5: Know Your Basic Rights
We all have basic rights. Among these are the right to be treated with respect, to say no without guilt, to do less than humanly possible, to make mistakes, and to not need to justify your decisions, with words or pain.

STEP 6: Recognize Emotions
Our bodies and minds are one. Emotions directly affect physical well being. By acknowledging and dealing with your feelings, you can reduce stress and decrease the pain you feel.

STEP 7: Learn to Relax
Pain increases in times of stress. Relaxation exercises are one way of reclaiming control of your body. Deep breathing, visualization, and other relaxation techniques can help you to better manage the pain you live with.

STEP 8: Exercise
Most people with chronic pain fear exercise. But unused muscles feel more pain than toned flexible ones. With your doctor, identify a modest exercise program that you can do safely. As you build strength, your pain can decrease. You'll feel better about yourself, too.

STEP 9: See the Total Picture
As you learn to set priorities, reach goals, assert your basic rights, deal with your feelings, relax, and regain control of your body, you will see that pain does not need to be the center of your life. You can choose to focus on your abilities, not your disabilities. You will grow stronger in your belief that you can live a normal life in spite of chronic pain.

STEP 10: Reach Out
It is estimated that one person in three suffers with some form of chronic pain. Once you have begun to find ways to manage your chronic pain problem, reach out and share what you know. Living with chronic pain is an ongoing learning experience. We all support and learn from each other.

First Appeal Denied

I'm sure you can guess I am pretty disappointed right now. Here I sit speaking into a microphone which translates my spoken words into type written ones, yet, the great powers that be tell me there are no reasons why I could not continue in the sales position in which I was previously employed or a similar position. 

This is from the Social Security website:

What We Mean By Disability

The definition of disability under Social Security is different than other programs. Social Security pays only for total disability. No benefits are payable for partial disability or for short-term disability.

"Disability" under Social Security is based on your inability to work. We consider you disabled under Social Security rules if:

• You cannot do work that you did before;
  
  
• We decide that you cannot adjust to other work because of your medical condition(s); and
  
  
• Your disability has lasted or is expected to last for at least one year or to result in death.
  
  

This is a strict definition of disability. Social Security program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers' compensation, insurance, savings and investments.

In this, what the Social Security office specifies as a strict definition of disability, they specifically say “you cannot do work that you did before." I'm baffled, for lack of a better term, baffled. I will appeal, which means next step going in front of a judge. It can take up to two years to get a court date. I'm frustrated, I know my husband is frustrated. I feel bad for my husband. He works 50 to 80 hours a week so that we can scrape by. Then, when he is off, he helps me around the house by vacuuming or mopping. At least he's frustrated with the system not with me.

Next week. I have my first visit with a new neurologist. I will keep you informed.

What are the signs of diabetes?

Some common signs and symptoms of diabetes are:

• tired all the time
• always thirsty
• sudden weight loss
• blurry vision
• always hungry
• vaginal infections
• numb or tingling hands or feet
• wounds that won't heal
• urinating often
• problems with sex

My Grandma

Anyone who knows me can tell you what a huge proponate of Breast Cancer Awareness I am. In fact last year for my birthday I received two big gift bags of “Think Pink” gear. The year before, pink pots and pans (which inspired a pink kitchen that thrills my husband). In fact, october is my favorite month. Breast Cancer Awareness, aka “Think Pink!” month is like my Christmas – pink everywhere.

What people may not realize or know is I am not a Breast Cancer Awareness fan or supporter because I love pink, rather I’m a pink fan because I’m a breast cancer awareness supporter. In 1979 my Grandmother, Virginia Phoenix, died from cancer that started in her breast. She had a large lump which, I understand from my Mother, she ignored for quite a while. By the time she went to the doctor it was too late, the cancer had spread to her lymph nodes then her entire body. I was eleven at the time so I don’t remember much about her… her smile, her thin curly short thin gray hair. Large family dinners at the holidays with a table that seemed to stretch for miles (Grandma had 8 children some of whom had large families themselves), her love of the color lavender or purple.
This is why I love pink. Right now I want you to feel your boobies. That’s right feel ‘em. Better yet, have someone feel them for you. And, if you haven’t had a mammorgram recently pick up the phone and schedule that too. YES, RIGHT NOW….. GO!!!!

Chicken n Veggie Orzo

I was hungry for a different kind of chicken noodle type soup one day and started fooling around. I didn't come up with a new soup recipe but I did discover this and it is sooooo good, I promise you. My husband who does not care for zucchini or red bell pepper really likes it.

2 chicken breasts
2 tbsp olive oil
1 medium tomato diced (about 3/4 - 1 c)
1 medium zucchini diced (also about 1 c)
1/2 c diced red bell pepper
1/2 c green onions (the green end) chopped
1 c orzo
2 c chicken broth
1 tbsp chopped garlic
1 tsp thyme

Cook chicken in olive oil. While that is cooking chop veggies. Remove chicken from pan when cooked. Put orzo, veggies, broth, garlic, and thyme in pan. Set timer for 7 mins. Chop chicken while that is cooking. Add chicken to pan when orzo finished and stir. Enjoy!!

Insomniac by Maya Angelou

I always say sleep is for the weak, but I think Maya Angelou says it so much better.

Insomniac by Maya Angelou


There are some nights when
sleep plays coy,
aloof and disdainful.
And all the wiles
that I employ to win
its service to my side
are useless as wounded pride,
and much more painful.

Ok so I'm Bipolar, Now What?

I don't really know what this means, I feel like I'm stumbling around in the dark. Ok, I kind of already figured I was bipolar, but hearing the doctor say it is another thing. That probably sounds silly. The thing is the doctor said we will deal with this after we get the neuropathy under better control and see where that leaves me basically. So I decided to do a little research on the internet on my own. 

Here is some of what I found: 

Doctors usually diagnose mental disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the DSM, there are four basic types of bipolar disorder:

1.      Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person's normal behavior.

2.     Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.

3.     Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior.

4.     Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

I think this would mean that I am Bipolar II. I have never had a full blown manic episode, more what is described as hypomania. I get extra creative during these periods and can not stop doing things no matter how much pain I am in. But, if I take two xanax, and crawl in bed, a lot of twitching ensues, and then I fall asleep and am ok the next day. 

Here is more information from WebMD on Bipolar II: II disorder (pronounced "bipolar two") is a form of mental illness. Bipolar II is similar to bipolar I disorder, with moods cycling between high and low over time.

However, in bipolar II disorder, the "up" moods never reach full-on mania. The less-intense elevated moods in bipolar II disorder are called hypomanic episodes, or hypomania.

A person affected by bipolar II disorder has had at least one hypomanic episode in life. Most people with bipolar II disorder also suffer from episodes of depression. (This is where the term "manic depression" comes from.)

In between episodes of hypomania and depression, many people with bipolar II disorder live normal lives.

Who Is At Risk for Bipolar II Disorder?

Virtually anyone can develop bipolar II disorder. About 2.5% of the U.S. population suffers from some form of bipolar disorder -- almost 6 million people.

Most people are in their teens or early 20s when symptoms first start. Nearly everyone with bipolar II disorder develops it before age 50. People with an immediate family member with bipolar are at higher risk.

What Are the Symptoms of Bipolar II Disorder?

During a hypomanic episode, elevated mood can manifest itself as either euphoria (feeling "high") or as irritability.

Symptoms during hypomanic episodes include:

·        Flying suddenly from one idea to the next

·        Rapid, "pressured" speech

·        Increased energy, with hyperactivity and decreased need for sleep

People experiencing hypomanic episodes are often quite pleasant to be around. They can often seem like the "life of the party" -- making jokes, taking an intense interest in other people and activities, and infecting others with their positive mood.

What's so bad about that, you might ask? Hypomania can also lead to erratic and unhealthy behavior. People in hypomanic episodes might spend money they don't have (my husband would say I know that one well), seek out sex with people they normally wouldn't, and engage in other impulsive or risky behaviors.

Also, the vast majority of people with bipolar II disorder experience significant depressive episodes. These can occur soon after hypomania subsides, or much later. Some people cycle back and forth between hypomania and depression, while others have long periods of normal mood in between episodes.

Untreated, an episode of hypomania can last anywhere from a few days to several years. Most commonly, symptoms continue for a few weeks to a few months.

Depressive episodes in bipolar II disorder are similar to "regular" clinical depression, with depressed mood, loss of pleasure, low energy and activity, feelings of guilt or worthlessness, and thoughts of suicide. Depressive symptoms of bipolar disorder can last weeks, months, or rarely years.

What Are the Treatments for Bipolar II Disorder?

Hypomania often masquerades as happiness and relentless optimism. When hypomania is not causing unhealthy behavior, it generally goes untreated. This is in contrast to true mania, which nearly always requires treatment with medications.

People with bipolar II disorder can benefit from preventive medications that level out moods over the long term. These prevent the negative consequences of hypomania, and also help to prevent episodes of depression.

Mood stabilizers

Lithium: This simple metal in pill form is highly effective at controlling mood swings in bipolar disorder. Lithium has been used for more than a century to treat bipolar disorder. Lithium can take weeks to work fully, making it better for long-term treatment than for sudden hypomanic episodes. Blood levels of lithium must be monitored to avoid side effects.

Depakote (divalproex): This antiseizure medication also works to level out moods. It has a more rapid onset of action than lithium, and it can also be used for prevention.

Some other antiseizure medicines, such as Tegretol (carbamazepine), are also effective mood stabilizers.

Treatment for Depression in Bipolar II Disorder

When taken for depression by someone with bipolar II disorder, common antidepressants like Prozac, Zoloft, and Paxil can set off a full-on manic episode. For this reason, the first treatment for depression should be lithium, Depakote, or an antipsychotic. If these fail after a few weeks, an antidepressant can be safely started. Psychotherapy, such as cognitive-behavioral therapy, can also help.

Can Bipolar II Disorder Be Prevented?

The causes of bipolar disorder are not well understood. It's not known if bipolar II disorder can be prevented entirely. It is possible to prevent some episodes of hypomania or depression, once bipolar disorder has developed. Regular therapy sessions with a psychologist or social worker can stabilize mood, leading to fewer hospitalizations and feeling better overall. Taking medicine on a regular basis also leads to fewer hypomanic or depressive episodes.

How Is Bipolar II Disorder Different From Other Types of Bipolar Disorder?

People with bipolar I disorder experience true mania -- a severe, abnormally elevated mood with erratic behavior. Manic symptoms lead to serious disruptions in life, causing legal or major personal problems. In bipolar II disorder, the symptoms of elevate mood never reach full-on mania. Bipolar II can be thought of as a milder form of bipolar disorder.

Electromyogram (EMG) and Nerve Conduction Studies

I have an appointment next Monday with Dr. Cuervo at the Neurodiagnostic Laboratory here in Lakeland. These are the tests that the scheduler mentioned the doctor may be wanting me to take:

An electromyogram (EMG) measures the electrical activity of muscles at rest and during contraction. Nerve conduction studies measure how well and how fast the nerves can send electrical signals. Nerves control the muscles in the body by electrical signals (impulses), and these impulses make the muscles react in specific ways. Nerve and muscle disorders cause the muscles to react in abnormal ways.

Measuring the electrical activity in muscles and nerves can help find diseases that damage muscle tissue (such as muscular dystrophy) or nerves (such as amyotrophic lateral sclerosis or peripheral neuropathies). EMG and nerve conduction studies are often done together to give more complete information.

Why It Is Done

An electromyogram (EMG) is done to find diseases that damage muscle tissue, nerves, or the junctions between nerve and muscle (neuromuscular junctions). These disorders may include a herniated disc, amyotrophic lateral sclerosis (ALS), or myasthenia gravis (MG). Find the cause of weakness, paralysis, or muscle twitching. Problems in a muscle, the nerves supplying a muscle, the spinal cord, or the area of the brain that controls a muscle can cause these symptoms. The EMG does not show brain or spinal cord diseases.

Nerve conduction studies are done to find damage to the peripheral nervous system, which includes all the nerves that lead away from the brain and spinal cord and the smaller nerves that branch out from those nerves. Nerve conduction studies are often used to help find nerve disorders, such as carpal tunnel syndrome or Guillain-Barré syndrome.

Both EMG and nerve conduction studies can help diagnose neuropathy.

How To Prepare

Tell your doctor if you:

• Are taking any medicines. Certain medicines that act on the nervous system (such as muscle relaxants and anticholinergics) can change electromyogram (EMG) results. You may need to stop taking these medicines 3 to 6 days before the test.
• Have had bleeding problems or take blood thinners, such as warfarin (Coumadin) or heparin. If you take blood thinners, your doctor will tell you when to stop taking them before the test.
• Have a pacemaker.

Important instructions to be aware of:

• Do not smoke for 3 hours before the test.
• Do not eat or drink foods that contain caffeine (such as coffee, tea, cola, and chocolate) for 2 to 3 hours before the test.
• Wear loose-fitting clothing so your muscles and nerves can be tested. You may be given a hospital gown to wear

Fibromyalgia: Time for the rheumatologists to hand over?

I have one question about this article that I would like comments on... the article calls for community-based teams of health providers consisting of occupational therapists, physiotherapists, psychologists, nurses and social workers asking them to work alongside GP’s. But then it goes on to mention that fibromyalgia is a chronic central nervous system problem. Doesn't that mean a neurologist should be included in the team?

The American College of Rheumatologists developed diagnostic criteria for fibromyalgia in 1990, the culmination of many years of debate and disparagement of the existence of this pain problem. At the time, it was thought that it was a rheumatic complaint due to the presence of body pain and soft tissue tenderness, so the diagnosis and management of it was firmly in the rheumatologists camp. Research over the last few years shows that it is in fact a pain syndrome centered in the nervous system. Two rheumatologists now suggest that fibromyalgia should no longer be managed by rheumatologists and it should be handed over to…primary care physicians.



The information above is drawn from an editorial by Shir and Fitzcharles, in The Journal of Rheumatology 2009; 36:4. What does this startling suggestion mean really?

There are several points that this editorial makes:

1.Fibromyalgia is no longer a diagnosis of exclusion, and diagnostic accuracy by GP’s has improved significantly (at least in the US)


2.Exclusion of serious rheumatological or other disorders seems to be carried out quite effectively by GP’s


3.Few investigations are needed to increase diagnostic accuracy


4.‘Successful management necessitates approaching the patient as a whole biopsychosocial being, with treatment strategies directed towards physical and psychological complaints within the context of family and society.’


I’m not going to argue with these points at all, but I am going to suggest that leaving the management of fibromyalgia simply to the family physician might not be the best thing for the person with FM. I don’t doubt the clinical skill of GP’s, and I think they are the best group to diagnose FM – but managing FM isn’t a single-clinician job.


While GP’s certainly know how to diagnose, and can prescribe the majority of medications used to manage fibromyalgia, my worry is that the rest of the management is not a medical task. In fact it’s a biopsychosocial problem, as the 4th point above makes. IMHO GP’s don’t have time or access to services in the community to help people with fibromyalgia to live well, it takes a team to do this.


If I had a wand, or the ear of a health funder, I’d be suggesting the formation of community-based teams of health providers consisting of occupational therapists, physiotherapists, psychologists, nurses and social workers. I’d be asking them to work alongside GP’s, (perhaps even in the same buildings!) so that people being seen by the GP could then be included in a team approach to help them develop active coping strategies to live well, despite their health problems.


Now, as it happens, I don’t have the wand or ear, but I can hope. As Shir and Fitzcharles state:
…the pathogenesis of FM is now firmly centered in the nervous system, and FM is not a musculoskeletal complaint. Optimal patient management requires attention to the many symptom components of FM in addition to pain management. Patients with FMwill also require prolonged care with continued tailoring of treatments, as symptoms are likely to change over time.


Maybe one day soon my dream of community-based interdisciplinary teams to help people be well despite pain (or other chronic health problems) will be realised. The sooner a biopsychosocial approach to managing these problems is adopted the better.

If you’re a person with fibromyalgia, some caveats about anything on the internet:


FM has been a wonderful thing for people who sell so-called ‘cures’. It’s such a diffuse problem, has been questioned for years by the medical community, is often not clearly diagnosed, and changes its presentation often – so people who are either unscrupulous, or are credulous can go about selling all sorts of potions, pills and gadgets for the ‘cure’ of the disorder.

FM doesn’t respond to very much, it’s a chronic central nervous system problem, and living with it means learning how to LIVE with it, not fight it, defeat it, or beat it. It won’t just disappear of its own accord, and it won’t disappear because of some herbal, crystal, magnetic Thing.

Be sceptical, ask for evidence and don’t accept anecdote or endorsements as evidence for the power of any treatment. Self management is really the only way to live well with FM, although some medications can help. Here’s a good site for learning about self management for FM, and here’s a brief overview of a study about how self management can improve the outcomes of exercise in FM.


SHIR, Y., & FITZCHARLES, M. (2009). Should Rheumatologists Retain Ownership of Fibromyalgia? The Journal of Rheumatology, 36 (4), 667-670 DOI: 10.3899/jrheum.08107

Pink Lemonade

This recipe is from my friend Stacey's blog. Stacey actually has several blogs each covering a fantastic, informative array of topics. This recipe comes from her blog at http://everybitcookinggardening.blogspot.com. She also has a fantastic blog about her struggles with fibromyalgia, and lupus while raising a family. This can be found at http://fibroandi.blogspot.com.

Ingredients

1 cup lemon juice, freshly squeezed or bottled

1 cup strawberries, sliced

1/2 cup splenda
5 cups water

1 lemon (optional, for slices)

Directions:

In a blender, puree lemon juice and strawberries. Strain through fine mesh strainer pressing berries with spatula. Combine juice, splenda, and water and stir until splenda is dissolved. Pour into a jar and cover. Refrigerate. Add lemon slices before serving. (ok call me lazy but I just put everything in the blender and didn't strain a thing, there was a foam on the top, but the lemonade was fantastic!).

The Long Search for Fibromyalgia Support

By ANNE UNDERWOOD
Fabrizio Costantini for The New York Times

Judy Robinson has been living with fibromyalgia.

Glenn Robinson was always physically affectionate with his wife, Judy. But after she underwent abdominal surgery four years ago, everything changed.

Long after the incision healed, Judy had pain in her hips, her lower back, her legs, her muscles, her skin. When Glenn tried to tickle or squeeze her, she would shy away. Hugs would elicit a grimace. “Don’t touch me; it hurts,” she would say, backing off. Glenn reacted the way any husband would. “I got angry,” he said.

The couple’s social life ground to a halt. Judy, 48, began begging off picnics, barbecues and trips to the boat races at Belle Isle Park in Detroit, where they live.

“We would make plans to get together with friends for dinner,” said Glenn, 50. “Come that day, beautiful weather, she wouldn’t want to leave the house.”

There were days when Judy didn’t even want to talk on the phone. And though she soldiered through eight-hour workdays in the shipping and receiving department of a leather company, she would take breaks to sit in the bathroom and cry.

The Robinsons became desperate to find out what could possibly be causing Judy’s pain. M.R.I.’s turned up nothing more than a herniated disc or osteoarthritis. Both can be excruciating, but neither could account for the pains Judy felt all over her body. Her doctor prescribed narcotics, but even those didn’t help. It hurt to wash her face. It hurt to raise her arm. It hurt to sleep. It still does.

“If you touch my back, it feels like it’s all bruised,” she said. “Lately it’s felt like electroshocks.”

In March 2009, after four years of suffering, Judy finally found a new doctor who could name her ailment: fibromyalgia.

If there is a circle of purgatory that Dante forgot, it might be the one reserved for fibromyalgia sufferers. The problem isn’t just pervasive pain. It’s the challenge of having a condition that is not well understood. It doesn’t help that there is no objective medical test to confirm it — no blood test, no cheek swab, no X-ray — just a patient’s subjective reports. Nor does it help that there is no cure. Many physicians don’t want to be bothered with incurable patients.

If doctors don’t sympathize, why would friends? How do you explain to people that you have no broken bones or burns or even infections, yet your body hurts all over? You look fine, yet beg off work and social engagements. Are you a malingerer? Are you just trying to claim disability? Are you simply crazy? And why don’t you get better?

“Divorce is a big problem,” said Sharon Waldrop, head of the Fibromyalgia Association of Michigan.

And yet, this is a huge improvement over the situation a few decades ago. Until 1990, when the American College of Rheumatology published diagnostic criteria, fibromyalgia was routinely dismissed as the imaginary sufferings of hysterical, middle-age women.

Muhammad Yunus, a rheumatologist at the University of Illinois College of Medicine at Peoria, has been a pivotal figure in the field. He published the first scientific study describing clinical characteristics of the disease in 1981 and the first genetic linkage study in 1999. But when he expressed his initial interest in fibromyalgia in the late 1970s, his mentor discouraged him. “ ‘You will ruin your academic career by dealing with these crazy people,’ ” he said his mentor told him. “ ‘They’re women. They’re complainers. They’re lazy.’ ”

Today, research is validating their suffering, showing that people with fibromyalgia really do process pain differently. The syndrome is recognized by the World Health Organization, the Centers for Disease Control and Prevention, the American College of Rheumatology, the Arthritis Foundation, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The Food and Drug Administration has approved three drugs to treat it — Lyrica, Cymbalta and Savella are the brand names — and fibromyalgia has its own diagnostic code for insurance forms.

“Insurance companies don’t have a code number for a disease unless it’s real,” said Dr. Mark Pellegrino, founder of the Ohio Rehab Center in Canton and the author of 15 books on fibromyalgia.

Doctors today have a much better idea of how to treat the ailment — not only with drugs, but also with exercise and measures to improve sleep. And though the suffering never totally goes away, it is possible to vastly reduce the pain and learn to cope with what remains.

Minnie Lee, 37, a financial planner in Playa Del Rey, Calif., is one who has managed successfully. Once bedridden with stabbing pains in her back, she now exercises regularly and has completed half a dozen triathlons. She even writes a fibromyalgia blog that offers encouragement to other sufferers.

Yet there are still rampant misconceptions, even among physicians.

“A year ago, a doctor told me only women had fibromyalgia,” said Randy Wold, 58, a drag racer and retired auto mechanic from Cypress, Calif., who has suffered from fibromyalgia since the early 1990s. Today he races his 1979 Z 28 Camaro and 1989 Pontiac Firebird with the logo for the National Fibromyalgia Association emblazoned on them and makes an announcement that if there is a man there with pain, he’s willing to talk. Without such support, he says, it can be hard for a man to get a diagnosis.

And no matter what gender the patient is, struggles with insurance companies are common. Lynne Matallana, president and founder of the National Fibromyalgia Association, says many members have complained that insurers make it difficult to receive the approved drugs for fibromyalgia.

“Since these drugs are new, there is no generic version,” she said. “But insurance companies often require that doctors prescribe generics first.”

As a result, patients have to demonstrate that they have failed to respond to cheaper drugs, prescribed off-label for fibromyalgia, before they get the ones that work best.

To Judy Robinson, such complaints are minor, compared with the stress and frustration of living with an undiagnosed disease.

Now that she has finally put a name to her ailment, she has found the right drug to treat it. Equally important, knowing the name of her condition has led her to her local fibromyalgia association, where she and Glenn have gotten emotional support and extensive information.

“Before this,” Glenn said, “I never really understood before what Judy was going through.”

I have to say I know exactly what this woman has been through, and I'm sure you do too. I love the reference to Dante's circles of purgatory, it's so true. I couldn't have said it better about not wanting to be touched. My husband can certainly empathize with her husband. Maybe there should be a support group for husbands, wives, and families of this disease. I am sure my husband could use someone to talk to who would understand,, like the support group I have. I too cringe at being touched. I used to love to snuggle. When we first met we would lay on the couch snuggled together for hours, just watching tv, my husband's arms around me. Now, I can't take the weight of his arm, it causes pressure. Pressue = pain. No, before you ask, sex is not an option. I've told my husband he can leave me, find someone who can give him the affection he craves, the physical needs he has. But, luckily for me this amazing man says our relationship has never been about the physical aspect.
I've also cried in the bathroom at work from the pain, slept in the stall from sleep apnea (before I was diagnosed), even fell asleep in the middle of a phone call with a customer, and broke my car in half in a total Dukes of Hazzard jump over 2 fences and a ditch. Landed in a cow pasture, luckily for me the cows were in the other pasture that day. Might have been cool to see, if I weren't sleeping. I wasn't hurt thank goodness, and neither were any cows. Unfortunately the gorgeous red firebird my brother gave me was broken in half, unrepairable. Sorry about that bro.

Excellent news

I did call Lilly Pharmaceuticals today and my application for prescription assistance was approved. This means cymbalta for free, what a relief. We have a limited insurance plan through my husband's work so it is not covered. And, with only him working we couldn't really afford it, but it helps with the pain. I missed a few days this week, because I was running out. I could barely crawl out of bed, I was so stiff and sore. This will cover me for a year. Every drug company is different. I know for a famiy of 2 I believe Lilly was a maximum of 44,000 a year. Which is pretty high. The website link is  http://www.lillycares.com/index.jsp. The medication is shipped to your doctor. If your doctor is better than mine they may actually call and tell you it's there. Good thing I have an appointment tomorrow!

Today I recieved an email from a lovely woman in Ontario, Canada. She searched for neuropathy information and found my blog. She has been diagnosed with neuropathy but not has diabetes. The doctors do not know how she got neuropathy. I hope she doesn't mind if I show you this excerpt from her email:
"Have been struggling with this for about 7 years now. Doctors here don't seem to know how to treat this. I have been on many kinds of medications. (Lyrica, gabapentine, celebrex ect) nothing seems to work. At the moment I am on oxycodone 1 tablet 3 times a day. This is far from being enough. It doesn't even take 1/4 of my pain away. On a scale of 1 to 10 my pain is usually 9 ... I have told this to my neurologist but she doesn't think it is that bad. I am so frustrated with all these doctors. I totally understand their concern with addiction but I was told by a doctor at a pain clinic in Toronto that I would probably be married to narcotics for the rest of my life. The report was sent to the doctor who referred me to this clinic and yet she doesn't think I'm in that much pain."
This is part of my response:
"Unfortunately this is all too common for someone with a chronic pain condition. The most important thing I could tell her is not to give up.
The problem with the amount of pain we are in is it is pretty rare, something like 4-7% of neuropathy patients. So then doctors think we are drug seekers, at least the bad doctors. It sounds like you need a new neurologist. Don't give up because when it comes to chronic pain conditions usually you have to see many doctors before you find the right one. I found this link for you http://www.neuropathy.org/site/PageServer?pagename=phy_int_ca_ontario . Those doctors might be able to help. It is important to keep a pain diary. Include what u are capable of doing and not capable of doing. Make a list of what you need to ask the doctor. Unfortunately the frustration you are going through for someone in chronic pain is not abnormal. It is also not abnormal to have some fog, like short term memory problems. And, no depression is not uncommon. How can you be in so much pain all the time and not be depressed? My doctor put me on cymbalta and it helps with the pain too ..

Have any of the doctors run any tests on you like EMG or other neurological tests? "
Tomorrow is my turn for the doctor. Gotta stand up for myself, get a referral to a real neurologist. I also need to remember to call about my application to receive cymbalta for free. Must do that now before I forget again. Soft hugzzzz to all.
Also, please feel free to email me anytime. Any questions, concerns, frustrations, or if you just need to talk to someone who understands. You will find me at alonelydragonfly@aol.com. Also, I am on MSN chat under brokendamselfly@live.com. I look forward to hearing from you... chele

Slow Cooker Yogurt Recipe

8 cups (half-gallon) of milk (I used whole milk, but I'm told you can use 2%, maybe next time)


1/2 cup store-bought natural, live/active-culture plain yogurt as a starter. I used plain Dannon yogurt.

1 packet plain gelatin

 Plug in slow cooker and turn to low. Add the milk. Cover and cook on low for 2 1/2 hours. Turn off the slow cooker. Leave the cover on, and let it sit for 3 hours.


Scoop out 2 cups of the warmish milk and put it in a bowl. Whisk in yogurt and gelatin. Then dump the bowl contents back into the slow cooker. Stir to combine.


Put the lid back on the cooker. Keep it  turned off, in fact I unplugged mine, and wrap a heavy bath towel all the way around the slow cooker for insulation.


Go to bed, or let it sit for 8 hours.


Line a colander with cheesecloth and put it over a bowl in the refrigerator. The extra moisture will drain off, thickening the mixture. Your yogurt will last for seven to 10 days. Save 1/2 cup as a starter to make a new batch.

Yogurt is excellent for an easy morning breakfast or a nutritious late night snack. Pair it with some fresh berries. I love this with some artificial sweetener and strawberries. I also like to put the yogurt with fruit in the blender for a smoothie to go.
Plus, the enzymes in live yogurt are terrific for your digestive system. I'm hoping if I eat some everyday it will help with my irritable bowel syndrome.

Tips and Tricks (and Questions) for Your Doctor's Visit Part 2

Tip 1 - make a list of items you have been meaning to ask, or mention to, the doctor, like I did.



Tip 2 - bring someone with you who will speak up for you when you won’t do it for yourself. Sometimes. I don’t mention something to the doctor because I forget, sometimes, I don’t for other reasons. I think it is an insecurity that comes with invisible illnesses like fibromyalgia and neuropathy. You don’t want to say something to the doctor for fear of them looking at you or just overall treating you like you are nuts (or even worse…. A hypochondriac!). For me this is my friend, and the big sister I always wanted, Nan. She’s a bulldog.


Here are some important questions to ask your doctor:

• What tests will you do to diagnose the problem and which of the conditions is present?
• How good are the tests for diagnosing the problem and the conditions? What is the likely course of this condition? What is the long-term outlook with and without treatment?
• What are my treatment options? How effective is each treatment option? What are the benefits versus risks of each treatment option?
• If my symptoms worsen, what should I do on my own? When should I contact you?
• Will I need to take medicine? If yes, What kind of medicine?
• What should I know about the medicine? For example, what are the side effects?
• What if I forget to take a medicine?
• Should I avoid any foods or other medicines?
• Can I drink alcohol?
• How long will I need to take this medicine?
• My worse problem is pain but nothing I take helps - what can I take for the pain?
• Besides prescription medicines, is there anything I can do to relieve the pain?
• What can I do to improve my balance? What are the other symptoms of neuropathy that I should know of?
• Will I be able to continue driving a car and can I continue to work with my symptoms?
• Are there any alterative medicines or treatments that can help my numbness and tingling feet?
• Do you have any other suggestions?