What Happens When One Fat Patient Sees A Doctor.

Check out What Happens When One Fat Patient Sees A Doctor over on The Establishment. 

Written by Your Fat Friend (snap), it's pretty dead on.

I happen to be seeing a doctor right now who has had weight struggles himself, so he's understanding and kind, but he is not the norm. 

If you have someone who is shitty about your weight, and then also shitty about your mental health, it's really the most dehumanising shit to wade through. 

A common theme amongst friends of varying degrees of fatness is not being believed. There's no way we eat vegetables, or walk as much as we day we do, or don't eat junk food three times a day. We must be lying because we're ashamed of our fat-people-choices. 

Check out the essay. 

Neal Brennan on mental illness, the brain and TMS.

Starting around the 01:01:00 mark, Neal Brennan and Joe Rogan start talking about mental health, research on the brain and all sorts of offshoots of brain health and mental health. Brennan discusses his history with antidepressants and the constant work of seeking treatment.

It's a solid conversation. Rogan is interested and Brennan is an active participant in seeking treatment. You have to be when you're depressed - as is pointed out many times in this interview - very little is actually known about mental illness and the brain in general.

In his stand-up special, 3 Mics, he also talks about his experiences with ketamine (in the above podcast he's still in the process of that treatment) and his experience with TMS (transcranial magnetic stimulation). 

I'm going to ask Dr. Rishi about TMS, because Brennan says it helped him a great deal. It's covered by medicare in Canada, and it seems to be available at the MUHC.

I'd suck on a magnet if it alleviates some of my fucking pain. I've sucked on worse.

Update (2016-04-20) - Jenny over at The Bloggess posted about TMS, asking her (extensive) readership about experiences with it. Check out the comments section for more.

My doctor is missing, again.

Well, it happened again. Dr. Rishi is missing.

He was suppose to change clinics this summer. He let me know he was opening his own, which seemed great, since the walk-in clinic he was in was far away and the service wasn't great.

I called to make an appointment with him, and was told he was no longer taking appointments while he set up his new practice.

I saw him on the street outside of work a few weeks later (maybe in July), and he said I'd get a letter with the details of his new office "in August."

Cut to the end of October - where I've heard nothing, so I e-mail his former office, which says they don't yet have any details, and to call the office on October X to see if I can talk to him while he's in.

I call on said day and they ask me to e-mail in. I do. I receive this response:

Dear Patient,

I am currently out of the office and unavailable until November 7, 2016.

I am currently working to move my practice to its new location in Westmount. I will leave full forwarding and contact info with my current clinic as soon as available.

If you require a renewal of medication, please have your pharmacist send a request by fax to 514-281-3885.

If you have an emergency, you should go the hospital. If a non-urgent issue that you would like to be seen for immediately, please visit the walk-in clinic. All of your results and dossier will be transferred with me, and I look forward to seeing you at the new clinic!

Thank you, 

Dr. Rishi 

I do as it asks, I fax in, since my meds are almost up, and I also need an adjusted referral for a dermatologist, and, of course, wait for it, the fax number is out of order.

Ghosted!

Still defining depression.

There's an article over at The Atlantic today entitled Why Depression Needs A New Definition. The article peruses past and present namings of depression and their etymology.

In 1969, the American existential psychologist Rollo May wrote in his book Love and Will that “depression is the inability to construct a future,” while the cognitive psychologist Albert Ellis argued in 1987 that depression, unlike “appropriate sadness,” stemmed from “irrational beliefs”—“absolutistic, dogmatic shoulds, oughts, and musts,” he wrote—that left sufferers ill-equipped to deal with even mild setbacks.

I always find this interesting, because I'm driven to find language that aids the representation of suffering from depression. Context, and whom is defining depression (or any mental illness) is so important, and credibility (in my eyes) isn't necessarily based on a medical degree here. But, what is used by the medical community affects the legitimacy of my condition as well as the way I'm treated by the medical establishment.

The worry is that the DSM (The Diagnostic and Statistical Manual of Mental Disorders) is still vague when it comes to depression. There still seems to be a lot missing, and varying degrees of depression and a cacophony of symptoms are all given the same weight. As Tom Insel from The National Institute for Mental Health is quoted as saying in the article:

Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.

Bruce Cuthburt (also from NIMH) adds:

Our current concept of depression is left over from times when we didn’t really understand it very much. We know so much more about it now—physically, genetically, neurochemically—and we should be using that.

It just seems like so much about mental illness is unknown. There is still so little fact regarding something I'm living with. I'm on meds - I'm on increasingly more meds. Will my generation be that who lived and died by depression the way people died flu's we now don't even think about? How much of what is being talked about as science and medicine is actually just the result of guess-work and lobbying?

Now you Doctor, now you don't.

HAHAHAHAHA!

Finally got a family doctor after 15 years without one. I was waiting to hear back from him about a psychiatric evaluation I did so I sent him an e-mail.

I got one from the secretary back, and was just told he no longer works at that clinic.

I had a family doctor who was engaged, caring, open, interested and had excellent bed-side manner for all of a month.

WHATEVER I GUESS I'LL JUST DIE THEN.

Afterwards.

It’s taken me a few days to get around to writing about my experience on Wednesday, since after the nearly 2-hour session I had a headache from talking so much.

I was pleasantly surprised by the whole experience.

I expected Dr. Singh and his team to be older, and well, shitty. They weren't. Dr. Singh seemed pretty young, maybe late 30’s, and his students were two early 30-ish folks, one male, one female. The conversations went well, they were receptive and seemed to be actively listening and engaged in trying to figure me out.

Apparently this will lead to a report that they will then give to my doctor. I spoke to a friend about it, and she said I should ask for a copy of the report (this hadn't occurred to me). We’ll see. I have an appointment with my doctor at the end of the month, it’ll be interesting.

Like I said, I left the session with a huge headache, it was just intense. It’s like running a sprint, but emotionally and intellectually. It's just so much talking, so much reflection.

I always find it so intense when you’re expected to recite your history. Your medical history. Your social history. I have such a bad memory for time lines and dates - it just seems like such a jumble. It also means sometimes really thinking about these things, when maybe you haven't - ever.

The entire day was odd - I should have started with that. The taxi drive over involved an aggressive cabby who asked a lot of personal questions in a pretty aggressive tone. Including gems like, “Why are you going to the hospital?” and “Are you married?”

Once I got there, the tiny hospital was a bit of a surprise. I made my way to the psychiatric floor - something I hadn't prepared myself for. Seeing folks in pyjamas with bandages on their wrists is very - pulling.

The waiting room was an exercise in staying calm and avoiding eye contact. This one person was just an avalanche of inappropriate comments and invasive questioning. 

A: Why’d you buy a coffee?
X: Um, because I wanted one.
A: Women always buy coffee.
X: That’s not true, guys like coffee shops too.
A: Then they’re gay.

I would read the person (A) as gay, so this was actually cute. But then stuff got progressively weirder.

A: You’re standing and leaning on the wall like you’re from the 1920’s.
Y: Oh….?
A: It’s good for your back. Stay there.

Anyway, it was just constant. There’s something about people with little or no filters - about how they could say anything at any time that’s just terrifying. Especially true things. Can they see everything that’s wrong with me? Why wouldn't they, isn't it obvious? What if they just rip me apart?

As if any of it is worse than the fear of what I really am.

Maybe he'd look at me, and see all of my flaws and just shower me with them. That's the fear. He'd list them, my shortcomings. My disgusting nature. Accuse me of my worst parts.

And then I'd be exposed. A raw nerve. An unclothed, grotesque body. To be pointed at, and ridiculed. To be jeered with revulsion.

That is the voice inside my head.

Walking into judgement.

I was lucky recently. A friend posted on facebook that a clinic in Westmount was taking new clients for gynaecologists and a few family doctors. I called and booked an appointment right away. My first appointment went really well. I really like my new doctor, he seems to be genuinely caring and concerned. He's young, and approachable, and doesn't seem like a douche. Our report was excellent, and he was engaged and listened.

My first appointment with him also meant discussing why I was there. This meant broaching my issues with mental health. I gave him a sparks notes version, and he ended up referring me to Dr. Singh, who is apparently part of McGill University's psychiatry department, and is heading up some type of practice at St-Mary's hospital. I called and booked an appointment, and a month and a half later, here I am.

My appointment with Dr. Singh is tomorrow around noon. I have mixed feeling about this.

Of course, I want to do everything I can to supply myself with emergency services and support if I ever need them. I want follow-through. My doctor seems to think Dr. Singh can potentially refer me to free or sliding-scale services I've yet to find. Maybe he's a wizard.

I also have a desire to be clinically assessed. I've experienced doctor's of all kinds, but I've never been clearly diagnosed. My assumptions are my own. Certain terms have been used. Nothing is official.

The only reason I'm even worried about this, is that months ago when a walk-in clinic doctor refused to be my doctor, he said psychiatric cases frightened him and that he wasn't comfortable taking on the responsibility of someone "like that."

What if one day I'm hit by a wave of depression so bad I can't function? Will it being clinically recognized aid me in asserting the legitimacy of what I'm living?

The legitimacy of my mental illness can only be recognized by others - since my brains and insides are nothing but glumness and tricks. How can faulty wiring calculate it's own efficiency?

And so I am filled with a sense of dread about tomorrow. I was told I would be evaluated by three doctors. Two residents and Dr. Singh. I will be asked to lay everything out. I will be asked questions I don't feel are pertinent. I will be asked questions that are cutting to me.

I want to think if I feel something is inappropriate or that someone is being a dick I'll have the gaul to say something about it. But I'm not sure. These spaces for assessment are cold and difficult. And as is often the case, so are the assessors.

How is it one can be a doctor of the psyche, yet have so little understanding of compassion and empathy?

Maybe I'm getting ahead of myself...

I sit here and try and think of the things I should or could say tomorrow. It ends up a long list, a long list of ways in which sickness can warp into different areas of your life.

Are there links I can't see? Are the habits I feel trap me, obvious to others?

Can you see that I'm in pain by looking at me?

I have questions. But that's not what tomorrow is about.

I am going to try and be... not bitter. It's very difficult. There are only so many times a doctor can ask you to regurgitate your pain without it leaving a bad taste in your mouth.