Wednesday, April 25, 2012

Putting the Needles Away for Now

Hi Bipolar Knitter fans,

I have decided to hang up the BPK needles for right now.  I'm not doing well keeping up with my posts, and I've kind of dropped out of lots of parts of my life at the moment.  I guess the ultimate problem with suffering from mental illness is that it kind of rules you sometimes, and even best-laid plans go astray.  I plan to pick this blog up again sometime, hopefully in the near-ish future.

In the meantime, check out amykrug.com for my other blog.

Thanks for reading!
Amy

Saturday, March 17, 2012

Update on New Year's Resolutions

Way back in January, I wrote a New Year's Resolution post about my one very small, seemingly easy resolution:  to stay out of the hospital.  Sadly, Monday I'll have to break that promise.

I managed to get through this last bout of anxiety and hypomania without having to go back into the hospital (it was touch-and-go, especially at the end of this week), but I have to go into the hospital Monday to get a lovely hernia taken care of.  Most hernia repairs are laproscopic and out-patient, but I get big hernias that take a team of people to fix (I don't really know that, but I know it's big and complicated) and will be in the hospital for at least a night, possibly up to three.

So send me good vibes and let's hope this is the last time I hear the word "hernia" in relation to me like, ever (I had another a couple of years ago which sucked).  When I'm back vertical I'll let you know how it went.

Wednesday, March 14, 2012

What Does Your Brain Tell You When You're Depressed?

One of the fun parts of hypomania for me (I use the word "fun" sarcastically) is that not only do I get depressed, anxious, and revved up at the same time, usually my depression and anxiety are the things that get revved up.  So my brain goes a mile a minute, but it's going a mile a minute about how horrible I am, what a bad person I am, and how I'm going to hell.  See?  Fun.

The hell thing is a recurring thought; every time I get hypomanic, that's what I tell myself, over and over again.  I'm  lousy person, a lousy parent, ugly, fat, and worthless, and my ultimate punishment (as if having these thoughts isn't punishment enough) is an eternity in hell -- whatever that is.  I know a lot of this can be chalked up to Catholic guilt, but I think it's more than that, too.

I think when you're depressed or anxious, your brain seizes on the most convenient negative thought possible and replays it and replays it like Elf on TBS at Christmas. I'm still working on how to get it to stop the replay; as far as I can tell, it's not as easy as pushing a button.

Does your brain tell you something over and over again when you're depressed?  Is there a thought on replay in your head?  Have you figured out how to turn it off?  If you have, more power to you.  If not, join the club.

Monday, March 12, 2012

But You Look So Good!

A while ago, I sat in a room listening to one woman tell another that even though she was depressed, she looked so beautiful and professional and "together."

I know this woman was trying to make the other feel better; I mean, who doesn't want to hear they're beautiful?  But having been on the receiving end of the same kinds of compliments (not recently -- recently I look like I've been beaten by the ugly stick), I know that when you feel ugly and crappy on the inside, usually the last thing you want to hear is that you look good on the outside.  I don't speak for everyone; I know there are people that this kind of compliment would make them feel better, and more power to them.  But for me, this kind of compliment is not helpful.

I think there's something about someone saying, "But you look so good!" when you're depressed that can minimize your internal suffering, at least in my experience.  It's like the complimenter (is that a word?) is saying, "But you look so good -- you can't feel that bad!"  Unfortunately, you can look beautiful and feel like complete shit on the inside.  Look at all the celebrities with eating disorders, drug and alcohol problems, and horrible relationship trouble.  Of course they look beautiful.  That's what they do.  But they probably don't feel beautiful.

I had a doctor's appointment this morning, my fourth in three weeks.  I actually considered putting on mascara this morning, and then a little voice told me not to, because, while I've been feeling somewhat better, I still don't feel great -- and I didn't want her to see mascara and think, "Oh, she must be better."  I would think I could expect more from a doctor, but you never know.

It's just another example of how we can't judge a book by its cover.  I think a lot of people still have the mental picture of depression and mental illness as a disturbed person on the streetcorner raving about academic fraud (a nod to my UD friends) or the end of the world, a person you cross the street to avoid.  That woman in the three-inch-heeled boots at Starbucks, the woman pushing her baby in an expensive, pristine stroller, the woman in the office next to you that always has her hair done so nicely, they may all be suffering from various forms of depression or mental illness.  Just because they "look good" doesn't mean they feel good.  It also doesn't mean they don't rant about the end of the world, but that's a different issue.


Wednesday, March 7, 2012

The Unending Chain of Side Effects

I saw my psychiatrist today, as I have the last three Wednesdays.  Let me first say, that despite the fact I have to drive over an hour down and back for my twenty minute appointment, I really do like my doctor.  She seems really on top of things, and also seems to be interested in continually expanding her knowledge.  To a teacher, that's pretty much the best personality trait anyone can have.
The reason I'm seeing her so frequently is that I'm trying to change meds.  I was on a ton of Seroquel plus lithium, and we're trying to phase out the Seroquel and get me on another atypical antipsychotic.  Last week, she cut my Seroquel almost in half and prescribed Abilify, something I was on a long time ago but don't remember a lot about.

Turns out, the Abilify (like Geodon before it, another atypical antipsychotic) gives me akathasia.  Akathasia, in lay terms, is when you get really antsy and jittery and feel like you can't sit still.  It was worse on the Geodon, but it seems to be getting steadily more irritating the longer I'm on Abilify.  So to combat the akathasia, my doctor prescribed a drug called Propranalol that works by lowering your blood pressure and making you less antsy.

To make a long story shorter, it ends up I can't take the Propranalol because it gave me chest pains, made me a little shaky, and I have a level 1 AV block (a very minor heart condition) that isn't a big deal by itself, but could be an issue on the medication.  So now we have to change directions and move towards Depakote rather than Abilify.

The problem with Depakote?  It causes weight gain, which is one of the reasons I was trying to get off Seroquel in the first place.  So now I have to go to my primary care doctor and see about taking a drug for diabetes 2 called Metformin, which helps with weight loss. 

I talked a few days ago about the idea of getting off of meds completely; this whole side effect debacle makes me even more interested in the idea of getting off drugs.  I feel like we're getting to the point where we're managing side effects more than we're managing the underlying problems, my bipolar disorder.

Does anyone with chronic problems have this same issue?  The daunting task of managing side effects?  Of taking drugs to offest the drugs you're taking?  It's frustrating, and if I didn't have anxiety problems already, I'd definitely have them now. 

Tuesday, March 6, 2012

The AM Crunch

I hate mornings.

Like, with a passion.  Detest them.  I hate them even worse on the weekends, when my husband, who knows I hate weekends, still won't get up on Saturdays to deal with them (in his defense, he usually does get up Sundays).

I hate waking up to a kid standing next to my bed, staring at me. I hate being exhausted, but having to drag myself up anyway.  I hate trying to go to the bathroom and get dressed while a mobile child stands whining that they want breakfast/want to watch TV/want to go to the zoo/whatever, while the baby lays in her bed, screaming to be changed/fed/whatever.  And then I hate having to hit the ground running, once I manage to pee and pull my hair back I have to practically move in super-speedy motion to get breakfast, change clothes, do hair, make beds, and all the rest.

So, yeah, like most moms, I hate mornings.

The last couple of weeks, courtesy of my therapist and a friend (thanks Robyn), I've been reading some books on trying to take control of your life and live more zen.  One of the suggestions made by my therapist, coming from the book The Artist's Way by Julia Cameron, is to try to journal three full pages before I get out of bed.  Pretty much, I wake up, sit up, and start to journal.  The idea is to try to purge all the "to do" type stuff in your head before you get out of bed, and to try to start the day fresh and open.  Incidentally, The Way of the Happy Woman (the other book I'm reading) suggests, similarly, to get up early, before anyone else, and engage in some sort of ritual that will energize you for the day (like journaling or doing yoga). 

I'm happy to report that for the last few days, I have been taking this suggestion and journaling before I get out of bed.  The first day, it seemed to help; I felt a little more calm and mentally "clean."  Yesterday it also seemed to help; I got up, then my kids got up at separate times, and I even played some nice, relaxing ambient music in the kitchen to try to keep everyone calm.

Today, well, was a different story.  I calmly wrote in my journal, but then my baby started hollering, so I had to deal with her.  After I got her out of bed and then dressed, my three year old immediately got up, doing this irritating cry/whine/shriek thing that she sometimes does.  The sound is the audio equivalent of someone sticking an ice pick in my eyeball.  Then my five year old got up, demanding to watch "The Octonauts." (seriously, is anyone else's kids totally addicted to this show?  I don't get it.)  The whole time, I could feel the calm I'd established like a nice, warm blanket draped over my brain.  By the time I got the baby her food, the blanket was on fire and I was bitching at my kids like a snapping shrimp (sorry, too much "Octonauts").

The one good thing I'll say about today is that I think it did take me longer to get to my tipping point with my kids than on normal mornings, so I think I was still getting benefits from journaling and trying to create a calm start to the day.  But nothing will stand up to my three year old's shriek noise, so I should just give it up.

I'll keep journaling before everyone gets up, and maybe the benefits will accrue.  Even better, after I journal, maybe I'll leave the house and go get coffee and stay away for about an hour.  I think THAT would create the best calm I can think of.

Thursday, March 1, 2012

Hey, I'm Back -- And Large and in Charge (Sorta)

Finally, an update.

I've had a rough few weeks, and couple that with the fact that even if I'm in a good mood, using my computer usually makes me want to break something, I've just kind of avoided any serious computer stuff altogether.  Which isn't an excuse, but it is a reason.

So, like I said, I've been having some rough times the last few weeks.  What am I doing about it?  Well, I'm glad you asked.

I've been trying -- albeit somewhat half-heartedly -- to take some control of my life.  A while ago I wrote about a blog post on OwningPink.com that discussed how many people may be able to get off antidepressants and help their moods themselves through exercise, eating, and the like.  When I wrote about it, I kind of scoffed at the idea, and pointed out that sometimes, medication can be empowering, rather than disempowering. 

The thing is, ever since I wrote about that blog post, I haven't been able to forget it.  It kind of lodged in my brain and won't leave.  I still don't know if I buy all of what she's selling, but I know I'm sure tired of feeling like crap.  I'd also like to avoid further ECT treatments, and further hospitalizations (both options that have  been discussed the last week or so).

I've taken a few steps to try to help myself out.  I said before that it was "half-heartedly," because I don't really have the energy to do much of anything full-throttle, and of course, if I fail, I can say that I only half-assed it, so that's why I failed (nothing like setting yourself up for failure, eh?).  So this is what I've done:
  • Stopped drinking Diet Coke, and all soda.  I've read so much about how bad diet pop is for your body, and how it makes you fatter, plus I know there are bad chemicals in there
  • Thought about going all vegan/organic, and stopped eating meat.  I am approaching this in stages; first, the meat, then all the animal or not-cruelty-free products.  I'd like to move my family over to this kind of eating as well, and I found an interesting food blog called PeasandThankYou.com that has an associated cookbook.  All the food is family-friendly and vegan.  Again, I'm doing this because I'm tired of thinking about the chemicals, hormones, and other icky stuff that is in our food -- and, even more so, in my kid's food
  • Started journalling again
  • Got a new therapist, and have actually kept my appointments with her
  • Tried to do more yoga, on a more regular basis.  I had to give up the treadmill because of my wonderful hernia (which I'll have fixed in about three weeks), but yoga doesn't bother me
  • Have been getting out of the house more.  Rather than sleeping whenever I have a babysitter, I've been trying, at least for a little while, to go run some errands or even just drive around in order to get out of the house.  There are days when I really, truly, detest my house -- I want to bash the walls with a baseball bat.  I think that's a sign that I need to get out
That's about it.  Remember, as I said, I haven't been doing any of these things  super consistently or anything, and I still feel like crap (though I do feel better than I did).  I'll keep you posted on my life-improvement quest.

Tuesday, February 14, 2012

Lingering ECT Side Effects

I've written before about some of the side effects that I've encountered after my 10 ECT treatments this winter.  I've had problems with finding the right word when writing, I've been overly tired, had slight memory loss, aches and pains, and other stuff.  But lately I've noticed two really odd things that I'm chalking up to ECT as well.

The first problem is hard to describe.  The best phrase I've come up with is "brain quake."  I'll just be sitting or standing somewhere, and it's almost like something in my brain snaps or slides and I feel really dizzy, just for a second.  It's so bizarre.  The best comparison I can draw is when you're trying to go to sleep, and all of a sudden you feel like you're falling and you jerk awake -- but it's more cerebral and less physical.  And the "snap" or "slide" feeling I get is always on the right side of my head, which is the side I had my treatments. 

The first time it happened I just chalked it up to some one-off weirdness, but then it kept happening.  I especially get it when I'm reading or concentrating on something.  It's more than a little unpleasant, and I wish it would stop.  I find it strange that it didn't start until I was actually done with my treatments, but maybe it's my brain's way of trying to get back in shape, or something.

The second odd side effect is a strange tic in my hands and legs.  I'll be laying in bed reading a book, or typing on my computer, and suddenly my hand or leg will just spasm.  It's a pretty noticeable spasm, too, not just a little jerk.  It'll happen in both hands, but more often in my right, and in both legs, but more often the left.  It's annoying.

I have to say, that it is possible that the hand tic thing is linked to increased lithium, as my doctor is trying to up my dosage. I don't want to unfairly blame ECT, so I'll throw the possibility in there that it's the lithium rather than the ECT.  But I'm still leaning towards the ECT, as I've been on lithium before but have not had ECT before.

Anyway, I'm not writing this just to bitch (though that's not all bad, either).  I'm also trying to document my personal experiences with ECT, as much for myself as anyone else.  But thanks for putting up with it.

Thursday, February 9, 2012

Depressed Parenting

This week I've been a little grumpy.  I've been working on changing my medication so I am not so tired all the time (400 mg of Seroquel will make anyone a little sleepy), and I think it's having a somewhat negative effect on my mood at the moment.  I think it's one of those things that when I get over the hump, I'll be better for it, but it kind of sucks right now.

So as a result of being in a bad mood, I've been a little short with my kids.  Nothing horrible, but I'm just a little quicker to snap or yell at them than usual, and have been engaging a little less.  It's nothing that's going to scar them for their whole lives (at least I don't think), but it's still not good.

The worst part, though, is that all three of my kids (the 10-month-old included) have all been grumpier and more difficult all week.  I find that so odd.  There's a respiratory thing that keeps bouncing around between all of us, which isn't helping matters, and the weather has been typical Ohio in February -- cold, gray, depressing.  So there are a lot of reasons why they may be in bad moods that don't necessarily tie back to my mood.  Or maybe we're all grumpy for some of the same reasons, I don't know.

I just know that more often than not, it seems like my kids' moods reflect or match my own.  A while ago I wrote a post wondering if babies can read their mothers' moods; I think kids have to be included in this question as well.  In theory, they should be happy -- I usually let them watch more TV than usual and cook them stuff that I know they eat (like hot dogs) rather than cooking something that they may or may not eat (nothing kills my mood more than getting up the energy to cook, and then having everybody turn up their nose at it).  But it doesn't seem to work that way.

This article at HealthyPlace.com talks about how children of depressed parents are more likely to not only be depressed, but act out and have other behavioral problems.  So I guess there are studies that show that parents' depression can affect kids.  Another reason to feel bad, right?  My depression is making them depressed -- how depressing. 

For now, we'll just keep muddling through and hope my med changes do what they're supposed to do.  Until then, let's watch Mulan for the fiftieth time and just feel good that at least she's a strong female role model.

Monday, February 6, 2012

Owning Our Antidepressants

On Saturday, I happened to read this guest blog post at OwningPink.com, about how the author believes that, contrary to what most modern medicine tells us, depression and anxiety are not physical ailments.  Instead, they really are "in the head," and, unlike a physical ailment like diabetes, medication is not the answer.  In her words, "attributing anxiety and depression to a chemical imbalance is horribly disempowering," and by prescribing antidepressants we're "throwing in the towel" and abdicating responsibility for our mental health.

The author, who is a Ph.D. in Psychology, cites some interesting statistics from a few "anti-antidepressant" books.  She says one doctor believes that as many as 75% of the people taking antidepressants could "significantly reduce" or eliminate their meds with the help of a doctor and lifestyle changes.  She also mentions one doctor who believes the whole "serotonin deficiency" approach to depression is a sham, and is based on some questionable, at best, science.

When I first read the article, I was irritated and a little mad.  I though her attitude was a little too simple, and a little too self-serving.  I also took some issue with her "research," as all her information seemed to come from the same two sources, and she goes on to contradict some of the research she presents.

Okay, so let's talk about the author (it's all about ethos, people).  Her name is Bethany Butzer and she has written a book called The Antidepressant Antidote, is a speaker on the topic, and is also a yoga instructor.  On her website, she classifies herself as a "Mental Health and Wellness Advisor."  The topic of getting off of antidepressants is obviously her passion and her platform.  She does say that she thinks antidepressants are good in some circumstances, and if they've helped someone get through a bad patch then fine, so she's not exactly "anti-antidepressants," she's more "uncomfortable" with antidepressants.

The more I thought about the post, the less irritated I got and the more reflective.  There were a few things she said that kind of made sense, that I think I agree with.

One point she made that I do, more or less, agree with:  she says, "I think our acceptance of this [idea that depression/anxiety are a result of a physical problem] reflects our longing and desire for a simple solution." I think most people who are depressed enough to consider going on antidepressants would love a "quick fix" -- who wouldn't?  And I think that in our society we tend to demand fast, easy solutions.  The irony here, I think, is that antidepressants usually take 3-6 weeks to work, and that's if they do work.  They really aren't that quick-acting.  

I think my biggest issue is with her general hypothesis, the idea that antidepressants are "disempowering."  I can see where the idea comes from; that if we have a medical problem, there's nothing we can do about it other than take medicine and wait for it to work.  But that's not entirely true.  If we think about diabetes, the go-to comparison illness for depression, there are lots of lifestyle changes a person can make that can improve their medical condition; the same goes for illnesses like heart disease and arthritis.  You may never be able to cure these problems, and these lifestyle changes usually have to work in tandem with medication.  But a person who manages their diet and exercise and takes insulin is going to be a much healthier diabetic than someone who takes insulin alone (something I'm trying to make my diabetic cat understand, but he's not buying).

My other thought is, what if we view antidepressants as empowering, instead of disempowering?  Rather than looking at medication as something that strips us of responsibility, it is something that enables us to be responsible. When someone is at the point where depression or anxiety has gotten so bad that they are visiting their doctor or a psychiatrist, the last thing they want to hear is, "It's all in your head.  It's up to you to fix yourself.  Start going to yoga and get on the treadmill."  Hell, I'd wager that 9 times out of 10, that's going to make someone more depressed.  But if the doctor says, "Okay.  I can give you this medication, but it's going to take a while for it to work.   It'll help you, but it will help more -- and quicker -- if you start going to yoga and get on the treadmill."  If you feel like you have a little bit of help, that you're throwing fixes at the problem from more than one direction, you are going to feel better faster -- regardless of if the antidepressant is really working on a serotonin deficiency or not.

In general, I kind of waffle about antidepressants.  I do think they are over prescribed, but I think they also help a lot of people.  I also think you'd have to be living under a rock to not know that exercise, a healthy diet, and other lifestyle choices help fight depression (that doesn't mean that people always make those healthy choices, but hey -- free will's a bitch, right?). 

Wednesday, February 1, 2012

A Phrase You've Never Heard: Antenatal Depression

As I mentioned in my last post, I'm working on a book proposal about depression in pregnancy.  For the entire time I've been working on this project, I've struggled with what to call "depression in pregnancy."  Is that the best phrase?  Is "depression during pregnancy" better?  Is "perinatal depression" right?  Is "prenatal depression" better?  As you can probably see, the phrase "depression during pregnancy" is kind of clunky and gets unwieldy when you're using it a lot, so I was getting kind of desperate to find an alternative.

I happened to have an appointment with my psychiatrist this week, and I thought maybe she'd know, so I'd ask her.  She told me the appropriate phrase is "antenatal depression," while "perinatal depression" means any kind of depression during or after pregnancy (i.e., it includes postpartum depression as well).  I was quite excited to actually find a phrase for what I've been talking about.

The only problem is that I didn't ask how to spell it.  I wasn't sure if it was "antinatal" or "antenatal."  So, like most people, I decided to turn to the most authoritative reference around:  Wikipedia.

And, wouldn't you know it -- Wikipedia didn't have a page on either "antenatal" or "antinatal" depression.  Can you believe it?  It wasn't on Wikipedia.   I still figured out how to spell it (it's "antenatal," fyi) because there were a few other pages that had links to information about antenatal depression, so I still accomplished my goal, but I was kind of stunned.  I was thinking that maybe all this time I just couldn't find the right resources because I didn't have the right phrase, but I was wrong.  I did find a page on postpartum depression, of course, and just about everything else I looked up while testing the theory that Wikipedia has a page on everything (random crap I looked up:  Dr. Zoidberg - a character from Futurama; Susan Stafford -- the original letter-turner on Wheel of Fortune; and a page listing all the Salute Your Shorts episodes).

So that's all I really wanted to say today.  That there is a clinical phrase for depression in pregnancy:  antenatal depression.  And that it's such an obscure topic-- despite estimates that as high as 25% of women suffer from it -- that it's not even listed on Wikipedia.   But now you know the phrase, and you can pass it on.  Don't you feel educated?


Monday, January 30, 2012

Looking for the Right...er...What's That?...Oh, Right! Word!

Last summer, I started to put together a book proposal about my depression issues when I was pregnant with my third daughter.  I searched and searched when I was pregnant, and there were virtually no books or resources about depression or bipolar disorder during pregnancy, and it was horribly frustrating.  It was one of those experiences that even when I was going through such a sucky time, and I was miserable and psychotic and almost out of my mind, one of the few lucid thoughts I had was, "Somebody's gotta address this issue."  That's how this blog was born, in fact.

Anyway, I stopped working on the book proposal for a while (for non-writers, just so you know, writing a nonfiction book proposal is a pain in the butt -- there's very specific information that needs to be in it, it requires research, and it's pretty involved), and am just now getting back to it.  Which, by the way, I think is probably a good sign, but that's not why I'm talking about it.

Why I'm bringing it up is because this is the first brain-bending writing I've done in a long time (not counting this blog), and my brain is totally resisting it.  I don't know what the problem is, but it honestly is a huge effort just getting through a sentence.  I can't find the right words or the right phrases, and nothing seems to sound right.  It's really frustrating.

I know all writers go through tough times now and again; there are plenty of times I know I've sat, staring off into space, struggling for the right word or the right way to phrase something.  And trying to write with three kids needing this, that, and the other every 30 seconds doesn't help, either.  So I think it's a little premature to blame this brain struggle on my ECT treatments -- but I have to kind of wonder.  I mean, it's nothing that would keep me from writing, or that's crippling me, but I definitely feel a little foggier, a little denser, than I normally do.

Maybe I'm just out of practice; maybe it's the lingering depression I'm still fighting.  For now, I'm going to blame those things.  But if it keeps up, I'm going to have to start wondering if the ECT had more side effects than I originally thought.

Friday, January 27, 2012

Dr. Oz and His "Controversial" ECT Show

At the beginning of this week, a few thoughtful people alerted me to the fact that, on Wednesday of this week, Dr. Oz was doing a show about Electroconvulsive Therapy (ECT). I was pretty excited, because Dr. Oz is about as mainstream as it gets, and to have ECT discussed on a mainstream show like that could be really helpful for a lot of people.

I think he did a pretty good job of talking about ECT in general; he had a couple of doctors (notably Dr. Keith Ablow, who used to have his own show, and is a fixture on "Fox and Friends"...hmmm), and also spoke to a few people who have had ECT. One, Julie Hersh (she writes about her experience with Dr. Oz here), is an author of the book Struck by Living: From Depression to Hope and also is a public advocate and speaker about mental health. The other patient Dr. Oz spoke to, Susan, was a "normal" person (i.e., no book, no speaking engagements, no websites -- just a woman who has had ECT treatments). He actually got her permission to film her having an ECT treatment, and showed it during the segment. You can get the videos of the segments from the show here, on Dr. Oz's website.

Dr. Oz started the show by saying it was one of the most "controversial" he'd ever done, but amusingly, there wasn't much controversial about it at all. In fact, it was kind of a glowing, enthusiastic commercial for ECT; I kind of wondered if he was getting a kickback from the ECT machine manufacturers (there was even a pretty obvious close-up of the machine in one clip). The doctors he talked to maintained that there were few, if any, side effects for most patients, that cost shouldn't be an issue for most patients because insurance usually pays for treatments, and that it was 80% effective in treating major depression, which was a much higher success rate than most antidepressants.

As he ended his discussion (which, I was disappointed to find out, only lasted half the show -- the other half was about being tired, or something), he said that he was just trying to "start a conversation" about this topic. He wanted to let people suffering from depression or other mental illnesses know that this option was available, and the treatment wasn't like what most people thought it was. I think he accomplished this.

However -- and it turns out that the National Coalition for Mental Health Recovery agrees -- I think the discussion was a little one-sided. While there was passing mention of memory loss as a potential side effect, it was pretty much glossed over as a mere annoyance. I know a lot of people have had significant memory loss as a side effect of ECT, and that side effect shouldn't be ignored. There's also the time commitment of the treatments themselves, which wasn't discussed, and the risks associated with general anesthesia that are always present. And then, of course, there's the risk of spending a ton of time and money on treatments and having them not work, or work only as well as medication does. In addition, in their response to the show, the National Mental Health Coalition said that the claims of 80% effectiveness were "'vastly exaggerated.'"

It's kind of an interesting coincidence that this show aired this week, because this is the first time in six weeks I have not had an ECT treatment. And you know what? I've kind of had a shitty week. I've been up and down, but it seems like mostly down. And I've been extremely irritable and prone to angry outbursts. Perhaps the most concerning change that I've noticed this week was that my urge to self-injure has returned. It was almost like magic when I started ECT that my desire to cut just disappeared, and it pretty much stayed gone...until I stopped treatment.

I don't know what this means. Does it mean that I have to have ECT treatments the rest of my life? I was under the impression that ECT helped on a more permanent basis; it wasn't just effective right around the time I would be having treatments. But maybe I was wrong, I don't know. I know it's concerning. And I also know that no matter what Dr. Oz says, or how safe and wonderful a treatment it's supposed to be, it still kind of terrifies me, and I don't really want to do any more treatments any time soon if I don't have to.

Did anyone else see the show? Any thoughts?


Tuesday, January 24, 2012

Parenting is Hard, Bipolar or Not

Yesterday was a horrible day.

I had pushed myself too hard on the treadmill the night before (I'm in that awkward stage where I'm really too fat to run, but too impatient to walk), so I woke up with with bad abdominal pain from aggravating some existing hernia issues.  So, right there, things were bad.  Then my three year old woke up acting as if she had been possessed by a demon sometime during the night, which was bad enough, but she also decided she was going to take the five year old down with her by baiting her into her own screaming tantrums. Throw in the normal morning crap -- the baby not wanting to eat, bright blue yogurt on the beige carpet, not wanting to brush hair, etc. etc., and I was a crying, hysterical mess by 9:45 a.m.

My morning dose of Xanax helped a little, and my mother coming over helped a LOT, but all day long I had overwhelming guilt issues.  I should be able to handle this crap myself, shouldn't I?  I mean, all moms have bad mornings, but they don't go crawling to the Xanax bottle or Grandma to get through.  I hate that I can't grit my teeth and do my job (seeing as how being a full-time mom is my current job).  I just could not pull myself together; I was crying, cursing, angry, and irritable.  I hate my kids seeing me like that.  Not to mention I'm much more likely to snap or yell at them, which I really hate.  My five year old, especially, is very sensitive and gets very upset when she's yelled at.

And all day long, I kept thinking about this blog post I recently read from the website BlogHer (it's a blog directory that I can't exactly figure out the point of, but anyway) entitled No Excuses:  Parenting Isn't Hard, which made me roll my eyes so hard I thought I sprained them.  The author's point was that it's not "hard" to avoid yelling at your kids, grabbing them, getting in their faces when they do something wrong, and that people use the excuse that "parenting is hard" to explain yelling at and treating your kids poorly. 

The analogy she bases her argument on is that if you were in a fast food restaurant and saw a man yell at a woman for spilling her drink, grab her by the arm, and drag her out the door, you would be appalled and maybe even say something.  But if you see a mother do that to a kid, it's just "life as usual."  And while I agree with her that it's never okay to abuse a kid (if you consider that kind of behavior abuse, which I kind of think is up for debate), her point that it shouldn't be "hard" to not yell at your kids, to always treat them lovingly, not not lose your temper -- all because they are "small, dependant people" and we love them so much that (in her words) we should want to "snatch [them] up and squeeze [them] to bits in a fit of overly-emotional love-smush."

Uh.  What?

I won't even get into why the analogy is faulty to begin with, or how ridiculous the phrase "love-smush" is.   I'll just deal with the general argument.  Now, I probably have more irritability issues than a normal person, but I think the idea that it's "easy" to not lose your temper with your kid just because you love them so much is a tad...freaking insane. 

Of course I love my kids.  Even on mornings like yesterday, I love them.  But I admit, I don't always like to be around them.  And yeah, I lose my temper and yell -- but it's not because I don't love them, it's because I can only take so much.  When I tell three year old to take her yogurt to the kitchen because the baby was going to get and spill it, leave the room, and two minutes later hear the five year old yelling that the baby spilled the yogurt because the three year old didn't move it, these children that I love are incredibly, unavoidably frustrating.  And, oh my God, parenting is the HARDEST job I have ever done.  No, it's not complicated;  no, it's not intellectually taxing (usually).  But it's intense, and it's exhausting, and it never ends. 

Am I crazy (well, crazier than I thought)?  Am I in the minority?  Do most people think that parenting isn't hard?  Is there something wrong with me that I'm not constantly overcome with the desire to "love-smush" my children?  Is this attitude another side effect of my bipolar disorder, and should I just crawl back to my mind-numbing meds?

Somehow, I suspect if you took an informal poll of moms, most of them would say that, at least at different times, being a parent is hard.  But maybe I'm wrong.  Maybe I'm the one who is flawed.  If so, I guess I'd better call and get my psychiatrist to up my Xanax dosage, because hard or not, parenting is one job you don't have the choice to resign from.

Friday, January 20, 2012

Goodbye, ECT, and Good Riddance

Wednesday was my tenth and last ECT (electroconvulsive therapy) appointment.  I am so very excited to be done with these treatments, I can barely contain myself.

Oh, the things I won't miss...not having to drive 45 minutes each way for every treatment...not having to wait in the inevitible backlogged queue for it to be my turn when I'm finally there and ready...not having that "lost time" feeling every time I wake up...not wanting to sleep for two entire days after the treatment.  (Well, if I'm honest, I'll still probably want to sleep, because that's just the way I work.  But at least it won't be a drug-induced, fall-into-bed-and-pass-out sleep.)

I also won't miss the random aches and pains I have after each treatment, especially in my right shoulder and back.  What is that about, anyway?  I think the pains are a result of my muscles clenching up during the seizure, but I get muscle relaxers, so that shouldn't be it. It's a mystery.

The only thing I'm concerned about is feeling worse.  For all the irritating parts of ECT, I really think it did help.  And I notice that the further I get from my last treatment, the more depressed and irritable I get.  This mood change could also be due to the fact that I have to stop taking my lithium 48 hours before each treatment.  For right now, I'm going to assume that the lack of lithium is the culprit, and not the lack of ECT.  I'm not sure what I'm going to do if it turns out I need ECT regularly to feel okay -- that would, frankly, suck.  I don't even know how or if that would work.  Hopefully I won't need to find out.

For now, I'm just going to bask in the glory of "graduating" from my treatments, and hope for the best.

Tuesday, January 17, 2012

New Project & Old Whineyness

I looked back through my old posts to see if I'd written about what's on my mind recently enough that I shouldn't write about it again, and I couldn't find anything, so I'm going to go for it.

I've been in a serious funk lately, and I'm not sure why.  Post-Christmas crap, lovely Ohio weather, difficult children, drug side effects -- you name it, I probably am dealing with it.  What's hard for me is not to just throw my hands up and let myself slide down that slippery slope from feeling "funky" to being all-out depressed.

Because, let's face it, everyone has bad days, right? Even bad weeks.  Hell, bad months.  That doesn't mean they're on some sort of collision course with full-on depression.  It just means life isn't all that easy at the moment.  I have to try to remember that even though today may be a crappy day, tomorrow doesn't have to be. 

It's just that -- and this sounds really negative, but it's true -- for people suffering with mood disorders, I think if today is a crappy day, it may be a little more likely that tomorrow will be one, too, or maybe even crappier.  I'm honestly not sure how I'm supposed to tell the difference between a legitimately disintegrating mood and a bad day. It seems like, in the past, I've gotten stuck with my pants down, so to speak; I've thought that maybe I was just in a funk for a while, then all of a sudden I realize that my mood, usually depression, has gotten pretty far out of hand -- and that has meant, at least recently, hello hospital.  I would like to avoid that at all costs, since my one goal for 2012 was to stay out of the hospital.

So, in an attempt to keep my mood under control, I've started working on a few projects that may help.  For one, I've started to run again.  Okay, I've started to jog.  Okay, I've started to shuffle.  I am the world's slowest, ugliest, sweatiest, floppiest runner, but luckily we have a treadmill, so nobody really has to see me. 

I've also decided to try some craftherapy.  I got the bright idea to try to build a dollhouse with my girls.  I've been reading a lot about recycled crafts, so I've been wanting to try some different projects, and a dollhouse seemed like a good idea -- especially since we have a ton of old moving boxes just sitting in the basement crying out to be re-purposed.  And of course I have my knitting projects I started working on this weekend that I talked about yesterday, so those should keep me busy.   

Here's to hoping my different coping mechanisms will help my mood stay above the "danger" line...and if they don't, maybe my last ECT treatment tomorrow will.

Sunday, January 15, 2012

Knitting on a Sunday Morning

The other day I talked about how I'm not really interested in anything much at the moment, that I'm just kind of apathetic and miserable.  Well, I decided yesterday I'd try to get out of the house and find some activity to capture my interest, at least a little bit.

Rozetti Tundra Self-Ruffling Yarn
I decided to go look for this funky, self-ruffling yarn I keep seeing online.  It was all the rage around Christmas time, presumably so you could buy it and make a scarf for a gift.  Well, as usual, I'm late to the party, so I'm past gift time but I thought I'd still try to make a scarf with it.  I went to a little local yarn store not too far away (it's called Fiberworks -- sadly, locally owned yarn shops are getting harder and harder to find these days), and they had one hank left -- enough to make a scarf.  So I snapped it up.

Skip stitch scarf pattern with Tundra yarn
I started the scarf when I got home, and man, it's a pain in the rear.  It knits up reeeeeaaaaally slowly, and to make the ruffle happen, you're pretty much knitting into one edge of the yarn that is nothing but thread.  On the up side, the finished portion is pretty.  This is one pattern for a scarf using the yarn; I sort of made up my own that isn't a skip stitch pattern.  I don't know if that's making it slower to knit up or not. 

On another note, though, I'm really excited about this book I got at the store.  I don't know if I've mentioned it before, but I'm a knitting (actually, arts/crafts in general) book junkie, and I'm especially a sucker for knitting books with really beautiful, artsy photos.  For example, Teva Durham's books are beautiful -- she was an editor at Vogue Knitting and has really cool designs (check out Loop-d-Loop:  More than 40 Novel Designs for Knitters), and I also love Knitting Over the Edge and all the related books in that series.  I don't know that I've ever actually completed any projects in either of those books, but I just like looking through them.

Anyway, I found a book at the store called Knit Noro Accessories:  30 Colorful Little Knits.  All the designs use some incarnation of Noro yarn, which pretty much means they're going to be beautiful no matter what -- I think Noro has such pretty, tactile-ly pleasing yarn.  But there are some seriously cool scarves and other random patterns in there (a tea cozy! -  but it sure ain't like your grandma's tea cozy) and I want to dig right in.  I even thought about trying to do a "Julie and Julia" thing and do each one of the patterns in order, but I don't think my bank account would hold out -- one little catch about Noro yarn, is that it can be pricey (especially if you're practically buying it in bulk, which I would have to do to make every pattern in the book).  So I thought I'd just start with one and go from there. 

Long story short, my quest to find something to interest me has paid off, at least for the time being.  I'm kind of in a place where I feel like everything I touch turns to crap, so it may be a little bit dangerous starting some sort of new project, but I gotta try something.  I'll keep you posted.

Oh, and I FINALLY finished that book I'd been reading for like, three weeks.  It was good.  I'd recommend it -- The Leftovers, by Tom Perrotta

Thursday, January 12, 2012

This is Me...This is My Brain on Psychiatric Drugs...Any Questions?

I think a big question that plagues many people who take antidepressants, antipsychotics, and other types of psychiatric drugs is, how much do these drugs change your personality?  And, how much does that matter?

Obviously, if you're taking some sort of mood-altering drug, it's because your mood is interfering with your life, presumably in a negative way.  You're depressed, psychotic, anxious, or have some other undesirable problem that you've sought treatment for.  The only problem is, often times, the drugs you get to help you through the original issue cause other undesirable issues that may or may not be worse than the original problem.  For example, I wrote a few weeks ago about the mountains of Seroquel I'm taking and how they make me blunted and tired.  Add that to my ECT treatment from yesterday, and I've slept the better part of the last day and a half.  I'm lucky I have a babysitter so that I can sleep as much as I need, but I still feel like the world's laziest person.

Another issue I've noticed being on a higher dose of Seroquel in addition to ECT treatments is that I just kind of feel stupid.  My reaction times are slower, I can't think of words or phrases as quickly as I usually do; I can't flesh out ideas like I usually can.  While I don't think I'm a particularly great artist or crafter, I feel like my normal pool of creativity is definitely shallower than it used to be.  When it comes down to it, those things are small prices to pay to be a functioning member of my family and society.  It's more irritating than anything, to have a half-formed idea hanging in your brain and lack the ability to give it structure and substance, but it's irritating, nonetheless.

One last complaint (let's face it, this is just one big rant) I have is that I just don't care about most things.  My weight, cleaning the house, getting out and doing stuff, setting up fun, structured activities for the kids -- I just can't be bothered.  It's as if my mantra is, "Whatever." I did manage to get my girls signed up for ballet and theater classes, and I made the giant step in managing my weight of buying a bunch of Lean Cuisines.  Maybe just the fact that they're in my freezer will rub off on my other food and make all of it low-cal, tasteless and cardboardlike.  I can only hope, because that's about as far as I've got.

Even entertainment-type stuff has less appeal.  I can hardly sit through a whole television show anymore; I just don't care.  I've been reading the same book for three weeks.  And it's a good book!  I just can't get that interested.  Even knitting and crocheting hold less appeal for me; I feel like just about everything I do turns out crappy and I just can't get excited about anything.  I flip through lists of projects in my head and nothing grabs me.  It's so frustrating.

So, to sum up, I'm going through that unavoidable existential crisis that most people who are on mood-altering drugs go through at some point.  If I think, therefore I am, what am I if I think slower, or less sharply?   If I think differently, or less?  If I think, but I just don't care?

Monday, January 9, 2012

More About Health Insurance and Mental Health Care

On Friday I discussed the article in The Dayton Daily News to close Greene Memorial Hospital's psychiatric facilities.  Today there is another health care related article in the DDN, this time about a nonprofit organization from San Fransisco's efforts to push value-based health-care reform for the state's Medicaid program.

The Dayton Daily News isn't exactly a bastion of stellar journalism, so it took me a little bit of interpreting to figure out exactly what this means.  As near as I can tell, "value-based health-care reform" means shifting the bulk of the state's Medicaid contract payments to managed care providers who can prove that they're effectively treating their patients.  So, rather than blindly handing out money, providers will have to be able to prove that they are "adding value" -- i.e., they actually are providing services that are making their patients healthier.

Could it be that this is actually a good idea?  It kind of sounds like it, at least to me.  This article from 2009 in the New England Journal of Medicine  discusses value-based health care system as an effective strategy for health care reform, and makes a pretty good case as to why it's the best way to look at reforming the system.  The author says, and this makes perfect sense, that true financial savings in health care reform are really only achieved in health care reform if it's savings through good outcomes of services -- not through cost-shifting and restricting services.  So if Ohio is truly committed to reform through value-based health care, there really are a lot of potential places to save money and improve the current Medicaid system.

What troubles me about the article is that while the program won't "cost the state money" (the author seems to stress this point a little too vigorously), state officials don't "have quality and savings goals in place to measure success."  Any time I see a governmental goal discussed that doesn't have some sort of assessment method, I get a little worried.  And as to the question of mental health care reform, in my experience, mental health care is so trial-and-error, it may be very hard to quantify mental health treatment as a "value added" treatment--unlike, say, treatments for diabetes or heart disease. 

But, hey, maybe it's still a step in the right direction.  Gotta start somewhere.

Anyhow, I got way off topic. No more boring discussion of health care or health care reform for the rest of the week, I promise.

Friday, January 6, 2012

The "New Reality" is Cuts to Mental Health Care

Sad but true
Yesterday, an article in the Dayton Daily News discussed the closing of the inpatient psychiatric care facilities, as well as cutting back on some outpatient psychiatric services, at Greene Memorial Hospital, a member of the Kettering Health Network.  Patients formerly taken in by Greene Memorial will now be directed to Kettering Behavioral Health Center (the same facility that told me, when I was pregnant and walked in for an evaluation, they could "not ethically" let me leave because I was a threat to myself and my baby...and less than 20 minutes later dismissed me out of hand, because they could not admit me because I was pregnant and pregnancy was considered a medical condition they could not accommodate.  But that's a different story).

A spokesperson for the Kettering Health Network said that "'the new reality is that hospitals will be required to care for more patients with less reimbursement.'"  To get a general idea of how many mental health patients Greene Memorial usually services, the article mentions that they discharged 508 psychiatric patients in the "first 11 months of 2011."  According to US News and World Report, Greene Memorial Hospital has a total of 185 beds across all services, so it's a safe assumption that only a small percentage of these beds are in the psychiatric inpatient unit.  So the bottom line is that the area may be losing only a few total psychiatric inpatient spaces -- but when you've only got a few to start with, every space matters.

What's especially telling is that the amount of bad debt that Greene Memorial faced increased in the past few years, to a whopping 30% -- this while its patient volume actually decreased by 13% (these stats from the same article as I mentioned before).

Here's the naked truth:  mental health care is messy.  As I talked about when I discussed the closing of the Twin Valley Behavioral Health Center and replacement with the new Access Dayton mental health facility, many of the people in the mental health care system are also in some way involved in the courts/legal system -- meaning they have Medicare or Medicaid.  Thus we are right back around to the crux of the problem:  hospitals don't want to treat patients with Medicare, Medicaid, or other similar health insurance.  And it's no mystery why -- it's because the hospital very often doesn't get the reimbursement it needs to keep its services running, which then puts them at a deficit for other services, which messes with their financial solvency, etc. etc.   

I don't usually get real political on here, mainly because if I was pressed to profess an allegiance to any party, I'd say I'm in the Voter Apathy Party and I really just can't be bothered to sift through all the parties' crap to see what I really believe in.  But when I start talking about mental health care, it's a no-brainer.  Our health care system is broken.  It needs to be fixed.  I'm not exactly sure how to do that -- it's like moving a mountain with a teaspoon -- but just because it's a hard job isn't a good enough excuse to not do it.

Almost exactly a year ago, a state trooper  was responding to a disturbance at a trailer park near here (up towards Springfield), and was shot to death in a standoff-then-shootout.  There was much public outcry when it came to light that the shooter been in a shootout almost ten years before, then served two years in a mental institution after being found not guilty by reason of insanity.  Law enforcement called for a more accessible database of offenders found not guilty by reason of insanity, so the officers knew better what kind of situations they were walking in to.  Gee, I have an idea -- let's try to help these ill people so they aren't in another shootout.  I know, crazy -- but just crazy enough to work, maybe?

On a more national scale, one can point to the shooting of Arizona Congresswoman Gabrielle Giffords (and others) almost exactly a year ago, and all the discussion around the fact that the shooter, Jared Loughner, should have been receiving mental health care but wasn't, according to this NPR article, because of the stigma attached to mental illness.

Advocating for mental health care is not just about "taking care of our brothers and sisters," which clearly isn't a good enough reason for many people to take it seriously as a cause (though for those people who consider themselves Christians, it should be).  Mental illness, perhaps more than many other kinds of illness, has far-reaching tentacles that does not stop at the sufferer.  Failure to attain treatment for mental illness can reach far, affecting completely anonymous, innocent bystanders in the most horrific of ways. 

Unfortunately, with the constant closing of mental health facilities like Greene Memorial, Twin Valley Behavioral Health Center, and others all across the nation, I suspect it's going to get worse before it gets better.

Thursday, January 5, 2012

More Thoughts (Mostly Negative) on ECT

Yesterday I had my second weekly ECT appointment, and it occurred to me as I was waiting that I really, strongly dislike these treatments.

Did you ever have a person that you'd known for years, and one day it just hit you that you really didn't like them?  This has happened to me a couple of times recently, and I kind of liken it to how I suddenly came to feel about the ECT treatments.  I'm not saying that I don't think they're doing some good -- I do -- but just the whole process is really not my cup of tea. (Here's an article from PsychCentral.com about ECT side effects).

My first dislike (and I'm going to sound like a total baby here) is that every time I go they run an IV.  Obviously, they have to do that to administer the general anesthesia, and you'd think it would get easier the more frequently they do it, but it doesn't.  And every so often they kind of botch it up, and I'm left with a massive, painful bruise on one of my hands for a week.

My second complaint is the anesthesia itself.  I'm going to be clear and say, unequivocally, that I do NOT want to be awake for these treatements.  I want to be asleep.  I do not want to be conscious of being shocked into a seizure.  However, that weird "Lost Weekend" feeling you get after you go under general anesthesia really freaks me out.  Like, you remember being in the procedure room, then all of a sudden you're sitting in a chair drinking a Sprite with no recollection of how you got there, and no sense of passing time.  I think that's really the worst part, that it's not like going to sleep where you have some sense that an hour or so has passed; instead, you close your eyes and then (feel like you) immediately open them and an hour has passed.  For some reason, I think that must be sort of like being dead, or at least a close approximation.

Then there's other little things that just make the whole experience less-than-pleasurable.  Weird aches and pains from the seizure itself, the time involvement, and the draggy post-anesthesia feeling I get.  In the past, the anesthesia hasn't been so bad, but for several treatments I had this horrible feeling when I woke up that I was suffocating.  The doctor explained to me that it was because the sleep medication was wearing off before the muscle relaxers, so the heaviness in my muscles was making it hard for me to breathe.  The anesthesiologist fixed this problem by giving me more sleep medication,  It worked -- I haven't had the suffocating feeling since then, but I've also wanted to sleep for a full two days after the treatment.  I know my husband thinks I should just tell them to take away the other sleep medication, but if you've ever felt like you were going to suffocate or drown (even if you weren't), you'd know that there are very few reasons you'd voluntarily experience it. (Here's an article from MayoClinic.com about the risks of general anesthesia).

But, as I said, I do think they're working, at least on some degree.  I feel generally more mellow, and it's helped a lot with my "racing thoughts" (the bane of a bipolar person's existence) and overall suicidal feelings.  Well, at least till the last few days when I think my "normal" mental issues are vying for attention with some serious PMS problems and I'm just a not fun person to be around.

On a more positive note, I got a really cute book for Christmas called Itty-Bitty Toys, by Susan B. Anderson (her blog is listed at the left).  There are some adorable knit critters in there, and they look like pretty quick hitters, so I've dug in and started on a little bear.  Gotta keep the hands busy -- it helps the mind shut up!

Monday, January 2, 2012

The Required "New Year's Resolution" Post

I thought I'd join the rest of the world in dedicating my first post of 2012 to my "resolution" for the year.

I need to say, first, though, that I don't believe in New Year's Resolutions.  Or, at least, I don't believe in them for me -- I'm not good at saying "I must do this!", and then sticking to it.  As soon as I break my resolution, I pretty much give up and there go my good intentions.  Some people in my life would tell you that I lack resolve; I prefer to think that I like to stay flexible.

This being said, though, I am making one goal for myself for 2012. It's a little thing, really, and to most people, it doesn't seem like it would be particularly difficult, but judging by my 2011, it may be harder than it sounds for me.  My goal: stay out of the hospital.

With the year drawing to a close, I counted up all my overnight hospital stays I had in 2011, and it was a whopping ten.  Ten!  And it's not like I have cancer or some other terminal or chronic sickness.  Ten is unacceptable for an otherwise healthy 35 year old.  Here's the breakdown:
  • Three overnight stays of varying lengths for preterm labor problems when I was pregnant in the first part of the year;
  • One two-night stay when I had my sweet little 8-month-old in April;
  • One one-night stay when I had my gall bladder removed in October;
  • And a staggering five stays of varying lengths for psychiatric reasons -- three at the Lindner Center and two at the hospital.
I did a very cursory search for statistics on bipolar disorder and hospitalization, and according to the Stanley Bipolar Foundation Network, 85.1% of patients diagnosed with bipolar disorder had been hospitalized at some point, with patients being hospitalized on average 3 times.  Admittedly, this data is probably culled from the sickest bipolar patients (that's what the Stanley Bipolar Foundation works with), but it's still a pretty disturbing statistic.

So I've decided that I've used up my average number of hospitalizations -- and then some -- and I'm done.  In 2012, I'm going to be hospital-free.  All those "resolutionists" can keep their marathons, their 60 lbs, their TV-watching-reductions, their writing goals, and their volunteer resolve.

I just wanna stay home.