Day 3 – 27 July 2017

05:42
Partner: “So do you want me to fix that pork tenderloin tonight?”
Me: “That would be awesome. I’m done early. We could also – ” I don’t finish my sentence: grab a beer? walk for ice cream? They hesitate at the door, waiting for me to finish my sentence.
Me: “Who the fuck gives up alcohol and sugar at the same time?”
Partner: “Only you.”

09:55
I legit woke up at 05:30 – and then promptly moved to the sofa and watched a trashy show that I had recorded the previous evening. Baby steps. My work day does not start until 12:00, and I really don’t know what to do with this time. Fitness classes in which I participate are on different days at different hours. I want to meditate first thing in the morning, but the dogs have to be walked – do I meditate before or after? When do I eat breakfast if my fitness classes are at different times day to day?

Clearly I have not made a daily schedule. I am not procrastinating though. After a birthday a few years ago, I stated, “I am half-dead – if I’m lucky.” I likely am now 52 percent dead. Some might think that it is a morbid way to view one’s life. I don’t. It reminds me to beĀ intentional with my time. Some of the questions that I have been asking of late: “When I am struggling to move or no longer have beloved people around me, how will I view my time spent:

  • watching woman fight on television?”
  • reading mindless drivel on the Internet?”
  • under the influence of substances with (i.e., essentially absent from) people whom I love?”
  • frustrated with transitions that kept me from traveling?”
  • worrying about something about which I have no control?”
  • shopping on the Internet?”
  • yelling at a driver who intrudes upon my space in a bike lane and then feeling guilty for hours?”
  • fuming over a fitness instructor who does not start a class on time?”

I still watch women fight on television, but when I do it, I am very intentional. I.e., “I am going to put my brain into a mild coma and watch crap for one 42 minutes.” When I view it in this manner, I do not get caught in the endless cycle of looking for more to watch (or more time to waste). The Holstee Manifesto hangs in my office. One line reads, “If you don’t have enough time, stop watching TV.” I remind myself of that “mantra” every time that I complain about how little time I have or sit down to watch television.

This whole line of thinking is very new to me. Impulsively I went to a meditation class one day in April. I went back the next week, and my experience was pretty life-changing. I began to view my mind differently. While I am still herding cats in my brain, the cats have changed.

12:45
Someone dear to me says, “Things are shifting. I can tell. You are way less anxious.” I smile, they’re onto me. I’m growing.

13:35
It is hot out, and the air is juicy. Earlier today, I debated “ride share or bicycle” nine miles across the city. “It’s too hot and humid out,” my brain declares. But my brain is an asshole. I live in a City in which the weather graciously – and sometimes not too graciously – provides a reason not to move. I only need to open Accuweather 338 days of the year to say, “Yep, I should take a cab or public transportation.” Ninety minutes ago, I told my brain to bite it and hopped on my bicycle. One mile in traffic, and I am drenched in sweat. It feels awful and good at the same time.

19:02
I lay on the bed, having bicycled somewhere around 20 miles on a sticky, icky day. I wanted to succumb to the allure of sleep, but I knew that doing so would mean waking up at 20:30 and then staying up until midnight knee deep in Netflix. I read the New York Times about the Affordable Care Act, and it’s a good distraction. I tried very hard not to think about how this could impact both my patients and my own healthcare.

22:00
I reluctantly set down my smartphone and pick up a book. I have 30 minutes until bedtime.

 

 

The Treatment Plan

If one came into my office with a mood disorder (regardless of additional diagnoses), I would assess the following as part of their assessment and, ultimately, diagnosis(es):

  • Their sleep patterns and sleep hygiene;
  • Their relationship with food;
  • Their relationship with substances;
  • How much they move/exercise; and
  • Their compliance with any other health professional’s recommendations.

Most people with mood disorders struggle with these areas of their lives as part of their illness or to cope with their illness. Loss or increase in appetite, hypersomnia (i.e., sleeping too much) and insomnia (e.g., inability to fall asleep or intrusive wakefulness) all are diagnostic criteria for major depressive disorder. In addition, patients who struggle with depression, anxiety or post-traumatic stress can use food or substances to cope with unwanted emotions and their resulting symptoms. As a psychotherapist, looking at how people cope can tell us much about underlying emotional disturbances. Said another way, if one is in a good space in life, they sleep well, eat for fuel and the occasional indulgence, do not abuse substances and maintain or increase their health through activity and following health provider recommendations.

So why don’t people with mood disorders do what is recommended to them to manage their health?! Because their life is one big Whack-a-Mole game of managing different, sometimes conflicting symptoms. There’s another reason: most suck at structure. (You know who you are.) If they are so depressed that they cannot get out of bed in the morning, imagine trying to go to bed “on time” that night. These patients laugh in my face when I ask about their sleep schedule. I could spend the next 500 words, providing examples on how some patients hate – even are oppositional toward – structure, but I have to stick to today’s topic: The Treatment Plan.

For the next 365 days, I am going to follow every single one of the recommendations that I make to my patients. 

My immediate response to typing that sentence: “FML”, which I imagine that I will be uttering much during the next 365 days. However, I truly want to “walk the talk” as a healthcare provider. I also want to be the best damn version of me for however many years I have left on this planet. So, here it goes.

1. Sleep hygiene
Go to bed on time (22:30) and wake up on time (05:30) six days a week. No reading backlit screens after 22:00. One 30-minute nap on one weekend day is acceptable, but not recommended.
Degree of difficulty: 10/10

2. Mindfulness
Meditate for a minimum of 15 minutes per day. Lying in bed for 15 additional minutes to “meditate” does not count. (That hurt.)
Degree of difficulty: 4/10

3. No added sugar or artificial sweeteners
To clarify, naturally occurring sugars, such as in fruit, are allowed. (More on this recommendation to my self and some of my patients to come … )
Degree of difficulty: 7/10 (A 10/10 if I am around my dear friend who is an excellent baker.)

4. No ETOH (i.e., alcohol) or other substances
Nerd alert: I have never tried or done an illegal substance or something not prescribed to me. So, I will be abstaining from the one substance that I do use: ETOH.
Degree of difficulty: 9/10

5. Close all the rings on my Apple Watch
This equates to seven 30-minute workouts per week, twelve hours of standing for at least one minute and meeting a daily caloric “move” goal (currently 800 calories). One doesn’t need an Apple Watch to measure these activity or movement goals, but it’s a consistent, workable measure for me.
Degree of difficulty: 2/10

6. Follow doctors’ orders.
If I’m prescribed a medication that I agree to, I will take it. If a physician orders a test, I will do schedule and complete it. I will not cancel my dental cleanings. (I hate going to the dentist.)

That’s it in a nutshell. It – like my stubborn head – likely is going to be very hard to crack.