Sunday, November 15, 2015


I'm feeling so discouraged today. I know that my antidepressant is working because I'm just discouraged and not completely depressed and apathetic.

I've had a migraine every day for about a week and a half. And this morning's was the worst, 8+/10. I treated today with 4mg of tizanidine which brought it down to a 6/10, which is much more manageable.

The migraines have all been triggered by weather or hormones, but having a reason for them doesn't make the pain better. On the bad days, I take a triptan or tizanidine, but I can only take a triptan twice a week. I took ibuprofen on Tuesday, so I could go have lunch with Rosie Girl. (Ibuprofen is something I take very sparingly because I have mild kidney damage.)

I've tried to do the things that make me feel emotionally better when I'm in pain. I've been walking when I can, although that often makes my head hurt worse. I've tried to eat healthy. I made butternut squash soup and discovered that I don't like it. Sigh. Mint M&Ms, on the other hand . . . . 

And then Paris happened the other night. Yikes! 

I have lots of plans for the next couple of weeks and I'd really like my body to cooperate. Rosie Girl is in the university's choir and orchestra's production of Beethoven's Ninth Symphony next weekend. Then, the week of Thanksgiving, I'll be in Florida to help put on a big 50th Anniversary Party for my parents. It's going to be lots of fun, and I'd like to be able to enjoy it without a huge migraine!!

I'm hanging on the John 6:33 "In this world you will have trouble. But take heart; I have overcome the world." I'm not feeling it, but it's all I've got now.

Monday, November 09, 2015

Being Thankful

Yay, the holidays are here! Thanksgiving is just around the corner, so it's time to thank God for everything I have.

Except that I'm not feeling very thankful right now.

I'm on the fourth day of this migraine. No, it's not severe - only about a 5/10 - but it's bad enough to keep me from doing much. And the stabbing pain through my right cheek every 15 or 20 minutes could go away. And my PMS irritability is through the roof. Not to mention the cramping. And occasional nausea.

So, no, I'm not feeling very thankful. To God or anyone else. 

In fact, I'm feeling pretty sorry for myself, thankyouverymuch!

And right now, I'd like you to feel sorry for me, too!

So, now that that's off my chest, let's talk about what real thankfulness is all about. It's about giving thanks for what I have no matter what I feel like. God has been amazingly good for me, in spite of the migraines.

"Give thanks in all circumstances, for this God's will for you in Christ Jesus."
I Thessalonians 5:18

That was written by the Apostle Paul who had a lot of practice being thankful even when life was hard. And I think being thankful despite shipwrecks and being in prison is pretty impressive.

Actually, thankfulness is an act of the will, not something we feel. So, I can tell God that I am thankful for my family, my home, my church family, my friends, the fact that migraines are painful but rarely fatal, etc. even when I don't feel particularly thankful. When Patrick gets home, I'll thank him for being a wonderfully supportive husband even when I'm headachey and cranky. When Chris gets home, I'll thank him for bringing home Subway (not a day for me to cook!) and for being an awesome teenager. When I go to Stevens Point to see Lydia tomorrow, I'll hopefully feel more thankful, but even if I don't, I'll thank her for being an amazing young adult with a compassionate heart who cares about her mama. 

And having written all that out, I'm starting to feel a teensy bit thankful. (But I just had another stab of pain in the cheek, and that can really go away forever as far as I'm concerned!) But, mostly, I'm reminded to express thanks no matter what I feel. It's what God tells us to do, it makes me quit thinking about myself so much, and it allows me to communicate to others what they need to know.

So, go tell someone that you are thankful for them! (And quit feeling sorry for me - no matter what I said before!)

Thursday, September 03, 2015

Thinking About Gay Marriage

I've done a lot of thinking about gay marriage and homosexuality over the last couple of years. How could I not? It's in the news; it's in our churches; religious leaders are talking and writing about it ad nauseum.

I'm pro-gay marriage because it doesn't affect me if a gay couple wants to have the same rights and privileges that my husband and I share. As a physician, I know how difficult it can be to deal with medical and end-of-life issues with a friend of a patient, but how easy (relatively) it is with the spouse of a patient. That marriage certificate smooths many things, including being allowed into an ICU, being allowed to continue or terminate life support, etc. And I don't care if that spouse is the same sex or opposite sex of the patient I was caring for.

I will admit that my views have crystallized in the past few years because of a gay friend. She's not the first gay friend I've had, but she is almost a daughter to me and has been since she was five years old. She came out a few years ago. Now she has a partner and might one day like to get married. Last week, she and her partner came over to dinner before they went to the Fair with my daughter and we all had a wonderful time. Even if I believed that gay behavior was sinful (which I'm not sure about) and didn't support gay marriage, I would still be friends with these young women. They are lovely girls and are fun to be around. Just like lots of straight people.

I also know lots of divorced people and I hang around with them. They are great people and fun to be with. But, I know that divorce is wrong. But, that doesn't affect my relationship with them. I still love them.

I read a lot of Christian blogs. There has been a lot of virtual ink spilled about the evils of gay marriage and how it's going to destroy marriage in this  country. Very little has been written about the divorce epidemic in this country, and even in the church (yes, I know that committed Christians actually have a low divorce rate, but I'm talking about overall attenders).

I think that the reason we don't talk much about divorce is two-fold. The first reason is that once people are divorced, it's over and done with and they are forgiven and can move on with their lives. Generally, I buy this, especially when people are moving on from abusive marriages.

Second is that most of the people writing this terrible blog posts about gay marriage know plenty of divorced people and not a lot of gay people. It's easy to call gay people names and act like they're going to send this country to hell in a handbasket when you don't have much relationship with any. It's harder to write mean things about people you know and like. I have a feeling life would be different if they had lunch every week with a couple of gay friends - not just acquaintances, but friends. They might still oppose gay marriage, just like they oppose divorce, but their tone would change. They would be sorrowful, instead of angry.

Loving your neighbor is hard from a distance. Maybe we all need to figure out a way to get to know these neighbors that we rail about. I have a feeling what we write in blogs and on Facebook would be a lot different.

Wednesday, August 19, 2015

Suicide and Physicians

This week, it was announced that my colleague and pulmonologist was found to have committed suicide. He disappeared about two months ago and his body was found about a month ago. The medical community in the Fox Valley and Waupaca has lost a wonderful and compassionate physician.

I first knew Jeff as a colleague when I was working as a Family Doctor in Waupaca. I referred complicated pulmonary cases to him as well as getting ICU consults. He was always incredibly professional, but also just a nice guy. After I quit practicing, I went to see him for a sleep study and I was diagnosed with obstructive sleep apnea. I saw Jeff as a pulmonary patient once a year. Again, he was professional and a nice guy. And he always asked about my migraines and about whether or not I was close to being able to come back to practicing medicine.

He hid his depression well, as those of us with depression tend to do. But, 400 physicians every year commit suicide. 400. That's a lot. Too many. According to what I've read, the primary underlying cause is depression or bipolar with substance abuse coming next.

Why so much suicide? I've done a little research and what I've read confirms what I experienced. Even in physician groups that try to do a good job of finding depression in patients, physicians are terrible at taking care of ourselves. Many physicians don't have a primary care physician themselves. Many don't recognize the symptoms of depression to see a physician.

And then, there is the stigma of depression or, even worse, substance abuse. Admitting to substance abuse can affect licensure and future practice. This is devastating to a physician.

There are remarkably few support structures for physicians who are depressed. Apparently, Jeff was known to have a history of depression, so he, at least, was in the mental health system. But, he was in a minority. Most physicians with depression or otherwise at risk for suicide don't seek help and don't have much help available.

Working in medicine can be stressful and overwhelming. I worked in a large medical group that did make some attempts to provide some mental health resources in times of stress. After a case where we lost a baby, both the clinic and the hospital did debriefing sessions to help us process our feelings. At the hospital debriefing, the (humanist) chaplain said, "Well, we know that life has no purpose, but we can still find meaning in it." I left soon after. I was reading the book of Lamentations at home and trying to find meaning through God. I didn't find the chaplain helpful at all. At the clinic debriefing, we were led by an EMT and didn't try to find any religious meaning, but talked through our actions on the day in question. It was much more helpful. So, the current structures to help are iffy, at best.

But, it's not just the bad days that are the problem. Medicine is inherently overwhelming. Physicians are expected to not make mistakes day after day after day. Working in an ICU has the immediate life and death decisions, but even the day to day work of a family physicians has the overhanging dread of making a big mistake. And this is just wearing.

I'm going to miss seeing Jeff once a year for my pulmonary visit. I'm sure his friends, family, and colleagues are devastated by their loss. And what is so sad is that Jeff had an illness that probably could have been treated.

I've written before about depression. Untreated depression leads to suicide. And it leads to suicide more often for physicians than for other people. 

Please, whoever you are, if you are depressed, contemplating suicide, or even just thinking that the world would be better without you, talk to someone. If there's no one around to talk to, call 911. They know who to contact to get you help. 

Depression is a fatal illness. And it hurts more than just the person who has it.

Sunday, August 16, 2015

Depression, Medications, and Me

A number of years ago, I read a letter to the editor of the journal of the Christian Medical and Dental Association that questioned the use of anti-depressants. The author suggested that if some of the authors of the Bible like David and Jeremiah had lived in modern days they would have never written their portions of the Bible because they would have been medicated. At the time, I disagreed with the assertion, but I didn't have the confidence or experience to write back. Now, fifteen years later, I'm going to respond to that unknown physician.

Anti-depressants are used to treat depression, not sadness or guilt. Depression is not ordinary sadness. Yes, the primary symptom is sadness, but it also includes lack of motivation, inability to feel happiness, and physical symptoms such as sleep disorders and appetite changes. 

We know that anti-depressants work when someone starts to feel normal emotions, not just happiness. In fact, someone on anti-depressants will feel sad at appropriate times, but will be able to feel happy at reasonable times, as well. A depressed person can't feel normal emotions. I can speak to this because of my experience as a physician who has prescribed anti-depressants to patients, but also because of my own depression.

There's no evidence that David was depressed. He was still able to write much of the book of Psalms. A depressed person has difficulty doing things because of a lack of motivation. According to Psalm 51, David did feel appropriate regret and remorse from his "affair" with Bathsheba and his subsequent murder of her husband.

Jeremiah was very sad about the state of Judah and the prophecies that God had given him, but he was also able to continue to prophecy. Again, there was no evidence that he was depressed.

So, the whole issue comes down to whether or not anti-depressants make us "not ourselves" and whether or not God wants us to use them. After all, if they would change us so much that God wouldn't be able to use us to do something like inspire the writing of the Bible, then they must be pretty bad.

Hogwash! Depression is an illness of the brain. It makes it's victims feel sad and melancholy and unable to feel happiness. Anti-depressants don't make a person feel happy; they make a person able to feel normal emotions, both happy and sad.

I've felt the stigma of depression, but I'm glad I've been willing to accept treatment. My risk for depression was really high based on my family tree. There is depression and addiction scattered throughout my family tree on both sides. I was fortunate that my first bout didn't happen until I was in my 30s. Now that I've got chronic migraine, depression is an unwelcome companion.

Without treatment, I wouldn't just be sad, I'd be sitting on the sofa and doing nothing. My doctor and I are titrating up my dose of amitriptyline, which is the second anti-depressant I'm on (I'm also on citalopram). I don't really like the side effects of the amitriptyline (dry mouth, hunger, fatigue) but I've spent this summer being sad and headache-y from trying to go without my medication. 

My depression meds aren't my entire treatment. They help adjust my brain chemicals, but they are helped significantly by counseling, exercise (when my head doesn't hurt too much), and a (somewhat) healthy diet. 

Depression is real. It's treatable with non-medical treatment and with medications. It seems to me that if God is OK with antibiotics for strep throat, then he's OK with anti-depressants for the biological illness of depression.

And the meds work. I'm still having headaches, but my mood is finally better. I'm tolerating the headaches better. I'm not happy about the headaches, but i can feel a range of emotions again. And it feels so good.

Just stuff . . .

  • Chronic migraines suck. Really. I'm on Day 4 of this one and going crazy.
  • The increased dose of amitriptyline is decreasing the intensity of the headaches so I tolerate life a lot better. I'm increasing up to 100mg (with my doctor's permission) tonight to see if we can stabilize things even more.
  • The liquidators came this week and bought the last of our yarn, notions, and fixtures. They didn't pay near what they're worth, but we knew that. The fact is, they paid something and they took the stuff away.
  • Wild Man has the music room in the shop looking good. And we still have a good incentive to replace the old windows and update the heating and cooling system since he's keeping musical instruments in there.
  • When my head calms down, PWM and I are going to spend a night at a hotel with Sleep Number beds because we think that we want to purchase one. There's a hotel in the Valley that has those beds, though, and we'd like a full night's sleep to see if they're as good as advertised. Then, Rosie Girl can have our queen sized bed in her apartment and the double bed will go in the guest room out in the shop.
  • Poor Wild Man has a cold and went to see the NP today for the cough. He doesn't need antibiotics, but he got steroids, and inhaler and cough suppressant. The combination of steroids and inhaler makes him quite jittery and he's not happy about it! But, he's not coughing as much and will probably be able to sleep tonight
  • Rosie Girl has a real, live boyfriend. They don't get to see much of each other because of work schedules in the summer, but they'll get more face time when school starts!
  • I've been pondering 1 Corinthians 11. It's the chapter about head coverings in worship and it's quite confusing. The interpretation that makes the most sense to me is that Paul was having a mock conversation with the Corinthians. Here's a link to a good post.
  • I've been distressed this week at how little I've been able to do. I cooked dinner on Monday and Tuesday nights. Other than that, we've had food from The HItching Post, leftovers, and PWM grilled. So, we're not starving. I just feel bad when I'm sitting and reading a book when others are working.
  • We got a new deck. The contractor was just going to replace the sections that had been made with untreated lumber and leave the good stuff. It turned out that there was untreated lumber even all the way up to the house, so we had them just start over. Now, we have a brand new deck with all the railings up to code and the stairs with proper width, etc. I keep forgetting to take pictures. And, we have to stain it in about a month after the lumber all dried
  • Our tags for our items for the fair came in. We're still a bit confused about when to take our stuff and where, but we know who to ask now. The tickes had misspellings that had to be remedied and I didn't now that I could only submit one item per category so they just put my second item under PWMs name. I think we understand the basics now.
  • Well, it's probably time to try to sleep. I had a three hour nap today, so I'm not super tired, but I could probably sleep if I had a chance. We'll see.

Wednesday, August 05, 2015

Sin Management or Grace

First, you need to go read this post by Chaplain Mike at Internet Monk. Done? Good.

I don't want to talk about depression today, although I could and probably will spend lots of time talking about it later, especially now that I feel better. Instead, I want to talk about "sin management".

I grew up Evangelical and Modern and Productive and I'm very good at sin management. This is what Dallas Willard calls our tendency to find a sin in our lives and then make a project of getting rid of it. Our Christian bookstores are full of books to help us deal with our various sin issues. We find the problem, get to the root of it, deal with it, and we're done. I like that approach. We do that in medicine. Have an ear ache? I'll figure out what's causing it, give you treatment, and hopefully you are cured.

But, is sin management really how God works. Some people would say no. In fact, a majority of people, if pressed, might agree that sin management is hit and miss at best. And it's not really scriptural. Have you noticed how the self-help (sin management) books have to do a lot of proof-texting of bible verses to make their plain work? Have you noticed that Paul doesn't write letters saying, "Hey, here's a four step plan to quit drinking, a three step plan to quit lusting, and a six step plan for success in your business." Yeah. The greatest preacher in history didn't write much in the way of how-to.

So, what does Got want us to do? I mean, I grew up in a world of solving problems. That's what I do. When I was working in medicine, my job was to try to understand a person and their illness (not just the illness), figure out the problem, and come up with a rational treatment plan. And that's how I lived the Christian life for a long time, too

When I read the Bible, though, I find something different. In the Old Testament, God has given us the story of Israel. I think God wants us to get to know him through these stories. And I think he wants the same thing when we read the New Testament. We meet Jesus in the Gospels. Then we walk with Jesus through the Epistles and learn through the letters to the churches how we can use that wisdom in our lives today.

The sin management thing hasn't worked for me. And, nowadays, my biggest problem is pain. I don't need God giving me assignments. I'm just too tired. I need grace. I need to walk with Jesus. And when I slip and fall, he's still there when I come back. He hasn't chosen to heal my pain. Yet. 

And then, as Chaplain MIke reminds us, joy can break in. Because God is doing everything, not me. I just walk along with Jesus and do as I'm told. Because grace.

Friday, July 31, 2015

The end of The Knitting Nest

Tomorrow is the last day of The Knitting Nest. I have seriously mixed feelings about this. I really liked being a small business owner. But, I was never really the owner. PWM did all the paperwork; I never got around to learning QuickBooks. I liked the customer interactions except when I didn't. On the days when my head hurt - which was a lot - it was hard to deal with customers. And on really bad days - which are unpredictable - I couldn't get out of bed. So, yeah, I'm going to miss being with customers and talking about yarn and patterns. But, I won't miss trying not to be sick when I really am sick.

Something else that's hard for me, though, is that I have a sense of failure. I feel like I should be able to keep the shop open. My conscious self understands that this is crazy talk. I have chronic migraine which is a chronic illness. I can't predict which days I'm going to feel well. Trying to run a small business even a few days a week is an exercise in futility. Instead of doing something that's just going to lead to closing the shop in a few months, we're doing the responsible thing and closing now, in the summer, while PWM can do a lot of the work (especially since I've had terrible migraine and depression for the last month). And I'm going to keep telling myself that this is a good thing and we didn't fail.

And, it's going well. We've sold probably 75% of our stock already and are hoping that tomorrow is busy as well. What's left tomorrow will be given to some carefully selected charities and the rest will be liquidated. We have plans for the building, including a guest bedroom, woodworking space for PWM, and a music room for the kids. I'm excited because we're bringing my grandfather's armoire into the living room for my yarn storage! (Yay! Redecoration!)

So, this is a bittersweet time. We are glad for the four years that we had The Knitting Nest and for all the friends that we've made. (I've had two people give me their phone numbers and ask me to call them for them to come knit with me on days when I feel OK. Isn't that sweet?) We'll miss the shop. But, we're excited for what comes next. PWM loves teaching and is glad to be able to spend all his time focused on his students. I'm going to start off by spending some time resting and then working on some projects at home. After that, we'll see . . . .

Abortion July 31

Abortion and Planned Parenthood are in the news again. Honestly, abortion should be a headline every day. The killing of precious little lives, even if they are in the womb, is unconscionable.

But, what is also unconscionable is what brings women to abortion clinics in the first place: an unplanned pregnancy and a feeling of being trapped. This is where we need to spend some time and money if we are going to lower the abortion rate. Young men and women need to learn about sex and contraception and have access to affordable contraception. For a long time, I was an advocate of abstinence-only sex education, but studies have shown that kids in those programs were getting pregnant at a higher rate than their peers; it wasn't working. Kids in comprehensive sex education programs are the ones getting pregnant later. And, nowadays, kids are becoming sexually active later no matter which program is being used.

Women need access to contraception. Whether or not it is fair, women control the contraception decisions in couples. And women are sexually active these days whether they are married or not. Affordable contraception is important. For working women, contraception is part of normal healthcare insurance. For women who don't work full-time, Planned Parenthood and other community resources are necessary. In any case, without contraception, abortion becomes the back-up plan. And it's a bad one.

Women also feel trapped in their pregnancies because of what happens after they give birth. Women already in poverty know that having a baby almost eliminates their chances of higher education. Trying to work, find childcare, and a reasonable living situation are difficult enough when you already live well below the poverty line. And more babies equals more pressure.

What can we, as Christians, do to help stop abortion? There are lots of things. There is the political route of voting for candidates who will not support abortion. But this post is focused on social issues. First of all, make sure your own children get a full understanding of sexuality and contraception. If you have the chance to help at a school, then do so. If you are a medical professional who can work at a free clinic that provides women's health-care, then do it. Not only can you help provide contraception, but you can counsel women about minimizing their number of sexual partners, preventing sexually transmitted infections, and choosing life. And we can all participate in anti-poverty programs. Giving food to the food bank, giving to Goodwill or other thrift stores, helping with childcare organizations. Anytime we help with poverty, we are giving women a chance to lift themselves a little higher.

These aren't my only thoughts on abortion, just the ones provoked by a Facebook post by Rachel Held Evans. When my head doesn't hurt so much, I'll write more.  What are your thoughts??