Saturday, April 24, 2010

The Black Dog

Sir Winston Churchill, former British Prime Minister who led Britain through the dark years of the Second World War, suffered with depression.  His adult life was punctuated with mental health crises.  Although he's probably not the first to use the term, he famously referred to depression as "the black dog".

The black dog lives with me, too, and has since junior high school.

By now, most people understand that depression is different than "the blues" or a bad mood.  I've been taught that long-term clinical depression can take a couple of forms.  Some folks experience it as something that lurks in the background at a low level most of the time.  Others experience it as a series of troughs, but feel fine in the sometimes extended period between troughs.  I experience both forms.

Depression is like wearing unremovable glasses that radically distort one's view of the world.  One can become aware of the distortion, and to some extent adjust for it. But the distortion is still there.

Many people with diabetes experience depression. For many PWDs, depression occurs (at least in part) due to the daily burden of diabetes management. For me, I've been a diabetic for about two years and a depressive for about thirty-five.  It's possible, though, that causality goes the other way: I've seen that there's some clinical evidence that depression can be one of the cluster of things involved in the development of Type II.

The implications of depression for diabetes management could not be more profound.  When I'm depressed, it's hard to feel that even basic self-care is worth the effort, so such activities as dieting, exercise, blood testing, and even medications can become sporadic.  Depression brings perpetual low energy, so the impulse to "carb up" for at least temporary energy is very strong.  Planning and decision-making become very difficult, so I'm always eating out of impulse.  For me, I sleep less when I'm depressed, so that both affects BGs directly and also feeds negatively into the energy cycle.

The treatment of depression has become controversial.  I've never been hospitalized, though there was one point when maybe I should have been.  I am under the care of a psychiatrist, and take a couple of different medications.  The medications I take provide no kind of "high" or artificial happiness: I find that they provide a "bottom" to my mood swings so that I feel good enough to cope successfully with my life.  I would never advise somebody else to take medication for depression: it's a very personal decision.  I've very grateful, though, that I have the opportunity.

One thing I've learned that helps is that it's important to remember that depression lies. And one of the biggest lies depression tells me is that the pain I experience during an episode is forever, that it will never get any better, that I will never experience any peace, joy, or satisfaction.  So, I try to treat a depressive episode like a nasty head cold: sure it's really unpleasant right now, but it'll be better in a few days.

I also find that it helps to think of depression as something outside myself, as something that happens to me.  Yes, there are behavioral and cognitive components to depression.  But allowing depression to become one more thing to feel guilty about just isn't helpful.

If you "enjoy" the companionship of the "black dog", you're not alone.  If you're not receiving any treatment for it, you might consider discussing it with your doctor.

Friday, April 16, 2010

Sick Daze

(PLEASE do not take any of this as advice!!!!!!!!!!!!!!!!!!)

Ever since my diagnosis, I've seen a lot of material on "sick day management".  I know that most of this has to do with the impact of illness on the already tricky business of properly dosing insulin.  But, I've sometimes wondered what the effect of sick days would be for me.

This week I had the only sickness worse than an ugly cold since dx.  I think it was some kind of flu: periods when I couldn't get cool, periods when I couldn't get warm, muscle aches, fatigue.  I wasn't spending a lot of time in the bathroom, if you get my drift, but my tummy was intensely irritable.  (Even more than I am, if you can imagine such a thing.) 

Because of the rebellious tum-tum, I didn't dare take most of my meds, particularly the Metformin.  While I haven't had the sorts of GI issues with the 'met that some folks do, I'd never tried to take it when all my organs were circulating petitions against me.  On the other hand, I was eating almost nothing.

Tuesday and Wednesday, I seemed  to be a little high for me, but not inexplicably so, since I was choosing foods based on what I thought might be well received.  I didn't check yesterday, but then I was pretty much completely off food by then.

My BG this morning, with three days off Metformin and essentially two days off food?  102.  Go figure.

Saturday, April 10, 2010

(Not) Driving Mr. Bob

One great word that's not used as much as it used to be is "eccentric".  In its heydey, the word was used to describe someone that was a little bit (or even a lot bit) nuts, but in a way that was harmless or even charming.
  • Sample Sentence #1: "Eustace's eccentric Uncle Claude always thinks he's a carrot on Tuesdays."
  • Sample Sentence #2: "That Bob's a nice enough guy, but in some ways he's more eccentric than a bedbug."
But I digress.

I learned to drive at the same age others did, and did the normal amount of driving while I still lived with my parents.  But when I left home, I lived in a community where it was fairly convenient to get most places by bus or even by foot.  The next three communities I lived in also made it reasonably possible, most of the time anyway, to do without a car.  So, I went about twenty years during which I didn't own a car and rarely drove.  I'm grateful for the friends who have helped me with various transportation needs, but I've been able to be largely independent.

A few years ago, I finally broke down and bought a car.  After getting used to being behind the wheel again, I came to really enjoy the things it let me do.  I even enjoyed getting lost while learning my way around the city.

The trouble is, I proved not to be very good at driving.  I had three accidents in two years.  The first one was clearly my fault.  The second one was clearly not my fault.  The third was at an icy consideration, and the Great Computer in the Sky says it's my fault even though I don't look at it that way.  And there were all the times when I did something that might have caused an accident and didn't.

And it got in my head.  Now, although I'm not proud of this, driving terrifies me.  Every intersection seems to offer potential for disaster.

So, by and large, I don't drive.  There are entire months in which I don't drive.  Recently, I had to buy a new battery because I hadn't driven in so long the old one drained empty.

I'm fortunate in that I'm able to do just about everything I need to either walking or on the bus.  But sometimes there's something I'd really like to do that I can't get to.  And sometimes there are things that others would like me to do that I feel unable to do.  This is painful -- but it's where I am.

What does this have to do with diabetes?  I don't really see that it has anything to do with it.  But then, I'm a bit eccentric.

Monday, April 05, 2010

A More Balanced Diet for the Brain

I've always been a big reader.  (I mean I read a great deal, not that I myself am big, though I am.  Be nice, now!) And, beyond what I'd guess to be at least a couple thousand murder mysteries, I've tended towards nonfiction rather than fiction as a matter of personal preference. 

I've noticed that over the last year or so that I've all but abandoned long-form non-fiction (books and essays) in favor of Twitter and blogs.  There's nothing wrong with either of these: they feed my life and my brain in different ways.  Twitter's great for establishing and maintaining distance friendships, offering and receiving emotional support, and (especially in my case) thrusting feeble witticisms upon people with enough problems already.  Blogs are great for many things.  But neither Twitter nor blogs are especially good at presenting a lot of information in an organized way or exploring ideas in depth.  Sure, there are bloggers that deal in complex issues, but then individual entries often become longer than I really want to read off a screen.  (I understand that this is in part a generational thing.)

The other night, I picked up a book of essays by Malcolm Gladwell, the New Yorker writer who's authored such bestsellers as The Tipping Point and Blink.  The first piece I read was a profile of infomercial king Ron Popiel, and the second was about an expert investor with some very uncommon ideas.  This was all very satisfying, and I realized that I really need to feed my brain a more balanced diet by not leaving out longer pieces.  

How does this relate to diabetes and making healthy changes?  For me, it's a very direct connection.  I'm happiest when my brain is active, and reading a book that fits my interest of the moment or coming across something fun 'n' funky helps me make that happen.  (One of the most enjoyable things I've ever read was a book titled "Sayonara, Michaelangelo" about the restoration of the ceiling of the Sistene chapel...and the financing of the restoration by a Japanese television network...and the nature of artistic genius...and the history of Christianity in Japan...and a whole bunch of other stuff.  That's fun 'n' funky, don't you think?)

Making changes is tough, and those of us who are doing that need lots of support.  Part of that support comes from family and friends, but part of it comes from taking time for the activities that bring us pleasure and even joy.  For me, that can often be found in the pages of a good book: for you, it might be knitting, or scuba diving, or studying New Testament Greek, or making birdhouses.  I believe that these activities - whatever it is that works for you - bring us stress relief but also helps answer the "big whys" - why we should pass on that doughnut, why we should walk another few blocks, or why we should keep a better blood sugar log.

What brings you joy?
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T Minus Two by Bob Pedersen is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.