The Art/Body Connection

Well, my due date is tomorrow and . . . no baby! I have never been THIS pregnant. All my other kids were born early.

With my previous pregnancies the last month was the hardest. The depression usually set in around 35 weeks and it was a slow slide into Unhappy Land. Not so this time. This last month has actually been fun. A little crazy, but fun. Maybe it's because I was so busy during the rest of the pregnancy that these last few weeks have been my only chance to really think about this new little person that's been gestating inside me.

To be honest, though, last Monday was a terrible day. I didn't sleep well. I woke up exhausted. I had no patience with my children and no motivation to do anything but lay on the couch. My children watched movies for the bulk of the day and I stared at the wall. I was beginning to wonder if it wasn't time to break out my antidepressants.

But things turned around for me Tuesday. I think that's because, well, Monday was a bad day and people have those occasionally without actually being depressed. I forget that sometimes. Also, I think Tuesday was a better day because I had something to look forward to--and it's something I would heartily recommend to other mommies nearing the end of pregnancy--Belly Painting!

A friend of mine, Julia Cameron Damon, is multi-faceted, multi-talented woman who specializes in the art of body painting and photography. I've seen a lot of her portfolio and have found her work at turns whimsical, confrontational, enchanting, and instructive. So when she approached me about painting my extremely pregnant belly I wasn't sure what to say, but I decided this was a once in a lifetime opportunity and I might as well experience it.

It was so fun! I was surprised by how relaxing it was and how much I enjoyed the process. I'm the kind of gal who likes to invest meaning in things so Cam and I approached things from an Earth Mother/all creations point to the Great Creator vibe. Because one thing I love about pregnancy is the connection it creates between me as a creative being and Heavenly Father as a creative being. As Elder Uchtdorf said, "But to what end were we created? We were created with the express purpose and potential of experiencing a fulness of joy. Our birthright—and the purpose of our great voyage on this earth—is to seek and experience eternal happiness. One of the ways we find this is by creating things. If you are a mother, you participate with God in His work of creation—not only by providing physical bodies for your children but also by teaching and nurturing them."

Cam did a beautiful job by starting with earth tones and layering in some beautiful jeweled branches to reflect the eternal growth that my new baby's mortality is a part of.



The truly surprising thing, though, about all this was how after awhile the meaning became secondary to the product. The meaning behind it all was beautiful for me, but after staring at my resplendent belly in the mirror and seeing the photos I couldn't get over how pretty it all was. That I was pretty. That even in my incredibly bulbous and swollen state, I was doing something beautiful. Those feelings pointed me back to the mystery that is pregnancy and birth and filled me with positive emotions. The paint served to accent the beauty of human life and our connections to the eternities. It's like, God made magnolia trees and kingfishers and mountains and clouds because they are beautiful. And for a little while, I felt like I had tapped that feeling of beauty and made it part of my own body. It was a mystical experience that still has me smiling.

All images in this post are copyrighted and are not to be used without the express permission of Julia Cameron Damon

Thoughts on Motherhood (No Baby Yet)

Seriously.

I'll be 40 weeks on Saturday and no baby yet. I guess that's a good thing, but I am starting to get tired of this. I've never gone overdue, but there's a first time for everything!

Anyway, being astronomically pregnant on Mother's Day was an interesting experience. People around me kept hoping I'd go into labor because it would be so poetic to be in labor on such an auspicious day. I kept thinking I didn't want to share a day that is supposed to be about me with someone else! Then I realized, as I got kids ready for Church and walked with them through the hallways and tried to fulfill my Primary calling, the only reason Mother's Day meant anything was because it WASN'T about me. It's really about my kids and the fact that I am willing to try and corral them into some semblance of civility in the hopes that someday they will quit being just kids and turn into people.

Anyway, kudos to the rest of the women out there who bravely put up with the children (and sometimes man-children) around them in the name of the greater good. Being a mom is an awesome, awe-inspiring job. But it's also the hardest thing a gal can do. So, if you're like me (and every other woman in existence) and you're one of those women who wonders if you're really doing a good job and if it really matters and if it's really worth it I'll tell you, "Yes!" Even when the sentiment and the nostalgia have been wiped from your heart and the only thing facing you is the muck and hard work of mom-ing, I'll still say this is the most important thing you can do.

So much of the value in mothering is the fact that the women of the world keep showing up--even when it's hard and they're making mistakes. Mothers don't let your imperfections of their own imperfections or the any other imperfections stop them from loving you.

We attended my husband's grandma's funeral last Friday and I was amazed at what one woman could accomplish in a lifetime. She did a lot of the homey, stereotypical woman things like make afghans and cookies--which she enjoyed and were worthwhile and blessed people. But the thing most people remembered? Her hearty laugh, strong handshake, and the fact that she always looked you in the eye when she spoke to you. They were simple things that have reached across generations. That is what's at the heart of being a mother.

So, I'm going to go mom my kids now and wonder what on earth is actually going to expel this new being from my body. And remind myself, that even when it's not pleasant, even when it's dirty and hard, it's worth it.

The Final Countdown!

Hi folks!

Sorry I've been negligent blogger. But, well, a lot has been going on.

The big news: 2 weeks ago we moved. Hooray! Even though our new house is only a few miles away from our old house, it was still a crazy amount of work. Even with the 15 people who helped out from our ward, it was still a huge job. Two weeks into the new place we are figuring out where to put things, but the kids seem to have acclimated now so that's good.

(Tangentially related anecdote: Yesterday my four-year-old and my two-year-old got into a fight about whether or not we could still rightfully call our new house "new". The two-year-old is stubborn and illogical and would probably call it our "new" house forever. The four-year-old is also stubborn but is beginning to grasp a few logical concepts. She figured that since we've been in the house for "like a hundred days" no one was allowed to call it the "new" house any more. Cause "one hundred days is a super long time." The argument was never settled but it seems to indicate that they are all figuring things out in their own way.)

I think I'm feeling more settled too. For the most part, my stress level has gone way down since moving day and the contractions have slowed. The doctor wanted me on bed rest until 37 weeks and I've done my best to only tackle small projects around the house.

The other big news: I'm 37 weeks pregnant! Full term!! Hooray!

Technically I can be done with the bed rest now, but I don't actually want this baby to come quite yet. Taking care of a newborn is waaaay harder than being pregnant and I would like to get a bit more unpacking taken care of before Number Four makes her debut. Besides, we don't even know what we want to name her yet. Doesn't that mean she should wait just a little longer? However, we did find the baby clothes and blankets the other day so that's good.

One more item to catch up on:

*The psychological tweezing. Ever since I posted about this back in January I've been meaning to follow up but at a loss as to how. The most I can say about it now is that it was a harrowing process and left me exhausted. Once we put our house back on the market and things started picking up with the sale of our home and finding a new house the psychological tweezing eased. I had more than enough other stuff to occupy my brain and emotions. (Just as a side note, everyone should have to go house hunting with a pregnant woman. You've never seen emotional ups and downs like the ones I pulled. It made me a very discriminating buyer. *Wink, wink*) Since things have started to settled some of the memories/flashbacks and emotions have started to crop up again, but I've mostly been ignoring it. I don't feel ready to go back to that yet. And, as several of you readers suggested, I would probably benefit from some therapeutic help with the next round. EFT, you know the crazy tapping and muttering that isn't actually crazy, would probably be beneficial and I think that might be a good route to take next. I just don't know when I'll be ready to pursue it.

One more thing to catch up on: Being pregnant with a history of depression.

I really thought that I would spend a lot of time during this pregnancy blogging about being pregnant and depressed. Perinatal depression is real and frustrating and it's a subject that could certainly use more writing and thinking done about it. I had planned on contributing my own two cents to the whole thing, but it just didn't work out that way.

The weird part is that I haven't been as depressed this time. It's been an emotional time for me (duh!) but the emotions haven't been paralyzing like they have in the past. They've been intense and painful but they haven't gotten stuck. I've met with my psychiatrist and my therapist periodically and they both agree that I'm NOT depressed. I'm just dealing with some very, very real emotional stuff.

This really is a blessing, this whole not depressed thing. I kind of don't know what to make of it. When I was pregnant with Baby Number Three, Mr. J, I had such a hard time with anger and with feelings of defeat. But not this time.

I think things might be different this time in part because of the psychological tweezing and in part because of the increased support from family and friends. I've finally let my family in on a little of what's been going on and they have been so supportive. I can feel the powers of their prayers and how hard they are pulling for me. The same goes for friends. I've always struggled to maintain friendships but at this point in my life I have a few people I honestly believe like me and will predictably be there for me--even when I have nothing to offer them--and they will be caring and discreet and respectful about it. That is such a gift. Of course, my therapist and my psychiatrist are part of that support system too. It's always nice to have an objective, experienced individual to offer perspective when you need it.

I think another part of it is that I've quit trying to forecast the future. I used to spend a lot of time worrying about what all of this would mean down the road and trying to control long term outcomes. My therapist likes to remind me that no matter how much I think/worry/obsess about the future I actually have little control over it. I don't think I've mastered that ultimate zen ability of "living in the moment" but I do think my present has finally begun to outweigh my past and my future in importance and that has brought a great amount of relief. It's so much simpler to focus on today and the upcoming week and month rather than years ahead or behind me. I hope it's a way of thinking that I can hold on to.

Thanks for sticking this out with me and for being a part of my journey. I appreciate your comments and insights. This blog is definitely part of the support system that's been buoying me up.

Have a happy week!

I'll definitely post when I go into labor. Okay, well, I'll definitely TRY to post when I go into labor :)

Hurry Up and Slow Down: Validating My Irritable Uterus

Already the newest But Not Unhappy Baby is getting demanding. Well, it's more like my uterus is getting demanding.(I guess it's not really a good thing that I can ignore hours of contractions. Except when I'm in labor. Then it rocks.) It's been so darn irritable the doctor put me on "moderate" bed rest--which is apparently defined as "only doing the things you HAVE to do."

My first question: What have I been doing that I didn't have to be doing? I mean I'd already pretty much limited my to do list to things that are either smelly (dishes and laundry), whiny (children and husband), or embarrassing (I'm pretty sure you can fill in that blank!). Now which of those am I supposed to let go of? It's been a real conundrum.

I actually got put on bed rest last Thursday but it's taken me this long to get my head wrapped around it. At first I was just stunned. Then I was frustrated. Now I think I'm glad.

Over the last 24ish hours, when I've actually been sitting down and resting, I've noticed something: I'm tired! As in exhausted. My body, my mind, my spirit, all of me is tired. Now, I know I've been blogging about being tired for quite awhile now so this isn't a surprise to you all, but the extent of my lethargy surprised me. With all of our selling-and-buying-a-house-busy-ness I've been running on adrenaline for months now. Being forced to sit down and take it easy has made me face what kind of toll that has taken.

After Baby J was born, almost 3 years ago!, a therapist told me I needed to rest. She wanted me to find someone to take my kids (including the 2 month old baby) for 36 hours and then go find a quiet place and sleep. The therapist actually said to me, "You're not getting more depressed. You're tired. Fatigue and depression look a lot alike. Get some rest." Since I was breastfeeding I wrote her off. Who can sleep for that long when they have a nursing infant? It makes my boobs hurt just thinking about it.

Then, after months of Baby J's sleep problems, our family doctor said, "Can't you find someone to watch your kids so you can rest? Do you have any family in town? Can your husband take a day off work? Get a hotel room and sleep. For as long as you can. You need to sleep." Again, I wrote her off because I honestly believed there was no one who would take my kids for that period of time. Or that my kids would go for it.

Our family doc brings it up every time she sees me and it gotten to be joke between us. But then, the second time I saw my psychiatrist, she said the same thing. She too wanted me to find a quiet place to sleep for at least 24 hours. It was starting to sound familiar. . .

I had an "emergency" session with my therapist last month and she pushed me to set up a few days at a hotel so I could sleep and rest. Just have the opportunity to do nothing. And I almost did it. My kiddos are all old enough that I wouldn't need to nurse anyone and they could all deal with me being gone for awhile. I spent a whole evening looking online for a nice, affordable, quiet place but then things got crazy with our house being on the market and I never actually made the reservation.

I think there's this anti-rest attitude that has been hammered into my brain that just won't let me slow down. I think it partly has to do with the whole "be not weary with well doing" idea. You know, we're supposed to wear ourselves out doing good works and serving God. Who are the biggest Mormon female role models? Pioneer women who practically died on the trail helping others and modern "pioneer-type" women who work themselves to exhaustion serving at the temple/church/cubscouts/whatever. Rarely do you hear a conference talk or read an Ensign article about a chick who said, "Well, I've done a couple things today but I'm beginning to feel a little oyshed so I'm gonna just put my feet up and relax. Let someone else get it done."

I don't think the Church is entirely to blame, though. After all, let's not forget "Good, Better, Best" and "There is a time and a season." No, I blame society at large too. America has long been a country that values hard work--you know, Puritans and boot straps and all that business--and that's not bad. I think those ideas have taken a strange turn over the last 20 or 30 years, though,
when it comes to women. Especially women who have children and stay home with them.

Since the feminist movement (which, for the most part, I am a fan of) women who choose to have children and then choose to stay home with them have to validate their choices. Very few people second guess a woman who goes into engineering or becomes a lawyer. Even women who choose more traditionally female roles like nursing and teaching are understood and looked at as contributing members of society. Women who stay home with their kids have to prove their choices and we usually do it in not so subtle competitions: who has the most children, whose house is the cleanest, whose kids are the best behaved, whose children score highest on different tests or exhibit the most talent, who is the most frugal, who is the most fit, who spends the most time volunteering, or which mommy can do all those things and still hold down side jobs that bring in bonus cash so that her family can have that nice car or fancy vacation. I can think of only one or two women who are secure enough in their choice to stay home that they don't buy into at least one or two of these catty comparisons.

(Now a woman who does one or more of the above may not necessarily be doing it strictly for competitive reasons, but I'm betting self-validation and approval of others factors in more than she'd like to admit. When I look back on the most meaningful conversations I've had with other women telling them that their choices are okay--that they have nothing to prove--is almost always an easily identifiable theme. For evidence just go look at other mommies' Facebook statuses. They really want you to click the like button.)

(Other parenthetical thought: Do men struggle with this kind of competition too? The busier you are the better you are? Seriously folks. I want answers.)

Some of us chicks maybe try to prove we are more savvy and that we don't buy into these ideas by avoiding housework or not taking on extra jobs. But even then we talk too loudly and too often about why we're doing what we're doing because we're still trying to get people to tell us that they approve of our choices, because we ourselves are not sure how we feel about them.

So now it's the end of March and I've apparently been hard enough on my body that my uterus is yelling at me. It's tired and wants to rest. Even if I don't. So I'm doing my best to embrace it. My oldest is at school. My preschooler and my 2-year-old are watching a lot of "educational" (you can see me rolling my eyes, right?) tv. And I'm writing a really, really long blog post.

Because, in all honesty, I'm trying validate my restful choice. You better leave me a comment telling me that you validate it too! (wink, wink)

Pregnant and Depressed Status Update (and with more than 200 characters!)

So I've been feeling so stressed/tired lately that every time I get on the computer to blog I end up over on facebook and just read everyone's status updates over there and call it good. I don't even bother posting my own! Lazy, lazy, lazy girl! So here's some updates I could have posted but didn't.

Update #1: After 8 showings and 1 month on the market we haven't gotten any takers on our house. Learning patience. (And how to clean as I go. Sort of.)

Update #2: My myriad of supplements doesn't always cut it when it comes to my mood disorder. I've had a few days where I've been bordering on non-functional. Might be time to call my psychiatrist. Being mood disordered and depressed is probably worse for the baby than Prozac. . .

Update #3: Decided to wait on calling the psych. Decided to withhold judgment until fetus and I made it out of the first tri. Well, that was last Saturday and while I'm starting to get a little more energy my anxiety level is ratcheting itself up every day. What the heck was I thinking?!? Four children?!?!

Update #4: As scared as I am of having to deal with an infant and the crazy that comes with it (so scared I spent whole therapy session on it. EMDR here I come! Say what you want about the tapping and the eye-rolling; it works for me.) I like toddlers. I like preschoolers. I like first graders. Kids keep growing and they just keep getting better. *deep breath while contemplating light at end of tunnel*

Update #5: Embarrassing but true: I find the updates about New Moon fascinating. If only I could find a way to write a paper on that. P.S. Team Jacob folks, you crack you me up!

Update #6: Seems like all I ever work on is staying in the present. Today is no exception. Instead of rehashing the my PPD past or fretting about a future that I really have no clue about, I'm going to be where I am now. Maybe. Hopefully. Today is a field trip with my daughter's preschool and a sunny day and the last day of school before Thanksgiving break. It will be good.



p.s. Fall in Colorado is beautiful!!!

Pregnancy and Depression--how it's going thus far

I am now eleven and half weeks pregnant. I saw my OB on Monday and she got some good shots of a squiggling, half-alien, half-frog (but soon to be human!) creature--complete with beating heart. Never has any whooshing been so calming to my mind.

Mostly I've been trying to not think about this pregnancy so far. I mean, my family has already outgrown our little 1400 square foot home so we've been caught up in the busy-ness of putting our house on the market and my husband has been crazy-busy at work and we had a family sealing to go to last weekend and, well, I've pretty much been thinking about everything but the blessing/complication that is currently inhabiting my womb.

Of course just because I wasn't thinking about it doesn't mean I wasn't worrying. Every night as I go to sleep I chant "Grow little baby. Grow little baby. Grow little baby." And in every personal prayer I can't help but add, "Lord, if it's thy will, please help the tummy baby not to die!" I know it sounds little nutty, but worrying is what I do.

So, the appointment went well and I'm almost out of the first trimester danger zone and I'm starting to think about this pregnancy as a person. I can see the light at the end of the nausea and fatigue tunnel. I've never been visibly pregnant during the winter so I get do some (frugal) shopping. I'm starting to get excited. This is starting to be fun.

Especially when I remember that this is most likely my last. Barring any divine intervention I don't plan on treading the path of pregnancy again. It's too hard on my chemistry. And therefore my family. And therefore me.

So far the chemistry is doing okay. It was a little wobbly the first couple weeks off the meds, but I think it's mostly settled. My ups and downs are more intense, though. My temper seems to flare up more often. I screamed at the kids at bedtime. I cussed out my husband. I had to pray for the patience to make it through Church. Whenever my kids do something cute or someone does something nice for me I cry. I tear up at cheesy television voice-overs and commercials. I decided--unilaterally--the put our house up for sale and my husband got on board, but I was just overcome (consumed?) with the urge to find a better home for our family. It wasn't a bad urge, but it was an awfully powerful one.

I'm trying to stick with the supplement regimen that my psychiatrist and OB agreed to. I did a bunch of internet research and then called them both to get their okay on it. It was a lot of work and it made me wonder what most depressed chicks do. Knowing how bad it can be, having some pretty solid, scary memories of my own personal insanity, I was pretty motivated to figure something out. And I was lucky that I'm good with the internet and have a pretty good network of other depressed folks to hit up for advice. And that I live in an area where supplements are part of everyday life for most people; the people at Vitamin Cottage were full of info that correct and germane(!).

Here's what I'm supposed to take:

*AM: 1 prenatal vitamin (I've got the kind where you take 3 a day) which includes inositol. My OB had never heard of it but psych had; both agreed it was safe to take during pregnancy because it is a naturally occurring substance and (I think) similar to B vitamins so it's water soluble and you can't overdose on it. 1 fish oil For info on fish oil and mood disorders read this article at Webmd and this one at from the Mayo Clinic. 1 vitamin B. For info on vitamin B and mood disorders here's another article from the Mayo Clinic or try this one from the Linus Pauling Institute, you'll have to scroll down a ways to read about depression.

*NOON: 1 prenatal (inositol included) and 1 vitamin B.

*PM: 1 prenatal (inositol included), 1 vitamin B, and another fish oil. I'm thinking of switching out this second fish oil for a flaxseed one. Fish oil is an anticoagulant and so is potentially dangerous to the fetus when taken in large doses--which it usually is when being used for depression. I'm wondering if using flax oil instead would be better. . .

I asked both my docs about vitamin D and they both said that was an unsafe supplement to take during pregnancy. For info on vitamin D and depression read here. Actually the whole article, which is about nutrition and depression, is really excellent so here's a link back to the beginning!

It adds up to a lot of pills each day. I feel like I'm always popping something--especially when you add the probiotic yogurt smoothly I drink to ease the morning sickness. (Probiotics are also supposed to be good for your mood disorder. Seriously. Read this. It's only an abstract, but it's got some good info. It's also supposed to help my unborn baby avoid eczema--which is a total bonus given the saga we've gone through with J and his eczema. According to the internet probiotics are the source of all good things. I admit that all that enthusiasm makes me a little suspicious, but I like yogurt so I'm going with it. Anyway, back to the point here . . .) All those pills are a much bigger hassle than my one Cymbalta and my one mulitvitamin and if I get busy I do forget to take them. They were also very expensive. All the supplements added up to more than twice the cost of my monthly Cymbalta prescription. Now, that's mostly because my insurance covers most of the cost (lucky me!) after we meet our deductible--which we usually do in January when I fill my first month's worth of SNRI. Some of the supplements came in big bottles so they should last longer than a month, but still, it adds up. However, I do feel better when I take them so in my mind it's worth it. Because I'm getting a baby out of this.

So it's all worth it--mood disorder and all--it's worth it.

Ch-ch-ch-changes! It's time to Mom Up

So. . . I'm pregnant.

I've been meaning to tell you for awhile, but I keep freaking out. I guess the miscarriage in June made me a little superstitious. I had just told a few friends and then--whammo--spotting, bleeding, sadness, etc. So every time I went to write this post I got nervous and decided to just wait. I told a few people because they asked me point blank or because I felt like I had to explain some bizarre behavior (like suddenly deciding to put my house on the market or getting too woozy and needing to hang out for an hour instead of just picking up my kid from the play date and leaving), but mostly I've just been obsessing about it when I'm on the phone with my sister. And when I can get my husband to sit still and let me whine about my morning sickness.

I'm only 9 weeks along. (Read: My chance for a miscarriage is still around 40%!) I haven't seen my doctor yet. (Read: have not actually confirmed existence of baby. Could be a blighted ovum. Or a chemical pregnancy. Or an, ahem, hysterical pregnancy--isn't that right up my alley!) I'm sick and tired. (Read: those are good signs that this is a viable pregnancy, but they don't really induce me to blog.)

I'm owning up to it now since I hear I was outted at a ward party and because well, this random telling-people-sometimes-thing isn't working for me anymore. This pregnancy has raised a lot of issues for me and I find myself wanting to blog about it but being too afraid of what that would mean. So it's time I man up, or mom up, as the case may be.

I've met with my psychiatrist and per my pregnancy plan, it was time to wean off my medicine. Since I was on the smallest dose available that meant stop taking it. As near as I can tell I haven't suffered any real physical symptoms. Everyone on the internet who takes Cymbalta and then quits complains of "brain zaps." Haven't had any of those. My sweatiness has actually decreased since I quit the medicine and I appreciate that.

As for mood symptoms, well, the jury is still out. Don't get me wrong. I've been moody. Actually, MOODY is probably more appropriate, but there's no real way of knowing if it's the pregnancy or the lack of SNRI or the horrible weather we've been having or what. I feel like my intrusive thoughts are back. . . and that's been a little bothersome. They're mostly pretty quiet, though. Surprising but quiet. Prayer--and music, any music with words--has been helping a lot with those. I've been having trouble sleeping, too. Falling asleep is the hardest thing. My brain just goes nuts when I lay down, spinning out all sorts of disaster scenarios. But I'm working on a mantra to calm it down. I'm kind of scared for what the next eight-ish months hold. Perinatal (and postpartum) depression really is a crapshoot. A lot of the time it feels like there's now way to win. Not taking my medicine is supposedly better for the tummy baby, but not if I'm crazy. But if I'm not really crazy, then being on the medicine is a pretty big gamble.

I've been taking my prenatals and some supplemental fish oil and vitamin B because those two have helped a lot of other depressed people going off their meds. But the vitamin B turns my urine electric lemon yellow (you wanted to know that, right?) and since it's water soluble the recommended dose for depressed people is really high--which doesn't seem safe since there's a bun in the oven. The fish oil is fine going down, but every now and again it gives me fish burps, which don't help with the nausea. And the recommended dose for depressed folk is again very high--which is absolutely NOT SAFE when pregnant because of fish oil's anticoagulant properties. I need to talk with my OB about it, but I don't see her until the end of the month.

So basically I'm a slightly fatter, very moody version of myself who is going sometimes-crazy trying to get her house ready to sell--while mentally crossing my fingers for good luck this time around. I hate being on the wrong end of statistics!

Anyway, I hope you all are in just as exciting places in your lives :) Let's make a deal: I'll keep my fingers crossed for you and you keep my fingers crossed for me and then we can all relax. . . After all, it's time to mom up and do this.

When the Monkey Falls Out of the Tree: inside a psychiatrist's office

On the front of her brochure, my psychiatrist (yes, I actually got one. . . it was a complete fluke; I happened to call right after a patient canceled an appointment so the receptionist stuck me in that slot. Really. And no. The psychiatrist is not covered by my insurance. *Sigh*) was tall-ish and blond-ish and smiling. In living color, she was lanky and gray-haired and frighteningly skinny. She also had glasses that she had to frown to see through. And she had a lot of bookshelves with oversized books about pretty much everything.

I think I liked her. When I think about the $400 I dropped for the two hour intake exam, besides feeling nauseous, I thinkI really like her. Finding a new psychiatrist would tantamount to burning money at this point.

For simplicity's sake I think I'll refer to her as my Personal Female Freud, or the PFF, from here on out.

I was a little nervous going in. The kiddos had swim lessons today and that is always stressful. (Three cold, hungry children plus one mommy multiplied by a germy, slippery locker room equals a gazillion bemused/horrified on-lookers and a lifetime of embarrassment. Someone please remind me of that next summer when I'm signing up for swim lessons.) And we had to run to the library. And my visiting teachers also came today. And the sliding door of our Toyota Sienna got a massive scratch--you can see it from far away--in the rec center parking lot. I was pretty tired and stressed--and late!--by the time I reached my PFF's office.

I sat down on her cushy couch, checked the clock, and immediately began talking--rapid fire style. I quickly listed all the dates of my pregnancies and deliveries along with my medicines and dosages. When she asked for a family history I listed in all the people with mental health issues in generational order, complete with relation to me and treatments received. I began giving her examples of my symptoms (what I am like when I'm raging, what I'm like when I'm truly down, what are my panic attacks like, what types of intrusive thoughts I have and what happens when they get too loud) when she interrupted me.

I was startled. My therapist, who is more of a BFF than a PFF, rarely interrupts me, which is a major reason why I like her. I have a real need to be heard and understood and I don't always get that in my life. So when the PFF cut me off, I was little offended. But then I realized that a PFF is not a therapist. She's an MD. A doctor. A diagnoser and prescription writer. I slowed down and began giving condensed, yet honest, answers. My PFF wanted specific details and a few big picture clarifiers, but not my memoirs.

After a few more history questions, she began getting out her big books and a magnifying glass. The big books were full of such small print that she couldn't read them without one. She opened her Physician's Desk Reference, held her magnifying glass about half an arm's length away, and began reading aloud about my medication and pregnancy and lactation. Here are my notes (which, I feel obligated to point out, don't serve as a substitute for a trip to your own PFF. Seriously. Get your own!):

*Cymbalta is new. As in, only two years old. The previous generation drug, Cymbalta's mommy, was called Effexor. There isn't a ton of research on Cymbalta directly, but there are some conclusions you can draw based on research about the older drug.

*In pregnant rats and rabbits who took 7 to 15 times the human dose of Cymbalta, there were issues. Duh! You could give them 7 to 15 times the human dose of water and they'd have issues. You know, when you consider that animals are spiritual beings too, well, that's really sad that some of them are experimented on that way. I'm grateful to them. I also think I'll have to search out quite a few vermin in the next life and thank/apologize to them. (That last part was my conclusion. Not the PFF's. The Physician's Desk Reference doesn't talk about spirituality. Even though it's so big it will hang off the end of your knees when you put it in your lap and looks like it's the actually the Big Book of Everything.)

*In women who took Cymbalta while pregnant there were some correlated complications, especially for those who too them during the third trimester. The symptoms the newborns exhibited (like an increased startle reflex, difficulty regulating body temperature, and shallow/irregular breathing) were similar to those in adults who were having a serotonin overdose. No one knows if that's what is really going on with the babies, but there is something different about some of them. No long term effects were mentioned. Probably because the drug is too new to know.

Then the fun started. The PFF started running a battery of tests that I believe she called a mental status exam. She asked me common sense questions (What's today's date? Who's the President of the United States?) common knowledge questions (Who was the previous President? And the one before that? And the one before that? And the one before that--at which point I told her I hadn't been born yet, but I was willing to guess. So then she asked me, "What's the capital of Spain?") and some non-sensical questions (What does it mean when someone says, "Even monkeys can fall out of trees?"). Then she had me draw some pictures, copy some shapes and repeat back lists to her. Then came the toughest question I have ever answered: Count backwards from 100 by sevens. I started to sweat. "It won't take as long as you think," the PFF intoned. I began to calculate and fumbled and tittered and lost my place. I shook my head. I closed my eyes, took a deep breath, furrowed my brow, counted on my fingers, and managed to get the answer right. Turns out the test, my PFF told me when I was done, was to test my concentration. Apparently a lot of people who have been treated for angry/anxious depression are actually ADD. My counting backwards skills proved I'm not that, but as the PFF pointed out, it sure "Looked like your performance anxiety got to you, huh?" Awesome.

As two hours wound down I was tired--it was draining to focus on my issues for that long--but good conclusions were drawn: in my case, particularly because of my perinatal depression, it's probably best to stay on an antidepressant with my next pregnancy. Cymbalta is not the best choice and it's worth trying to wean off it--slowly--and start a different drug near the end of the pregnancy (probably Prozac. Oy! I've never felt so cliche). Apparently there's some estrogen variant that is produced by the placenta that makes pregnant women feel good and we're hoping that will keep my mood adjusted for the bulk of the pregnancy. I'm supposed to call after a month on the reduced dose and we'll decide how fast to take it from there. If I get preggers before the Cymbalta is out of my system, that's okay. No need to cold turkey. It's only the third tri that appears to be a problem.

Walking out of the office, I felt good. we have a plan I can stick with. And the PFF is another supporting fixture in my life, which feels really good. After all, like I answered about the monkey falling out the tree, "Even when you're doing something that should be natural to you, that you should know how to do, you can still end up on your butt."

Oh, and the icing on the cake: one of my visiting teachers cleaned my house while I was at my appointment. The place was trashed when I left and gleaming when I came home. I cried a little. For real. The Visiting Teaching program is just one reason why I love my church.