livingwithablackdog

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Food Glorious Food 25/09/2011

Filed under: Clinical Depression,Depression,Managing Depression,Physical health & wellbeing,self-management strategies — jillnottelten @ 5:54 pm
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Fruit.  Vegetables.  Meat.  Protein.  Dairy. Iron.  Carbohydrates.  Breads.  Cereals. Rice. Pasta.  Vitamin E.  Vitamin C.  Vitamin D. Vitamin B.  Fats.  Sugar.  Cholesterol.
Hormones.  Blood Sugar levels.  Chocolate.  Shortbread…

How we eat makes a big difference to how we feel.  It affects how much energy we have.  It affects how efficiently our system processes what we do eat and how easily it will break down and prevent or minimise constipation.  For some it can affect them at a more vital level – for those with diabetes it is even more important to monitor food intake, as for those with particular allergies.

Recent studies indicated that people with depression have a high (anything up to a one in two) risk of developing diabetes.  That is an enormously scarily high statistic.  You might ask, “Why?  Why this on top of everything else?”

A large part of the answer is thought to be tied up in lifestyle issues.  They actually think that for most people this is preventable!  Risk factors for development of type 2 diabetes include lack of exercise and sedentary lifestyle (ie sitting around a lot and inactive), obesity especially if your weight distribution is more around your stomach than your hips and thighs, eating unhealthily is a major cause of type 2 diabetes – too much fat, too many simple carbohydrates and not enough fibre in particular; also high blood pressure, high cholesterol levels, high cortisol (stress hormone) levels,  smoking, family history, gestational diabetes and aging (over age 45 becomes higher risk).

A lot of these risk factors overlap with issues that occur regularly in people with depression.  It is common for people with depression to have little physical exercise and very sedentary lifestyles, poor diet and become overweight due to a combination of this and at times side effects of medications – and the lovely little belly that the medication leaves is usually a tummy rather than hips and thighs.  Stress level hormone levels may be high due to anxiety levels; depression, like diabetes often has genetic links, many of the high levels can be secondary to diet and lack of exercise and statistics indicate that a high proportion of people with depression also smoke.  Oh – and yes, we might say that we’re 39 for a while, but everybody ages.

The good news is that the majority of the factors identified as risks are preventable.  They are also helpful ways to improve the prognosis of the course of our mental health.

Look for ways to become more active.  Start small and build up a little at a time.  Sooner or later you will feel like you are exercising.  In the meantime, you will be stretching out those muscles and getting them ready for a challenge.  One of the biggest weight loss programmes in the world was started by a woman who started out by walking around her clothesline.

Research what needs to go into a balanced diet.  Plan what you will eat ahead of time and stick to it.  I find this really hard, but it really is worth it.  I have more energy when I do and it helps keep a lot of other things more balanced.  Try cutting up your veggies when you get them and storing them ready to use – that way you don’t have as much to do to prepare food when you have to cook.  Same with your meat and everything else.  It takes longer to store – but half the time (at least for me) a large part of the battle in getting the energy together to get something healthy and wholesome to eat is in overcoming that ‘I don’t feel like all the preparation’ feeling.  At worst keep a couple of pre-cooked healthy meals stored in the freezer for when you don’t feel like cooking.

Talk to your doctor about a Quit smoking programme.  It is possible.  People do it all the time.

See someone about some anxiety management strategies.  If you already see a case worker, therapist or doctor ask them for advice about what to do or where to go.  Look around for local programmes through community health resources.  If you get stuck and are not sure where to start, check out the mindfulness and CBT pages on this site or post me a comment and let me know.  If you’re in Australia, ask your GP to write you a referral under “Better Health” to see a psychologist or clinical psychologist.

Just to start off, this week I had a really simple meal of a piece of steak about the size of the palm of my hand.  I had a couple of mushrooms that I chopped up and cooked with it in the pan.  I then steamed in the microwave generous serves of broccoli, cauliflower, both green beans and yellow ones and some snow peas that I grew in my garden.  It was filling, plain and simple.

Why not share something healthy that you cook/prepare or plan to cook/prepare after reading this in the comments.  Maybe we can collect some recipes and ideas?

 

My Pyjamas 07/09/2011

Filed under: Depression,Function,Managing Depression,Routine,self-management strategies — jillnottelten @ 12:37 pm
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I know better.  I really, really do.  There are good reasons why it’s not uncommon to find me in my pyjamas long after I get up.  Really …

Firstly they are comfortable.  Soft fabric, loose, warm, cosy.  In summer soft and breezy.

They’re warm (it’s still cool down here in the Southern hemisphere)

I’d need to take them off and be unwarm for a little while to get dressed.

I don’t feel like having a shower and all that yet (today is my day off).  Too much effort.

I’m not sure what I want to wear later today and am not that motivated to choose at the moment because it really doesn’t matter.

I’m at home.

They’re home and relaxing kind of feeling things.

Nobody else is going to see me.

I LIKE my pyjamas!

It saves washing???

Smell? What smell? …  ohh! you mean the one that’s following me when I do this for three days in a row without changing?

But that’s not me today.  Today’s my day off.  Lots of people mooch around in their PJs late into the morning on their day off.  Yet, only last week I was recalling that this behaviour – when habitual is one of my warning signs.How do I know the difference?  In truth – I don’t.  At least, I’ve missed the warning signs until too late enough times that I know that I’m not yet able to reliably spot the difference.  What can I do?

The first option is to not let myself stay in my PJs after getting up whatever the day – rather to go straight for the shower or get dressed as soon as I get up.  Reality is that I don’t really put a serious start to the day while I’m still in my PJs – and I need to move past the ‘getting up’ phase of the day earlier than I do much of the time.

The second is that I time limit it and say that I need to be out of my PJs by a certain time.  I’m thinking of taking this one up.  Which means the next thing that I need to do is head for the shower because it has passed that time already.

Wish me luck.

 

Attishoo! Attishoo! We All Fall Down 31/08/2011

Filed under: Depression,Function,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,Physical health & wellbeing,Routine,self-management strategies,Work — jillnottelten @ 9:42 pm
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What’s going on?

I’ve got a headache that I’ve had on and off for a few days now.  I’m so tired so much of the time.  I’m disorganised.  My house is a mess and getting less clean than I’d like it to be – it’s not grotty, but without action it could get there without a lot of effort … I’ve spent the last couple of days off loafing in my ever comfy PJs and while I’ve gotten up and done stuff, I’m sure I said ages ago that I was going to stop doing that…

Hang on.  These things are all among my early warning signs.  I’m off my game.  Nothing serious yet – but now is the time to act.  I’ve been going really well for ages.  It’s not even my Depression that’s knocked me off my game – it’s the damn cold that I’ve been fighting.  Yet this I do know.  In the past relapse has often followed physical illness.  The dog acts when he knows I’m not at my best.  He takes advantage of weakness.

So what do I do now?  Give in? Panic?  Book an extra doctor’s appointment?  Nope.  Now is the time to reach for my WRAP – my Wellness Recovery Action Plan – something that I should probably be going over more regularly to remind myself of the daily and weekly/regular things that keep me well.  In my WRAP I found that I’ve been neglecting a lot of these over the last couple of weeks and that I have gotten sloppy with a couple of my routine maintenance markers over the past couple of months.  My work WRAP (my own experiment) shows me that I’ve not been sticking to my wellness goals about leaving on time and planning my day either – no wonder I’ve been feeling like I’ve been run over by a truck.

Now is the time to restart the action plans.  I need to tell someone that I’ve noticed that I’m off my game and that I’m acting on it – that way they can ask me how I am going with my action plan in a couple of days to see if I need some help to get things moving again or if I’ve been able to self-start again solo (often harder than I think it’s going to be).  I’ll wait to see how things progress and talk it over with my friend before I rush into moving any appointments forward.  I think I’m okay if I get reorganised at this point.

So its back to setting alarms and keeping them for going to bed and lights out at night.  I’ve been letting the sleep run thin.

I need to plan my meals rather than look in the fridge and hope that there’s something I feel like eating in there.  And I probably need to start putting more attention towards the balance of what I eat because I don’t think I’m eating enough fresh fruit and vegetables (that’s a new strand to the plan for me).

I need to put away the things that are lying around and creating clutter.

I need to clean the house.  When that goes to my list though it will read room by room and the floors will be separate.  That way I can do it in parts and feel like I’m making headway when I cross things off on my list.

I need to set up a routine for maintaining my housework.

I need to set aside time for doing things that I like to do.

I need to work out how I want to prioritise a couple of things that I have going at the moment so that I can put away what I am not going to finish in the immediate future and finish off what I am doing in my ‘projects’ department.

I need to set aside time for some meditation and prayer.

I need to make sure I leave work on time.

I need to make better use of my diary and go back to keeping a list of things that I need to do to mark off and prioritise – this works well for me

I also really need to put some effort into starting to exercise and to spending more time outdoors.

If I need help with anything, I can and will ask.

I’ve been good with most of my other stuff but things involving routine, and doing things that I’m not instinctively motivated by (like exercise and cooking for anything other than guests) are difficult.  It may get easier.  Who knows?  My goal is to find something that I enjoy in the things that I find difficult to do at some point – but not now.  Now the need is to just do it.

We all fall down.  We all need to know the best way to get up again too.  Take the time to be prepared.  I use the WRAP (http://www.mentalhealthrecovery.com/wrap/ .  You can now download an old edition of this from “Recovery X-Change” http://www.recoveryxchange.org/downloads/RxChange%20WRAP%20WorkBook.pdf  if you want to check it out a bit more closely).  There are a number of different systems people have.  The most important thing is to be ready to be ready.

All I have is a cold.  It does not have to become a relapse.

Right now though it’s approaching bed time.  So rather than editing anything else.  I’m going to post this and head for the sack.  Good night.

 

It Works For Me 14/08/2011

Filed under: Depression,Function,Goals & Purpose,Managing Depression,Routine,self-management strategies,Work — jillnottelten @ 11:59 am
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In every culture there are certain norms.  Rules if you like.  What type of food people eat, the structure of families and social networks, the kinds of things that people do, our attitudes to authority and among other things our attitude to work.  In most western cultures the attitude is that you’re supposed to engage in it – but it’s also something to complain about.  The idea is to have a lot of other things you’d rather be doing.  Work, school all things regarded as ‘compulsory’ are often seen as restrictive.

I returned to work recently after a long absence from the workforce.  The initial period was due to a nasty relapse of depression.  Most of the months were while human resources were getting their act together pushing me through ‘independent’ doctors who were giving clearance for graded return to work plans all the while saying that the doctors had not said that I was not fully fit for duties.  It reeked of them trying to get rid of me.  Alas for HR, they failed.  I got back in.  What is more I got another job which I will start next week  and was offered others while they were stuffing around – with disclosure about my depression.  But enough on that.

Some of the Benefits of Productive Activity and Work

My return to the workforce has brought one thing to my attention in a stunning way.  I love going to work.  Sure there are some tasks that I could do without.  But on the whole, work is something that I need.  While I was off, I had to work hard to manufacture work for myself in the form of projects and I enjoyed them a lot.  But it feels good to be doing something productive.  To see people and say “hello” to them and pass the time of day with them.  And that’s before I’ve even gotten my first pay!  And to be busy.  I am enjoying being busy.

I am really fortunate this time too.  My latest medication regime is leaving me non-drowsy.  My attention is better in the morning than the afternoon – so I will have to gear my day around doing the close work that needs that kind of focus early, but otherwise things are looking good.  I am well.  The dog has gotten the message that he needs to stay at heel and not strain on the lead.  At the moment I am tired at the end of the day.  Very tired, but I am convinced that in the coming weeks this will pass. Some of this has been helped by the fact that I am not starting cold.

I am convinced that my determination to keep busy with projects that required concentration, busyness and maintenance of a routine while off work has helped enormously with this, because in this too the dog was given little space to roam free on my time and thoughts.  He essentially had to stay out of the way.

People, let me say that I am a convert.  I believe that people need work – not necessarily paid work – but productive activity of some description to keep them feeling like they are moving and breathing.  I believe that work brings freedom with it.  Sure there is a need to have support and watch your early warning signs.  Sure there are unpleasant tasks.  Sure there are jobs that you would prefer over others.    But work – work is grand!

 

The Stranger 04/07/2011

Filed under: Clinical Depression,Depression,Function,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,My Black Dog,self-management strategies — jillnottelten @ 5:19 pm
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I sat down to do my WRAP a few months ago.  My Wellness Recovery Action Plan.

The idea is that you describe what you’re like when you’re well, what helps you stay that way, what your triggers are and what you plan to do when you encounter triggers to prevent spin-off effects; then what your early warning signs with an action plan for what to do if you notice them emerging; also what happens when you’re feeling much worse and again what helps in those instances.  You also make a crisis plan, identify supporters and how you agree that they will support you/what you would like them to do for you, identify people who you don’t want involved in your care/treatment and people who need to be notified, your current meds etc.  There are a whole bunch of different ways of a similar process.  Mary Ellen Copeland’s Wellness Recovery Action Plan is the one that I have been using – and hence describing (see link to website).  The point is then to read it regularly – she recommends daily and to stay on top of your management plan and to know yourself, to recognise when you are not yourself; to be watchful and vigilant for triggers, warning signs and symptoms and to act immediately, instinctively.  Also she recommends to have a couple of others who check in with you regularly to help out and give you their perspective or who will tell you if they notice that things don’t seem right.

I think that almost the hardest part of the process to complete was the first question.

“What am I like when I’m well?”

It had been a long time since I had been well for longer than a few months at a time.  What’s more, I have changed.  I am not the same as I once was.  This battle – this relationship with my dog has changed me.  What am I like?

I was in my mid twenties when I had surgery for a massive aneurysm.  Somewhere over the period of the next five years came the prodromal and early symptoms of Depression without being diagnosed until I was almost 30.  I have been wrestling to learn self-management skills until reasonably recently.  It has been a long time since I was truly healthy, although between brief periods of mood change or minor undiagnosed episodes in my twenties until my eventual breakdown with depression I’m sure I was fine.

My point?  What am I like when I’m well?  I don’t know anymore.  What’s more, it always feels like such a silly question to ask other people.  I mean – asking people to help me to identify what I’m are like when I’m not well … that makes sense because I know that my insight is not at its sharpest.  But well?  Shouldn’t I already know that?

Not that I was ever good at describing myself.  Always self-critical, I was never particularly sure why people wanted to be friends with me after leaving school when I had hadn’t had many friends at school.  But that’s school for you – start school somewhere awkwardly and the perception sticks with you til you leave.  Even as an adult I struggle to have a clear picture of what I am like.

What am I like when I am unwell?  What helps when I am unwell?  These questions I can answer reasonably these days.  I have even thought to discuss some of this with others or take notice of comments that they make.

But to know myself well.  To know the self that has been changed by this dog of an illness, by periods of chronic pain, by a swollen blood vessel in my brain waiting as a time bomb for its final burst – but found before it could; the self that has been altered by periods of self-imposed hermit style living apart from the workplace.  This is a person that I must relearn.  This is a person whom I have lost and who has changed while she has been away.  She is a stranger.

I need help to know this person.  Friends.  Family.  Memories.  Time to explore the things that interest me again, to develop new ones.  To reflect.  To do.  To explore.  To discover. To learn.  To grow.  To live.

 

The Phantom 02/07/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,self-management strategies,Social Supports & Networks,Talking About Depression — jillnottelten @ 5:20 pm
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I have a secret identity.  Not just a pseudonym.

She appears when the black dog prowls.  But she’s not a superhero.

Her superpower? She melts into the weave of the sheets and the very mattress on my bed like 3 day old macaroni cheese sauce on the lounge of a bachelor pad in summertime.  She can barely roll over and will do anything not to.  Almost anything.  She won’t wet the bed.  She will tell you the most atrocious lies in the universe.  Anything to make you go away and leave her alone there.  She barely eats or drinks – far too much effort.  She stinks – goes for days at a time without a shower or cleaning her teeth.  The thing she does do is sleep.  She excels at that … except when she needs to.

And she can never tell you how she got to that state.

I am pleased to say that she has only taken a firm hold on my space a couple of times, but cleaning up after she has even attempted to gain entrance is a nightmare.   It’s hard work chasing her out when she’s just passing through and catches me out.  Next thing I know, there she is sitting there.  She’s not looking like moving anywhere.  She looks like she knows she’s not welcome, but can’t bring herself to move.  A lazy visitor.  In the way.  Impeding the things that need to be done.  And looking like she’s stay the year out given the opportunity.  She has no sense of time.  Little sense of purpose.  And little sense of the ‘other’.

And then I look over my shoulder and see my dog pacing.  He’s never still when she’s around.  They feed off each other.  Stalker and sidekick.

I am learning that the secret identity has more pitfalls than safeguards.

Superman.  Batman (without Robin).  Spiderman had pretty lonely existences – and they were the good guys.   Secrecy is isolating.

Maybe just one or two people need to know about my secret identity.  Need to know now while she’s not around – so that they know to come looking before too long if I disappear; so that they know what to do with my secret identity before she takes over again completely.  So that they know when to say “Bulldust!” and when to be gentle.  So that they know that I am also vulnerable to her bullying ways for short bursts while I am physically sick.  Not everyone – just a couple of people.  Perhaps then one or two will know to come not call.  To peek in the fridge.  To offer a lift rather than remind me.  To ring just that little while after I say I’m planning to be up in the morning for a chat – til I sound like I’m awake and alert and up for the day (and to try again in ten minutes if I don’t answer in case I was in the shower or just missed the phone).

It’s hard to disappear when there are a carefully selected few making constant contact and stripping away the secret identity.

Soothing the dog.

Because everyone needs someone who will come looking.  The biggest question is – is there anyone I trust enough for that task?

Do I want to share the ugly signs that show that my black dog is starting to pace?  That the secret identity is moving into play?  How do I decide who to share with?  How much can I ask of people who put up with so much from me anyway?

But if it means avoiding the black dog at his worst …

If it means I can keep a job ….

If it means keeping a friend …

If it means not exhausting my family through another painful and exhausting regathering process …

If it means keeping some perspective on life …

Perhaps I am asking less of people than I am by struggling on alone.  If only I can bear to share the secrets with those close to me …

… in exchange for those that they have already discovered that I have been too blind to see.

 

I have a Dog 23/06/2011

Filed under: Depression,Managing Depression,My Black Dog,self-management strategies — jillnottelten @ 11:13 pm
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I have a dog.

Lots of people have dogs.  Most of them are called things like Spot, or King or “Here, Boy”.  They’re spotty Dalmatians, flat-faced Rotties, alert Alsatians,  perky Jack Russells, yappy little floor mops, podgy Pig dogs, loyal Labradors and trusty Heelers.  Or so we say.  Most of them are bitzers.  But the average household dog is loved.

My dog is a black dog.  He is with me everywhere I go.  I have what  is known as treatment resistant Depression.

My journey has been a strange one.  I find myself standing amidst two different worlds on a regular basis.  In one world I stand with my black dog, visiting a doctor.  In the other I stand with the doctors and other health workers trying to keep my dog out of the way while I see others who come to me, some trailing their own black dogs.  I am also a Mental Health worker.  In fact, I was a mental health worker before my black dog came to join me.  While I had been an empathic one before this, the shift in perspective gave a lot of insight to the way that I worked.

I will always be glad not to have been in the workforce at the point in my journey when my symptoms of depression became so severe that I couldn’t function.  It was a spectacular crash.  I was – it seemed – irretrievably tangled in this black dog’s unsecured lead to a point where I had tripped and was unable to get up again.  Mongrel dog.  As it was with a lot of time, hard work, patience and medication I was able to get untangled – but I’m stuck with the dog and the lead.

More time, more and more review and adjustments to medications by my Psychiatrist, a lot of work with a Clinical Psychologist, an excellent GP, a supportive supervisor and manager at work, a couple of great friends and a magnificently supportive family behind me and eight years later I have my black dog much better trained.

With a lot of time, effort, meds, bucks, sweat and tears I have trained my dog to walk at heel.  He does not run riot anymore.  He is not a puppy.  He is still a challenge and will always need a close eye.  There will always be times when he moves unexpectedly and I stumble on his lead or get pulled in a different direction.  There will always be places that are not as dog-friendly as others, even if it’s not deliberate.   When making plans I must plan not only for my needs, but for those of my dog.  They can be costly in all senses of the word.  They can be inconvenient.  They can seem impossible.

But if I plan for him, I can plan for me.  And I can do all manner of things.

He is not my pet.  He is my responsibility.  I am never without him.

He is my black dog.

 

 
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