Mental illness is hard.  Full stop.  It is hard and different for everyone.  Currently, my mental illness is harder than usual.  I have a foggy brain.   My heart pounds for no reason.  My anxiety is kicking my ass.  My depression makes me just want to stay in bed all the time.  Or maybe it’s fatigue. Or maybe it’s that I need more sleep.  Or maybe it’s my thyroid.  I’m cranky and bitchy and my tolerance for all the things is waaaaaaay down.  Maybe that’s my mental illness.  Or maybe it’s stress.  Or maybe it’s me starting menopause (even though I’m obviously much too young to consider that).

The problem with my current mental illness state is that I have too much other shit going on.  My depression and anxiety are getting pretty dramatic – is that because my medication isn’t working as well anymore?  I mean, I did go off of it to try other meds that weren’t as expensive (or, as it turns out, as effective for me) – thanks, Blue Cross/Blue Shield.  And now I’m not feeling nearly as much like myself as I was.  But, I’m also on thyroid supplementation.  Maybe my dose isn’t high enough and that’s what’s causing the brain fog.  Or maybe I have Bartonella and that’s causing the brain fog.

In my career as a veterinarian, I frequently have to figure out what is wrong with my patients that have many different factors and potential illnesses that could be contributing.  (Also, they can’t talk.)  (Also, also, the owners that come in with them sometimes talk too much about things that don’t help.  But I digress).  The way I try to figure that out is by using SOAP.  While sometimes I WOULD like to wash my eyes or brain or ears to get rid of some of the things I see or hear, that’s not what SOAP is.  SOAP stands for Subjective, Objective, Assessment, and Plan.  It’s a way to organize the information we have to try and figure all this shit out.  So, I’m going to SOAP myself.  When I type that, I feel like maybe I should set up a webcam and get some $$ for it…  Haha.  J/K  No one would pay to see that.  Also, J/K  it’s not that kind of SOAP, so get your mind out of the gutter.  And pull mine out too while you’re at it.

Here we go

(Edit: P = patient.  That’s me; hx = history; HR = heart rate; EENT = eyes, ears, nose, teeth; H/L = heart and lungs; PLN = peripheral lymph nodes; M/S = musculoskeletal; abd palp = abdominal palpation – which is weird to do on yourself, btw; Neuro = neurologic system; Integ = integument – aka skin; Ddx = differential diagnoses – aka things that could be the cause)

S: P experiencing “brain fog” and memory loss.  Has pounding heart unable to associate with any inciting factor.  Severe fatigue and lethargy.  Depressed.  Hx of anxiety and depression.  Medication previously effective but has changed recently – once changed back to original medication, it seems less effective.  Weight gain.  Not interested in exercise and has difficulty motivating herself to get up, much less exercise.  Losing interest in things she usually loves. Emotional lability, unpredictable.  Gets hot easily (this is new).  Occasional night sweats while husband keeps bedroom a balmy -10000000 degrees. Joint pain.  All of them.  Can’t hold onto thoughts – they slip away and it’s super frustrating.  Easily distracted.  May have ADD but has never been diagnosed, even though she fits the bill quite well.

O: Overweight/obese, sedentary (except at work when she stands all day, but then she sits all the rest of the time when she is not lying down in her bed which is pretty much any time she can get away with it; at least when she sits, she looks less lazy).  HR – usually 70bpm, but sometimes pounds (HARD) at 90 bpm.  Bounding pulse quality at that time.  Normal pulse quality otherwise.  12 breaths/min.  Can’t assess my lung sounds because it’s weird and I can’t seem to do it. But I don’t feel like I can get a good breath without coughing. EENT – no obvious dental disease except that one tooth that hurts all the time and the dentist thinks it might be fractured but p doesn’t want to spend the money to get it pulled and have an implant. Eyes are shitty and super nearsighted but now p can’t see to read very well either, so basically she’s old.  Pain on palpation of ethmoid sinuses, maxillary sinuses, and frontal sinuses.  Probably the sphenoid sinuses as well.  (ok just got back to this from learning/googling about all the sinuses in the human face and where they are located and what they are lined with and their purposes – to lighten our skulls and also to be torture devices – and where they drain. Where was I?) H/L – see above about pulse and not being able to auscult my own lungs. PLN – all seem normal size except that one lymph node on the right side of my neck that has always been big – no recent change; Abd palp – Fat.  Not painful.  Very jiggly.  M/S – see obesity above; see joint pain above; stifles make TERRIBLE creaking noises like small trees breaking in a storm when they are flexed.  Lower back pain from having weak core muscles; Joints may be hypermobile, although it hurts for them to bend as much as they used to, so p avoids it.  Neuro – holy hell who knows.  Integ – dry skin.  Chafing of thighs when wearing shorts and skirts.  Getting old lady skin – it’s looking thinner and less collagen-y.

A:  (DDx)

1) Sinus pain – allergies/chronic sinusitis; sinus infection; punishment from the gods

2) Obesity – inactivity and poor diet; hypothyroidism (supplementation too low or needs non-synthetic hormone because of course I fucking would.  Nothing normal works on this stupid — i mean unique- body); aging/slow metabolism; Cushing’s disease (I add this because of my patients, not because I really think I am Cushinoid, but who knows)

3) Brain fog –  hypothyroidism, Bartonella, brain tumor, this is just me now, allergies, immune mediated dz, ADD, stress, depression

4) Emotional lability – mental illness flaring up, Bartonella, brain tumor, menopause, stress, depression

5) Fatigue/Depression- SSNRI not working as well, stress, hypothyroidism, poor body condition/out of shape, Bartonella, immune mediated, viral infection, just luck

6) Irregular pulses/ runs of tachycardia- HYPERthyroidism (oversupplementation), stress, heart disease, menopause, anxiety

7) Joint pain – Bartonella, age, hypermobility catching up with me, immune mediated,  DJD, stress, viral infection

8) Night sweats/Day sweats – hyperthyroidism, hypothyroidism, diabetes, menopause, stress

9) Dry skin – hypothyroidism, heat on (does a thermostat set at 64 count as having the heat on, really?), menopause, allergies, old age/loss of youthful collagen

Aaaaand that’s where this fun exercise ends.  Because I’m not sure how to make a plan.  I am going to start with a visit to my doctor because she is smart and thorough and she listens.  But it’s an awfully big mess to sort out and I don’t like being a complainer.  Which is dumb and has put me in a lot of stupid situations (looking at you, Incident) when I don’t reach out and end up losing my mind completely or just suffering in silence when there is no reason for it.

I’m not really sure why I put this here.  Maybe just to help me sort it out like I would if I were assessing a patient?  Maybe to see if any of you have ideas?   Maybe to let you know that you’re not the only one who is a chewed up bubblegum sandwich?  Or maybe to let you think “Oh wow.  Yeah, she’s pretty messed up.  I don’t have it so bad.”?

Any of those things are ok I guess. So, if you were thinking that you were the only one out there confused and with all kinds of shit going on, don’t worry.  There’s lots of us out here.  I mean, I deal with the ones that have sweet eyes and (usually) 4 legs and (also usually) are covered in fur with pure hearts and souls.  But there are the other ones, like me, who have squinty eyes and damaged hearts and souls and may also be covered in fur when it’s winter time and I don’t really feel like shaving tyvm.  We’re out here too, just trying to figure things out.  The problem is, things KEEP CHANGING.  Like, our metabolisms, or our response to medications, or new stresses or just different stresses or hormones.  Things are always changing and we just have to try to keep up.  Sometimes it’s helpful to take a step back and SOAP ourselves to see what the possibilities are — and sometimes we just need to take a long bath and relax – which is where I am going right now.  Love you all.