Overcoming Phone Anxiety, One Vet Trip at a Time

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I hate making phone calls. A strange sort of performance anxiety makes me script it out in my mind and practice over and over with the number dialed in, waiting for me to hit the call button. I never feel ready. Eventually, I get so fed up with myself that I have to just press the button and hope that my verbal skills are adequate for getting me through the act of ordering delivery or making an appointment or whatever it is. And, they are. I’m not actually bad at phone calls. I don’t think I’ve ever had a call that validated my fear – that I’ll just forget how to talk and have to hang up after embarrassing myself with gibberish. Once I’m on the phone with someone, it usually goes smoothly. For whatever reason, the lead-up is the worst part.

I’ve had to call the vet numerous times in my two short years as a dog owner. My dog, Stella, is what you’d call “high-energy.”

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Zoomies around the couch.

She needs activity, either vigorous exercise or a long, meandering “smell outing,” as I call them. (There’s not much walking. It’s mostly smelling.) She gets into a lot of weird, wonderful stuff outside – sometimes she puts it in her mouth, sometimes she rolls on it. She plays fetch with reckless abandon – skidding to a stop or wiping out in a cloud of dust. Stella’s ability to seek out disgusting, physically risky situations is pretty incredible. First, it was giardia. Then, it was an eye infection. Then tapeworms, then another eye infection, kennel cough, a bloody, broken nail, and finally, another eye infection. Actually, this time she had an ulcer on her eye. Yowch. When I woke up and saw her swollen, watery, goop-laden eye, it wasn’t hard to pick up the phone.

I think it’s common to feel braver when you’re doing something for someone else than when doing the same thing for yourself. It’s easier to give up when the only one impacted will be you. When you’re being depended upon, either by volunteering to help or because it’s your responsibility, there’s much less room to waffle. I’ve found that in calling the vet for vaccinations, checkups, eye infections (ugh!) my anxiety is dramatically reduced because I don’t consider it an optional task. When I have to do it, I have to do it; there’s no point in waiting.

I also find an extra boost of authority in advocating for someone else. It’s like I’m calling up the vet and saying “Ah, yes. I’m calling on behalf of my dog. She… doesn’t know how to talk, so I promised to call for her.” And then it’s like I’m not even a part of the phone call. I’m just a proxy for a four-legged creature with a goopy eye.

I think I might start using that when I have to make other phone calls. I’ll just imagine that I’m calling on behalf of my anxious self, who I promised to take care of. “Yes, hello? I’m calling about Gen’s prescriptions. Yeah, she’s overthinking right now and can’t come to the phone.” I’ll be her more courageous counterpart. She needs me, poor thing.

I know people who use this tactic for public speaking – pretend you’re someone else. You’re playing a character. That way, the attention isn’t actually on you, because you’re not really being yourself. It’s an interesting little mental trick that, I’d imagine, takes a lot of commitment to pull off.

For a while, I thought that my anxiety about phone calls was because of the lack of visual social cues. It seemed like the potential for misunderstanding or blundering mistakes was higher when I couldn’t see the person I was talking to. But why, then, wouldn’t texting make me anxious? The written word is where I’m most comfortable, mostly because it gives me time to think through what I want to say and edit before I hit “send.” Maybe that advantage outweighs the anxiety of not being able to see the recipient of my words.

In any case, I hope that Stella chooses to be a little more cautious in the future. But if not, I’m prepared to call the vet for her, seeing as I’ve had plenty of practice.

A “low-energy” moment

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The Subtleties of Water: The Ketamine Chronicles (Part 27)

Genevieve4 Comments

I’m always looking up at the sky when the water closes over me. This time, it was cold, and an eggshell-thin layer of ice formed above me while I watched. Gentle waves followed one another, freezing over the previous layer and leaving a frosty texture on the surface. Darkness spread from the periphery of my vision until I strained to see through the last window of light, the only notable image being the shadow of a person standing above me on the ice.

I didn’t put a lot of effort into remembering this IV ketamine infusion. I know there were graceful, disembodied hands dancing amid blue and red lines, swirls, and dots. There was more water – ripples and waves, mostly. There was a pyramid with a circle above it, which turned into a blinding white light. I’m certain that there was a lot more, but it’s faded away from me by now.

Treatment-Resistant Depression

My mental health is declining. I’m not sure why. IV ketamine treatment doesn’t seem to be working as well for me, now. Every day, I have to rate my mood on a ten-point scale. It’s hard to capture how I feel in numbers. Potatoes are easier, but still not quite enough. Honestly, sometimes words themselves seem too limited. How can I describe how I feel?

This morning, I woke up at 4. I got dressed in the cold – same clothes as yesterday – and went to the kitchen for some food. I walked the dog when the sun came up, but we came home quickly because of the sharp, cold air. My eyes feel heavy. Not the lids – the actual eyeballs; they sit heavy in their sockets, like wet marbles or enormous caviar. I wonder, if I tip my head forward, will they fall out? When my depression is worsening, I often notice this feeling in my face. Everything is heavy and hard to move, and I’m sure my expression is grim. I think the clinical term is RDF – resting depression face. At least my pandemic mask covers most of it.

Maybe the person above me on the ice in my ketamine dream is me. I’m on thin ice. Skating across a just-frozen lake in my wool socks at 4am. Someone else is waiting beneath the surface, straining to see through the darkness. Is she also me?

__________

Why Do I See Water in My Ketamine Treatments?

My recent IV ketamine infusions have all featured water, and I’m often drowning in it. It’s not scary – it’s peaceful. It’s soothing. I’ve never stayed up by the surface before; always finding myself sinking into the dark, quiet depths. But this time, I was floating – pressed against the underside of the ice, trying to see through it to the person on the other side. I was curious about this person, but the darkness closed in before I could begin to unravel what was happening, and then I found myself in a different scene, which I do not remember.

I’m fascinated by this recurring theme of water, especially because in my regular life, I’m not a big fan of it.

An Early Trauma

I have sensory processing disorder, and as a young child, I flat-out refused to swim. I was overwhelmed to the point of tears by the splashing, the echoes in the pool, the temperature change from air to water, and most of all, the fear of people touching me. I eventually came around to the idea, but never enough to take lessons. So, having never properly learned how to swim, I nearly drowned at a friend’s birthday party when I was 8.

I remember being uncomfortable going into the deep end, but my friend was insistent. I lost my grip on the side of the pool and began to sink. When people say that drowning is not a dramatic event – there’s no splashing or screaming – they’re right. My head tilted back instinctively as I went under, and I could see my hand, extended above me, slip under as well while the rest of my limbs flailed uselessly underwater. A panicked hopelessness overtook me as I choked on chlorinated pool water. Then, my friend’s hand broke the surface, reached down, and grabbed my wrist.

I have never felt relaxed on or in water, and it’s not just the near-drowning that explains it. The same sensitivities that kept me from participating in swimming lessons have persisted into my adulthood. I dislike the unsteadiness of water, the unpredictability of how it will splash, the feeling of water on my face.

And yet, when I’m reclined in my doctor’s office, ketamine moving into my bloodstream, visions of water are soothing. I can feel the cool, constant pressure of being underwater without the anxiety or the sensory overload. I can feel myself standing on the deck of a boat, watching the foamy water beneath me leap forward and recede, and I feel peaceful. I’ve seen whirlpools, rivers, melting glaciers, and the unbelievable enormity of oceans. It’s a strange experience to suddenly realize what water might be like for other people, as those feelings are foreign to me in my waking life.

Open ocean near the surface with light filtering down from above.
Photo by Cristian Palmer on Unsplash

I feel as though, unhampered by the symptoms of my sensory processing disorder, I can connect to a larger, evolutionary interest in water that I am unable to find under normal circumstances. Humans have been fascinated with water for millennia. In fact, some evolutionary anthropologists believe that nearness to water supported the development of large brains – that we are, in part, the heritage of small, coastal communities of early humans whose lives revolved around the movement of water and the food within it. To this day, many island and coastal cultures retain great reverence for the ocean. When we gaze out upon a watery horizon, it is difficult to not be awed by the vastness before us. In my eye, to find our place in relation to bodies of water is akin to our struggle to find our place in the vastness of space. Questions of identity and survival are found in the depths, and I believe we carry the answers within ourselves.

Lessons from IV Ketamine Treatment for Depression

My depression is a constant in my life. It is all-encompassing, lonely, and feels like drowning. I’m not one to find meaning in every dream, but the images of water that I experience during IV ketamine treatments have begun to feel profound. What does it mean? Certainly not that I should give in, wave a white flag and let the water crush me. Nor should I wait breathlessly under the ice, squinting as if to look through a frosted pane of glass, uncertain if I’m even above or below. Rather, I believe my visions of water are windows into the nature of the human experience. Perhaps they’re snapshots of how I feel – how depression feels to me. My mind is an ocean, and at times, it’s oppressive. I sink within myself, finding it easier to let the water cradle me as I descend than to keep swimming. At other times, I find comfort in accepting the changing nature of my illness. Like a river flowing downhill, impermanence is unstoppable, and the emotions of being a human move inexorably back and forth. When we crest the top of a wave and begin to fall down the other side, we wait for the next one, just as we take each arriving day. And when you are drowning, reach up. A helping hand may be just about to break the surface.

If you’d like to read more about my experience with ketamine for depression, start from the beginning of The Ketamine Chronicles or visit the archives. Click here for mobile-optimized archives of The Ketamine Chronicles.

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Self-Compassion When Living With Depression

Genevieve2 Comments

I had a conversation the other day about the balance between recognizing that treatment-resistant depression is chronic and pushing oneself to do difficult-but-healthy things.

It started with a question: What advice would you give someone about dealing with depression?

Personally, I find it helpful to remind myself that depression gets in the way of my ability to think clearly. Depression brain is a liar. It makes me think that I’m a stupid, horrible burden and that everyone would be better off without me, even if they say otherwise. It makes me think that feelings are forever and that I must be too weak to effectively change myself.

It’s really hard to change the way you think, especially when depression is sitting on you, yelling into your ear about how terrible you are. Sometimes it helps to remember that I have a disorder that skews my thinking. But that doesn’t mean that I shouldn’t push myself. It’s a difficult balance; to recognize that my symptoms explain my behavior, but they aren’t the be-all-end-all of what I do.

You know how frustrating it is when a well-intentioned but misinformed person tells you that if you’d just try barefoot ultra-marathon running or hot goat yoga at 5 am, you wouldn’t be depressed? That person is inside my brain all the time, and because I know that it’s unreasonable to expect myself to just *poof* try harder and not be depressed, I’ve always struggled to write something on this subject. I don’t want it to come across in the same way that my brain talks to me, because I would never, ever talk to anyone about their depression in same the way I think about my own. My brain says stuff like this:

“Yeah, you feel pretty crappy today, and you know why? Because you only ran one mile. Maybe if you’d run THREE, you’d feel better. You only have yourself to blame.”

The example that I’d like to set as a person who writes about mental illness is something more like this:

“I still feel crappy, even though I went for a run. I’m glad I did it, though, because I know that it’s helpful – even if it doesn’t feel like it.”

That kind of thinking is really hard to implement, and I won’t lie – I’m pretty far from doing it naturally. It’s hard in part because we know that things like exercise, being outside, and social connection are helpful for depression. How much pressure should I put on myself? How much am I capable of when I’m depressed? Should I be expecting these things to “fix” me? Whenever I ask myself these questions and get bogged down in the details of how much I’m doing, my plans for doing more, why I should be doing x, y, z, I miss the obvious point.

I’m mean to myself.

I’m trying to convince myself that it doesn’t really matter how much I decide to do in miles, minutes, or step-by-step sequences. It only matters that I did a little bit more than I wanted to. It only matters that I did something because it’s good for me, not because I bullied myself into it. It’s good to set goals (or clams, if you’re being fancy) for yourself, and it’s fine to go at a pace that works for you under your current circumstances. I know that for me, I often fall into the trap of expecting myself to function at the same level that pre-depression me did. Sometimes I worry that if I don’t berate myself enough, I’ll get complacent and stop striving to improve. In reality, I know from experience that the motivation to grow returns naturally when I’m feeling better. It’s tough to believe it, but my first priority should be to treat my depression, and everything else will fall into place.

If you’re hard on yourself for not meeting your own expectations while depressed, I relate. A lot of people relate. After all, feeling bad about yourself is itself a symptom of depression. And to be clear: trying to be nicer to oneself is not advice intended to invalidate that symptom. It’s not to say “you’re doing it wrong, just be nicer to yourself,” it’s that combatting negative self-talk with positivity (or at least positive-tinged neutrality) is a strategy intended to treat that symptom.

I’m not very good at it yet, but I’ll keep working on it. Gently.

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The Taste of Music: The Ketamine Chronicles (Part 26)

Genevieve5 Comments

The last couple of weeks have been hard for me when it comes to depression. I recently wrote about how IV ketamine can make me feel like I’ve been launched out of a metaphorical cannon. The last time, it was like a little pbthpbpthh – an underwhelming puff that was more like being propelled by air coming out of an untied balloon than like being launched out of a cannon. I don’t remember much at all of the previous ketamine infusion, so I didn’t push myself to write about it. I thought it would likely be boring, anyway.

The Ups and Downs of Ketamine and Depression

I can’t say for sure why that IV ketamine treatment was less effective than others. It could be hormones. It could be the changing seasons. It could be that I haven’t been exercising much. Maybe it’s all three. Whatever the reason(s), I’ve been front seat on the struggle bus – sleeping in my clothes multiple nights in a row and then wearing them the next day, getting my work done late or barely on time, napping by mid-morning. I find myself paring down my daily activities. Prioritizing one thing means getting rid of another thing, as the energy needed to do both is more than I have. In some ways, I’ve been getting along ok – my mood has been dipping here and there. But overall, that hasn’t been terrible. The hardest part is honestly the lack of energy.

Dissociation with IV Ketamine for Depression

So, I’m hoping that this week’s ketamine infusion can knock me back into better functioning. One change this time around is that I decided to stop using scopolamine for my infusions. I used it the last time and it resulted in a very…buried experience. I’m not sure how else to describe it. It was sort of smothering – as though I had sunk far, far below the surface of the Earth, and there was nothing I could do to get back to the room.

Every once in a while, from leagues above me, I’d hear someone tell me to take a deep breath – the pulse oximeter on my finger had alerted them to the fact that I had stopped breathing. And I found that often, I just did not care. I felt like my body was just a suit I was wearing, and maintaining it was proving to be a lot of work. I could feel that my heart rate was slowing and my lungs were waiting for me to inhale, but it didn’t feel like it was innately me, and so I was content to just watch it happen. In fact, when I was told to breathe in, my recollection is that I felt a little annoyed at having to exert the effort. A couple of times, I tried to ignore it, but the voice was persistent, so I relented.

My experience with scopolamine is not entirely strange, I don’t think. Apparently, it can add to the dissociation that ketamine produces, which explains my sense that my body was not really a part of me. My description of that infusion is a little unsettling in hindsight, but in the moment, I don’t remember being afraid or anxious at all. Actually, the whole infusion was very relaxing, minus the slight annoyance of having to breathe. You know, those fragile humans, needing oxygen. Geez.

Acceptance and Flow in Depression Treatment with Ketamine

The most notable aspect of this infusion in my memory is that at some point, my music stopped. I’ve never had an infusion in which there was no music, so when I noticed its absence, I was mildly worried about what it would be like without it. Not worried enough to move or to say something, of course. That would be too much work. So I just waited, accepting that it wasn’t what I had planned for, but that was okay.

Noise in the IV Ketamine Clinic

The sounds of the room, which are often prominent at the beginning of my infusions but fade away as time goes on, were extremely loud. I was most aware of the infusion pump next to me, which emitted constant mechanical noise. My mother was typing in the corner, and every once in a while, I noticed the sounds of papers shuffling or a door closing. I remember thinking that I felt like a pillar in a sandstorm, tiny particles being whipped into motion around me. The sand was the noise, and as it bounced off me and flew around the room, it started to sound a little like music. Rhythmic whirring from the machine combined with staccato typing somehow resulted in organic, landscape-based images in my mind. There were lots of shades of brown, but that’s pretty much all I can remember.

Brief Synesthesia?

Another first for me this time was that I seem to have experienced synesthesia. To some degree, I think I always come close to it during ketamine infusions – the way I associate music with colors and images is not something I’m able to do when lucid. This time, though, I could taste sound. I can’t quite conjure it up enough in my memory to understand what it was like, but I do remember it dawning on me that tasting sounds is not something people usually do.

When the noise in the room morphed into strange music, I became distinctly aware of the inside of my mouth. My tongue felt oddly small in the cavernous space behind my teeth, and the general feeling was of something… earthy. There is absolutely no way I can accurately compare the experience to anything, especially because I don’t remember it clearly enough. As I wrote in my hasty, post-infusion notes, “I can taste music. Indescribable.”

Images from My Subconscious

The rest of the ketamine infusion is jumbled in my memory, but I’m pretty sure the other images I can remember were from the beginning, when the music was still playing. I remember watching dogs eating something, and then their faces stretched and stretched until they turned into alligators. Eventually, an alligator head kept on stretching until it turned into the tendons of a human hand, which stretched until they were the layers of a landscape. Somehow, my brain went from dogs to alligators to tendons to landscape. I could explain the associations from my recent thoughts and experiences, but it would be convoluted. Suffice it to say, all of the elements of that bizarre sequence somehow make sense to me. Brains are fascinating.

Seeing Improvement in Depression Symptoms

Given my general lack of response to the previous IV ketamine treatment, we tried adding magnesium to this most recent one. It’s been two days now since my infusion, and I am definitely feeling a bit better. I woke up this morning, put on clean clothes, washed my face, and did three laps at the dog park instead of one. Improvement is improvement, no matter how small!

If you’d like to read more about my experience with ketamine for depression, start from the beginning of The Ketamine Chronicles or visit the archives. Click here for mobile-optimized archives of The Ketamine Chronicles.

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Working on Depression

Genevieve1 Comment

Sometimes I feel like a bird that can’t figure out how to fly. I periodically get launched out of a cannon (in this metaphor, that’s due to IV ketamine treatment for depression), then flap and flap to no effect. I’m trying to make progress, but gravity is always there. Eventually, I sink lower and lower, just exhausting myself with all that flapping.

That’s how it feels, but I don’t think that’s entirely accurate. Yeah, ketamine wears off eventually, and yeah, my brain has a biochemical problem that means I can’t fix depression just by flapping. But the flapping is doing something. All that work I put into therapy and maintaining a routine and getting exercise must be functioning in tandem with the IV ketamine to push my little bird wings just a smidge farther.

I know this because my mood still dips pretty low sometimes, but on the whole, I’m in a better place than I was a few months ago. Perhaps it’s that I bounce back faster, now. Or maybe it’s just knowing that it won’t last forever.

And now, being able to look back and see that I’m flippity flapping on my own a little makes it just a little bit easier to continue. Chipping away at something day by day is tedious and frustrating, but all of that work adds up. If you can look back at where you were a little while ago, it helps to notice that in working on depression, you have made progress, even if it’s just in the personal growth or a skill you’ve learned or the support you’ve gotten.

Keep flapping, everybody.

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Therapy Code Words

Genevieve2 Comments

Unfortunately for me and my therapist, my ability to write words does not always translate well to being able to speak them. I need time to think through an entire thought before I speak it, and I struggle sometimes to get the words out when the topic is something challenging. And not just for sensitive topics like self-harm or suicide, but even for topics like life goals.

In fact, the word “goals” makes my stomach twist. I feel so much internal pressure when it comes to my ambitions that any discussion of the topic overwhelms me. It’s as if I know that once I start really acting to reach my goals, I’ll have to go all out because I don’t know how to not do something 100%. And that’s overwhelming. And unrealistic. So I try to avoid talking about it or thinking about it beyond my daily sense of guilt for not “doing more.”

It goes without saying that I don’t like this. Goals are important, and they should be exciting, not something you dread. Yes, they often take hard work to reach, but I think the balance of work to reward should be worth it. I don’t want to put in work just to alleviate an unhealthy internal pressure; I’d rather work for something because I want the excitement and fun and pride of achieving the thing. Depression makes this hard. Excitement and fun and pride are not feelings that depression wants around. So, I find myself terrified of adding more to my plate and pursuing my goals, and terrified that I’ll do nothing and fall even more behind my self-imposed schedule. Trapped in between the two, “goals” is a scary word.

Here’s where the code word comes in. Instead of “goals,” my therapist and I talk about “clams.”

It’s groundbreaking, I know.

There’s no significance to clams, it was just the first word my therapist thought of, but it stuck. Much like the Potato Scale of Depression is useful in its humor, “clams” are somehow easier to talk about because of the silliness. It takes away the gravity of having a discussion about goals and replaces it with a lighthearted conversation about a bivalve often eaten with a lemon-butter sauce.

And this is how I want my goals to be. Not so scary. Not so enormous. Just little steps to bigger results, like shucking one clam at a time to make a chowder.

Photo: Andy Castille – @kikini

5 Ways I’m Reducing My Depression Naps

Genevieve2 Comments

I sleep ok at night and WAY too much during the day. When I’m really depressed, I can get up early to take care of my dog and then go back to sleep until late afternoon. Sometimes, I can limit my depression naps when I have a lot keeping me busy, such as any work tasks I might have – which I do from home and largely on my own schedule within a day. But for the most part, I find myself frustratingly vulnerable to the sandman’s influence. Plus, now that Stella is no longer a puppy, she’s happy to spend hours on end with me, dreaming of whatever dogs dream of while we sleep on my bed. She used to wake me up every couple of hours to demand something from me, but now, it’s all snoozing.

1. Running

Running is a two-birds-one-stone solution for me, because it offers both the physiological and biochemical benefits of exercise in addition to the incredible fact that you can’t sleep when you’re running. I’ve lost a lot of my endurance, but I’ve been maintaining at least some regular running, which is remarkably easier to do the more recently I’ve had a ketamine infusion. I recently noted that the day after an infusion, I ran three miles without stopping, which I hadn’t done in months. Then, a few days before my next one, I struggled just to run one mile. Why is it so different? I guess that as the ketamine wears off, I lose the mental energy to push myself very far, and I’m worn out as soon as I start. It’s frustrating, but I try to just be pleased that I got out there at all. Perhaps, if I manage to rebuild my endurance a little, it’ll be easier to keep it up even through the changes to my ketamine buffer.

2. Setting the Intention with No Nap Monday

No Nap Monday was created in response to the smashing success of Yes Day, both of which were proposed by my therapist. No Nap Monday has been far less successful, but I do try to at least sleep less on Mondays. Sometimes I set an alarm for something reasonable, which is definitely subjective and changes week to week. Sometimes, my depression naps are an hour. Sometimes, they’re three. But no matter what, it’s good to at least have the intention.

3. Adding Activities

Ultimately, my goal is to not only sleep less, but also do more. It follows that I should attempt to add things to my routine. Volunteering is option that interests me. Over the years, I’ve volunteered or worked with animals in a few different capacities, and I always really enjoy it, so I tend to look for opportunities in that area. There’s an animal rescue near me that needs volunteers to feed the bunnies, and that sounds right up my alley. I just have to tackle my expert-level overthinking habit and then plow through my anxiety about new things and I’ll be right on track!

4. SAD Lamp Makes Me Happy (or at least less sleepy)

It’s now mid-October, so I pulled my seasonal depression lamp out of my closet the other day. The weather doesn’t affect me as much here in Colorado as it did in Michigan, but I can tell after a few cloudy days that I’m in need of some sun. Simulated sun will have to do.

5. Changing My Routine with Depression Naps

Much as I hate doing it, deviating from my routine often keeps me from giving in to depression naps. I tend to get irresistibly tired as noon approaches, and my mood slopes downward in the afternoon anyway, so that’s my prime depression nap opening. By forcing myself to be busy doing other things during that time, I keep my brain on its toes. The downside to this is that I do well with routine for other reasons, so abandoning that makes me anxious and sometimes decidedly cranky. But at least I can prove to myself that I am capable of functioning without depression naps.