A Letter to my GI doctor...physical and mental and physical and mental

I'm in the middle of a physical and mental health crisis.  I'm dealing with multiple doctors who seem to be trying to help but instead are treating me as a bunch of symptoms with no real coordination, and I need that so badly right now since my poor physical health is affecting my mental health severely and my mental health declining is affecting my physical health severely.  So I have talked to my psychiatrist and have an appointment with my GI doctor this week, and I decided to write him a letter to either read or have me read to him since I am so overwhelmed that I can't get to everything I need to say without breaking down, forgetting, and just getting anxious and crying.  So here's the letter:

Dr. Iyer – Thank you for fitting me in.  I appreciate it.  I will apologize in advance because I know doctors hate when you come in with a long list of issues, but I feel that I am a complex case, and I am sorry this may take more time than you had hoped for.  I hope you will listen and understand all of my concerns and try to see the full picture, not just a list of symptoms.

First, please take into account always that I am disabled with mental health issues that include bipolar depression, severe anxiety, panic attacks, agoraphobia, and Non-24 Sleep Disorder.  These are important to remember as they are always reflected and impact my physical health as my physical health in turn always impacts my mental health, both to a severe degree.  I want to be a good patient, but I also have learned that I have to be my own advocate to the extent that I am able.

After our last appointment and the scheduled Upper GI Series (which was extremely uncomfortable, nauseating, and verging on painful), I heard from your assistant a week ago on Friday at 4:45 p.m.  Maybe there was a miscommunication, but I clearly remember her telling me that you would be referring me to a surgeon for a hiatal hernia and that she would be calling me back at the beginning of the week with that information.  That left me all weekend to stress and overanalyze and overthink and research.  I know this is part of my disability that I work on with both my psychiatrist and a therapist, but it is part of me.

What I learned was distressing and caused me to mentally spirally downward while increasing my anxiety and causing my physical symptoms of nausea, vomiting, and pain to increase, which has been happening for two months and shows no sign of letting up.

Then on Monday your assistant called to say that you were not referring me to a surgeon, which surprised me and concerned me.  I do not want unnecessary surgery, but I also do not want to continue to live my life with these miserable symptoms that are affecting my mental health severely.  I have since read the results of the test which show a mild to moderate hiatal hernia and severe esophageal reflux along with a rapid movement through my system of the barium which seemed unusual.  She said you wanted to see me in 6-8 weeks, but I did not feel that I could wait that long so she fit me in even though finding a driver for the long drive here was a challenge.  But that is not your concern, I know.

So my primary concerns are, why did you change your recommendation to refer me to a surgeon and then decide not to?  I do think I would like a referral as a second opinion and hope that does not offend you.  I have started trying to make changes to my lifestyle and diet to try to help with my symptoms but have not yet seen any changes.  In fact, the pain that I am having has now increased from my upper abdomen into my chest, as well, sometimes mimicking the symptoms I get when I am having a panic attack, which then causes a panic attack.  It has taken me years to deal with my panic attacks and constant fear that I am having a heart attack, and the combination of these has only intensified the frequency and pain and fear.

My psychiatrist and I are also concerned that with the constant constipation/diarrhea/vomiting that perhaps my medications are not being absorbed properly and certainly not if I vomit shortly after taking them which sometimes occurs at random times.  I do understand that the constipation and diarrhea are a separate issue that may not be able to be resolved at this time, but just so you know, the diarrhea is almost daily for hours on end every 10-15 minutes.  The opposite happens if I miss a day of diarrhea and have immediate constipation which causes straining and that increases the pain in my abdomen/chest.

I did not fill the prescription that you sent in for Levsin (I think was the name) as my research and discussion with my pharmacist indicated that this was primarily for cramping types of pain in the stomach and intestines and colon and the side effects, while I know I may not get, are also nausea and vomiting.  This is not the type of pain that I am having.  So I do not have any medication to help with the pain.

I apologize for the length of this.  I feel this is the only way to truly get the help I desperately need.  Can you please explain your thought process on the potential for surgery, dealing with these major symptoms constantly, and the treatment plan as it is affecting both my physical health and mental health and has been for months now.  I was already brushed aside and insulted by one physician, Dr. Mahajan, and I really need someone on my side to help me.  I’m pleading with you.  Where do we go from here?  I just want to feel better, both physically and mentally, and my psychiatrist doesn’t feel that she can adjust my medications at this point with the symptoms I am having.  Can you please just talk to me?  I am not an idiot.  I have a bachelor’s and master’s degree so I am not cognitively impaired.  I just need to understand and have a plan of action to help.

Thank you for reading and/or listening to this long summation.  Again, I apologize for the length and for the time and hope with all my heart that you will take all of this into consideration in treating me.  I know my case may be relatively complex, and I need to have faith that you are a strong part of my team.  I can’t just be seen as a set of symptoms to be monitored as I have been dealing with so long, and my life has become a constant state of misery.

The Fucking Government Shutdown, the wall, the real deal with Social Security/Disability

So here's the deal from my perspective.  This whole fucking government shutdown is a nightmare for those of us in desperate need.  Because of my severe anxiety and panic attacks, I do tend to catastrophize and become overwhelmed.  And that's where I am right now.  Worried about the future as the impacts are already being felt by Mom and me.

First of all, the wall is fucking stupid.  It won't do anything.  More drugs, illegal aliens, and trafficking comes through sea ports, over the road trucking, and tunnels than ever walk across our border.  We allow plenty of immigration from "developed" countries than we do from this proposed wall.  Trump is a bully throwing a tantrum about something he lied about, saying Mexico would pay for this stupid, fucking wall in the first place.

Next, social security and disability are not "government handouts."  My mom and I worked hard for over 40 years to have a lot of money taken out of our paychecks to fund these payments.  This is OUR money, not the government's.  It is not theirs to play with.  And it is not welfare.  This is a fact.  The only "government handout" we receive is that Mom receives some food stamps/EBT each month because she only gets $800/month in social security.  We barely scrape by.  And now we are told that our food stamps will stop this month until the government shutdown is over.  And Trump is quoted (FACT) as saying that he doesn't care if it lasts months or years to get what he wants.  He is holding the most needy citizens hostage while he, the VP, cabinet members, secretaries, etc. all received a pay raise equal to more than half of what I make in a year.  So now we have to choose between eating, paying for medications and doctors, paying bills like utilities and such.  I hate him.  I truly do.  And while the government shutdown is not yet interfering with social security and disability, there is debate about whether this will be the case if the shutdown goes on past September.

I know we are not alone.  There continues to be a trickle down effect.  Supposedly those working without pay will receive retroactive reimbursement, but that is not the case for those who have been furloughed, as they can apply for unemployment to the tune of about $200/week.  Trump is quoted as telling these people (even our Coast Guard) to do odd jobs such as baby sitting, painting and carpentry for the landlords to help pay their rent.  He lives in a different world. 

And those who are going without pay and have been furloughed are not getting their health insurance paid, either.  Which is going to start impacting our health care system with hospitals being overcrowded, nursing homes struggling with patients who do not have payments coming in to pay for their care, and people such as those who are on dialysis at centers who do not have the insurance to pay for their treatment.  As my daughter is a paramedic for a private company, and my sister works in a nursing home, this may start impacting them at some point if this continues for very long.  Not to mention all of the patients, the disabled, and elderly, and children.  Our food banks are already drying up.

So, yes, this is a rant and vent.  You may not agree with my statements, but they are facts, not opinions.  Trump is a liar and a bully and a narcissist and a poor excuse for a human being.  Just giving you the view from the inside of this whole mess.  For someone with mental health illness already, this is enough to push me right to the edge.  I am scared for us.  All of us.  I have lost hope and have nowhere to turn.