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It is fair to say that the last time I spoke to a GP a couple of weeks ago was a relief. The pre appointment anxiety was dealt with swiftly by a doctor asking me to tell her what was going on, and listening as I spoke. Then encouraging me to share more information, before discussing with me what my options were. Well today was the follow up to that appointment, a checkpoint to see how things were going and what could and would happen next. Now feeling a little more confident about speaking to the GP about it again, I was ready with what I wanted to say. However, I was in for a rude awakening.

The call itself was a little later than planned, but that is fine, schedules slip and all that. Although I had not received the usual text reminder yesterday about this, so did at one point worry a little that I had got the date or time wrong, or something else of my own doing. None the less, the call came in.

After introducing herself, she told me that she was calling to follow up on her colleagues appointment with me a couple of weeks ago. All good so far.  I thanked her for calling, and we got into the consultation. It went a little like this.

GP: You were prescribed 25mg of meds, is that correct?
Me: Yes that's right
GP: How has that been?
Me: Errm OK really, no real difference.
GP: No 25mg is a very low dose, we use this to see how it sits with you. I will increase the dose to 50mg, is that OK?
Me: Yes, ok if that's whats needed
GP:OK I will send the prescription to the pharmacy now. In the meantime take 2 of the 25mg a day until you collect the new prescription.
Me: OK will do. 
GP: I also need your BP, so do you have a machine at home?
Me: Yes I do
GP: OK I will text you now, reply to that with the reading when you can.
Me: OK I will do that shortly
GP: OK if thats it, we will arrange an appointment in 4 weeks to follow up with you, reception will call you. 
Me: Oh, OK then, thanks.

By the end of the whistle-stop conversation it felt apparent that this was not a GP I was going to feel comfortable having dialogue with, so just kept it short and sweet to prevent myself getting frustrated or upset by it. Lower my expectations to match the perceived level of interest. Something I have learned to do over the years. There will be another appointment, so I will bide my time and save the more intimate stuff for someone I feel is interested and listening to me. I think this is one of the issues with phone consultations, not being able to see the person, so having to gauge their levels of interest and interaction by voice and tone alone. Not always easy, and definitely not always right either. 

So now there are 4 weeks until I speak to my GP again, and the decision on taking, upping or abstaining from meds sits heavy with me. In the meantime my general state of mind has improved somewhat since getting the ball rolling on speaking with HR at work, them arranging the OH appointment, and my other decision surrounding the idea of returning to an office. Having a back-up plan has really helped, and just knowing that I am OK with finding a different job if it comes to that has made me feel far better about myself. 

Right now I would say I am in a stable place. Although today's perceived lack of interest and engagement has wobbled me for a bit. Not feeling comfortable to ask the questions I had, and explore other avenues at this point is frustrating, but not life changing, so deep breath, and looking at things in perspective, and it will be OK. The time for that will come, and I am in control of the situation. Screening etc can be done without the GP involvement, but at a financial cost... But so be it. 

In the meantime, I have my other appointments coming up with others such as OH and IAPT, so still more to do before worrying about what comes next. The WFH decision is a slow one, but in the pipeline, so that also just needs a little time, to get the final outcome, from which I can then decide which direction next. Options are aplenty. 

In general, day to day well-being has taken a bit of a hit in the past week or so. Physically my back is still giving me a bit of grief, but a lot better this week thanks to Andrew Fung the Osteopath, who I am seeing again later this week. This has led to a drop off in cycling and a complete lack of returning to running for now. Frustrating to say the least, but also has a knock on effect to my mental health too. 
In that respect, my brain is telling me all sorts of weird and wonderful horror stories of what might happen if I go riding. I want to get out on the single speed, but brain says "what if, what if, what if".... So I don't!

Running wise, I have a half marathon at the end of the month, which is looking less and less likely to happen, or at least certainly won't all be running, as it has simply been so long since I ran any distance whatsoever. So trying to jump back in with a half marathon might be asking for trouble. Although... Maybe if I keep the pace down....  !! We shall see. I want to try and get a run in before the end of this week. 
So til then, here's to next week and my appointments with OH and IAPT. As for WFH, no news is good news, as it means the 30 day countdown to return to the office has not yet started. But watch me eat my words in the next day or so. That said, just because the notice is given, it doesn't actually set a date for me to return at that point. 

Here ends todays update.  Thanks as ever for reading. 

It has been a few days, and as the mood continues to dip, so do the energy levels. Earlier in the week I put the lethargy down to the high temperatures, but as the weather has returned to normal, and my sleep periods extended, the tiredness has really taken a hold. Lack of interest in getting up in the mornings, seemingly slipping towards the "just another half hour" of the days of depression. And even once up, unless I am fully engaged doing something, I quickly feel ready to sleep.

Another thing I have noticed is a long background headache. The past couple of days now, its just there nagging away, threatening to get worse. It's not dehydration, caffeine deficiency or anything like that. As usual my fluid levels are sky high, and my caffeine intake has not differed. It is more like a stress/ tension headache, which just doesn't want to give up. 

Speaking of tension, the lower back muscle tightness and pain still doesn't seem to want to ease up in any way, and it spreading into my shoulder and neck. Just feels like I am turning into a big ball of stress right now. Which in some respects is hardly surprising. The discomfort, combined with the tiredness I have been feeling are starting to leave me less and less able to focus on tasks. Instead becoming distracted by either symptoms, or starting to put things together in my head, and worry myself into a deeper state of stress and anxiety. 

I have the doctors in a couple of days time, and already that is starting to worry me too. Going over the consultation in my head over and over. What do I say, how do I explain why I think I am feeling this way. Will I sound bone idle and like I am trying to pull a fast one. What is deemed a "disability"? Dare I even utter those words? It just seems such a crass thing to say, when others around me suffer much more in different ways all the time. 

In reality, I am hoping I will see a decent doctor, who I will feel comfortable explaining my symptoms and situation to. Hopefully I will be able to discuss the past 15 or so years, and how I have slowly learned what I can and can't do. Periods on medication, total periods of depression and anxiety on record. And somehow get across how different the past two years have really been for me, until now anyway. 

In the meantime I am trying to keep up with my exercise, and stay active, to at least get a mental boost that way. But I can't deny being distracted while I exercise now. Morning runs and rides are thwarted with thoughts of "I might not be able to do this soon", which really kills the mood I have to say. Not to mention the back pain too, which kinda makes riding and running that bit more difficult. A 40 odd mile ride yesterday wasn't too bad, and thankfully I managed to lose myself for a bit. But by the end I was truly exhausted. A run this morning, first in a while was uncomfortable to say the least, pressure around the hips and pelvis from the muscle tension made it a bit miserable. 

One thing the ride yesterday helped me with though was reminding myself of the difference between mental and physical exhaustion. Are highlighting that what I am feeling at the moment, during a working day is mental exhaustion. My brain absolutely running at full speed, some on day to day work stuff, and the rest seems to be preoccupied and bunged up with worry and overthinking about what is going on, and what lays ahead. 

Boy oh boy, I am getting tired just thinking about it all to write this, so I am gonna go and write myself a list to take to the doctors with me on Wed. Part of me is hoping they don't suggest meds right now, but the other part realises that at times like this, I am not great at judging my own state of well-being, and have turned to a doctor for a reason. I think I would like to stay off meds at least until any discussion between my line manager, HR, and the seniors has taken place, but who am I to judge. 

Right now I am 99.9% positive it is the news of the return to the office that is the cause of this. Over 15-20 years of mental health issues, there have only been a handful of times I feel I can put my finger on the trigger. It always amused me before when I was asked by doctors, and I had no answer. On this occasion, I am pretty darn sure of it. Now I just have to wait and see what everyones opinions of my thoughts are, and how it is treated.


*sigh* Right, back to the real world. Thanks for reading. 

The clock is ticking down on my next session at the Royal College of General Practitioners on Friday, and I have to say the suspense and stress is building. It will be my second rush-hour trip to Central London in the week, which never bodes well with me even at the best of times.

The first session I did was a real eye opener, and while it was fun, it was quite draining too. That was starting from a nice high spot in my mental cycle. This time around I am somewhat lower than I was before, so it will be interesting to see what impact that has. Whatever the cost to me, the important thing is being able to help the students understand the presentation of anxiety and depression.

On the plus side, the whole day is a known thing now, it is not full of surprises and uncertainty, so that will help enormously I am sure. I will just get there nice and early again, missing the majority of the morning rush, and have a little wind down walk before getting started.

I will have to put some thought into the scenario for this time too. I am quite happy with the original, but it is good to mix things up a bit. As much for my sanity as theirs. Really is quite draining mentally, recalling events from your life, and playing them out in a scenario over and over for a day. By the end of the day you are mentally exhausted. I kind of envy the actors who also participate in these events. Surely it is much easier to pretend to suffer with something you don't already struggle with. Maybe I am wrong, who knows.

Either way, as I say, the main thing is the students come away from it all with a better understanding. I really do want to have more time to answer questions, and help in any way I can. With so much work being done to raise awareness of mental health issues, it is only right to make sure it can be identified and caught nice and early, so help can be given before the issue worsens for the patient.

Which reminds me actually, I have got to read back through my emails, and do a submission to the BMJ as suggested by Niki. It may come to nothing, it may be the beginnings of being able to do something more positive, time will tell. Not like I don't like writing now is it!

Right, better get my head in gear and thinking cap on, ready for the (next) big day.

Thanks for reading.

PS, students, you can now find all my MH writings on my new website www.snazy.co.uk (if you are not already reading this entry there)