Struggling With Dueling Personalities

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As my 18 year old daughter pushes through her second semester in college to become a RN she has come face to face with the fact that there are many psychology and sociology classes to attend. She knows the human brain really fascinates me and she knows I have my own out of the normal box way of thinking, meaning I question everything. Because of my age and personal experiences I tend to have a jaded opinion about my fellow human beings. It makes me hard to talk to at times because I don’t want to talk about “how” I got where I stand today because much of my personal past is still unknown to even the closest people in my life. Simply put, there are things I choose not to discuss, its just the way it is.

Anyway, she had a paper to write about personality disorders versus mental disorders. She didn’t know the “line” between them is often blurred, often confused, often misidentified, and very often a person gets mislabeled. Now, she is familiar with bipolar disorder since her brother struggles daily with it. She had to learn the “disorder” in order to live in peace with her brother in a comfortable manner for both of them. She thought she had this paper nailed until she asked me to review it. Its not that she had it all wrong, because she didn’t. But, because the terms are confusing, it makes the information available confusing. Jokingly, I told her that the specialists who study these and other disorders make it difficult to learn for job security, which is both true and false in every conceivable way. So, I gave her my interpretation, whether it helped or not we will have to see when she gets her grade. Below is how I see it.

Sometimes people confuse two mental disorders, only one of which could be referred to as “common” within the population which is bipolar disorder and then schizophrenia. This confusion has largely resulted from the common use of some of these names in popular media, and as short-hand by people referring to someone who is grappling with a mental health issue. The disorders, however, have little in common other than the fact that many who have them are still stigmatized by society.

Bipolar disorder is a fairly common mental disorder compared with the other two disorders. Bipolar disorder is also well-understood and readily treated by a combination of medications and psychotherapy. It is characterized by alternating moods of mania and depression, both of which usually last weeks or even months in most people who have the disorder. People who are manic have a high energy level and often irrational beliefs about the amount of work they can accomplish in a short amount of time. They sometimes take on a million different projects at once and finish none of them. Some people with mania talk at a faster rate and seem to the people around them to be constantly in motion.

After a manic mood, a person with bipolar disorder will often “crash” into a depressive mood, which is characterized by sadness, lethargy, and by a feeling that there’s not much point in doing anything. Problems with sleep occur during both types of mood. Bipolar disorder affects both men and women equally and can be first diagnosed throughout a person’s life.

Bipolar disorder can be challenging to treat because, while a person will take an antidepressant medication to help alleviate a depressed mood, they are less likely to remain on the medications which help reign in the manic mood. Those medications tend to make a person feel “like a zombie” or “emotionless,” which are feelings most people wouldn’t want to experience. So many people with bipolar disorder find it difficult to maintain treatment while in their manic phase. However, most people with bipolar disorder function relatively well in normal society and manage to cope with their mood swings, even if they don’t always keep on their prescribed medications.

However, schizophrenia is less common than bipolar disorder and is usually first diagnosed in a person’s late teens or early to late 20’s. More men than women receive a diagnosis of schizophrenia, which is characterized by having both hallucinations and delusions. Hallucinations are seeing or hearing things that aren’t there. Delusions are the belief in something that isn’t true. People who have delusions will continue with their delusions even when shown evidence that contradicts the delusion. That’s because, like hallucinations, delusions are “irrational”, the opposite of logic and reason. Since reason doesn’t apply to someone who has a schizophrenic delusion, arguing with it logically gets a person nowhere.

Schizophrenia is also challenging to treat mainly because people with this disorder don’t function as well in society and have difficulty maintaining the treatment regimen. Such treatment usually involves medications and psychotherapy, but can also involve a day program for people who have more severe or treatment-resistant forms of the disorder.

Because of the nature of the symptoms of schizophrenia, people with this disorder often find it difficult to interact with others, and conduct normal life activities, such as holding down a job. Many people with schizophrenia go off of treatment (sometimes, for instance, because a hallucination may tell them to do so), and end up homeless, without friends or family, and sometimes end their life as a plausible solution.

All people suffer, period. No person wants or needs to be a “lab rat” in the discovery of what ails them mentally. But, society dictates we label and judge others based on our opinions, ignorance, lack of understanding, and the pure lack of compassion. I know what y’all are thinking, and yes I do judge people myself in regards to stupidity and the utter lack of common sense. So, I do live the double standard in many ways, I ride that double edge sword like the evil bitch she is. Its one of many of my personal faults. I’m definitely not an expert on this topic, but in my defense I have read about and studied this topic for many, many years because the subject is very near and dear to me. Nor do I claim that what I have interpreted or formed my own opinion on is dead nuts accurate. As with all things, interpretation is the ultimate devil in the woodpile.

We can learn allot by paying attention and observing our fellow humans, but more often than not we choose to just ignore the people around us. We have become dependent on others to guide us in life for some fucked up reason. However, I do know two doctors, y’all know who you are, who take a different approach to medicine, they look at the person first, not the diagnosis. They take into consideration that we a people with feelings, emotions, and look at alternative ways to treat the various symptoms of life. I appreciate my two friends a great deal, one day I would like to shake the hands of Kris and Rexi because they have taken time out of their lives to include me into their lives. They are both amazing women in my opinion and anyone who has them in their daily lives are truly lucky.

Anyway, in closing, helping my daughter helps me more often than not because it gives me a chance to reevaluate the things I think I know well and opens my mind to the possibilities that there are other options. I get pretty set in my damn ways sometimes but my thirst for knowledge will never be quenched as long as I’m still breathing. My dad once told me, the summer he died, that people prey on the closed mind, they prey because the closed mind is that of a victim, and they begin with the upper hand because they know how defenseless a victim is. Is it true? I still challenge myself to this very day not to be a victim with a closed mind. Do you?

Still Dancing With My Demons

I have found that information is the best way to educate my mind when I’m left with unanswered questions. Today is no different, actually Thursday was no different, as it was Thursday, yes that I had yet another bomb dropped in my lap by my friendly VA doctors. It was good news to hear that there is now a solution, but bad news because of what the solution involves when it comes to the repair and pain relief in my knee. Anyone who visits this blog regularly over the last several years will have read about my knee, my challenges with the VA, playing the waiting game, and in many ways, dancing with my demons, or at least entertaining them on a dark rainy night.

I really was blindsided as I was led to believe that I merely had ligament problems once again, but no, these two doctors took a very blunt and honest approach with me, thank you, and explained and showed me just how fucked my knee really is. First of all, bone to bone contact because of deterioration of the cartilage is a rather challenging pain to explain. As well, that same space being approximately 100% covered with arthritis. I’ve always said ignorance is bliss because it allows one to disconnect from something and become very indifferent to ones grief. So be it, not everyone has had a broken knee to include broken femur in two places, broken tibia, destroyed ligaments and muscles, and so forth. I get the precious innocence of ignorance to my personal hell. I give these doctors credit, it was like they were in my head reading my thoughts and knowing my daily challenges. It was cool but also some freaky voodoo shit was going down too, I think. It was almost nice hearing my own personal words coming out of someone else’s mouth right there in person. Anyway, below is the best description I could find about the corrective surgery. I have spent the last two days reading, trust me, but I think this might just be my answer. However, I will put this out there for y’all, if you know a better answer, please pass it on. So, here it is.

Originally written here.

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Knee osteotomy is commonly used to realign your knee structure if you have arthritic damage on only one side of your knee. The goal is to shift your body weight off the damaged area to the other side of your knee, where the cartilage is still healthy. When surgeons remove a wedge of your shinbone from underneath the healthy side of your knee, the shinbone and thighbone can bend away from the damaged cartilage.

Imagine the hinges on a door. When the door is shut, the hinges are flush against the wall. As the door swings open, one side of the door remains pressed against the wall as space opens up on the other side. Removing just a small wedge of bone can “swing” your knee open, pressing the healthy tissue together as space opens up between the thighbone and shinbone on the damaged side so that the arthritic surfaces do not rub against each other.

Osteotomy is also used as an alternative treatment to total knee replacement in younger and active patients. Because prosthetic knees may wear out over time, an osteotomy procedure can enable younger, active osteoarthritis patients to continue using the healthy portion of their knee. The procedure can delay the need for a total knee replacement for up to ten years.

Surgery

Depending on where osteoarthritis has damaged your cartilage, an osteotomy removes a wedge of bone from different areas of your shinbone. The most common type of osteotomy performed on arthritic knees is a high tibial osteotomy, which addresses cartilage damage on the inside (medial) portion of your knee.

The following surgery section provides details about the high tibial osteotomy procedure that apply in general to most other osteotomy procedures. The procedure usually takes one to one-and-a-half hours to perform.

During a high tibial osteotomy, surgeons remove a wedge of bone from the outside of your knee, which causes your leg to bend slightly inward. It is like realigning a bowlegged knee to a knock-kneed position. Your weight is transferred to the outside (lateral) portion of your knee where the cartilage is still healthy.

Surgery
After anesthesia is administered, which may be regional, or general, the surgical team sterilizes the leg with antibacterial solution.Surgeons map out the exact size of the bone wedge they will remove, either using an X-ray, CT scan, or 3D computer modeling.A four- to five-inch incision is made down the front and outside of your knee, starting below the kneecap and extending below the top of your shinbone.Guide wires are drilled into the top of your shinbone (tibia plateau) from the outside (lateral side) of your knee. The wires usually outline a triangle form in your shinbone.A standard oscillating saw is run along the guide wires, removing most of the bone wedge from underneath the outside of your knee, below the healthy cartilage. The cartilage surface on the top of the outside (lateral side) of your shinbone is left intact.The top of your shinbone is then lowered on the outside and attached with surgical staples or screws, depending on the size of the wedge that was removed.The layers of tissue in your knee are stitched together, usually with absorbable sutures.

Day Of Surgery

At most medical centers, you will go to “patient admissions” to check in for your outpatient arthroscopic surgery.

After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your knee area may be shaved (this is not always necessary). You will wear a hospital gown and remove all of your jewelry.

You will meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room.

Here are some important steps to remember for the day of your surgery:You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general anesthesia.Wear a loose pair of shorts or sweatpants that will fit comfortably over your knee bandage when you leave the hospital.Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Recovery Room

Following a knee osteotomy, you usually stay in the recovery room for at least two hours while the anesthetic wears off.

This procedure typically causes significant pain. You will be given adequate pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do over the next couple of days.

Your knee will be bandaged and may have ice on it. You may have significant pain early on and you should take the pain medicine as directed. Remember that it is easier to keep pain suppressed than it is to treat pain once it becomes present, so ask the nurse for medication when you feel pain coming on.

You should try to move your feet and ankles while you are in the recovery room to improve circulation.

Your temperature, blood pressure, and heart rate will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital or, if necessary, be admitted for an overnight stay. Most patients remain in the hospital for two to four days following an osteotomy.

Post-Op In Hospital

After knee osteotomy, you usually are taken to a hospital room where nurses, anesthesiologists, and physicians can regularly monitor your recovery. Most patients spend two to four days recovering in the hospital.

As soon as possible after surgery is completed, you will begin doing continuous passive motion exercises while in bed. Your leg will be flexed and extended to keep the knee joint from becoming stiff.

This may be done using a continuous passive motion (CPM) machine. The CPM is attached to your bed and then your leg is placed in it. When turned on, it takes your leg through a continuous range of motion.

There will likely be pain, and you can expect to be given pain medication as needed. Ice also helps control pain and swelling.

For two or three days after surgery, you may experience night sweats and a fever of up to 101. Your physician may suggest acetaminophen, coughing, and deep breathing to get over this. This is common and should not alarm you. The incision usually starts to close within six days and the bandage can be removed. Physicians commonly fit you with a knee brace that may allow a limited range of movement and helps push your knee into the correct position. For a high tibial osteotomy, the knee brace pushes your knee inward, making you slightly more knock-kneed. Please note that some surgeons will cast your knee for 4 to 6 weeks to ensure that the osteotemy heals.

You may be able to put some weight on your knee, but physicians usually prescribe crutches for at least six weeks. You will be given a prescription for pain medication and usually schedule a follow-up visit sometime around six weeks after surgery.

Rehabilitation

Most patients can begin physical therapy around six to eight weeks after surgery. Unlike other surgical treatments for arthritis, osteotomy relies on bone healing before more vigorous, weight bearing exercises in the gym can begin. In the best scenario, people respond to strengthening exercises and stop wearing the brace after the first three to six months of therapy.

Light exercise is one of the most effective ways to relieve arthritis pain by stimulating circulation and strengthening the muscles, ligaments, and tendons around your knee. Strong muscles take pressure off the bones so there is less grinding in the knee joint during activities. In conjunction with a healthy diet, exercise can also help you lose weight, which takes stress off your arthritic knee.

Stretching

In the first few weeks of rehabilitation, your physical therapist usually helps you stretch the muscles in the hamstrings, quadriceps, and calves while flexing and extending your knee to restore a full, pain-free range of motion.

Aerobic Exercise

When pain has decreased, physicians generally recommend at least 30 minutes a day of low-impact exercise a day for patients with arthritis. You should try to cut back on activities that put a pounding on your knees, like running and strenuous weight lifting.

Cross-training exercise programs are commonly prescribed when you have arthritis. Depending on your preferences, your workouts may vary each day between cycling, cross-country skiing machines, elliptical training machines, swimming, and other low-impact cardiovascular exercises. Walking is usually better for arthritic knees than running, and many patients prefer swimming in a warm pool, which takes your body weight off your knees and makes movement easier.

Strengthening

Strength training usually focuses on moving light weights through a complete, controlled range of motion. You should generally avoid trying to lift as much as possible with your quadriceps and hamstrings. Your physical therapist typically teaches you to move slowly through the entire movement, like bending and straightening your knee, with enough resistance to work your muscles without stressing the bones in your knee.

Once your physical therapist has taught you a proper exercise program, it is important to find time each day to perform the prescribed exercises.

Recovery at Home

You will likely feel pain or discomfort for the first week at home after an osteotomy, and you will be given a combination of pain medications as needed. A prescription-strength painkiller is usually prescribed and should be taken as directed on the bottle.

Swelling in your leg usually decreases over a span of three to six months after surgery. There may be some minor bleeding for a few days, but by the time you are released from the hospital, most bleeding should have stopped. If you notice an increase in swelling or bleeding, you should call your physician.

Physicians generally recommend that you avoid putting stress on your knee until the bones have healed. Putting weight on your knee too early may damage the bone surface and prolong healing time.

Here is what you can expect and how you can cope after an osteotomy:Icing your knee for 20 or 30 minutes a few times a day during the first week after an osteotomy will help reduce pain. Ice therapy may need to intermittently continue for a few months if pain bothers you.As much as possible, you should keep your knee elevated above heart level to reduce swelling and pain. It often helps to sleep with pillows under your ankle.Immobilize your knee in the prescribed, hinged knee brace for about six weeks. You may remove the brace for brief periods to perform passive motion exercises with the aid of a physical therapist or a CPM machine. Range of motion exercises are important for healing. Regaining full extension is just as important as bending your knee.Your leg may appear slightly bent after the surgery as it heals into its new alignment.Most patients have to keep the incision dry for seven to ten days. Your physician can recommend a surgical supply store that sells plastic shower bags. Wait until you can stand comfortably for 10 or 15 minutes at a time before you take a shower.Crutches or a cane may be needed for between six and ten weeks, depending on the pain. It is difficult to describe the amount of pain any given patient will experience.Six weeks after surgery, your physician usually gives you a check-up. X-rays can determine how your bones are healing and whether you are ready to begin rehabilitation.You may have to take between six weeks and six months off from work, depending on how much you rely on your knee to perform your job.

Prevention

After rehabilitation, preventing osteoarthritis is a process of slowing the progression and spread of the disease. Because patients remain at risk for continued pain in their knees after treatment, it is important they are proactive about managing their conditions.

A fall or torque to the leg during the first two months after surgery may jeopardize the healing of your bones. You should exercise extreme caution during all activities, including walking, until your physician determines that your bones have healed.

Maintaining aerobic cardiovascular fitness has been an effective method for preventing the progression of osteoarthritis. Light, daily exercise is much better for an arthritic knee than occasional, heavy exercise.

When you have arthritis in your knees, it is especially important to avoid suffering any serious knee injuries, like torn ligaments or fractured bones, because arthritis can complicate knee injury treatment. You should avoid high-impact or repetitive stress sports, like football and distance running, that commonly cause severe knee injuries. Depending on the severity of your arthritis, your physician may also recommend limiting your participation in sports that involve sprinting, twisting, or jumping.

Because osteoarthritis has multiple causes and may be related to genetic factors, no simple prevention tactic will help everyone avoid increased arthritic pain. To prevent the spread of arthritis, physicians generally recommend that you take the following precautions:Avoid anything that makes pain last for over an hour or two.Perform controlled range of motion activities that do not overload the joint.Avoid heavy impact on the knees during everyday and athletic activities.Gently strengthen the muscles in your thigh and lower leg to help protect the bones and cartilage in your knee.Non-contact activities are a great way to keeping joints and bones healthy and maintain fitness over time. Exercise also helps promote weight loss, which can take stress off your knees.

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