Nursing & Depression

[carpe_de_em]

While visiting in the lounge one day, we discovered that every nurse there was on an anti-depressant.

I have had 'Treatment Resistant Depression' for about 20 years--as long as I've been a nurse. Now I am totally burned out, on major meds, and am seeking disability d/t depression/anxiety.

I beleive years of long hours, high stress, high expectations and little appreciation (from management, not patients) has contributed to this.

How many other jobs consider you a tratior b/c you call in sick? And trying to get off for a sick child is an unforgivable sin. How many other jobs want you to work overtime on the days you are scheduled, call you at all hours of the night or day when you are off, first pleading w/ you to come in, then laying a guilt trip on you if you say "NO!" And let's not forget the mandatory inservices and CEU's that take time away from your family.

If any profession should understand the importance of the individuals' physical, mental, social and spiritual self it should be nursing--after all we are taught in nursing school about treating the patient as a whole, not just a disease! Why don't we treat our staff the same way.

Anyone out there in the same boat?

[Youda]

Sphinx, could you describe the pelvic pain in a little more detail? I have an idea. But, I don't want to suggest it until I know a little more. Also, do you have headaches, mostly in the temple? Or any tempo-mandibular pain? Pain, aching, anywhere else? When is it worse? When is it better? And, finally, how old are you? I don't need exact, just give me the decade. Also, any visual disturbances, even minor? Any rash or skin involvement, especiially lower extremities? Was the onset of the pelvic pain gradual or sudden? As I said, I have an idea, so indulge me, OK?

[sphinx, BSN, RN]

Well I don't have the pelvic pain anymore. It did come on suddenly, I guess, I never had it till after my tubes were tied, about 2 years after.It was a sharp pain on my lower left side, accompanied by cramps that were so severe I'd be sick to my stomach. I would also have low back pain, like what you get with cramps, but way worse, like a burning, boring pain. I also bled a LOT with my periodsI had a laproscpy to check for endometriosis, but none was found. Yet my Dr did not then decide I was a nut case, and decided to treat me medically. I did a 6 month coourse of Lupron, which helped.....no pain at all. But that put my into a deep depression which led to another hospitalization. After the 6 month course was over, I had a few months with no periods....no pain. With my first period, I was in agony, in tears. My GYN put me on continuous birth control pills (no placebo). I continued to bleed every day, even with taking a break every few months. I eventually went through 5 types of pill, all with higher and higher dose, basically bleeding every day for at least a year. The last pill worked.....for 2 months, then the bleeding started, and I was so upset, I went off it. By that time, I'd been getting side effects from the higher doses, and didn't want to increase to a higher dose. My GYN sent me to the specialist, who did a very thorough exam, and his suggestions were about the same as what we'd already tried, or a TAH and LSO, which he thought had a good chance of helping the pain (and of course 100% chance of stopping the bleeding). They knew it wasn't endo, thought "maybe" it could be adenomyosis, but they did the hyst, and the path showed nothing significant...just some minor cysts, but nothing that would have caused the pain. BUT I have had NO recurrance of the pelvic pain, OR the back pain since then, not even a hint. Now this other pain, which at the time was mostly epigastric, was happening at the same time, so I was a miserable camper. I felt like all I did was so to one doctor or another, and all the tests were negative. I felt like a head case, totally.

OK, anyway...yes, I get headaches...often. Usually daily, usually a general all over type. Other pain......I tedn to get jaw pain, certain antidepressants bring on bruxism, and beyond that I'm a big time clencher anyway. I use a neat gadget called an NTI splint, which is great, helps with jaw pain and some headaches too. Other pain? I have had R shoulder pain, for a while, PT dude feels it,s related my tendon as well as muscle. It's gotten a lot better, it helps now that I don't lug so much stuff on my shoulder; use a wheeled backback to haul all my crap around in. I have some visual thingies....when I first wake up, I see lines at the edges of my vision. My eye doc worked me up, says its nothing. Skin? Not really. I will sometimes get itchy wrists, but it seems to be related to anxiety......I'll scratch and scratch, then later it's gone. And...I am 34.

I have taken to hardly eating these days....I just don't want to. In addition to all this mess, I have had big constipation probs for a few years.

OK, back to watching a movie and vegging out a while. Gets my mind off "things". Besides, sitting "up" hurts the worst of all. Let me know your thoughts?

Heather

[Youda]

Is the pain worse in the mornings? Does it seem to get a little better if you lay down? Does the pain increase with activity, or does activity relieve it?

Would you say that you have had pain the is in the neck, shoulders, lower back, and/or hips, either at the same time or one or the other locations or pain all the time?

Does the pain seem to jump around?

Would you say you have any stiffness? Or just pain?

Any carpal tunnel-type symptoms?

Are the muscles of your upper arms or the muscles of your upper legs tender if you squeeze them a little?

And have you had a recent sed rate (ESR) done?

[abrenrn]

Two questions from me, Sphinx, when you have time.

Where do you live?

Did you have any health problems before tubes tied?

[sphinx, BSN, RN]

youda...ummm, sometimes pain is worse in am, but also afternoon, sometimes evenings. It really just depends. So, no easy asnswer there. I still have pain when I lay down, but it is *worse* when I am sitting up. I do get aches and pains in other loactions, but nothing I'd consider unusual, just normal stuff. Same goes for stiffness.....I may wake up stiff, but after I shower I'm ok. Only time I had any *real* carpal tunnel type symptoms was YEARS ago when I was working for a temp agency peelings labels off of computer data tapes with a metal tool. Nothing since then. I *do* get frequent tingling in the fingers and occasionally tremors, but the tremors are supposedly related to wellbutrin, and I understand topamax can cause the tingling. Sore muscles? I don't know. Seem a little sore, but maybe it's the power of suggestion. It's nothing i'd ever complain about. And no, I don't think my sed rate has been among my recent bevy of blood work....maybe last year??

abrenrn.......I live in Rochester NY. Except for depression, I didn't have any major health problems till I had my tubal, till a year or two after. When I was a kid I was sick a lot, the usual...strep, mono, even scarlet fever........but was pretty healthy for the most part. Of course, I remember being depressed even when I was young.

The right sided pain I've been having, was real bad this morning, I didn't want to eat, but made myself.....hurt real bad for hours after. It's eased up, but still there. I haven't eaten anything since that "brunch".

[abrenrn]

Sphinx -

Even without fever, I'd be concerned with the abd. pain. RUQ, you said you're 37 or something, I don't know how you look but Im thinking of the four F's of gall baldder disease - fair, female, fat (sorry about that one - don't know, not a nice word), forty. You hit one on the head, close to forty, don't know about the other two.

If you have lost weight recently, at higher risk for gall bladder disease as well.

A few other questions: have you ever had trouble with latex - hands itching when you where gloves, etc. Latex allergy is one of those epidemics among health care workers that is not discussed enough. I have sensitivity. Can be tested by RAST ( a blood test). Mine was done by a hospital that actually screened for this - though I had already figured out I was allergic by the time they did.

Is there much lyme's disease where you live? Have you ever been tested? Though tests are not always specific.

Have you ever been tested for Hep C? May seem a stretch - you said lab values were normal. Were LFTs low normal or high normal? Hep C impacts other organs besides liver. It is now very common, think things like tatoos, piercings, manicures may spread it (I don't think this has been proven yet, just suspected).

And, as Youda asked, have they done an ESR or other rheumatology work up?

But first things first. I think you need to take care of your tummy.

Sorry if I sound like MD. I have worked as NP though, certified and everything. But - Youda's questions got me thinking about some of the things you said.

[Youda]

Hi, sphinx.

Let's assume for a moment that all (or most) of your symptoms come from a common cause. That may not be true, but let's think that way for a few minutes. List your current symptoms (these are the ones I get scanning your recent posts):

lower back and shoulder pain

fatigue

weight loss / loss of appetite

depression

headaches

visual disturbances

GI distrubances

jaw pain

referred abdominal or gallbladder-type pain

From what I'm hearing, most of these are "subjective" symptoms, that is, docs can "test" for a headache, and can't "see" a headache, for example. So, docs do a smattering a blood tests to figure out what's going on. They come back normal or near-normal. Any other more invasive testing comes back "normal" also.

I have to make this clear here; and you'll understand why. I am not a doctor. I am not entering into a professional relationship with you. You are responsible for your own medical care and consulting with a doctor. Ok, now that the legal crap is said . . .

When I do some searches on medical websites, and list these symptoms, the results seem to point to a rhematoid or an inflammatory-type answer: fibromyalgia, lupus, lymes, arteritis, polymyalgia rhematica, etc. Without looking in that direction, or getting an ESR, there isn't much use pursuing that line of thinking. But, you might want to research some of these and see if they seem to fit or ask your doc what he may think. As you know, most of these are autoimmune diseases, but one of them might explain a lot for you. They may be things a doc has already thought of, and ruled-out. I'm real bad second guessing doctors and when I try it, I'm usually wrong. So, take that into consideration, too.

But, I do have problems believing that a 34 year old is just falling apart with all the symptoms and discomfort you've been having, along with the untreatable depression. Seems to me they must be all related in some way. It's rather useless to blame the physical symptoms on "psych problems" unless all possible alternatives have been exhausted. It's time to start looking further, I think, Sphinx, and not to just give-up or accept how things are. In our profession we hear all the time that a delay in diagnosis was caused because, although the docs were doing everything they could, they just didn't find it for awhile. That may be happening to you, too. So, write out your list (I wouldn't get into a lot of narration, though), and give it to your doc and see if it rings any bells for him. And, ask if he'll do a ESR. :)

I sure hope this helps. You're such a dear lady, and you deserve to start feeling better.

[cargal]

Sphinx.

Youda and Anne both said it all. I hope you're feeling better soon.

[sphinx, BSN, RN]

Thanks all......wow, I am overwhelmed. I really don't know what to say. OK, well 1st, Anne, I guess the 4F's might describe me, although not sure about being fair....well, while I am dark haired and dark eyed, my skin is not dark (ie I do don't have that beautiful Italian girl look, haha), and I'm not quite so close to 40, I am 34 not 37. But anyway. The scan did find something. When the PE called me on my cell phone with the results, I was at a pateint's house, and had to make it quick, then I just never got back to her. She said it had to do with delayed emptying of the gallbladder. As for my weight, Im not afraid to say how much I weigh, I weigh 190 lbs. I *have* lost weight, but not recently, and when I did it was on purpose (weight watchers). that was about a year ago, then I just quit, but haven't gained any back. I haven't had any appetite for some time now, but still have not lost weight, I suppose my metabolism has slowed down, gone into "starvation" mode. ha! What a laugh!

As for latex, I've never had a problem.....just the powder, and then, it just dries out my hands, so whenever possible, I wear powder free gloves. But the latex itself has never bothered me.

I don't know if Lyme disease is real prevalent around here, but I doubt it. I know I have never been tested.

And yes, I was tested for Hep C, but that was several years ago.....my ex husband contracted it through a cryo infusion, and it was a while before he found out, and we were both tested, I was negative. To be honest, I don't know if my LFT's were low or high normal. It depends on who I talk to at the office, some will tell me the exact results, others will just look at the report and say "everything was normal" (I hate that).

OK, Youda.....I think your idea is interesting, I hadn't really thought of that angle. But, first....I don't have the lower back pain anymore. That went anway along with my uterus. Second, the weight I lost was on purpose, I didn't just lose it. My appetite is lousy, but I haven't lost any weight in the past year despite that. Third, although I never would have expected it, they did find something hinky with my gallbladder. I was really surprised. Frankly, I think I tend to be a little hyper when it comes to such things, like I have a super low pain threshold, or it is psychosomatic or something. My doc is great! I'll have to see if she's done a ESR....she might have, and I don't recall.......I know she's checked a lot of stuff I never would have thought of. And once, last year her NP sent me to get labs, and I checked off a bunch of other labs too (I was curious).

I just get tired of goin to doctors. And my doctor is good....and very popular. She actually takes time to sit and talk to you, and listen to you....more than the 12 minutes insurance allots you or whatever it is these days! She is alwasy very thorough. I'm sure she'd be very open-minded if I brought these ideas of to her. I just hate going there! She is very busy, and because she actually takes time with her patients, there is usually a wait.....and I feel like such a head case...always coming in with a laundry list of problems. Like the freak of the week. Maybe thats all in my head. I never know any more. I can hardly think straight.

One thing, though......I used to post on a board for women having or who have had hysterectomies...I still post there occasionally, they have a board esp for talking about depression, etc. I posted there about how I've been so depressed, the pain I've been having, and about my cat. One of the girls there replied to me, saying that I didn't give it a second thought to get my kitty help when she needed it, and I should do the same for myself. It's true. I found her lump one week ago, she was disgnosed Monday, had more tests on Tuesday, and surgery on Wednesday. That might me inexplicably said. Because inside, I guess I don't feel that *I* am worth it! And that, my friends, is quite pathetic.

I'm just babbling now, I need to do something to center myself. Like nap!!??

[abrenrn]

Sphinx -

Pain is hard to measure, we've all learned that. Somtimes I've looked for other signs to tell me if my pain is real, or exagerated. In your case I would think, hmmm, I have seen grown men crying, curled up in a ball, overwhelmed by pain due to gall bladder disease. Some symptoms you have indicate that, plus a test showing problems. From this other data, I would conclude, no, I doubt she is overstating her pain

From a previous episode, when you had pain consistent with pacreatitis and an elevated lipase, I think of what a book about using pain to dx said about pancreatitis: often trying to curl up on table, unable to stay still, though, trying to reduce pain with movement. So, I conclude you were not overstating then.

I also go back to first things first. Severe abdominal pain can be an important warning of a serious problem. In ERs they call it a "hot abdomen" - must r/o all serious causes so appendix won't rupture, so gall bladder won't get so inflamed one ends up with peritionitis, etc.

Your abdomen sounds rather hot right now. I'd rather have a thorough evaluation to r/o other causes before concluding that you are overstating your pain. It's the safest way to go.

[abrenrn]

PS - rapid wt loss, purposeful or not, can lead to gall bladder disease. It is a risk of all weight loss programs.

[sphinx, BSN, RN]

Well, a day like this, while rare, where the pain is minimal, is what makes me go back to thinking it's all in my head, HIDA scan nonwithstanding. I just want to go to bed and not wake up, just to not have to deal with anything ever again. I am tired of all this.