getting involved in the community

My friend Alexandra recently recommended me to be a member on the Young Professionals Board of the Park Center, a local agency that provides opportunities and promotes recovery of persons with mental illness through holistic services that focus on their needs, choices and strengths (See their PSA above). I haven’t been officially ‘inducted’ into the group yet, but with a meeting coming up with their development director in the next week, it’s almost certain that I will soon be on the board of the Park Center in the fall. It’s an incredibly exciting opportunity for me, and I hope that I can gain further insight into the mental health community through being involved with this organization.

I think this commitment will affect this journal/blog in some way, because I’m definitely looking forward to talking about all that the Park Center does, because their gamut of programs, from homeless outreach to pre-employment vocational services, are really amazing. Because I do have this blogosphere platform, I believe I have an obligation to talk more about mental illness beyond my own experiences. While I don’t plan on changing the tone of this journal, I’m sure that, as I become more aware about the projects that they have, I’ll certainly be more inclined to write about them.

My soon-to-be relationship with Park Center will open an amazing new chapter to becoming more than just a blogger about the mental health community, and I’m really looking forward to it!

weight and see

I’ve been gaining pound after pound over this entire year, and it’s been really hard to figure out why. It’s true that I’ve gone out to eat more often during the week now that I have the boyfriend to have fun doing things like that. But that doesn’t really explain for the extra twenty or so pounds I’ve put on in the last several months (about forty pounds total over the last two years). I work out about three times a week and even tried the 1,500 calories-a-day diet for a couple weeks, but the weight didn’t budge a bit. Finally, when I met my psychiatrist today, I complained about my weight. As I told her how much I weighed, she made a sound indicative of shock, and then immediately said, “It’s the Abilify.”

She was hesitant to take me off of Abilify since the combination that I’m currently on has been fairly well tolerated by me. And with school starting in a few short weeks, she wasn’t sure this was the best time to test out a new mood stabilizer. So, she gave me a choice as to whether I wanted to try something else later or now. I picked now.

Because I’ve been on quite a number of different of meds, the options have dwindled quite a bit. So she thought it’s time to try something new, as in they haven’t even made some animated commercial for it for television yet. It’s called Latuda, and it’s currently been FDA-approved for treatment of schizophrenia. Apparently, it’s supposed to be weight-neutral, but can cause tremors, which I’m not a fan of because of previous experiences with similar issues.

I really hope I lose some weight, but I’m really hoping that Latuda does make a good fit for me.

 

new Seroquel XR commercial

I posted the animated Abilify commercial on the site in March, and was fascinated with the depression ‘blob’ that follows the depressed woman around. I came across this what I’m guessing is a pretty new commercial for Seroquel XR the other day and noticed that this one features a cloud that follows the depressed people wherever they go.

Does too much sleep lead to depression?

I’ve been having a really hard time getting up in the morning. I could stagger from the bed to the couch, but I can easily fall right back asleep for hours. It’s not like I’ve been going to sleep that late. It’s gotten to a point where I can sleep even after 11 a.m., which kills trying to get anything accomplished in the morning. Then I’m having a somewhat similar problem at night where I start falling asleep, sometime after dinnertime.  What am I doing wrong?

Apparently, this ‘condition’ could be called hypersomnia (excessive sleepiness, tiredness), and I came across a new study that reported that hypersomnia among bipolar disorder (BD) patients who are in an inter-episode period may predict future depressive symptoms. According to the article in the Journal of Affective Disorders, Allison Harvey (University of California, Berkeley) and team explain that BD patients “in the inter-episode period spend roughly 50% of their time unwell, and these symptoms predict relapse into mania or depression. Hence, there is a critical need to identify aspects of the illness that contribute to inter-episode dysfunction and to relapse.” (Below this post is a shortened version of the article)

So, what am I to do about this? If I fix my sleep issues, would I be able to avoid a possibly incoming depressive episode? This particular study doesn’t answer that question, but I’m hoping that this is the case. If anything, I can go back to getting to sleep around the same time every night and try my hardest to get up at the same time each morning. If that means curing my hypersomniac tendencies as well as ward off future depression, I’m more than willing to follow that rule.

——————————————————————————————————————————————

Hypersomnia in inter-episode bipolar disorder: Does it have prognostic significance?
Katherine A. Kaplan, June Gruber, Polina Eidelman, Lisa S. Talbot and Allison G. Harvey
Journal of Affective Disorders, Volume 132, Issue 3, August 2011, Pages 438-444

Background
Hypersomnia in inter-episode bipolar disorder has been minimally researched. The current study sought to document the prevalence of hypersomnia in a sample of inter-episode patients with bipolar disorder and to examine the relationship between hypersomnia and future bipolar depressive symptoms.

Methods
A total of 56 individuals with bipolar disorder (51 type I + 5 type II) who were currently inter-episode, along with 55 non-psychiatric controls, completed a baseline assessment, including semi-structured interviews for psychiatric diagnoses, sleep disorders, and a battery of indices that included assessment of hypersomnia. Approximately 6 months later, participants were recontacted by telephone and mood was re-evaluated.

Results
Three of six indices suggested that approximately 25% of participants with bipolar disorder endorsed symptoms of hypersomnia in the inter-episode period. Within the bipolar group, hypersomnia in the inter-episode period was associated with future depressive symptoms. This finding was independent of baseline depressive symptoms and medication use.

Limitations
Small sample size and concurrent psychopharmacology in the bipolar sample.

Discussion
Though no gold standard measure for hypersomnia currently exists, this research takes a step towards identifying a clinically and empirically useful hypersomnia assessment. This study demonstrates that hypersomnia in the inter-episode period of bipolar disorder relates to future depressive symptoms, and adds to the growing body of evidence on the importance of inter-episode symptoms predicting bipolar relapse.

if not a magic bullet, then what is it?

The summer’s not yet over, but I’m already looking back at it. I think about the hypomanic episode I had and bouts of depression following it.  In fact, those moments of depression never seem to be that far away. Everyday I take medication in effort to keep all those things at bay, and see a therapist weekly. And, oh yes, the ‘little spark,’ too. Electroconvulsive therapy is still on the roster.

I’m not sure this is what I expected. It’s been over two years since my first series of ECT treatments, and I’m still just maintaining, not necessarily thriving. People talk about ECT being a life saver and the ‘magic bullet,’ but as time goes by, I’m not sure if that’s how I would view the experience anymore. Yes, I’m still alive, and that’s (I guess) a good thing, but—-Where would I be  had I not had those shock treatments? Would I be dead, or in a much worse shape than I am in now? Or would I have eventually found my way to this emotional point that I am currently at? I’m still taking mostly the same cocktail of meds. What criteria determines if, and to what degree, I’m doing better?

Perhaps I’m making some logical error in contemplating this whole thing. After all, constant suicidal thoughts did pretty much go away after all the ‘little sparks.’ And wasn’t that the point? Didn’t the treatments accomplish their goal? I may be asking a question that can’t really be answered. I could just as easily ask “what if I had never started taking meds,” but I don’t seem to be doing that. Instead, I keep coming back to whether ECT was the right treatment to have—and still be having.

I seem to give some people the perception that I am obviously an avid endorser of ECT because I have a journal/blog that talks about the subject. But I don’t think that’s what my purpose is in writing on this topic. While I admit that I’m not anti-ECT, I am constantly conflicted about getting this treatment. But maybe I should also be just as conflicted by the medication.

it’s a date!….at my therapist’s office

One of the things that binds me and the boyfriend together is our extensive experience with depression. Because of our shared illness, we’ve definitely accumulated some unresolved issues that influence how we think, and ultimately influence how we interact with each other. Nothing is really going wrong in the relationship, but I really felt like our wounds from the past would heal—and thus lead to a better relationship—if we discussed our problems and concerns more openly.

That’s why I asked him to come with me to my therapy sessions. And he agreed.

My therapist also specializes in couples therapy, so we decided to show up together every other session (I still need some time to myself on the other weeks). I don’t really know what I expected, but so far, it’s been a learning experience to have another person incorporated into the session. Yes, I do think that it’s already made our relationship stronger by airing out our laundry in this format, but I also think that I’ve learned something about making a good relationship.

First, you really have to listen to what the other person is saying. I think one aspect of couples therapy that is totally different from individual therapy is that, well, obviously there are two of us (plus the therapist) in the room, and it’s not just you now; you must listen to what your partner is saying. Sometimes it’s easy to tune out the other in an ordinary setting, but therapy teaches you to be attentive to your mate.

Second, you must be ready to respond to what your partner has just said. Listening isn’t enough. I’ve learned that when the boyfriend has brought up a certain issue to the table, it’s my responsibility to react in some way. In order to solve a problem, I can’t just be quiet. It’s no longer my problem or his problem. It’s our problem, and it takes both of us to solve it. And while what the therapist has to say is important, our own feedback is crucial.

Third, you have to learn to communicate clearly. At home if I’m annoyed by something, I could just give a vague reaction. In a therapy setting, I must be able to express what it is that I’m annoyed about. That means digging down and organizing my thoughts about a certain issue before opening my mouth. Therapy teaches me to be precise about how I feel and communicate those feelings to my partner.

Finally (for now), you have to keep talking. I tend to just stop talking if there’s another person in the room that can do the talking. This does not do the relationship any favors. I realized that in bettering communication, I must do the communicating. The fact is that if I don’t say what’s on my mind, I can’t expect the other person to figure it out.

So far, I believe this experience has been a valuable part of building this partnership, and I hope I can keep learning more about creating a better relationship.  But what’s a huge bonus from going to therapy together? There’s a Mexican popsicle shop (Las Paletas) on the same street. Nothing like a post-therapy ice-pop to decompress from an hour-long session.

 

 

 

 

What are some barriers to mental health treatment? Help find out.

My friend is an undergraduate student at an university in southeastern United States, and is conducting research into the barriers which people perceive when they try to access mental health services, and whether or not a person’s race influences their perception of those barriers. He is conducting a series of online focus groups. If you are interested, by clicking on the link below (or here: bit.ly/kx3AiE), you will be taken to a prescreening survey where you will answer some basic demographic questions and enter contact information; the survey take less than 5 minutes. He will then email or text you the passcode information for the chat room While the chat sessions will be recorded, no identifying information will be associated with the transcript, and the only people who have access to your name will be him and his faculty advisor.

Because this is a study about racial barriers, you must be willing to identify your ethnicity, so that data can be generated from the sessions. You do not need to have received mental health treatment to join the discussion. If you are not available for any of the chat sessions, please contact him at mattb291@gmail.com and he will attempt to set a time for an interview. Thank you in advance for participating in the discussion about this important topic.

And if possible, please pass this message on to anyone that might be interested!

bit.ly/kx3AiE

IRB#11-338

antidepressants lead to more depression?

Patients who use anti-depressants are much more likely to suffer relapses of major depression than those who use no medication at all, according to new research. In an article that is likely to ignite new controversy in the hotly debated field of depression and medication, an evolutionary psychologist concludes that patients who have used anti-depressant medications can be nearly twice as susceptible to future episodes of major depression. (read the story in ScienceDaily)

Below is the abstract for the research which was published in Frontiers in Psychology:

Some evolutionary researchers have argued that current diagnostic criteria for major depressive disorder (MDD) may not accurately distinguish true instances of disorder from a normal, adaptive stress response. According to disorder advocates, neurochemicals like the monoamine neurotransmitters (serotonin, norepinephrine, and dopamine) are dysregulated in major depression. Monoamines are normally under homeostatic control, so the monoamine disorder hypothesis implies a breakdown in homeostatic mechanisms. In contrast, adaptationist hypotheses propose that homeostatic mechanisms are properly functioning in most patients meeting current criteria for MDD. If the homeostatic mechanisms regulating monoamines are functioning properly in these patients, then oppositional tolerance should develop with prolonged antidepressant medication (ADM) therapy. Oppositional tolerance refers to the forces that develop when a homeostatic mechanism has been subject to prolonged pharmacological perturbation that attempt to bring the system back to equilibrium. When pharmacological intervention is discontinued, the oppositional forces cause monoamine levels to overshoot their equilibrium levels. Since depressive symptoms are under monoaminergic control, this overshoot should cause a resurgence of depressive symptoms that is proportional to the perturbational effect of the ADM. We test this prediction by conducting a meta-analysis of ADM discontinuation studies. We find that the risk of relapse after ADM discontinuation is positively associated with the degree to which ADMs enhance serotonin and norepinephrine in prefrontal cortex, after controlling for covariates. The results are consistent with oppositional tolerance, and provide no evidence of malfunction in the monoaminergic regulatory mechanisms in patients meeting current diagnostic criteria for MDD. We discuss the evolutionary and clinical implications of our findings.

Michael C. Neale, Charles O. Gardner, Lisa J. Halberstadt, Susan G. Kornstein, Paul W. Andrews. Blue Again: Perturbational Effects of Antidepressants Suggest Monoaminergic Homeostasis in Major Depression. Frontiers in Psychology, 2011; 2 DOI: 10.3389/fpsyg.2011.00159

a misspent livelihood

There are days when I am so annoyed with myself that I don’t really know what to do. That day is today. Since the time I woke up, I’ve felt all angry inside, and don’t know how to release all of that tension. Instead of listening to my professor in class today, I drew a picture of a person’s head that’s confused. Also, It inevitably got inflicted onto my boyfriend, who takes it as a sign that I am annoyed with him. But the thing is, it’s not really about him that’s getting to me.  I’m just annoyed at myself, for being fat, for not being able to have a clean house, for not accomplishing anything of value, etc. We went and had a martini at a restaurant early in the evening, and he told me that despite all that I’m feeling, I am valuable. I really did appreciate him for saying that, but I still feel like I’m ruined.

I know I’m wasting time feeling sorry for myself (which I’m not sure this is exactly what I’m doing, but I’m sure not helping myself any by feeling this way), and it probably might help to just open up and tell someone how I feel. But if I do pour out all this crap, it’s like I’m exposing someone to a virus, contaminating everything in sight. And the last thing I want to do is hurt other people.

I saw the quote above on a book at West Elm the other day. As much as I thought I agreed with the quote, now I’m not so sure. Right now, I’d really rather have a perfectly kept house so that I didn’t have to show anyone how messed up I am.

#petlove

When I come home, I am greeted each and every time by my cat, Simon (see above). Lately, he’s been sitting on my sweater that’s on the table, but other times, he trots on by to say hello. It’ll be seven years in September since I adopted him as a little kitten from the humane association. In the time that I’ve known him, I haven’t had a suicide attempt. Is it coincidence or has my cat affected my mental health? Journal of Personality and Social Psychology (an online publication by the American Psychological Association) just published a paper titled “Friends with Benefits: On the Positive Consequences of Pet Ownership” which contends that pets indeed are good for our mental health. “Specifically,” said the lead researcher Allen R. McConnell, “pet owners had greater self-esteem, were more physically fit, tended to be less lonely, were more conscientious, were more extraverted, tended to be less fearful and tended to be less preoccupied than non-owners.”

Below is their abstract:

Social support is critical for psychological and physical well-being, reflecting the centrality of belongingness in our lives. Human interactions often provide people with considerable social support, but can pets also fulfill one’s social needs? Although there is correlational evidence that pets may help individuals facing significant life stressors, little is known about the well-being benefits of pets for everyday people. Study 1 found in a community sample that pet owners fared better on several well-being (e.g., greater self-esteem, more exercise) and individual-difference (e.g., greater conscientiousness, less fearful attachment) measures. Study 2 assessed a different community sample and found that owners enjoyed better well-being when their pets fulfilled social needs better, and the support that pets provided complemented rather than competed with human sources. Finally, Study 3 brought pet owners into the laboratory and experimentally demonstrated the ability of pets to stave off negativity caused by social rejection. In summary, pets can serve as important sources of social support, providing many positive psychological and physical benefits for their owners.

This research is a pretty big deal considering that most previous research into the benefits of pets has looked only at the relationship between two variables, but didn’t show any real correlations. In addition to the social support provided by the pets, the researchers also found that pet owners were just as close to key people in their lives as to their animals, indicating no evidence that relationships with pets came at the expense of relationships with other people, or that people relied more on pets when their human social support was poorer.

It is a fascinating study, especially since it’s a very quantitative one involving experiments rather than compiling a bunch of anecdotal, qualitative evidence from pet owners.

‘Men’s Health’ guide to less stress

There’s an interesting list in Men’s Health titled “52 Ways to Control and Conquer Stress.” Some of the tips are actually practical. I copied and pasted a few of them below….

Drink More OJ
Researchers at the University of Alabama fed rats 200 milligrams of vitamin C twice a day and found that it nearly stopped the secretion of stress hormones. If it relaxes a rat, why not you? Two 8-ounce glasses of orange juice daily gives you the vitamin C you need.

Put a Green Dot on Your Phone
This is your secret reminder to take one deep breath before you answer a call, says Susan Siegel, of the Program on Integrative Medicine at the University of North Carolina school of medicine. Not only will you feel better, but you’ll sound more confident.

Spend Quality Time with a Canine
Yours or someone else’s. According to research at the State University of New York at Buffalo, being around a pet provides more stress relief than being around a two-legged companion. As if we needed a study to determine that.

Go to Starbucks—with Your Coworkers
Researchers at the University of Bristol in England discovered that when stressed-out men consumed caffeine by themselves, they remained nervous and jittery. But when anxious men caffeine-loaded as part of a group, their feelings of stress subsided.

Shake It Out
When you’re facing that big-money putt, shake out your fingers, relieving the tension in your forearms, hands, and wrists and shifting your focus to the only thing you can control: your preshot routine. You won’t think about making—or missing—the shot, says Alan Goldberg, Ed.D., a sports-psychology consultant in Amherst, Massachusetts.

Listen to Music at Work
And make it the blandest playlist you can create. According to a study at Pennsylvania’s Wilkes University, Muzak lowers your stress levels at work, while also reducing the risk of the common cold. We knew Celine Dion had a purpose.

Shut Up and Smile
Freaking out about a speech? Smile, look at the audience, and keep quiet for 2 seconds, says T.J. Walker, president of Media Training Worldwide. It’ll slow you down and create the impression that you’re relaxed and in control. The audience will then feel more comfortable, leading you to actually be relaxed and in control. Now start talking. Unless you’re a mime. In that case, as you were.

Talk with Your Hands
To keep calm in a job interview, rest your arms on your lap, with your elbows bent slightly, and have your fingers almost touching, says Walker. This will keep your body relaxed, which will keep your tone conversational.

Run Fast
Bike hard. Punch the heavy bag. And we don’t mean your mother-in-law. A University of Missouri at Columbia study found that 33 minutes of high-intensity exercise helps lower stress levels more than working out at a moderate pace. What’s more, the benefits last as long as 90 minutes afterward.

Hit the Sauna After Your Workout
In an Oklahoma State University study, those who combined sauna use with group counseling had greater stress relief, feelings of relaxation, and sense of accomplishment compared with those who only had their heads shrunk.

Remember the Lyrics to Your Favorite Song . . .
. . . name at least 30 states, or assemble the All-Time Band of Guys Named James (the James Gang doesn’t count). In other words, give your mind any all-consuming challenge, as long as it has a definite finish—unending problems cause more stress, says Toby Haslam-Hopwood, Psy.D., a psychologist at the Menninger Clinic in Houston.

Lay The Journey to Wild Divine
It’s a CD-ROM game that works like this: Three biofeedback sensors worn on your fingers sense your stress level and translate it into your ability to perform tasks such as levitating virtual balls or controlling birds in flight. The more you play, the more mastery you gain over your emotions. Go to wilddivine.com for more information. It sells for about $300.

Find a Breathtaking View
Now take a breath—and a good long look. You’ll walk away from the brink with a sense of context and a bigger perspective, which will make the 5,000 things on your to-do list seem less daunting, says Allen Elkin, Ph.D., director of the Stress Management & Counseling Center in New York City.

See the rest here.

Free bipolar disorder report

Surely we’ve all bought “How to” guides for our respective illnesses from Amazon or other booksellers, but The British Psychological Society is offering a guide about bipolar disorder for free! “Understanding Bipolar Disorder” provides an overview of the current state of knowledge about why some people tend to experience periods of extreme mood and what can help. Much has been written about the biological aspects of bipolar disorders: this report aims to redress the balance by concentrating on the psychological aspects, both in terms of how we understand the problems and also approaches to help and treatment. They hope this report will influence the way in which services are delivered, so that more people have access to psychological treatments and that services will no longer insist that users accept one particular view of their problem.

“Understanding Bipolar Disorder” is available on their web site to anyone.

v58.69

I finally went to the diagnostics place this morning to get my blood drawn in order to have some tests done. On the form that my psychiatrist gave me to take to the testing place, there was a code: “v58.69″ scribbled in the billable codes section.  I got curious so I looked up what it might mean. Apparently, v58.69 means “long-term (current) use of other medications.” As much as I knew that my overall health is now incumbent upon how my body reacts to all the medication that I take, seeing that code on that sheet of paper was a cruel reminder that I cannot separate myself from those drugs.

It’s too early to say if anything is wrong, but it is obvious that my doctor thought that if anything was off, it’s probable that it’s because of the stuff I’ve been taking. While I’m not one to speculate on what could possibly be wrong with me, let’s say my use of some of the meds has led to something like diabetes. I hesitate to say that my feeling less depressed would be worth getting diabetes. I ask myself, what is the opportunity cost of taking medication? Thinking about “side” effects of the meds that we take made me recall a time several years ago when I experienced tremors and then lost most sensation below the waist. I ended up seeing several neurologists who tested me for all sorts of disorders from spinal cord syndrome to Parkinson’s, with one neurologist concluding that all of this is probably because of the lithium I was taking at the time. The symptoms eventually dissipated, and I got off the lithium sometime later.  But if my body indeed reacted to the lithium in such manner, I have to say any sort of mental wellness it gave me wasn’t worth having to go through months of utter fear and uncertainty about whether I could even have control of my own body.

Wouldn’t getting diabetes make me just as unhappy as I had been before I was medicated?  Just because I would have ‘the tools’ to deal with such diagnosis thanks to taking those medications, that doesn’t mean that getting diabetes or any other illnesses is ‘just the way it goes’ with these drugs. In fact, I’d say that these mental-health medications have more of an obligation to not have to affect people more negatively—-because negativity is what they’re trying to escape, and it doesn’t make sense if the medication itself led to further depression.

I don’t need another illness on top of the one I already deal with. And to find out that the treatment for my first illness caused the new one would be one bitter pill to swallow.

ECT Lessons-I’ve-Learned #11: post-ECT aches

One can probably guess that headaches could be a problem after waking up from ECT. And while I don’t always get them each and every time, I did have them for a while this time around. Headaches can be taken care of by taking your usual pain meds—or something else, should your doctor choose to prescribe you something like Lortab.

The ache that bothered me more this time wasn’t the one in my head, but the one in my throat. I thought that my jaw would hurt more because of the bite block and all, but I really had an issue with my throat hurting for about a day or so afterward. I’m not quite sure how it is that my throat hurt so much (probably because of the oxygen being pumped in at some force), but other than the headache, this is another type of ache that shouldn’t be a surprise if you do end up having a sore throat. I didn’t try to treat it with anything in particular, such as lozenges or hot tea, though it did bother me some. But it eventually went away.

 

See other “Lessons-I’ve-Learned”

day after the shock

It’s a day after my 34th electroconvulsive therapy treatment, and I’m awake. I got up around 8am, which had been a really hard thing to do for the last week or so, but today, it really wasn’t bad. I drank some coffee and ate a biscuit, took my cocktail of bupropion SR, concerta and deplin (at night, instead of concerta, I take abilify), and then went on my errands. I ended up purchasing myself a Roomba (yes, the robot vacuum thing…), and signed up for a year-long Koko Fit Club gym membership. Now, I’m back home and sitting around thinking about what to get done next.

I must admit I feel much better today than I have this past week. My mind isn’t stuffed with guilt, disappointment, etc. Rather, I feel much calmer and tolerant of even the things that are frustrating in life, like the weight I can’t seem to lose or choosing a path in this life. Even my boyfriend thought I seemed a little happier, which is definitely a good sign. But what is ECT worth? Like practically any medical treatment, there are side effects to having it done. Though I’m not sure if the following is as a result of the ECT or I’ve always been this way, but I can remember having read something—-but not what they were about. Yesterday before ECT, I was talking with someone who had brought his mother to ECT. When I was about to leave, a man said something to me.  I had to be reminded by him that he talked to me before the treatment. I don’t think the memory loss that I’ve experienced has been that bad, but it’s certainly not a good sign, worse, if it has a cumulative effect. I agree that this most recent procedure has allowed me to feel much better than the last few previous days, but could I have reached this point without having this treatment? Would I rather have medication dictate the direction of my mental (and physical) health, even though they, too, have plenty of side effects to mention? Which is better, or should they both be a part of my treatment plan for now? Because I had some depressive and hypomanic episodes over the last few weeks, what was supposed to be close to the end of my ECT cycle now seems far away. But the fact remains that I get to decide which path to take, and right now, I don’t know.

Either way, I’m going to have a healthy dinner, and later in the evening, go workout at the gym. As much as I should  be frustrated over making this decision, it’s nice to be back to feeling better again……..thanks to ECT.