Friday, 15 July 2016

Adapted cutlery product reviews- compare and contrast

I have been given these products by the sites mentioned to enable me to write this post. Although the products were gifts, all opinions in this review remain my own and I was in no way influenced by any of the companies.

I decided to write this post due to my own difficulties using standard cutlery (as a result of weakness in my hands from several conditions, reduced dexterity, and significant fatigue-related difficulties), and the fact I have become aware both of the number of potential options when purchasing adapted cutlery, and the difficulty obtaining useful advice or comparisons; I decided I'd like to write a blog post to help others in a similar situation to mine by exploring and demystifying the various options. Many thanks to all 3 companies for their enthusiasm, support and for providing the products to make this post possible.

NRS Healthcare Kura Care Cutlery Set from NRS
The main selling points according to the company are as follows:
  • Finger indents and profiled grip for comfortable use
  • Two toned styling – reduces appearance of the curved profile whilst making the cutlery more inclusive
  • Spoon has a deeper bowl for reducing spillages
  • Knife has a serrated edge for easier cutting
  • Dishwasher safe
I think they're all important points. Possibly except point 2, not because I think they look particularly bad (they don't), just because adapted cutlery never looks completely standard, but isn't a fashion statement at the end of the day, so I feel that's negligible really. It is the most discreet of the 3 sets though. The most important element is obviously the function, and I think the product is really great actually. The handles aren't quite as wide as the other 2 sets I'm reviewing here, although they're still significantly larger than standard cutlery so still help with weakness and grip, and particularly for small hands, the size is great. The thing that I think makes this set special, is the shape of them- I've found it really does help with hand position and control. I cannot use standard cutlery with my hands in a 'normal' positioning, but with these the shape and the increased bulkiness mean that I can hold them normally, or fairly normally, and my weakness and control difficulties are minimised greatly. Also, they are suitable for both right-handed and left-handed use; I swap hands depending on which hand is functioning best, and they all sit comfortably in either hand. They are also available in red, which can be particularly helpful for dementia sufferers, and there's a right hand angled spoon and a children's set available too.

Price at time of writing for the set including knife, fork and spoon (not angled version) is: £11.99 including VAT, or £9.99 without, for sale here:

Comfort Grip Cutlery Set from Stress No More
The main selling points according to the company are as follows:
  • Adapted cutlery for anti-slip grip
  • Easy grip cutlery to make dining easier
  • Comfort grip cutlery is kind on your hands
  • Ideal for elderly and disabled people; makes eating food easier
  • Dishwasher safe teaspoon, fork, knife and spoon with built in cushion-grip handle
These ones aren't specially shaped like the NRS set, but the size of the handle is really good and chunky. In terms of hand weakness, this set is really great. The easier grip, and a less slippy surface, makes this set much easier to handle than standard cutlery. You can also hold them however suits you, e.g. in a fist, and it's still comfortable and little grip power is required. I'd say this is the set that looks of the highest quality to be honest too. I also really like the fact there's a tea spoon. Again these ones can be used comfortably in either hand.

Price at time of writing is £9.99, available at:

Red Handled Cutlery Set from Co-operative Independent Living

The main selling points according to the company are as follows:
  • Range includes a knife, a fork, a spoon and a teaspoon
  • Large, ribbed handles for improved grip
  • Extremely sturdy stainless steel heads
  • Ideal for those with arthritis or poor grip strength
  • Bendable fork and spoon heads
  • Dishwasher safe for improved hygiene
  • Latex free design
  • Bold red colouring for easy recognition
  • Suitable for use in dementia care environments
I feel that this set is quite similar to the previous set in terms of the grip. Before they arrived, I thought the extensive ribbing could lead to discomfort, but they're actually much softer and more comfortable than anticipated. The feature that makes this set special, is the fact you can bend the heads of the fork and spoons, allowing you to put them at an angle that minimises the need for wrist/arm movement, particularly if your movement is limited in a predictable way. My own wrists bend backwards which can be frustrating when using cutlery, but this is not reliably the same unfortunately. While it's tempting to think you can just keep repositioning the heads to suit your current wrist position, you cannot reposition them more than 20 times maximum, so I think it's a case of finding the position that works best for you, and then leaving them alone. Also consider the fact that once bent, they will only suit use in one hand. It really is a great feature though, that will be really useful to some people! And they can obviously be used straight too if you'd prefer. Anyone with weakness will need help with bending them- the metal is thicker than it looks in the picture, as it's flat front to back. The spoon in the set is quite large, but this set does also include a tea spoon. The knife is a rocker knife, altering the movement required, and helping significantly with weakness- you don't have to lift the knife from the plate so much which is good! I'd say this set is particularly great for weakness and restricted wrist/arm movement.

Spoon, fork and teaspoon are currently: £2.88 with VAT relief, or £3.45 including VAT. The knife is £3.29 with VAT relief, or £3.95 with VAT if not eligible. Available here:

Which set do I think is best? It all depends on what exactly you're looking for really, and on your specific impairment- all 3 have their own merits. For limited wrist/arm movement, I'd recommend the red handled set due to its bendable heads. For the most comfortable/those with the widest handle, particularly if you hold cutlery 'abnormally', I'd say the comfort grip set. For the most ergonomic/ones that fit most naturally in your hands and help with control, the Kura Care set. It all very much depends on your particular difficulties, and if you have a changeable condition, several different sets might actually be the way to go!

Any questions do feel free to ask and I'll help if I can!

If you have a product or products that you would like me to review, please drop me an email at

Thursday, 14 July 2016

Back to hospital I go!

I found out on Wednesday that I'm going to be admitted into hospital again.

Shocked is an understatement. I wasn't expecting it at all. Not one bit. Even now it doesn't feel real.

I'd gone to hospital for an outpatient appointment in a spasticity clinic with a rehabilitation medicine consultant. I thought it was a case of assessing whether I had spasticity and if so deciding whether to go down the route of Botox injections or muscle relaxants. I thought that was as drastic as it was going to get..

I arrived at my appointment to be greeted by the consultant, another doctor, and a neuro-physio.

As some of you know, I have medical/post-hospitalisation PTSD, following some traumatic experiences and an incident where I was treated abusively by 2 members of staff. Hospitals and I don't mix well, so I was pretty anxious.

She started taking a bit of history about how I ended up how I am. It's always hard to know where to start given that I've had chronic conditions since 2009, but all my new neuro-type problems started in October 2015. But I explained a bit, and answered some questions.

I told her how things had progressed over time. We talked about my chronic fatigue syndrome and neurally mediated hypotension, my loss of mobility over time, and then what happened in October. We didn't discuss the details of all that happened during my hospitalisation to a great extent, but I told her a bit about what happened.

We then discussed my medication to an extent. She was horrified by my list, given my age. There are concerns about my meds, and they think they need to get me off some of them, as it's impossible to distinguish between side effects and symptoms. One of the meds I have 'as needed' that I was taking quite a lot at one point in hospital, apparently can cause Parkinson's if used regularly, so they're not happy for me to take that at all. It's thankfully one that I never really take these days, as I find it pretty ineffective (always have done!). I used it less once my nausea was controlled by the mirtazapine. My nausea is no longer controlled, but I still don't see the point in taking a medication that I don't find helps.

We discussed my level of mobility and the way I was able to transfer. (I can't stand at all, but can do pivot transfers or use a slide board)

She asked about bladder and bowels (both fine but doctors are seriously obsessed with these!) and allergies and all the really standard stuff..

She asked about how my control difficulties (particularly of my hands) and spasms felt. I explained that what I try to do and what my body does is different. (This is completely typical of functional neurological disorder, as it's almost like crossed wires- the messages are wrong)

I was asked a little about my sleep- currently difficult (used to sleep loads of Mirtazapine, but not now!).

Paragraph trigger warning: depression and suicidal thoughts
At one point we touched on my mood which was a bit awkward, as I said I'd been depressed and was outright asked whether I'd been suicidal or had suicidal thoughts. The true answer was kind of yes to be honest (a week or 2 earlier- possibly medication related), but I hadn't properly admitted them to anyone. I was reluctant to let on and it was a bit of an unexpected question in this type of appointment, so it was hard to answer, but I think I somewhat indicated that my head had ended up there but a change of medications has meant that I honestly don't feel that way anymore at all. I really don't want to die, I just didn't want to live this half-life with suffering and lack of independence and fear. I wasn't satisfied with my quality of life, and couldn't see how things would ultimately work out in a way I could tolerate. But I'm tolerating things much better now, and am seeing things far more rationally. Once my meds were sorted, I could see a way forward, felt more hopeful and felt more able to face my difficulties and rehabilitation. Please, if you ever feel suicidal, or even start considering it, please seek help; it's likely to be a temporary feeling- don't act on it, please! I didn't want to live any more but have completely come out the other side- with the right help, it's absolutely possible that you'll no longer feel the same way, whatever the difficulties in your life.

We then got to the stage where they needed to examine me. This was incredibly anxiety-provoking for me. I wheeled over to the examination bench, transferred, and they moved my wheelchair away to give them access. Bare in mind that I've not seen any new doctors since my PTSD arose, and I freak out with ones I've known years. The 3 medical professionals gathered round the bed and a screen was put across incase anyone came in, but it meant shutting off my parents to a large extent. I would've rather not had the screen, but didn't feel able to say anything (despite the fact I know they were all lovely and wouldn't have minded!). Everything that was done was familiar to me as I've had a lot of obs taken and neuro exams over the years! Touch, and being moved around, is difficult for me. It's also hard when I can't control my muscles to do what they want me to do (they're trying to test the strength of movements, but activating and maintaining the right movement is really tough with my FMD). Some of it was incredibly painful, as it triggered spasms. At one point she needed me to close my eyes- I wasn't comfortable with that at all, as closing my eyes has been triggering for me just recently (as it's reminiscent of seizures, and most of my traumatic experiences have been during seizures), and trusting medical professionals not to do anything to me or hurt me with my eyes closed is inexplicably hard. I can't even close my eyes in the daytime in my own home just at the moment, so this was close to torture for me. But I managed it to an extent, although I think she might've done more checks with my eyes shut had I not been so clearly uncomfortable. When the lovely doctor asked, I just sort of looked at her, unsure whether to say that would be too triggering, or not. I wanted to co-operate, but some things are inexplicably hard for me. She was very aware how tense and anxious I was, and the difficulties I was having trusting them. She kept trying to reassure me, and I think at one point she actually said 'what do you think I'm going to do- hurt you?', and I felt like saying 'well I don't logically think that, but my body definitely does'. It's not that I distrusted her or either of the others specifically, it's just that I know from experience that there are health professionals out there who will hurt you, and that's not something you just get over. None of my freaking out is due to conscious thoughts or anything rational, it's due to things reminding me of traumatic things I've been subjected to in the past. Reflexes were very brisk due to anxiety. Blood pressure was normal due to stress (normally low). Reflexes on the bottom of both feet were completely absent, despite several attempts on each- they said they were 'completely mute', and kept asking whether I could feel it, which I could (haven't had any significant sensation problems at any point). There was significant weakness, particularly in my legs.

They then wanted me to attempt to stand, and I agreed to. The physio trapped my feet and blocked my knees, and I held onto her shoulders. All very much something I'm used to after all my weeks in hospital. We then attempted to stand me up but my weakness and the lack of control of the right muscles is far too severe. We had several attempts, but it was clear it was never going to happen, and the neurophysio eventually made the call that it wasn't going to work. We couldn't get me on my feet despite the support of several people and significant effort. All the touch and invasion of personal space, plus pain and effort, made me feel a bit weird and I was quite spasmy and a bit spaced out, but no actual seizure thank goodness! Just had a bit of time leaning on and being held up by 2 people I'd just met.. Which in itself is pretty distressing for me. They couldn't let go because I would've been at definite risk of falling from the examination couch, but I did struggle with them holding onto me. I think we were all relieved when I was safely back in my wheelchair!

We then sat round to discuss things.

She said I don't have spasticity, so there's no need for Botox or anything. But she said she was more concerned having examined me than she was beforehand, despite the lack of spasticity. She recognised my very significant level of disability and the horrendous affect it has had on my life, and the lives of those around me.

She broke the news that they would need to see me as an inpatient, as my rehabilitation needs are far too significant to be managed in the community. I can't get the really regular input from physios etc that I so desperately need outside of a hospital ward. I need trained people doing passive movement with me and things to begin with. They want me to be admitted onto the neurorehabilitation ward in the hospital. There's no real other choice, and I'm incredibly lucky to be given this opportunity, as it goes against the standard admission criteria, but my need is too significant to be ignored. She said I can't get the help I need to be able to make decent progress without being taken in.

But it's terrifying. Truly and utterly terrifying. I developed PTSD due to the traumatic experiences I had in hospital during my 10 week hospital admission last year. I've had incredibly bad experiences since that have worsened my PTSD significantly. I really don't cope well with hospitals.

The latter part of the appointment is a bit of a blur to be honest. I know they said there would be regular (weekly?) meetings, which my parents will be able to attend with me if I want, and I'll be fully included in everything. Everything will be focused around helping me to achieve MY goals. So that's all fab. There will be physios and OTs and psychologists etc. Everyone will be working with me to achieve the function I want and require.

They're going to be seriously reviewing my meds, as some of mine can potentially cause dystonia and other symptoms, and they also think my meds are potentially contributing to my fatigue. I have serious concerns about how I'll cope with bad pain flares etc as a result of any changes, although I think changes will be managed gradually, and I do find it hard when a doctor doesn't know the extent of what I've been through and how things were when I was put on the medications.. BUT I'm on board with what's been said, and at least as an inpatient things can hopefully be dealt with swiftly if they get out of hand and unbearable. There are meds like pregabalin where I'm on the maximum dose, but think I have become tolerant to it- it helps to an extent, but I'm still in significant pain; doctors keep wanting to increase it, but they can't with me being on the maximum dose already.. It would be good to be able to start over with it, or move to something different that might control things better, as I'm not sure my pain management is optimal right now, but I also know we tried to reduce my pregabalin in hospital before and it didn't go well at all.. I ended up in absolutely horrendous agony. I'm not looking forward to potentially going through the same again. It wouldn't be an overnight process- it would certainly take a while to be managed appropriately, and I'm not even sure it will be what they choose to do with my meds, but if we can get my meds as minimal as possible, but managing symptoms as well or better, then that's certainly my hope.

I asked whether the consultant trusted every member of the team on the ward, and she gave me her word that she absolutely does. She said that if she was in an accident tomorrow, she'd want to be taken to the ward where I'm going. I know it seems like a strange question, but due to past experiences, trusting medical people is really tough. Sometimes I ask a question not necessarily to hear the response, but to see the way in which they respond. There was no hesitation or doubt in her voice- I feel she was telling the truth, she really does trust them. The other 2 members of staff were also in agreement. None of them will have seen the staff from a patient perspective, but it still reassures me to an extent.

As I was clearly very anxious about the whole thing, the physio took me up to see the ward after my appointment before I left. By the time I got up to the ward, tears were streaming down my face- it was all such a shock and so overwhelming and I was terrified. I knew I didn't want to go, but also knew it was necessary for my physical recovery. I knew I couldn't turn down the opportunity, but I am so afraid of the idea.

It's a small ward with only 12 beds. Some are rooms with up to 4 people, some are individual rooms. I asked whether I could be put in a room with others, as I think I'd feel safer that way, as there are people aware of you and those that are with you, at all times. I feel that that way there'd be less risk of anyone doing anything to me that they shouldn't. Hopefully. They said they couldn't guarantee it, but that they'd make a note of it, and it would be taken into consideration. Given that most people would prefer an individual room, they said there should be a good chance. All rooms are single-sex. There's a day room which looks alright, and I'm considering spending quite a bit of time in there, as I think I might cope better there than in the standard hospital bed/chair area, which just screams hospital. I'll see when I get there though. Probably depends who I'm sharing with, what I'm wanting to do, how I'm feeling physically, and how I'm coping with mixing with people, and different aspects of the environment. Yeah, I'm overthinking everything- I know.. 

The gym has equipment for passive exercise and standing frames and parallel bars etc, so there should be access to all the equipment needed. None of it is nice looking though, and a little bit frightening.

Now that I'm having far fewer seizures and have far more control over them, I feel that I have fairly good rehab potential with the right help, as do the team, and this seems like exactly the right help, with plenty of input from all the professionals needed.

The consultant was so lovely. She said it would be such a waste to leave me in a chair and functioning as little as I am, and not give me the help needed to fulfil my potential, both for me and my family, and for society. It was such a nice thing to say and meant a lot. She seems really keen to help me get my life back on track in every way, and helped me see that I can have a future- something I so desperately need to hear and believe. I have some use of all my muscles, none of them are completely paralysed, they're just weak and there are significant problems with control, and some triggering of spasms, so there's going to need to be a lot of retraining. Progress isn't going to be rapid and over-night, but she believes I have the potential to make a significant recovery. That belief in my rehab potential means the world. It's worlds away from the 'but you're functioning well from a chair' response I got from my consultant neurologist last time I saw her. I just hope the team's hope and confidence in my ability to heal doesn't diminish, as happened during my last hospitalisation. This consultant said she won't give up on me, and the team will fight to help me get where I want to be. She seemed to genuinely care, as did the other professionals. It means so much. My mum welled up, delighted that someone was offering me some real help, and her and my consultant hugged at the end of my consultation. I wasn't up for hugs, but she put her hand on my arm and wished me all the very best, and I thanked her. And I truly am thankful, just terrified too..

The actual consultant I saw is sadly only around until the end of the month, due to personal circumstances, but she's hoping to get me onto the ward before she leaves. Regardless, she said she'll leave a treatment plan of sorts to be followed by the consultant taking over and the rest of the team. Although largely a plan will be put together once I've been assessed by the different members of the team on arrival. She said she will be in touch to check on how I've got on on her return, which again was really appreciated.

The physio who took me up to the ward was also so, so kind. She said if I ever needed to speak to someone or see a familiar face then she will be around a lot, as she is a physio on the ward and her office is on the ward too. She was very willing to answer all my questions, and spend the time showing me around the ward to try to put me more at ease, which meant a lot. She genuinely made it seem like staff will be really approachable and I'll have people supporting me through my rehabilitation. She said if I had any concerns just to speak to a member of staff straight away and they'll work with me. It seems like most places are fairly visible from the nurses' station (where there's normally multiple staff), so hopefully that will help me feel a bit safer. I will also keep my wheelchair with me at all times, and I have the ability to get around the ward a bit independently these days, so I'm not going to be stuck in my bed and lacking any autonomy.

I'm going away with some family today for a week, but will then be admitted anytime after that, probably at short notice. I'll have to pack a bag and get things sorted and ready when I get back from holiday so that when I get the call I can head in without any added stresses.

My parents will be able to visit me regularly, and there's an area where they can bring my dog to meet me. I have a friend who works at the hospital, so hopefully she'll be able to nip in to see me some days too, which would be fantastic.

I've looked online and I should be able to pay for WiFi access. I definitely need Internet access to be able to cope! There are TV systems too, but I know I couldn't manage those when I was in hospital before, so I'll just have to see what the set-up is with the screens and whether they're accessible for me. I might have to rely on catch-up on my phone and iPad if not, which is fine. I'll take colouring too, and anything else I can think of for distractions.

It feels weird, because I have far more knowledge about hospital life than I had when I was admitted last time. Last time I was very severely unwell when I was admitted, and incredibly disabled, with very little understanding of what to expect. This time, there are elements of the unknown because it's a different ward, completely different staff, and a different type of ward (neurorehabilitation rather than acute neurology), but I know what to expect to an extent, and have had time to get over the shock of my actual condition. Apart from the massive issue of my PTSD, it should be easier this time round.

From what's been said, the elements I found so difficult last time (decisions being made about me and not being included etc), will not be repeated this time. They've said I'll be included throughout the whole process and people will always be able (and willing!) to discuss plans etc. Of course, despite plenty of reassurances, I have significant concerns about what all the individual healthcare professionals will be like and how much they'll understand my conditions, and how they'll respond to things, but I know I need to take this leap into the unknown in order to give myself the best chance of a decent recovery. My parents aren't far away, so if needed I'll be able to get them in to support me through things, or if I'm falling apart. The physios that I have met seem really lovely, so hopefully I'll get to feel comfortable with most of the team. I really do think everyone is going to be really supportive, particularly as they realise (to an extent) how psychologically challenging this is for me. It's so difficult to have PTSD related to medical stuff when I'm disabled and medical stuff is going to be a significant part of my life for a while. I never thought I'd be thrown in at the deep end like this, but my mental health is also being negatively affected by my lack of progress, and this admission should give me the specialist support I need to really move things forward physically, and regaining abilities will hopefully really positively affect my mental health. I wouldn't say I'm depressed at the moment, but given how badly depressed I've been so recently, I need things to be moving forward to reduce any risk of another relapse, which is something I'm very keen to avoid!! It's going to be hard on my PTSD, there's no doubt about that, and I might go back into a trauma response and/or quite dissociative (although being a bit detached and oblivious to my distress might not necessarily be a bad thing! At least initially anyway..), but if I can get through, with support, then this could be the help I need to really turn my life around, and open opportunities and a normal life back up to me!

The thought that I might get a decent quality of life back is incredible.. I'm terrified, yes, but also hopeful that this could be the turning point. I desperately needed hope and I now have reason to. They're going to help me. They can see that my life has fallen apart and they're going to help me piece it back together.

As frightening as it is, I'm incredibly fortunate to be being given this opportunity. There are people who would give anything to get the full-on, multidisciplinary rehabilitation that I'm being offered. I'm not going to waste it!

Thursday, 7 July 2016

Medication change, update etc.. (Mostly mental health)

It's now 9 months on from my first non-epileptic seizure (or the dystonic reaction that triggered them- debate with my doctors, they don't know) and being admitted to hospital. The last year, and particularly the 3/4 of it with FND, has been such a rollercoaster: physically, mentally and emotionally. But, I've lived to tell the tale, I have friends and family that love and support me, and professionals doing their best for me. I don't pretend a single day is easy, because it isn't at all, and the pain and suffering are overwhelming at times, but I have amazing people in my life riding this rollercoaster with me, or willing to step aboard as needed. My PTSD is a constant nagging reminder of how awful humans can be at times, but although my PTSD doesn't like me to believe it- they are certainly outnumbered by the good ones. No-one will ever convince me that there aren't bad people, that they aren't where you'd least expect them, or that I won't come to harm because of them, because there are, they were, and I did... but I can keep reminding myself that as well as the bad, there are the good, and past experience certainly can't disprove that, particularly after all the love I've been shown during these tough months. 

My level of disability still isn't something I've properly come to terms with. Even after 9 months, it hasn't really sunk in that I can't currently safely stand up. I can't explain it. It's my every day experience, but that first seizure may as well have been yesterday with how abnormal it all still feels. A lot has happened, and things have changed and evolved, and I've learned a hell of a lot, but none of it is behind me really. 9 months I've lived with the threat of seizures constantly at the front or back of my mind. For 9 months I've been on wheels full-time, apart from the limited number of steps I took during physio sessions while I was an inpatient. But I still find both of those things, and many more, very challenging. There's a huge, huge difference between part-time wheelchair/scooter use and using a wheelchair full-time. And I know that I'm incredibly fortunate to be able to transfer completely unaided- there are people who are far more severely disabled than me. Yes, sometimes I'm completely unresponsive for hours at a time and then only able to move my eyes (without full control of my blink) for a while longer, and that's pretty much at the extreme end of disability, but at least I get to experience something far closer to able-bodied the rest of the time, which is the vast majority. I wrote that and then thought 'some disabled people would argue that their lives are no worse than those of able-bodied people' and they're entitled to that opinion, and I'm truly glad they feel that way, but I can't say I agree to be honest. Partly that's because I've known different, partly that's because I'm ill and in pain and I suffer (which certainly isn't always the case with disabilities), and partly that's because I'm very aware that there are still significant differences in opportunities and a lack of accessibility. Given the choice, I'd opt to be able-bodied again in a heartbeat, but I know of disabled people who wouldn't, or would have to think about it. Neither is right or wrong, but I can't see me ever changing camps on that one.

I've adapted to live with so many new symptoms/conditions over the last 9 months, but I can't say I've always coped well.. The last couple of months I've coped fairly terribly in all honesty, but things are complicated, and sometimes we have to hit rock bottom before we can find our way back up.. After my last post, my mood continued to spiral downwards, kind of into unknown territory to be honest. I wasn't in a good place at all..

Last Wednesday my community OT came and I started using my Butterfly transfer board. To be honest, I was initially a bit disappointed as it seemed quite tricky as I wasn't sure where to hold onto and it seemed like not much of an improvement, but with a bit of perseverance and practice, I've found it easier and it's helping reduce my upper body pain to an extent, although it's not useable for all transfers. Being able to stand briefly for transfers would make a big difference, but I'm not there at the moment, so for now this definitely helps. While she was here we had a bit of a chat about how I was getting on generally, and I had to admit I wasn't making much of an effort with things. I didn't admit to quite how bad my mental health had become, but I think she realised to an extent that I was struggling.

On the Thursday I spoke to my long-term CFS consultant. We did a telephone appointment due to me being out of area and the journey would've been tricky. I admitted to him that my depression was a problem. I also said I wasn't happy to increase my mirtazapine (which was my current antidepressant) because I'd put on so much weight so quickly because of it, and it gives me acne, and increased dosages in hospital made me really unwell and my seizures much more frequent. He agreed that that wasn't a good way forward after I'd explained, but said I'd need to discuss with the GP I'm seeing here in that case, as he obviously couldn't start me on a different medication over the phone. We had significant discussions about uni and career options etc too. I definitely won't be starting back at uni in September. The earliest that's likely to be realistic is September 2017, but I'm going to start looking around at career options with my current qualifications, to make an informed decision about whether to put myself through the significant stress, and relapse risk, of starting back at uni. We'll see. But I'm starting to come round to the idea that even if I can't make it back to uni or my original career choice, then it's not the end of the world. There will be other opportunities that might be better suited to my circumstances.

After speaking to my consultant on Thursday, my parents took me to a farm place with a farm shop/cafe and animals (yes, for children, but I'm still a big kid!). The wonderful staff agreed to get a Guinea pig and rabbit out for me to cuddle- it was fab. Despite being in the depths of a depressive episode, I smiled, and loved it. It's so calming and therapeutic cuddling little furries! I'd love a couple of guinea pigs again, but I'm not able enough to look after them myself at the moment, and mum already has me to look after and isn't well herself, so no luck convincing the 'rents so far, but I'll keep trying..😉

On Monday, I saw my GP about my low mood. I was anxious about it. An hour before my appointment, I quickly typed up a sheet listing my meds and about why I was there (typing is easier than writing) and basically just mumbled something and handed it to him when I got in there.. I then spent the next 5 minutes staring at my hands in my lap and taking my rings on and off my fingers nervously. He eventually started asking some questions and I answered them. But I can't do medical appointments these days- they stress me out. He was nice enough, but has limited understanding/appreciation of some of my conditions (which is fine and to be expected with a complex history like mine, but tricky). He started asking about whether I was walking plenty around the house (a conversation we've had before), I explained again that I couldn't stand, and he said I'd be getting increasing muscle wastage the longer I'm off my feet- not what I needed to hear when I was struggling with feeling unable to ever recover.

I was there about my depression, but he basically said that pills 'won't make me happy'. 'I'm my own best doctor', and 'medications and professionals can only take me so far' etc. He's right to an extent of course, but I was fighting my mind as hard as I could, and was failing dismally- more than anything I needed hope that things would improve and I wouldn't always feel so awful, and that wasn't the message I got in all honesty. I'd ended up at the doctors because I was scared by just how depressed I'd become and some of the thoughts I was having, yet I came away from the appointment feeling possibly more depressed than prior to it, and feeling invalidated in a lot of ways, unheard, and misunderstood. I've been badly depressed once before and the right medication helped hugely (citalopram, but I was taken off that in hospital to try the mirtazapine both for my nausea, and because of concerns about interactions). Sometimes brain chemistry has just gone haywire and needs a bit of help to get back on track. Meds are not always the answer, they're certainly not for everyone, and they don't get rid of the problems in your life/underlying issues, but the right medication can be literally lifesaving. I realise that it's natural to be (perhaps very!) fed up in the circumstances I've found myself in, but it wasn't just my circumstances- they hadn't changed- depression is an entity all of its own, and circumstances are largely irrelevant to be honest, although I was an easy target as someone severely disabled, in chronic pain, with an unknown prognosis. Once it took hold, it was easy for depression to convince me that life would be incredibly arduous and painful and I'd never amount to anything.

Although I didn't feel that my doctor grasped just how low and desperate I was, I was there to get my antidepressant changed and he did do that. To prevent interactions he's also taken me off Amitriptyline, which was to help nerve pain. I think he gave me the choice actually, but I hadn't really considered whether I wanted to come off Ami, so just kind of agreed without much thought. I get more nervous about interactions than I used to after all my problems in October (that led to my current level of disability) were arguably caused/triggered by medication(s). It would be nice to stay off amitriptyline if at all possible because it would mean less risk of interactions and serotonin syndrome etc, but I'm just going to have to see what happens with my pain over the next few days and weeks. I've been moved from Mirtazapine to Sertraline to try to lift my mood- I'm pleased, and think it was an absolutely necessary switch, but am also concerned about my nausea potentially becoming unmanageable again..

Mirtazapine has been incredible for my nausea and appetite! I've put on a lot of weight very quickly which was amazing, and very much needed, although it became a concern as time went on. I don't know what will happen now in terms of weight because my GP said pretty much all antidepressants can cause fluid retention and weight gain to an extent, but I never experienced that with citalopram, and citalopram and sertraline are closely related (SSRIs), so we shall see.. My weight gain definitely isn't just fluid retention though, it was caused by eating lots, due to my lack of nausea, an insatiable appetite and constant drive to eat, caused by the mirtazapine. I'm under no illusions- I ate the food to make it happen (although immobility will have contributed), it wasn't some weird kind of magic. It would be nice if my weight just stabilised and stayed as it is, and my appetite stayed similar, but with a few less sugar cravings! At the moment it's mostly a case of wait and see, both what happens because of the sertraline, and what happens because of the lack of mirtazapine.. Only time will tell whether the medication change was a good call..

After nearly 3 days on the new medication, I'd say there are definite pros and cons. My depression was the absolute priority, as I'd largely lost the will to keep fighting, and in all honesty pretty much lost the will to live, and the new medication has definitely helped that already, which is a huge relief. To be honest, I'm questioning whether the mirtazapine was actually somehow having a negative effect on my mood towards the end, given how quickly I've noticed the difference. I feel much, much more like me again. As hard as things are, I can have a laugh about things again and my mood is pretty normal. It's been a bit more difficult getting to sleep, but I was awake til 2am even on the Mirtazapine, so although the mirtazapine should have helped with that, it's been no great loss in that regard. I've woken up significantly earlier feeling far more alive which is a big positive, and one I hadn't even particularly considered. I'd got so used to the horrendous mirtazapine-induced grogginess after months of it, but it's amazing for that to be gone!! And I think that in itself has helped my mood too.

My biggest concern was my nausea, and that's back- ugh! I've felt really sick and been retching a lot again.. But at the moment, the nausea is actually far preferable to the depression. I'm hoping it might ease a bit once I get used to the new medication and any side effects from that reduce, but mirtazapine was also an antiemetic, that's why I was put on it, and sertraline isn't. Those of you who know me well and/or have been following my blog for a while will know what I've been through with my nausea, narrowly avoiding NJ tube feeding etc, so it's a big concern, but at least my weight is much, much better at the moment. I did wonder whether I could use a small dose of mirtazapine simply as an antiemetic but that is more risky with interactions etc again, plus I don't know whether a small dose would work, or what degree of side effects I'd get at a lower dose, so we'll see (I'd obviously discuss with my doc first!).. Hopefully that won't be necessary. May have found the way to lose some of the mirtazapine-weight though, haha.

When my nausea was so awful a few years ago, I was told it was probably gastroparesis but I decided against a referral for to a specialist for this, because I was suffering from serious test-and-hospital-fatigue so another referral and more prodding and poking really didn't appeal, plus it wouldn't have changed anything in terms of my treatment, and at that point I'd found a medication that helped quite a bit and I was managing to eat alright-ish. When I had to come off that medication in hospital, and lost weight and pretty much stopped eating again, leading to me being tried on Mirtazapine, it seemed pretty miraculous to be able to eat loads and be practically nausea-free. It was a huge relief, but distracted by other significant challenges, I didn't give it much thought. On the return of my nausea, I thought yesterday that if I was managing to eat so much and just get a bit of reflux while on Mirtazapine, then it couldn't be gastroparesis, surely. So out of interest I googled 'Mirtazapine gastroparesis' and a load of scientific journal articles popped up about success of Mirtazapine at treating different cases of gastroparesis, including those that didn't respond to the standard treatments. Oh. I haven't read any of the actual papers, but it's interesting nonetheless. It's definitely not a medication without side effects, but there are times when I'd have given anything for a medication to give me some relief from the nausea, even if only temporarily. All those months with the threat of tube feeding hanging over me because my weight had become 'dangerous', and no guarantees that even that would be a success, the situation was truly desperate. Mirtazapine hasn't ultimately worked out for me, but it's certainly proof that the right medication can get my stomach doing its job/rid me of my nausea! Even just that gives me hope.

The other medication change- reducing my amitriptyline (have halved for now, will stop completely in a day or 2)- has led to increased pain, but nothing too drastic. It's been mostly hip pain, leg pain and back pain.. It's the first time I've been off amitriptyline since my back was hurt, so I hadn't realised it had been helping that.. I'm taking the odd painkiller, but I'm trying to avoid taking tramadol as I'd rather not be taking that daily again, and I know the pain will be ongoing. So although the pain has been bad, I've had other meds I could've resorted to and haven't, so not a disaster so far which is good!

The next potential medication change I'm waiting to see about, is something for spasticity/spasms, depending on the opinion of a specialist when I see her. I've had an appointment through to see a consultant in rehabilitation medicine in a 'spasticity clinic' next week, to assess whether I do or don't have spasticity in my legs, and what (if anything) we do about it if I do. At the moment, if I do certain things with my legs they go into agonising spasms, and it makes it difficult for me to do stuff, and difficult for physios to do things with me. The neuro-physio was keen for this specialist to see me to assess me in terms of what they should be doing with me too. So hopefully it'll be a beneficial appointment and I've been told she's a good and empathic doctor. It doesn't mean I won't freak out about the appointment because I will (hospitals/medical stuff and I don't mix well these days, if only that meant I got to opt-out of medical problems!!), but it's always nice and reassuring to hear positive reports about a doctor in advance!

Yesterday another self-propel wheelchair arrived, which is for upstairs. My stairclimber gets me up the stairs, but then I need to transfer into another chair, having left my main chair at the bottom. I had a chair with little wheels that my parents could push me around in and I could move it a bit by pulling on things around me, but it'll be great to finally be able to move around my room independently and get around upstairs without help. That's if I can negotiate it through all the doorways etc!! Fingers crossed..

Today I was back at the CFS service seeing their OT and neuropsychologist, and it was positive and helpful, despite also being quite tough and distressing at times. I'd met the OT once before, but feel I'm now getting to trust her, which is really important for me, and met the neuropsychologist for the first time today, but she seemed nice and it was good to meet her while with someone already familiar, so would be happy (well as happy as I can be with a medical person and relative stranger) to see her alone in future. Both of them are so understanding and unfazed by all my problems, which is fantastic. The rest of this has been typed over the last few days, and I don't feel well enough to go into today's appointment more than that just now, but it went well and I'm happy with the plan going forward, with input from various different members of their team.

My head has not been a fun place at all just recently, but the last couple of days on the new medication, and my appointment today, have given me some hope back that I can do this, I can get better. I might never be 100%, I probably won't be in all likelihood, but I've known that for years- that's something I can come to terms with and learn to live with. I just need to learn to be kinder to my body and encourage its recovery, to whatever extent is possible, rather than constantly punishing it for not managing what I'd like.. It's not Jess vs Body. I need to be kind to my broken body, because it's doing its best, it's the only one I've got, and berating it isn't going to solve anything!

Who knows what degree of recovery is possible for me, but there are clear areas needing attention, so the obvious thing to do is to start to work on those in the ways I can, as much as I can manage, with advice, guidance and help from professionals, and then see where things go from there.. Onwards and upwards.

(And yeah the irony of me including a picture of a staircase when I'm a full-time wheelchair user at the moment isn't lost on me!😅 I can't take a literal step, but I'm as capable of taking a metaphorical step as anyone 😉🙌🏻)