A Letter to My College Self

Dear College Me,

I am writing to you from the brand new 2017 to tell you that you survived! Take a moment to smile and relish in that knowledge. Now, I hope you are sitting down because, right now, you are still in college. Did your heart just skip a beat? I bet it did! Don’t worry. It’s not a bad thing. It just goes to show you, things don’t always turn out as planned and that’s ok, better even. You are about to finish your Ph.D.! Yes, this is really you. I am certain.

I wont spoil the story on how you get here because I think you need to experience it in order to appreciate it. What I will tell you is that college is a unique experience that you should take seriously, but also enjoy. Here are a few things that may help you do both.

Frosh Week friends are just that. Don’t feel bad if you don’t hang on to the people you meet during that first week full of parties and orientation That’s all they need to be. Think about it, do you even have anything in common? It’s everyone’s first week in a new place and they are all alone. Everyone, including you, is desperate for friends. Once you get into classes and join various societies and clubs, you meet people that you have things in common with. These people are the ones that you’ll be telling stories about until you’ll wrinkled and grey.

Coffee is like oxygen. Ok, well maybe that is a bit extreme. Between two and four cups a day can improve heart health, longevity and memory. Exams, hint hint! Coffee will help you stay awake in that physics lecture with the monotone professor. Hot chocolate has too much sugar to drink that often and trust me, physics is not one you want to nod off in. You should invest in a good thermos and either volunteer in a lab or make friends in grad school. Labs and grad students usually have a pot of coffee constantly on the go. You can join their coffee club and contribute $0.25 to the pot versus over $2.00 for every cup at the café. This will save you so much, you have no idea.

No one cares about your minor. Stop stressing about fulfilling all the requirements for your major and for a minor. Not once since you graduated has anyone ever cared, let alone asked about your minor in biotechnology. You were thinking a minor in biotechnology sounded impressive right? It’s not even printed on your diploma. Take classes that interest you. Learn what interests you. Don’t worry about sounding impressive on paper.

Take the fluff classes. Fluff classes are basically easy As. Take them. Having a minor and those impressive classes may not matter, but your GPA does if you want to go to grad school. Even employers care when you have very little work experience right out of college. Future employers and grad school supervisors wont blink if you have an A in “Basket Weaving” on your transcript, but a C in “Artificial Cellular Technology” might hurt you.

Standardized tests are not so scary. There are tons of books and websites about how to study for these tests. Don’t let it intimidate you. There is nothing on those tests you haven’t already learned. You should definitely prepare for them, but don’t stress. You spent the entire summer before senior year studying and stressing about writing the OAT and you walked out of the exam laughing. It’s not worth it.

Summer school is for the smart ones. To graduate in four years, you need 5 classes per semester. Being in sciences, you will likely have theory exams as well as lab exams. That could mean up to 10 exams at the end of the semester! Take summer classes so you can lighten the load during the year. Summer classes tend to be easier to digest too; daily classes and only one subject to focus on. Take that “Linear Algebra” everyone is saying is tough. You’ll ace it. Just don’t take English. Reading all those mandatory novels and deciphering poetry in the condensed amount of time…not so smart.

Get to know your professors. At a large school like yours, this is difficult, so volunteer in their labs or be a teaching assistant for the courses you like. The experience is always good, but once you graduate, you’ll need reference letters. You’re more likely to get good ones if the prof can remember you.

Class is not always essential. Go to all your classes when they start. This will allow you to get to know the professor and their teaching style. Some professors are great teachers but some are there for the research and only teach because they have to. If they basically recite the textbook, don’t bother. You can read from the textbook on your own schedule.

Take your own notes. Take them in lectures and make your own notes from the textbook. The act of taking notes helps you learn faster. You are hearing the information, seeing the information and actively writing it. These are three different methods of absorbing it, plus, you have something to study later. If you are good at it, you can even sell your notes as a guide to students who take the course after you.

Join Facebook. Stop being a stick in the mud and just do it. Just because everyone else is doing it doesn’t mean you shouldn’t. How is that for a reversal of a cliché? Facebook will let you stay in touch with so many more people than the old fashioned phone will. Having a network will come in handy when you start looking for jobs. Besides, Facebook is fun and brainless. Trust me, you’ll appreciate having something to do that doesn’t require your brain sometimes.

Apply. Apply. Apply. In terms of scholarships, apply for anything you qualify for. You will get rejected more often than you get something, but don’t get discouraged. If you don’t apply, you definitely wont get anything. Aim for scholarship competitions that have a restricted applicant pool. You are more likely to get something if you are competing against students in your region or with your major than versus the whole country.

Loan refinancing. Repaying loans isn’t always as straightforward as it seems. You’ll want to set up a payment plan that avoids interest as much as possible. Paying lump sums when you have the extra cash or paying the loan off early can have penalties. Your taxes will also be involved. You’ll want some advice on this in order to save as much as possible.

You will fail. I’m not trying to scare you or be overly negative. I’m not only referring to classes either. You have always gotten good grades, you’ve gotten awards and you got into all the schools you wanted. You’ve always sort of been the big fish in the small pond. You’ve never failed, not really. Now, you’re at college with all the big fish. You’re not going to be the best at everything anymore. You may fail classes, you will get your heart broken, you wont get that scholarship or loan you applied for, you may not get into grad school or you wont get call-backs for jobs and people will be mean to you. It will hurt, some of it may be devastating, but you will survive. You will learn that it is ok to fail. You will take what you learned from that failure and take the next step in life smarter than you were before.

Now, knowing what I was only privy to in hindsight, start college, be a sponge, learn all you can, but have some fun too. Most of all don’t be afraid to fall flat on your face because you will, and you’ll be just fine.

Love always,

Future Me

Macular Degeneration and Low Vision Awareness Month

February is Macular Degeneration/Low Vision Awareness Month. Being a vision scientist, specializing in low vision, you would think I’d have been aware of this. Nope. Shame. Most of the planet knows that October is Breast Cancer Awareness Month, but very few have any idea that this month is Macular Degeneration (AMD)/Low Vision Awareness Month. There are more cases of AMD than there are of breast cancer. In fact, the number of people living with AMD is similar to the number of people diagnosed with all types of invasive cancers. I know, I know, AMD is not fatal, but it is the leading cause of irreversible blindness in older adults. It affects the independence, mobility and quality of life of those that have it. That should make it worth noting.

AMD is a multifunctional disease, meaning it’s caused by a lot of things. Age is the biggest factor. Some ophthalmologists start looking for signs in those as young at 50. Genetics also play a role. If you’ve had a family history of AMD, that puts you at higher risk. In terms of ethnicity, Caucasians have the highest risk. Scientist believe this has something to do with a lack of melanin. Your lifestyle can have an impact on your risk of developing AMD too. Obviously, smoking is bad for you, but it affects your eyes too. Smokers are three times more likely to develop AMD. Since inflammation has been shown to contribute to AMD, keeping your blood pressure and cholesterol levels low can be helpful. Probably the simplest thing you can do to reduce your risk is to wear your sunglasses. UV light wreaks havoc on your skin, imagine what it can do to your eyes when it is directly absorbed by the delicate photoreceptor on your retina.

There are two forms of AMD; dry and wet. The dry form is the most common, affecting about 90% of people who develop the disease. The central retina starts to deteriorate causing blind spots to develop or vision to be come blurry. Dry AMD progresses slowly, but can turn into the wet form at any time.

Wet AMD occurs more suddenly and progresses more rapidly than the dry form. It is referred to as “wet” due to the abnormal growth of blood vessels under the retina. These vessels tend to be leaky, releasing blood and fluid into the retina. The bleed is often noticed by patients when something they know is straight (a lamp post or slats on a blind) appears distorted or wiggly.

To date, the only treatment for dry AMD is preventative. The Age-related Eye Disease Study (AREDS) recommends taking a daily mixture of vitamins and minerals called Vitalux® to prevent and/or slow down the progression of the disease. Other preventative measures included lifestyle changes such as quitting smoking, keeping weight healthy, maintaining a normal blood pressure and wearing UV-blocking sunglasses.

There are more treatments available for wet AMD, but they are by no means a cure. The most common treatment today is called anti-VEGF. It is a recombinant antibody that is injected directly into the eye (if a needle in your eye isn’t enough to get you to wear your sunglasses, I don’t know what is!) Anti-VEGF’s purpose is to prevent the growth of those abnormal blood vessels. This treatment usually clears whatever fluid is present out of the retina, preventing it from doing further damage. Lost vision is rarely improved however, and the problem is likely to recur.

AMD takes away your central vision. Central vision is functional vision. It allows you to see fine details, colour, contrast and depth. Loss of central vision allows affects how steady you can hold your gaze. When you are fixing your eyes on something, they aren’t completely still. They drift and have tremors that are small enough for you not to notice, but when you lose central vision these movements become larger in magnitude, making maintaining a steady gaze difficult.

One of the biggest complaints the people I work with have is not being able to read anymore. No, enough magnification is not going to fix the problem. In AMD, the retina deteriorates to the point of scaring. No amount of magnification is going to help see through that scar. Another big complaint is inability to recognize faces. One man told me he wished he could tell his grandsons apart. He said they all have brown hair and sound pretty much the same, the only way he can tell who is who is by their heights. If they are seated or aren’t next to each other, it’s impossible.

Other folks are upset about their driver’s license being taken away or not being able to play cards on Sundays anymore. The worst cases are those that have become depressed. Growing older is not easy and it has its own stigma attached. Losing your vision on top of that, something you have depended on your entire life to get around, to socialize, to be independent, makes it that much harder. Not everyone adapts well.

There are organizations that can help those who have low vision adapt. The Canadian National Institute for the Blind (CNIB) is one of those organizations. People with AMD don’t go completely blind, some peripheral vision remains and they can be taught how to best use that remaining vision. Places like the CNIB have devices and techniques that can help those affected adapt to their vision loss. Certified low vision therapists can even make house calls to adapt a client’s home to meet their needs. According to some local research, 33% of people diagnosed with AMD have no idea rehabilitation agencies exist and 13% know of their existence, but decide not to try it.

My Gran had AMD and she joined the CNIB. Gran could no longer read, so they would send her several audio books every month. She would listen to them while playing solitaire using a special deck for people with low vision. Gran was a pro at cryptic crosswords too. For a long time, she wasn’t able to do them. She was thrilled when the CNIB gave her a device that allowed her to do them again. They came to her apartment, taught her some tricks and set up the place so she was still able to cook, clean and wear clothes that matched. Gran lived with AMD for 15 years. Thanks in part to the CNIB, she stayed busy, happy and independent right up until the week she died.

I could go on forever about AMD and low vision but, I’m afraid I would lose you, so I’ll stop here. Take care of your eyes and educate yourself. Tell your relatives, tell your friends. AMD is caused by many factors. Some, like aging, genetics and ethnicity, are out of your control, but others, you can control. Stay healthy, get regular dilated eye exams and for Pete’s sake wear your sunglasses!

Alphabet Soup

MDD, GAD, SAD, OCPD, BPD, CBT, DBT…..Argh!! Sometimes when it comes to my mental health, I feel like I’m living in a bowl of alphabet soup. These letters are constantly floating around me and half the time I have no idea what is going on. Health professionals don’t always have the time to explain what these things mean. Sometimes I think they find it easier not to mention them at all and I’ll just get a referral slip with a bunch of letters on it. I know going on the internet to figure things out isn’t always the brightest idea, but I’m glad I starting reading blogs. I’ve learned so much about mental health and these letters are starting to feel less like alphabet soup and more like acronyms that have actual meaning.

When I was 21, I was persuaded to go to a youth clinic for depression. The general practitioner there, diagnosed me as having Major Depressive Disorder (MDD) with some Generalized Anxiety Disorder (GAD). That’s the diagnosis I’ve known for the last 8 years.

Not too long ago, I had an appointment with the local clinic to start up talk therapy again. At the beginning of my treatment, I thought there was just medication or talk therapy, but over the years I’ve learned that there are different types of talk therapy. Cognitive Behaviour Therapy (CBT) was what I was usually referred to. Anyway, this local clinic woman was offering therapy that was new to me (Dialectical Behaviour Therapy or DBT). She was kind, easy to talk to and didn’t seem to be in a hurry so, out of curiosity, I asked her what my formal diagnosis was. She said it was a primary diagnosis of major depressive disorder or MDD (old news) and a secondary diagnosis of Obsessive Compulsive Personality Disorder (OCPD) and Borderline Personality Disorder (BPD).

Wait, what?!

I had never heard of OCPD before. I am familiar with OCD or Obsessive Compulsive Disorder, but OCPD? She explained that OCPD is basically my need for approval and my being a perfectionist, beating myself up over everything. It’s a completely different condition from OCD. Ok, fine. That makes sense but, what about BPD? That doesn’t make sense. I don’t know much about BPD, but I do know they tend to get a bad reputation (clingy, unstable, impulsive, demanding, reactive, difficult relationships, etc..). This sounds like the polar opposite of me. Most of it is probably misunderstood, a stereotype created by so many referring to Glenn Close’s character in Fatal Attraction as an example of BPD. I was pretty sure that the emotionally reactive/unstable mood part was accurate though.

The woman I was with was nice, but she didn’t have the time to answer ALL my questions about this, so I turned to Google.

Here is the DSM IV diagnostic criteria for BPD. A diagnosis of BPD is determined by meeting five of more of these criteria.

• frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. Maybe. I think this is the reason I’m such a perfectionist. I worry people wont like me if I don’t do a good job at things. I always feel guilty that I’m not doing enough.
• a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This doesn’t sound like me at all.
• identity disturbance: markedly and persistently unstable self-image or sense of self. This could be true. I can’t seem to figure out what I want, what is important to me. I just aim for what I think everyone else wants or expects of me or I choose the hardest route so I can’t be accused of being lazy.
  
• impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. I am guilty of binge-eating, skin picking, isolation, over sleeping, ignoring emotions….
  
• recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. Yea, ok.
• affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). My moods can change relatively quickly. An emotion will come on all of a sudden and I just wont understand it. For example, I’ll be fine in the morning and then, in the depths of despair in the afternoon. This is something I don’t show to people though. No one can tell that I’m dreading something and having a total panic attack on the inside unless I tell them. I think I taught myself to do this because people would feed off my reactions and make things worse for me.
  
• chronic feelings of emptiness. Yes.
• inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). I get very intense feelings of anger, but I am always in control. No displays of temper or fights…I’m more likely to wait until I get home and then just got to sleep for a day or turn on the TV and eat junk until I feel numb.
  
• transient, stress-related paranoid ideation or severe dissociative symptoms. I don’t think so…

Oh….

So, maybe I do fit the criteria…

Google also told me there were different types of BPD (High-functioning, Low-functioning, Extroverted, Introverted and Transparent). You can read more about these different types here. Based on this, an Introverted Borderline with High-functioning tendencies sounded a lot like me. I asked psych about this when I saw him last week and he agreed. Funny that he never shared this with me before. I guess he doesn’t like labels. No one fits perfectly into a cookie-cutter diagnosis when it comes to mental health.

The mystery of why my brain works the way it does is a little less mysterious.

No more alphabet soup….for now.

The Rest of the Quentiapine Story

At the beginning of September, I was at an all-time low. Psych had recommended changing my Fluoxetine (Prozac) and Bupropion (Welbutrin) to Quentiapine (Seroquel or Q) and Bupropion instead. Q was supposed to treat depression as well as the sleep problems I was having. I wrote a post about it here and then abruptly left you guys hanging for several months.

So what happened with Q? At the last post, I had been on a nightly dose of 50mg of Q for a few days. I decided that I had to keep going with it. It is important to give medication time to work before ruling it out all together. I lasted a few more days before I swore it off. You see, I blame Q for my most recent embarrassing moment!

I cringe just thinking about it. I was on the bus on my way home from work. I was uncomfortable because adjusting to Q had been making me nauseous and the bus only amplified it. I had been dealing with it for about a week and I was handling it. I’m no stranger to nausea. I normally get motion sickness riding buses or in the back seat of a car. I’m never actually sick though, thankfully. I threw up a lot as a kid. I think it was an anxiety thing. Anyway, the benefit to this is that I know my body pretty well and I know the difference between “I’m going to throw-up” nausea and just plain motion sickness.

So, here I am sitting on the bus in rush hour traffic. The bus is packed and I’m nauseous as usual. Whatever, this is my life. But, suddenly, I start getting a different feeling in my throat. It’s like the lining of my throat is being pulled downward into my stomach. That’s it. That’s my signal. I know I’m going to throw up! I know I have 30 seconds at the very most. This is what was going through my head….

“OMG I’m really going to be sick. It’s actually going to happen this time! It can’t. I have to get off the bus!”

*Turns head to see where we are and signal stop*

“Noooo!! We just got on the highway! The bus can’t stop and I’m not going to make it to the next stop! What am I going to do?!” The window! I’m sitting next to the window, I’ll open it.”

*Grabs the handle and pushes the window open all the way…….it opens about 2 inches.*

“Aaaagh!! What am I going to do now?! Press my mouth into the opening and projectile vomit onto the car next to me?! It’s going to splash back all over me. What else can I do??? A bag!!”

*Frantically searches through tote bag for a plastic bag, a tupperware, kleenex, anything…but there’s nothing*

“OMG! Running out of time!”

*Looks around for somewhere to be sick*

“I’m out of options! I’m stuck, there are so many people. The seat beside me is occupied, the window is on my other side, there is someone directly in front of me, seated at the end of my knees. There is just enough room on the floor for my feet and the person’s next to me…..”

Time is up. I convulsed. Everyone looked. It wasn’t pretty.

Current Plan of Action and a Bit of Ewok

It is a really cold day! I’m in bed with a hot tea right now. Why am I in bed in the middle of the afternoon? Well, for one, it is THAT cold!! Second, it’s because I wanted to hang out with my cat, Ewok. Within the last few days, Ewok has discovered how comfortable it is to nap on soft cozy surfaces. Her spot of choice has been at the end of the bed burrowed into blankets. No matter how many times I bring her in the other room to spend some time with me…she ends up back in her burrow. So I have given up and decided to do things her way. So here we are in bed in the middle of the afternoon.

This may not sound strange to a lot of you, but it is definitely strange behaviour for Ewok. She normally doesn’t like soft spots, she likes to lie on hard surfaces. Even as a kitten, she would usually fall asleep on the floor or the coffee table, never the couch. We later found out this was because she was peeing on the couch. Poor confused kitten. Don’t worry, we were able to clean it! Eventually, we moved and got different furniture, but she still preferred hard surfaces. Her napping spots were usually the coffee table, a stiff carpet or on top of the printer. When she got older, she started sleeping by my head in bed, but only if I moved the pillow and blanket to make room for her. So finding her the last few days lying on the bed, sinking into the mattress surrounded by blankets has been a weird sight. I hope everything is ok with her. I think she’s fine, she’s eating and drinking and happily snorting away over there.

The reason I want to be around Ewok is because she is a great comfort to me. I’m not sure how to describe how I am feeling right now and listening to her snorting or purring or seeing her cute little smooshy face makes me feel better. I am definitely feeling better than I was in the fall. I’m not overwhelmed and not having the suicidal ideation, but I’m not great either. My sleep is so-so and I feel sort of paralyzed. I have to force myself to do everything, otherwise, I just get lost in my head. Thinking about work. During the holidays I was preoccupied with the dread of going back to grad school full time. Now that I know I’m going to start back part time, I’m not feeling panicky and having nightmares about it. I’m still dreading it though.

The plan is to go back two days a week. I’m going to make a detailed schedule for the next two months and have it approved by psych. When the two months are up, we’ll evaluate and see if I should continue as is or take on more. I think that is fair. Hubby does too. He thinks I always jump into things and take on too much. Maybe he is right.

I hope I can finish my Ph.D. I’m not sure if it’s the depression talking or not, but I think I hate it. I like parts of it. My supervisor is great, I’m learning a lot. I like reading, brainstorming, gathering information, sorting it, teaching it and writing about what I learn. I don’t mind managing students and volunteers either. It’s the constant trouble-shooting, working around barriers, asking for money, trying to find people who qualify to participate and then begging them to participate. When working with human subjects, research depends a lot on the cooperation of other people. It’s not that others don’t want to cooperate, they just don’t want to take on extra work (no matter how minute) or disrupt their routines. I don’t just mean potential participants, I mean doctors, receptionists, technicians, volunteers and other hospital staff. I am always friendly and polite with these people. I even bring them treats, but they are never happy to see me. I am a symbol extra work, change or disruption to their routine. It’s not a pleasant work environment for me. Research is also a lot of rejection and a lot of work for very little success or progress.

Now that I have gotten all these studies through ethics, all I am doing are the things I hate. Thinking of going in fills me with dread. I really hope I can get through it. As a more senior researcher (someone with a Ph.D.), I wont have to do this part anymore. I can send students (like me now), research associates and volunteers off to do it for me. I just don’t think I’ll ever get there. If there were an end in sight, I could probably force myself through, but there is no end. I have lost faith in my project and it feels like I will be a student forever.