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Author Archives: rachelmankowitz

Haircuts and Cortisone Shots

 

Cricket and Ellie went for their first joint haircut last week, and they came home looking a bit bedraggled. First of all, they both refused to wear the shiny pink and silver hair bows that the groomer was putting on all of the other dogs. Second, Miss Ellie had mats on her ears and tail and was shaved down to the nubs in both places. And, really, Miss Cricket just looked grumpy because we could see her eyes again. But also, Cricket’s back was hurting again. It’s a chronic thing that comes up once every year or two now.

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Haircuts improve their ability to use mind control. Chicken treats, chicken treats.

I wanted to wait an extra day before going to the vet, to see if the pain would resolve with rest and massage. We do some light stretches and massage, and then she just leans on me and gives me her poor me look until I give in and continue the massage, or give her extra treats. It was scary watching Miss Cricket struggle going up the stairs, and even refuse to be picked up onto the bed or the couch, but at least I knew what I was looking at, as opposed to the first time she had back problems, when I thought she had developed a fatal neurological disorder.

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“What is Mommy talking about?”

 

Once her eyes were visible again, and she looked as vulnerable as dogly possible, we took Cricket to see the vet. She’d actually gotten herself up onto the couch at breakfast, because Grandma made sausages, and Cricket knew Grandma would want to share. But the stairs were still a problem and we couldn’t hold out sausages for her all day every day. She was, predictably, terrified when we got to the vet’s office. Actually, she was already hyperventilating in the car, squishing herself between my neck and the headrest. When she actually walked into the waiting room, though, she fell in love at first smell with a little dog resting in his mother’s arms. It turned out that he had diabetes, so it’s possible that what Cricket really noticed was that this stranger smelled suspiciously like Miss Butterfly, and therefore he must be worth knowing.

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Miss Butterfly!

Of course, by the time we saw the vet, he said, eh, no big deal, here’s a shot of cortisone and some pills for the week. And as soon as Cricket left his office she was bouncing like a rubber ball.

Ellie gave Cricket a full sniffing when she came home, and seemed to approve of the vet’s work. Then she went off to play with Cricket’s toys (because all toys belong to Cricket, of course). Cricket has actually seemed to be okay with Ellie playing with the toys, despite Ellie chewing through Ducky’s nose and chopping the top off of the pink plastic vase. But, finally, once she was fully medicated, Cricket hit her limit, because Ellie started to play with Platypus, Cricket’s bestest friend since puppyhood. Cricket didn’t go directly to Ellie with her complaints, though. She went over to Grandma and started barking. Do you need food? Still barking. Water? Still barking. Do you need to go outside? Barking, barking, barking, and glaring over at Ellie who is chewing on Platypus at that exact moment. Aha! Another toy was chosen for Ellie, and Cricket celebrated by mouthing Platypus for a second or two, and then leaving him in the middle of the floor while she returned to her bed for a well-earned nap.

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Ellie and the poor nose-less Ducky

 

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Cricket and her oldest friend

 

She did get back up, though, when it was time for more peanut butter, I mean medicine. She’s still a little ouchy, and not up to jumping on beds, but she’s not giving me the I’m-dying-and-you’re-just-sitting-there look anymore. So, that’s progress.

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Progress!

Going Back to Shul

Now that I have more free time, because I don’t have a social work internship this semester, I’m free to return to my regular activities, including the irreverent Bible seminar at my synagogue every other Thursday night. I could even go to the open choir practices, which are supposed to be less stressful than the ones I tried five or six years ago, where I tried to learn twenty new pieces of music, in four part harmony, in a month. Or I could join a committee, of some kind. But, I’ve been feeling reluctant to step back into the flow, aware, all over again, that I don’t quite fit in.

On the first day of Rosh Hashanah, every year, we have the one event of the year where my dogs are invited into the synagogue community. The service is called Tashlich and it’s all about casting our sins into the water, by way of bread (traditionally), or bird seed, or cheerios. It’s a kid and dog friendly service, because it is held outdoors and it is short. There’s also singing, which makes it Rachel-friendly. I am not a believer in this casting-off-of-sins business, so I never join in with that part of the service. But I go, because it’s dog day. How could I skip dog day?

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“But, isn’t every day dog day?”

It was pouring rain for Tashlich this year, but I wasn’t going to skip Cricket and Ellie’s only opportunity all year to be seen and heard. We arrived before anyone else, and Ellie tried to make friends with the geese, despite the rain, dragging me through puddles, and piles of green goose poop, while the geese studiously avoided her. Someone I often see at services arrived after us, and said he was surprised that I had dogs, which seemed off to me. I thought everyone in the world knew that I had dogs; that you could see it through my skin. My dogs are my family, but I’m not sure that’s something the people in my community are able to understand, because my dogs aren’t human children. There is no synagogue school, or dog-friendly classes, or services for them on a regular basis. I can’t bring my girls to the bible seminar, or to choir practice, which means I can’t bring a big part of who I am with me.

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“I never knew going to services could be so much fun!”

The dogs were completely soaked by the time the rest of the small crowd arrived, but they got the chance to meet a grey-haired toy poodle who looked suspiciously like a baby lamb, and a tiny Maltese, and even a few bigger dogs. I met a woman with a husband, two little boys, and a dog, and she told me that she had to come despite the rain. I thought I’d found a kindred spirit, but she said, no, it’s not because it’s the one time of the year that dogs are allowed, but because she had so many sins she needed to get rid of. I wasn’t sure if she was joking or not.

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“Mommy, did you know that rain is very, very wet?”

The next day, the junior rabbi came up to me at services, congratulating me on going to services, “rain or shine.” I explained, for what felt like the hundredth time, that I went because it was my only chance to bring my dogs to shul, but she didn’t seem to understand what I was saying. Maybe, in her eyes, I was just an obsessively religious person, I don’t know.

And then I missed Yom Kippur with vertigo, and continued to wonder if it was really worth all of the effort to keep going to shul if I was left feeling, endlessly, unknown. I went to Friday night services, two days after Yom Kippur, because the world had stopped spinning, and because I just like Friday night services. When the senior rabbi came up to me, to see how I was doing post Vertigo, he asked if there was anything he could do, and I got brave for a second and asked if Ellie could come to services on Monday morning, for Sukkot, since the services were being held in the Sukkah, and the Sukkah is, technically, outdoors. And the rabbi said yes.

I’m not sure I would have been motivated to get up early for services on that Monday morning, without the promise of Ellie being able to go to shul with me. I knew not to even think of bringing Cricket; she’s terrible with crowds, and her Attention Deficit Disorder would have made the two hour service torture for her. But Ellie was perfect. She sat quietly on my lap and let people pet her. Only one person seemed to have a problem with her being there: when I first walked into the Sukkah, holding Ellie in my arms, and sat down in the back row (of three), one woman from the back row stood up and moved up front. She didn’t say anything to me, just moved, so I don’t know if she was allergic to dogs, or just didn’t like being around them, but it made me feel uneasy. I worried that other people would have the same reaction, but as soon as they began to notice Ellie, they smiled and reached out to pet her. One woman purposely sat down next to me and fell in love with my Ellie within minutes. The junior rabbi laughed at Ellie’s funny faces from across the Sukkah, and made sure that the one little (human) girl at services had noticed the puppy dog. The senior rabbi made a point of publicly welcoming Ellie, as a hypoallergenic family member who was able to join us at services for this special occasion.

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Ellie learning how to be a therapy dog, in therapy.

I’m still trying to absorb how good it felt to be allowed to have Ellie with me at shul. I don’t expect to be able to bring her to synagogue with me on a regular basis, because we are rarely outside for services or other events, but just knowing that she’s been seen, and that I’ve been seen with her, means a great deal to me.

 

My New Nephew

 

I finally got to meet my new canine nephew last week. His name is Coby and he’s an eight month old Husky. He came home five or six months ago, but this was my first chance to meet him in person. When I entered my brother’s house, Coby and his canine sister, Lilah, a black Lab, fought for the right to hug me first. I have the black and blue marks on my arm to prove it. I pity any burglar who tries to enter their house, because he won’t know what hit him with all of those kisses.

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“You let other dogs kiss you?”

We didn’t bring Cricket and Ellie with us for the visit because Cricket has had trouble with visits when there was only Lilah to contend with; two big dogs would have given her a heart attack. I think Ellie would have liked to meet Lilah and Coby, and maybe even enjoyed running through the back yard with them, but Cricket would never have forgiven me for leaving her home and taking Ellie out for the day. And, when Ellie inevitably peed on my sister-in-law’s rugs, family violence would have ensued, so we were better off leaving her at home as well. It was actually Ellie’s longest stay at home with just Cricket for company. The evidence of her anxiety was left on the living room rug, because Miss Ellie is not clear on the difference between rugs and wee wee pads, and will pee and rest on both. So now we have a new, indoor/outdoor, easy to clean, living room rug, and I’m hoping that Ellie will figure out that rugs are not for peeing on.

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Ellie getting cozy on the wee wee pad.

Back at my brother’s house, we spent some time out in the Sukkah, getting to know Coby, and catching up with my other canine and human nephews and nieces. Miss Lilah, the black Lab, has that long suffering big sister look that Cricket wears constantly, but she made sure to bring me both her leash and Coby’s when she wanted to go for a walk. Cricket would never have been able to relate to such a thing.

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This is Coby, in the Sukkah, sitting on his human sister’s lap.

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Sweet Lilah.

My second oldest nephew is the dog whisperer of the house. He willingly wakes up in the middle of the night when Coby, still not quite potty-trained, asks to go out, and Lilah has a huge dog bed that fills most of his floor, but she still prefers to sleep in his bed, leaving my nephew two or three inches to stretch out in. He doesn’t seem to mind sharing his space with the dogs, or allowing the housekeeper to come in and clean, but he’s building a fingerprint lock to keep out the other members of the family. He hasn’t figured out how to add a paw print censor to the lock, but I’m sure that will come next, or else the dogs will just break down the door. He even has a 3D printer of his own, to build new parts for his fingerprint lock and other creations, and he made me a name plate as a gift, to show me how it works. It’s nice to have geniuses in the family, but it’s even better when they are also sweet, and kind and good people (or dogs).

When we finally got home, Cricket and Ellie were wild-eyed, as if they’d spent most of the day convincing each other that we were never going to return. They’d probably also been talking to their canine neighbor across the hall, Oliver, a black haired Shih-Tzu/Bichon mix, about the horrors of being left behind by their humans. He’s their size, and therefore manageable, even for Cricket. If only we could temporarily miniaturize Lilah and Coby, maybe they could spend a day visiting with Cricket and Ellie, just like Oliver does sometimes. I’ll have to discuss this with my second oldest nephew, he’ll be the one to know where to start.

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This is Oliver, carrying one of Cricket and Ellie’s toys on his walk.

The World is Spinning

 

So, as I was reading well wishes on the blog about my attempt to go back to physical therapy, I discovered why the physical therapist was so insistent on my seeing an ENT (Ear, nose, and throat doctor). Vertigo. Or at least that’s what they called it in the emergency room, after my second attack of the day refused to recede.

I’d woken up that Monday morning feeling like the world was spinning. No, not just feeling it, but seeing it spin. Every slight movement of my head made me feel like molten lava was about to pour out of my chest. It took a long time to inch into a sitting position, and even longer to stand and then to walk. I called my doctor’s office, and the secretary told me to go to the emergency room. When I told her that even walking to the front door was impossible, she said that she would have the nurse call me back.

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The girls watched me with concern, and/or suspicion.

After about forty minutes of sitting and waiting to hear back, I attempted to stand up, thinking I’d have to get to the emergency room, but I discovered that the severity of the symptoms had lessened by then. The nurse never actually called me back, but I was able to move around, slowly and carefully, and I decided not to set off to the ER and instead to go ahead with my pre-scheduled visit to the Endocrinologist, in the hopes that a doctor, of any kind, might be able to tell me what to do with what had just happened to me, or even give me an idea of what to call it.

The endocrinologist, after addressing my thyroid, which was the reason I was seeing her in the first place, listened to the symptoms I’d experienced that morning and said “it sounds vestibular.” She agreed with the physical therapist that I should see an ENT, preferably one who specialized in the middle ear, and gave me a recommendation. As soon as I got home I called for an appointment, and since the worst of the symptoms had passed, I accepted the earliest appointment available, the following week. By then I was exhausted from all of the drama, and the nausea, and the doctor visit, and trying to concentrate on homework while my head was still not quite right, so I took a nap.

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Ellie helped.

When I woke up a couple of hours later, the world was spinning again. It took ten minutes to sit up this time, and even the idea of standing made me feel wretched, so I called the doctor’s office again. The office was closed, but there was an emergency number and I called it. One of the doctors called me back immediately and he said to go to the ER. I’d been hoping he could suggest some kind of medication I could take, to lessen the symptoms, but he didn’t want to diagnose me over the phone and he was worried that my symptoms could represent any number of different things. It took me about fifteen minutes to walk from my apartment to the car (and no, I did not try to drive myself, Mom drove).

I felt silly for making such a fuss, because I figured, hey, if I can walk, I must be fine. There were so many more serious cases around me at the ER, too, like suspected heart attacks and serious diabetic wounds and dementia.

I was given a bed in the hallway, because all of the rooms in the ER were filled. There was even a number to mark out my parking spot in the hallway. I’d already had an EKG and a finger stick (to check my sugar, both fine), and once I was in my parking spot they attached me to a heart monitor and put in an IV. The girl who put the IV in was either nervous, or unwell, because her hands were shaking the whole time and she had to wipe up a lot of blood off my arm in the aftermath. When I asked the purpose of the IV she said it would be to give me medication. And then the waiting started. I was in a prime location to overhear all of the latest gossip from the doctors and nurses and Physician’s Assistants and nurse’s aides, because their desks were two feet away from my head. Confidentiality is not really a thing in the Emergency Room.

There were so many people on staff and each wearing different colored scrubs to attempt to tell you what their jobs were: navy blue, and black, and royal blue, and grey, and green, and bluish green, though no one actually explained what the colors referred to (I really could have used a chart on the wall, like a McDonald’s menu). And there were different patterns of beeps to denote different patient needs, but I couldn’t figure out which ones were serious and which ones were mundane, and I didn’t see anyone in a real rush to respond.

Oh, and they all walked around with rolling computer workstations, for when they were away from the stationary computers, but there wasn’t actually room for all of these little vehicles in the hallway, on top of patient beds and staff and wheelchairs, so it was a bit like bumper cars out there.

Time passed. The Physician’s Assistant came by to do a quick neurological exam and said I would be getting medication soon. Eventually, someone came by and gave me a Valium (a pill, not through the IV), and when I asked why I needed a Valium for dizziness they said it was the best choice for the ER (they were wrong, it did nothing for the dizziness or nausea, just made me tired). And they still hadn’t given me the anti-emetic (for nausea) or the Anti-vert (for dizziness) for my actual symptoms.

I finally went for a CT scan at around 10:30 pm (that’s three and a half hours after I’d arrived), even though by then the PA, a nurse, and a doctor had all told me that the CT scan wouldn’t show anything. Then they gave me two bags of fluids through the IV (finally, some reason for the IV!).

Mom was getting tired, and frustrated, so she started to stalk my nurse (one of three or four male nurses on the floor), while I watched cute animal videos on my phone. We were told that there was only one doctor on duty for the whole ER and he had to check on every case and that was why things were going so slowly. More blood was taken, from my non-IV arm, though no one could explain why more blood was being taken. And then the doctor’s shift ended and the new doctor had to be updated on all of the cases before he could make any decisions (like prescribing medication for me, though I’d thought that had been done much earlier in the evening. And, he had to wait for the results of the second set of blood tests.

I was finally medicated and discharged at four AM, in pretty much the same shape I’d been in when I’d gotten there nine hours earlier. They gave me Zofran for nausea and anti-vert for the dizziness. When I looked those up, and the Vertigo they had, by then, diagnosed me with, one of the first things mentioned was ear infections, but no one, the whole night, had even looked at my ears, let alone in them.

When we got home, Mom walked ahead of me to get the dogs, and they came out to greet me as I slowly made my way up the walk to our building. They were subdued but gave me lots of kisses and when we got inside we all collapsed from the exhaustion.

I was afraid I would wake up in the morning and the whole thing would start again, but, luckily, the symptoms were more muted the next day. I was still dizzy and nauseous, but at least not having the I-am-going-to-die level of intensity. The world was still spinning, and I couldn’t quite predict which direction my feet were going to go in, but I could, slowly, sit up and move from one room to another, so I had to cancel my physical therapy appointment, and email my rabbi to let him know I wouldn’t be able to do my public reading for Yom Kippur services (some part of my brain wondered if I’d gotten sick at this particular time just to get out of dealing with Yom Kippur, but I tried to ignore that though; missing Yom Kippur was just a perk).

Mom was exhausted. She’d survived on granola bars and Cheetos and caffeine in the hospital the night before, and got as little sleep as I did, so we were both a little bit worried that we’d end up back at the ER, for her this time. While Mom napped, I made the herculean effort to walk the dogs in the pouring rain, and they were wonderful! They didn’t pull or bark or complain at the incredibly slow speed of their walk, and when we got back inside, Cricket went back on duty, watching Grandma sleep and Ellie came back to nap with me, so we were both in good hands.

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Don’t be fooled; Cricket is on duty.

The symptoms receded a little bit each day, with the help of medication and rest. And when I went to the ENT the following Monday, he diagnosed me with Benign Positional Vertigo, even though I wasn’t showing symptoms anymore. He said I should come back if the symptoms returned and then he could do a maneuver that would shake my ear crystals back into the right place, but other than that, Shoo. No cause, no cure, you’re fine.

The physical therapist was relieved at the news and started me back on track with my exercise plan the next day, and so far, the world isn’t spinning, much. Just a bit blurry, at times, with some double vision, but, that’s normal. Right?

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“I’m supposed to be blurry, Mommy. I’m moving.”

My Apartment is Springing Leaks

 

First it was the drip drip from the bathtub faucet. No, wait, months ago there was the drip from the kitchen sink, which required a very expensive repair. Then last week, or two weeks ago, there was the bathtub leak. And then an attempted repair, which led to a lake on the kitchen floor (on the opposite side of the wall from the bathroom). At first we thought the kitchen lake was coming from the dishwasher, and called the dishwasher repair guy, but then realized that the leak only happened when we took showers. Oh, and then the toilet started to screech each time it flushed, with the water pipe connected to the wall doing a little drip drip of its own.

I was pretty sure we were going to drown.

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“Hey! Don’t joke about drowning!”

The leaks also seemed to coincide with the constant rain, which caused the bathroom door to swell and have its own panic attack where it tried to jump out of its skin. Really, we kept having to jiggle the door back into its skin in order to close it. Mom took on the project and took the door off its hinges, glued it back together, and put it back in place. I am not handy in that way. I can put together any kind of IKEA furniture, but the door didn’t come with a handy dandy diagram for me to follow, so I was at a loss.

So, the door was fixed, but not the leaks, which only got worse.

I may have written about this before, but I have a phobia of strange men coming into my apartment. Phobia is too light of a word. I would be hiding under my bed, if there weren’t containers of old clothes stored under there, leaving only enough room for Cricket to squeeze in. So, when the maintenance guys came to check on the leaks, I pulled the dogs into my room and shut the door. I’m supposed to be an adult who can manage basic household responsibilities, but in this case, I can’t. The dogs begged to be let out so that they could bark at the invaders in person and tell them what for. But I just stayed in my room, shaking, and waiting for it to be over.

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“Bark! Bark bark bark!!!!”

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“Should I be barking?”

But it wasn’t over, and we had to call the plumber, and then the maintenance guys came back. We have two maintenance men at our co-op, one is quiet and unassuming, and the other is very very loud, smokes cigars, and likes to blame everything on anyone else. It was the loud one who came over to argue with the plumber about what needed to be done. I couldn’t quite make out what anyone was saying from my hiding place, but I could hear the shouting, and it made me regress even further. I don’t do well with shouting.

I really should move the plastic containers out from under my bed, in case this comes up again.

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“You can’t come in.”

After an hour or two of shouting and futzing around, it was decided that we just had the wrong faucet in the bathtub, and Mom was sent out to get a new one, which, fingers crossed, seems to have solved the problem. For now. The squeaking toilet is going to stay as it is, because the plumber said that repairing it would be prohibitively expensive and we’d be better off waiting for it to die and then replacing it.

The dogs had a great time barking at all of the foot traffic in and out of the apartment, and received an inordinate number of chicken treats in a failed attempt to pacify them. My only consolation is that now I can go back to showering without worrying that I’m creating the next great flood. I was really worried, because I don’t have an ark, and I have no idea how to make one. I’ve never even seen an ark in the IKEA catalog.

 

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So we hired an architect.

 

Physical Therapy, Again

 

Once my internship ended in August, I started scheduling doctors’ appointments right and left, to make up for two years of putting off everything but the most essential (which still turned out to be a lot). One result of all of these doctors’ visits is that I’m back in physical therapy, again.

I’ve had this pain in my neck and shoulder for three or four months now, and driving, sitting at the computer, and walking all made it worse. I could barely turn my head, but I kept putting off a doctor visit because I knew I wouldn’t have time to do all of the testing and drug taking and exercising she’d expect me to do. And then, just before my internship ended, this strange buzzing started in my left shoulder.

I went for x-rays, I tried Tramadol and a muscle relaxant, which wiped me out and did nothing for the pain, and then I got an appointment with a new physical therapist who came highly recommended. I’ve been through physical therapy so many times before: for my lower back, neck and shoulders, balance, gait, etc. I’ve also gone for acupuncture and chiropractic, cranial sacral, massage, and on and on, so I wasn’t sure how hopeful to be.

The new physical therapist did a long evaluation, with lots of questions, and muscle testing, and range of motion testing. When she had me turn my head to the left I became so nauseous that I had to sit down. She also said that the buzzing in my left shoulder could be coming from pressure on nerve bundles in my neck, because my upper body is so rigid. And she asked if I’ve seen an ENT (ear, nose, and throat doctor) recently. Three years ago seemed pretty recent to me, but she looked skeptical. She gave me three exercises to start with, and a print out in case I forgot the exercises immediately (which I did).

I’m actually fascinated by the weird glitches in my body: the way the nausea kicks in if I move my head too far to the left, or if the physical therapist presses on a certain spot in my upper back; and then the dizziness can be triggered just by a movement of my shoulder!

But I’d like to be able to turn my head while I’m driving, without feeling like I’m going to vomit all over the car. I’d like to be able to do Tai Chi again, or yoga, or just exercise regularly without feeling like my limbs are going to disarticulate. I’d really like to be able to run with the dogs at the dog park without needing a heating pad and a three hour nap in the aftermath.

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“Not that the dogs mind napping.”

So, for now, I go to my physical therapy appointments twice a week, and do my at-home exercises, and I worry that I’m going to have to add an appointment with the ENT to my long list of doctor visits coming up, just to be told, one more time, that I’m fine and no one knows why I have all of these symptoms, so it must be in my head.

I’m trying to watch Ellie for inspiration, because she does something new every day, not because she thinks she has to, but just because she discovers new things she can do. She didn’t know these things were possible before, and she didn’t know she would enjoy them so much! She didn’t know how much she’d like massages, and spending time with her humans, and smelling everything in the backyard, and checking in with Cricket. She even tried pickles, because Cricket likes them so much, but she hasn’t discovered a great love there. She’s also discovered that she hates having her hair combed and her teeth brushed, but I think that’s because Cricket has been whispering in her ear.

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“They tell you they’re going to comb your hair, but really they’re scooping out your brain. It’s true.”

Miss Ellie has also been creating her own physical therapy plan. She went from needing to be picked up every time she wanted to come up on the couch or the bed, to jumping up (and down and up again) at will. She can stand up on her back legs, for long periods, begging for treats. She even figured out how to jump into the back seat of the car, which she was sure was impossible. And then she does all kinds of stretches, swishing her neck and back every which way to work out the kinks. I’m pretty sure my physical therapist would not approve if I tried to follow Ellie’s plan, especially the swishing around part, but it looks like so much more fun than mine!

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“Hi, Mommy!”

Cricket has taken to watching Ellie’s antics with a big sister’s eye roll, as in, Oh my gawd, she is so weird! But I think, secretly, Cricket is getting inspired too.

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” No, I’m not.”

 

 

Personality Disorders

 

In my Assessment and Diagnosis class last semester (for graduate school in Social Work), I had to spend a week studying the personality disorders. These are, at least for now, seen as the enduring pathological character traits people live with in their daily lives. The personality disorders are separated out from other mental health disorders because of their lifelong nature, and because, usually, the patient doesn’t see his or her behavior as problematic, which makes them very hard to treat. But more often than not, the personality disorders are used as epithets, by lay people and clinicians, to describe people who resist therapeutic help. The current list of personality disorders is broken into three clusters: the not-quite-schizophrenia-but-still-odd-and-occasionally-psychotic personality disorders; the criminal-manipulative-lacking empathy-selfish personality disorders; and the fearful-avoidant-dependent-obsessive-compulsive personality disorders.

 

 

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“Are you diagnosing me, Mommy?”

This small strip of the DSM (The Diagnostic and Statistical Manual of Mental Disorders) has come up recently, in our public dialogue, as people struggle to explain the president’s behavior. We don’t know if he has dementia, or some other mental illness or medical diagnosis, but we can certainly see traits that fit Narcissistic (grandiose and exploiting of others), Histrionic (melodramatic and attention seeking), Paranoid (preoccupied with doubts of loyalty in others), and Antisocial (lying, intentionally harming others, and lacking empathy) Personality Disorders.

The value of the personality disorders is that they give us categories to put people into when they consistently behave in abnormal ways, and categories can help us feel like we have some control, and some understanding, about what’s going on around us. But, are personality disorders actually mental illnesses, or something else? The personality disorders attempt to describe the perpetrator of domestic violence (Antisocial personality disorder), and the victim (Dependent personality disorder), as equally ill, and/or equally character disordered. Meaning that as a society we have as little compassion for victims as for perpetrators, something that is objectively true, but still horrifying. Other personality disorders are just lower level, and more persistent, versions of mental illnesses we already have in the book, like Obsessive Compulsive Personality Disorder, which is seen as different from Obsessive Compulsive Disorder (and, yes, that’s weird).

The personality disorders are the most extreme example of what’s wrong with the DSM: it focuses only on the negatives, the weaknesses, and the disorders of human beings, and never on the strengths that mitigate illness. The same person who has Major Depressive Disorder may also have a great support system that keeps her going. The same person who obsessively washes his hands or checks the lock on his door, maybe also obsessively study or work or create and accomplish great things. The same person who lives daily with Social Anxiety Disorder may have an even stronger need and desire to connect with other people, which allows her to reach out despite her fear.

Miss Cricket has her own reason for thinking that the personality disorders are unnecessary: she knows, in her gut, who to spend time with and who to avoid, and she doesn’t think she needs a diagnostic manual to help her. For her, it’s all about a complicated internal set of calculations, based on how much you smell like someone who gives out chicken treats (she is doing her best to teach Miss Ellie this wisdom as well). I have seen no mention of generosity with chicken treats, or any other positive character traits, in DSM 5. Clearly they have more work to do for the next edition.

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(Cricket transmits a lot of information through her butt. Who am I to judge?)