Tuesday, March 4, 2014

Let's Talk About Depression, Baby

Hey guys, what up? So I have this insanely cute three month old baby, who, sheesh, acts like a baby sometimes. Okay, I don't know what it is, but in all honesty, there is something so cute about Wallace that I just want to eat his chubby baby cheeks. Like it is a literal biological desire inside of me to gnaw on his cheeks. I can't help myself. But good grief that boy is a lot of work. Bria was probably the world's easiest baby. I think this is because her soul is approximately 80 years old, so everything in life she's like "meh, nothing fazes me." Wally's soul is brand new, I think. Everything in life he's like "what. the. hell." This is an overstatement. If you compare anyone to the World's Easiest Baby (Bria), they're gonna seem like a colicky monster. So I'm mostly just kidding. Wally falls in a completely normal range.

This is to say that I'm really glad I'm in a better emotional place this time. What is it about emotional issues-- "mental illness"-- that we feel like it's weird to talk about? I'm going to talk about it a bit. I wrote this draft several days ago, and I have debated whether or not to post it. This stuff is hard to talk about!

When Bria was born I launched into a dark haze of postpartum depression. I didn't know how much was normal, and I had no idea how to get help. I feel sad knowing I didn't enjoy that time as much as I could have had I addressed the problem, because it lasted a year. A whole year of my life and Bria's entire life up until that point.

This time around I was on alert going into things. I took some precautions to ward off depression, and Sam and I talked a lot the first few days. The labor and delivery were 8000% times better this time around, so I wasn't coming off any trauma, but we were both cautiously surprised when I felt fairly stable and happy at first.
Then the anxiety started settling in. I have a long history of intense anxiety-- mostly social-- though this was a kind I had never experienced before. All day long I had a constant pit in my stomach. When I thought about anything, it would make me feel incredibly nauseated. I really mean anything. It could be "Bria has school tomorrow" or "I'm going to watch an episode of New Girl while I feed Wally," and this wave of nausea would make me cringe and sometimes double over. I felt sick with anxiety all day every day. It created this static separating me from reality. You know when you're hands are freezing cold so that you can't move them properly-- they almost feel like they're moving at half speed? That's how I felt emotionally. Though I felt constantly panicked and frantic, I also felt paralyzed. And though I was so exhausted I would be near tears by 8 or 9 every evening, I would lie in bed at night and just stare at the wall, wide awake. I would also wake up in the middle of the night and not be able to go back to sleep, sometimes for up to an hour.
The other thing I was dealing with is actually pretty hard for me to talk about. In addition to anxiety, I also have a history of OCD, and after Wally was born, I noticed a return of obsessive thoughts. I am lucky I haven't had to work through any compulsive behavior recently, but obsessive thoughts can still be incredibly intrusive. As I walked around the house holding Wally, all I could see were potential dangers. I had incredibly vivid thoughts of things like tripping, where I could see myself fall and Wally landing on his head, or smashing into a corner. Even sitting down I would panic about potentially dropping him. All day long I just had these detailed images of Wally being injured in various accidents. It was as disturbing as it sounds.
After a month I knew I needed some real help, but I wasn't sure how to get it-- which was part of my problem the first time. Looking back, I should have lined up a therapist before I had Wally, just in case. I didn't know if I should call a doctor, find a therapist at that point, or what. I waited until my 6 week follow-up appointment with my midwife and explained the situation. She gave me the names of a couple people to call, including the Five Trimesters Clinic at GW. This is an amazing place that offers short-term counseling and psychiatry services to women who are trying to get pregnant, are pregnant, or postpartum. The services are significantly discounted so that anyone has access during such a potentially fragile and unstable period of life. They will meet with you a handful of times to establish a plan (recommending support groups or counselors, prescribing needed medications, etc.) so that you can take the reins of your own care after a couple months.
I set up an appointment to meet with one of the psychiatrists and met with her at the very end of January. After going through my history and discussing everything I was experiencing, she prescribed an SSRI to me.
The first ten days or so of taking it, I was so anxious I thought I was going to die. But then there was one day that I realized I felt normal. I didn't feel anxious. And the next day. And the next. After a week I realized my obsessive thoughts would only poke their heads in occasionally. I have felt more stable over the last month than I have felt in who knows how long. It's amazing. I was worried taking an antidepressant would make me feel flat or fuzzy, but I actually just feel like myself. And far from fuzzy, I feel like I've come out of an anxiety fog. Luckily I've also connected with a therapist who is helping me work through some issues that keep getting me stuck. The sleep thing is coming along. I'm still not sleeping great, and though it takes me a long time to fall asleep at night, I don't wake up on my own (other than with Wally) anymore. So that's a relief. I hope this will continue to get better.

There is so much stigma that surrounds depression and anxiety, and if you've never experienced it, I think it can seem nebulous or dramatic. If you feel unfamiliar with depression and anxiety, I recommend watching this TED talk. His description of anxiety is the most accurate I've heard (at least how I experience it). I haven't spoken much publicly about my own experiences, but I think it's time. That stigma is part of what kept me from getting help six years ago. I am so happy that this time around I have the help I need so I can enjoy every moment of Wally's first year, gobbling up those chubby cheeks.

Monday, January 13, 2014

"Obamacare": One Average American Family's Experience

Guess what? I'm going to write about Obamacare. Guess what again? I'm going to call it the Affordable Care Act (ACA) because that's actually what it's called.
(There' s chance this will be part one of a series. This is the just the report of how it went signing up for an insurance plan. I think it's important for people to understand what the ACA means to families like ours, but I'm not super into talking about politics publicly. So we'll see.)

Let's get started with some back-story:

We are an average American family. My husband works full time as a self-employed television editor. I work occasionally as a freelance writer and I am also a graduate student, but mostly I am a stay-at-home mom to our two children.
Because Sam is self-employed and I am not really employed at all, we have purchased our own private insurance up until this point. It's actually not as simple as it sounds. Because of pre-existing conditions and cost, Sam has actually not had any health insurance since he was in college. Our daughter and I also flew by the seats of our medical pants until two years ago when we were finally in a financial position to pay for private health insurance. Up until that point, even though Sam worked full time (often up to 80 hours a week), and I worked consistently as a freelance writer and editor, we could not afford health insurance for any of us. I can't tell you how happy I am those days are over. But those are stories for another blog post. So there's a basic idea of where we are coming from.

Two years ago, we finally bought health insurance for me and our daughter. It cost about $360/month with a $2400 deductible. Nothing was covered until we met the deductible, but, thanks to the ACA, our daughter's well-child visits and my preventative care visits were covered at 100%. This meant she could get her immunizations and a check-up for $0. One year ago our premiums increased so that coverage for the two of us cost $459/month for the same plan.

I was eager to find out what our options would be going through Virginia's marketplace. I logged onto healthcare.gov pretty soon after it rolled out and was able to quickly start an application. I wasn't able to do much since I was pregnant. I was expecting our son at the end of November, so it made no sense to start our application just yet-- we needed coverage that started February 1st.
Shortly after the baby was born, I got back to my application. Only this time, I couldn't get past basic log-ins to start an application. Every time I tried, there was an error. I finally chatted with someone online, and they said I would need to call in order to complete my application. Annoying. Though I hadn't been aware I was able to complete everything over the phone, and the phone lines are open 24/7.
The first time I called, I waited to talk to someone for over an hour (though I recently called my current insurance company and waited on the phone for over 90 minutes, so...). I talked with the customer service representative for almost an hour as she verified all my personal information for the application, and gathered data according to my tax return to calculate our subsidy. She explained that we are able to use as much of the subsidy as we like. If we don't use the entire amount, it will become a tax credit, and we will receive a refund on next year's tax return.
Then, because I could not access anything online, she went over each of the insurance plans available to me. This was particularly frustrating because I had to write down the information for each plan. There were plans ranging from $120-$4000/month, so you can imagine it was a lot of information to go over-- though I obviously didn't bother going over the plans costing $4000. Sheesh.
I told her I would think about my options and get back to her, so she saved my application and gave me a reference number. Including wait time, I was on the phone for 2 hours.
I took the next week or two to research the plans we were interested in. I was able to find the plans on each insurance carrier's website. I compared deductibles, premiums, and coverage details. I was also able to search which providers were covered. Everything was very straightforward, simple, and easy to compare. We chose a plan with Innovation Health for two main reasons: the available plan already covers our pediatrician, my midwife, and psychologist. Also, visits to primary care and specialists are covered before meeting a deductible. So, if our daughter gets an ear infection, I pay $25 flat-- not $25 after meeting my deductible. Our deductible is quite a bit higher: $7000 for the year. If I were anticipating a big medical event (like having a baby) I would not choose a plan with such a high deductible. But under this plan, I only have to pay $50 to see my therapist, so the higher deductible is worth it to me.
I called back to update and finish our application. This time I waited less than ten minutes to speak to someone! (Note to self-- wait until January to make phone calls regarding insurance.) I told them how much of our subsidy we would use (not the entire amount), and informed them of our insurance plan choice. Then we went over dental plans, and I chose a plan that allows us to get check ups for $10 and covers everything else around 50%, with an out of pocket maximum at $1400. We finalized everything else, and he told me our new insurance companies (health and dental) would be in touch with me within 3-5 business days. Once I paid our first month's premiums, coverage would begin February 1st. We were on the phone a total of 30 minutes.
Health insurance to cover our family of four will cost $513/month and our dental insurance will cost $68-- including our subsidy.

So, was it frustrating that I couldn't get the healthcare.gov website to work and that I had to wait on the phone for over an hour the first time? Sure. But I now have legitimate health insurance for my entire family for $100 less per person per month. High fives all around.