Shrink appointment this morning went fine.  No change in dosage.  We talked a bit about situational depression vs clinical depression.  He explained that they look for a couple of things to determine if someone is experiencing clinical depression.  The three main areas: do you have interest in things, do you show interest in socializing, do you have motivation to go out?  If the answer is no, then they look at timing.  He said a few days is no big deal; the cut off for them is two weeks.  Two weeks of not have interest and not wanting to go out because you’re sad or feel like it’s not worth it means that you may be clinically depressed and may be helped by medication.

He said for me it seems like I am just adjusting to my new reality and things are as they should be.  I suspected that would be the verdict, so it was no surprise.  And frankly I am glad not to be changing yet another medication.

He also asked if the pain was manageable.  And I said more or less, with medication.  He said that his view of manageable pain (and I think his understanding of the medical view of manageable pain) is that if you’re limping along then it’s manageable.  I found it interesting that he used the word limping.  So often, we with chronic pain, think of our old lives when we walked normally, but the truth is our new standards are different.  I was reading something earlier (I wish I could remember where!) that said people with chronic pain have a different scale.  A four pain level is our new zero.  I have found this to be true.  A good day is no longer a pain free one, but one that is tolerable without much pain medication.  So yeah, manageable pain is when we are limping along.

On another front, third dose of MTX is behind me.  This week I have now added the dreaded nausea to the fatigue.  Frankly, I feel pretty awful all around.  Tired, nauseous, achy.  Etc.  Really looking forward to the side effects of this med being behind me.  Or manageable!