GA, diet or depersonalization??

[Jaquta]

Hi.
I underwent breast surgery on Friday afternoon.  I took a long time to wake up.
I feel devastated by the post-op recovery and are trying to understand it better.

I am wondering if my response was due to the GA, diet, other factors or ?depersonalization?

Info:
I underwent surgery about 6 weeks ago with no complications other than waking up a little agitated and feeling a little disoriented.

Differences this time:
-I had lost nine kg in two weeks.
-I told my GP I was feeling tired, faint and light-headed.  I queried whether this was due to diet.  He thought it was most likely stress and anxiety related.
-over the past month I had used a total of 11 Lorazepam and 6 Zopiclone tablets.
-my hay fever had been triggered and my asthma was slightly affected (I have been quite SOB at times).
-on the day of the surgery I went for a 40 minute run.  Maybe not such a bright thing to have done.  I expect I was dehydrated and hypoglycemic.
-my pre-op BP was 124/48.  I don't know if that means anything.

After surgery I don't even know what happened.
At some point I became aware of people calling my name, pinching my ear, rubbing my chest, etc.  I felt very tired, couldn't (?wouldn't) open my eyes, etc.
I heard people referring to my file and psych notes.  I think some people may have perceived it was a game.  Or another interpretation, that I took excess meds??
I think my blood sugars were taken and it was 6.2 post surgery.

Is it possible to go through surgery and then wake up depersonalized?  Is this what happened?
At some point there was awareness, but a lethargy and a desire to be asleep.
I don't understand and I don't like all the implications it could have been psych related.
I have been feeling extremely judged, ashamed, humiliated, etc.

Any suggestions would be greatly appreciated.
J

[Jaquta]

Hi Amph
I'll try and answer some of your questions.  It may not be very thorough though because I'm feeling a little miserable.  I ache, I have a temperature, a sore neck and a headache, I feel sick, I think my wound is infected, there is blood in my urine, etc, etc.

I think a psych consult could be a good idea.  I'll run this past my GP tomorrow.
Sometimes one day feels like a long time.  Even that one day can sometimes be too long.
In some areas I am better at asking for help, in others I still need lots of work.

I ended up staying in hospital on Friday night -much to my chagrin.  I was starting to feel extremely agitated, stressed and anxious so I spoke to one of the nurses.
I was given half a sleeping pill.  It was pretty useless so about three hours later after I had plucked up the courage to ask I told her that I was still feeling stressed.  I was offered another half a sleeping pill.  I still wasn't able to settle and sleep.
In the end it seemed like a waste of time asking.  I think we need to keep persisting and keep being honest with ourselves/ trusting ourselves.

We find excuses that conveniently complement our beliefs.  Sometimes help is like a double-edged sword.  This is much like my eating.  If only I were to address key issues I could make some long-term changes and reap the rewards.

I think on a personal level I can appreciate some of my deficits.  It just becomes hard when I need to discuss them with others.  Even on the internet, which feels relatively safe to me, I haven't been able to open up.

There is a book written by a person with a strong interest in pain management.  I forget his name and the title of the book.  John Kabat-Zinn.  Full catastrophe of Living.  Something like that anyway.  He uses meditative techniques to deal with pain.

I think becoming vulnerable by trusting a doctors professional, and personal, opinion.
Also trusting the diagnosis and the treatment.
Does this person truly have my best interests at heart?  Trusting them when my expectations or approaches differ.  Just trusting them.

These days not everyone has the time, or makes the time, and give the impression they just want the facts and not the emotional history attached to it.
Maybe they can work with facts, but it doesn't seem very holistic.  Maybe it's better -more objective??

The therapy session was the day before surgery (but the day of the surgical clinic).  I didn't feel contained during the session and it felt extremely threatening to me.  I think, that if I were to test this T (which I expect I would do at some point), that she wouldn't be able to hold me.  I just don't know!!
I have another session with her.  At some point we'll need to decide whether we can work with each other.

I really need to go before I'm sick.  Sorry!  Too much info.

j

[Amphitrite]

I think you should get a psych consult. A year in situations like ours(and by that I mean having a generally hard time) is in my opinion too long. I felt the same way for a different reason. I had left therapy when I got physically sick and when my docs wanted me to go back because Chronic Pain can have a devestating effect on the quality of life I avoided doing it. But finally I agreed and had a psych assesment (I'm sure my pain doc wanted me to have one also just to know I wasn't bordering on any addictive behaviors taking such strong pain medications). Anyway, after I had gone I couldn't believe how long I had waited and how much they could help me. I was in denial about my anxiety and my nightmares.

I don't know what you mean by how much a patient should trust a doc. Do you mean right off the bat or in general?
I think that's something that needs to be up to you. It's normal for people to feel uncomfortable with trust when it comes to therapists and psychiatrists but that's where developing a relationship comes in over time.
No one expects anyone to walk in and immediatly trust them with their thoughts and feelings. Feeling comfortable with someone takes time especially when you feel your putting yourself in a vulnerable position by talking about such personal things.

I'm curious why your T would need to protect you from doctors? Of course if you feel uncomfortable answering that's ok. I'm just wondering if there was a reason she felt doctors posed a threat to your treatment. But maybe I'm not understanding correctly.
I understand why she wouldn't want your treatment to be fragmented. The best case senario is to have a therapist and psychiatrist who work at the same facility and can work closely together to make sure you're recieving the best treatment possible.
But that's not always a possiblity. The facilities in my area are so backed up with three year waiting lists that people can't wait that long(more than understandably) and need to see help as they can find it available.

You've had such a big change after your T left that I would think you could benefit a great deal from having a consult. Going through breat surgery and all the rest is a very hard situation to be in and go through without the support you're used to having. And at the very least, it's just a consult. Your not being held to anything.

The session you had the day of your surgery. You were in a very anxious position meeting a new T. Do you think you may connect differently at this point. Not going on a day that shares an extreamly anxiety provocing situation?
Of course once you establish a relationship with someone going on such a day can be very helpful. But for your first session I can see why it might not have gone so well or left you feeling unsure of her ability to help you.
It takes time for a therapist to get to know someone and know what they may need in them. In my view she might win psychologist of the year if on the first ocassion meeting you and knowing exactly what you needed.
It's hard to ***** what skills a professional may have from only one visit especially when that first visit is overshadowed by such an anxious event like surgery.

What about going just once more and seeing how you feel when your not preparing for surgery? You may feel differently and you may not. But at least you gave it another chance.
I can remember not liking my T the first time I met her. But she ended up being the one who helped me the most. It doesn't always work that way but when you don't give it chance enough, you never know.

I don't mean to push, you know that. I just want to see you feeling better. I know these last months haven't been easy and I think you could use a break however you can find one(a healthy break of course).
Just like my anxiety. I waited so long to finally call and get some help. Now I realize I sat in that state when I didn't have to and put myself through some trauma by doing so.

Amph

[Jaquta]

Thank you both for your responses.
I might do a search on metabolic strain and metabolic induced mental confusion.

Currently I feel as though I've been run over by a bus -both mentally and physically.
I accept there are factors which are making me feel more emotionally vulnerable at the moment.

At the surgical clinic the day before surgery (due to management rushing all urgent referrals through prior to Christmas) I discussed with him the option of not treating the problem due to my feelings of worthlessness.  He thought everyone was worthy of such treatment.  I wonder why when I abuse/ have abused my body/ mind so much.
He said he didn't think I had.  Severe binge eating and restricting, etc feels like abuse.
My GP said not treating the disease was a form of self-harm.

The surgeon said if there was anything he could do ...  I was flattered and somewhat bewildered by his offer.  I don't think this is something he does very often or very lightly.
Why do these people care?  (Strong counter-transference issues only??)

I saw the new psychologist the same day as the surgeon.  I don't think the session went very well.  I fear she doesn't have the necessary skills to help me move forward.  She does have some skills though.
I don't know if working on a superficial level will help me in the long-term (no matter how hard we work together).

Today I was wondering why I hadn't had a psychiatry appointment in nearly a year.  (Talking and listening to the doctor here seems to clarify things).  I know my previous T tried to protect me from doctors and also from a fragmented treatment team.

My head feels like it is about to explode/ implode.  I hope this makes some sense.

If anyone has any suggestions about where to start addressing issues I'd be very grateful.  Would a psych consult after all this time be an appropriate place to start?  How much should a patient trust a doctor/ psychiatrist?

J

[Amphitrite]

My guess is if this was an allergy there would have been more indication of that. I would think any allergy to anestesia would be signifigant and would have at the very least happened last time it was administered to you.

You have told me how nervous you were to go under and have all those people touching you. An episode of depersonalization can be triggered by what you feel is a trumatic event such as going through the process of being anestetized. The surgery itself couldn't have been easy for you either because of what you may have found in the results. Now taking away your anxiety of the whole process, people can react very differentlt to anestesia. Some get physically ill, some wake up quicker and some feel extreamly groggy and fatigued.
I have terrible reactions to anestesia emotionally. For hours afterwards I'm emotionally sensative and often cry for little to no reason. I've also woken up during a surgery and said something to the doctor though I don't remember it at all.
So being that anestesia effects everyone differently and is an extreme change to your bodies functioning your feeling unable to open your eyes and that you may have experienced an episode of derealization doesn't seem out of the ordinary.

Waking from anestesia can be a strange experience as well as being put under. I would think, however the Dr. may feel differently that when you heard your medical notes being read they may have just been concerned and were going over what the problem could be with one another not nessesarily focusing on the fact that you had a psych diagnosis and this was a game you were playing but what info was in the notes in general or perhaps what psychotropics you may have been taking.
When you wake up from anestesia you can be very confused for a few moments until you realize where you are and so constructing a game in that state would be to me, very unlikely and I would think those with medical training would be aware of that.
Waking up your enviorment can seem unreal and that has nothing to do with you but with the effect of such a strong medication like anestesia.

Did they give you the versed before you were put under? That medicaton that completely knocks out the anxiety and helps you become very at ease with being put under?

Those are just my thoughts and the doctor may have a very different perspective.  I know you feel ashamed and embarassed but you have nothing to be ashamed about. The whole process of surgery is not a pleasant experience which is why they use medications like versed to make someone feel more at ease.

Hope this helped,

Amph

[Roger Gould, M.D.]

It sounds to me like you have a big metabolic strain on top of what is a very anxious inducing operation.  You probably exhibited a lot of unusual behavior that was part of the metabolic induced mental confusion....sounds like it is a finite reaction, and nothing to be ashamed of....

[Jaquta]

I forgot to mention potential drug allergies to anaesthetic agents but I don't think anything has been concluded.  I do have a drug allergies alert sticker on my file (for propofol, midazalom) though.  Maybe it's irrelevant, maybe the allergies are only mild??