Melissa Chieza, 25, is a qualified Occupational Therapist (OT), but working as a mental health Practitioner in GP surgeries in East of England.

Morning

Normally, my alarm is set for 6am, but most days I snooze it till 07.00am. This can very  much depend on how my fatigue levels are that day and some days I may need a bit more time to orientate myself to the world. Before I head downstairs, I will check my blood glucose via a quick finger prick to see if it accurate against my Dexcom G6.  I head downstairs and make a cup of coffee and I may sit at the dining table and complete my gratitude journal followed by listening to a short podcast before jumping into the shower and getting dressed for work.

Fatigue is a symptom associated with Lupus and it not something that is resolved easily with lots of rest. This is an ongoing challenge, whilst in remission I have learnt ways to manage fatigue and to allow myself extra time if needed.

I currently work some days from home and a bit at the GP surgeries depending on which day it is. I normally open my laptop to see the patient list before I set off to work, this gives me an idea of the responsibilities for the day, and what actions have been asked of me by the staff at the GP practice. I may note a few bullet points in my diary of things that I need to complete at the end of day e.g., sending patient text reminders or appointment or resources that we discussed in consultation.

Brain Fog is another symptom of lupus. People living with lupus are often misunderstood so to help me manage at work I have a to do list sheet on my computer or laptop and I keep emergency hypo supplied in random places e.g. the car, laptop bag, and dining table etc.

In the GP practice the patients are normally seen by the GP first. If the issues are related to mental health the GP would refer to us and we would conduct a 30-minute appointment with the patient to discuss mental health concerns. Some of the referrals we receive are Anxiety, depression, poor sleep, low mood and Bereavement and many more. Depending on the patient’s preferences I would see them either at the surgery or have a telephone appointment. I would assess patients based on a screening tool and may ask how their mental health has impacted them over the last few weeks and make recommendations such as signposting and providing resources.

Some ways to do this would be using a Likert scale to help understand how their mood has affected them completing activities of daily living, but also this can be used a baseline in future sessions to determine if progress has been made. We may set goals based on what the patient would like to achieve, and we can regularly review.

As part of my lupus management, I take immunosuppression treatment as well as a prednisolone and Hydroxychloroquine. I have been on these medication since diagnosis and the challenges, I have faced with prednisolone is the impact it has on my blood glucose management especially when I am having a flare up. I currently use the Dexcom G6 along the Tandem T-Slim Insulin Pump so when my blood glucose levels are running high the pump does correct me, which is a bit of a relieve as stress can be a big trigger for lupus.

My workload is diverse – I work with patients from 18 upwards with a range of mental health needs, however they could also present with physical health needs too. While supporting people living with mental health as a OT is something I am passionate about I am aware that some days can be challenging and difficult which is why I ensure that I maintain my wellbeing through activities I enjoy.

I have an hour lunch break which involves carb counting my food, so I give myself the correct insulin. Some days I may have weighed out my food the night before and have photos of the carbs on my phone. I try and go for a quick walk but at times this is not possible, especially if I’m driving to the surgery in the afternoon.

Afternoon & Evening

I may book patients in for the following week and start documenting some of my assessment findings onto the system.

If I have been typing for a long time, I may experience some joint pain in the hands, back and shoulder area. This is more common for me in the winter months than the warmer months. I try to set frequent timers on my apple watch to move around the consultation room to avoid feeling stiff or sore. I do have the option to use the standing desk if I wish too.

Before heading home, l review my to do ensuring everything I had written has been actioned. I leave the paperwork completed at the surgery and pack away my stuff.

I spend ten-minutes reflecting on the day and asking myself I would change anything, what went well and what did not go well.

On my not-so-great days, I still try to keep active, and this is through attending a regular spin class at the gym which helps me to manage the my wellbeing.