No Upbeat Bloggers Around Here

When I realized I was pretty sick this time my doctor and I decided to try a medicine (Risperdal, an antipsychotic) that I may or may not have had an allergic reaction to last year. I reacted in a sequence that went with it being from this medicine, but I didn't recover for months, until another medicine was removed. So I've slowly and cautiously been increasing my dose at a snail's pace.

Tonight I had to email the doctor and tell her that the signs of allergies are returning. I suppose this could all still be some coincidence, but I suspect it's the medication, especially because it's at the same dose that I had the reaction last year.

This is the 3rd antipsychotic I've had a reaction to. That means that I'm going to have to take one that I really do not want to take. Unfortunately a side effect of working with patients who take these meds is that I've got a good idea of how they affect people. In one case that actually benefitted my patient because I was able to insist that her behaviors were from a side effect I only knew about because I'd had it. After a quick exam her doctor agreed, her meds were changed and she quit beating people up. The meds I have left as options scare me. They cause more sedation and weight gain. Risperdal does for some people, but hasn't for me and I've seen more people function better on it than my remaining options (Seroquel or Zyprexa, which is actually a med I've already said I'll take only as a last resort because of the weight gain associated with it).

This is even harder to stomach because for 2 days I've felt the tiniest bit better, probably because I've had 2 nights of sleep. There is no telling what a med change will do to this gain, or if another med will help me feel better. I am so reluctant to lose that. I'm also so afraid of gaining weight. I lost 3o pounds due to being sick from my recent lithium toxicity. This is not a good way to lose weight, but taking meds is not a good way to gain it either. I've gained so much weight since I started serious psych meds and to be back at the middle of where I've been and where I started felt good. It has been so nice to have my clothes fit perfectly again, and to even have things that were way too big yet fit a few months ago. I've felt more confident about how I look than I have in years. I dread having that change more than anything else. Even if I just go back to my previous weight it feels so out of control.

So now I'm in the middle of the worst episode I've ever had, the whole thing has been complicated by lithium toxicity out of the blue, and now I may have to essentially start over with the meds. I'm starting to feel like I'm going to feel bad forever. I already know I'm going to be on disability leave much of the summer. It just seems so far off that I'll ever get my life back.

Grammar Lesson

Normally I don't care what grammatical errors people make. I know I make my share. But this one is driving me crazy of late: manic and maniac are NOT the same word. Nor does being manic make one a maniac.

Thank you. I feel better now.

Lonely Bipolar I RCME-S* Seeks Anonymous Friends

In designing this blog I did everything I could to protect my own anonymity. As I've said before, I fear the professional repercussions much more than personal ones. I realize that no blog is totally anonymous and I've chosen to live with that risk. As I've gotten more used to this it has actually gotten more difficult; I want to refer to things like the state where I live, or my job title, and that would not be a good idea. Sadly I have to limit what I can say about parts of the mentally ill mental health professional aspect of my job, and that's a large part of what I feel is unique about me.

One of the things I hoped would come from this would be a chance to meet others who either deal with bipolar in the same way I do, or who know someone who does. Although I certainly have times I feel sorry for myself, I have never been able to handle being told I "couldn't". If something really is in that category I need to find that out for myself. And it's worked; I have done much more than I "should" have done.

What I have not gained is much contact with others like me. Part of that is because there probably are not many. I fit into so many small categories of bipolar that even if I was more typical in how I reacted to those categories I wouldn't fit well. And then somehow so far I've managed to function better than expected much of the time, which just puts me in a weirder category.

I've tried online support groups. I don't fit in. I get fed up with comparing life to "normal" people, feeling constantly sorry for everyone, and the tendency to react heavily only to posts with great drama. Local support groups aren't an option because 1)I live in the middle of a large cow pasture and they don't exist 2) I can't interact with my mentally ill peers in this area as they may become my patients which would be all sorts of uncomfortable and potentially damaging 3) I can't travel far enough to get away from my referral base.

So, it's time to see what we've got here. I know some of you are coming back fairly regularly. In fact, 2 of you are from the same city and I'd love to know if you're the same person with 2 computers or are a big coincidence. If you are interested in being totally anonymous but interacting (all I know is what city you're in and sometimes who provides your internet service), please leave a comment or email me (see left column). Be as anonymous as you'd like. I will never "check you out" nor berate anyone for saying anything anonymously on this blog or in this email account. If I don't like what you say I'll ignore it. If you're bipolar I'd love to see a few bipolar patients interact here, especially if you have similar circumstances to me that limits interaction otherwise. If you're a friend or family member or professional or just curious, you too may join in. I don't often get to talk to anyone who is outside my own tight circle about what it is like to be around someone who is bipolar, what it is like for my colleagues who know about my illness to try to handle it (for me this is a big issue coming at me by the time I am ready to return to work), or anything else. My goal in starting this page was to facilitate communication so that someday I don't have other professionals who I deeply respect stun me with prejudicial statements about an illness they have no idea I have. Well, it's been nearly 6 months now, I'm bored, so let's do it!

*rapid cycling mixed episodes-severe (my credentials)

Day by Day

Things just keep going. I'm a little better the last few days. I increased 2 meds and at least I'm not feeling the dreadful pressure to move, move, move all the time. I'm so glad when I'm depressed. That sounds odd, but to me nothing is worse than that must move feeling. The worst part of depression is that I am not good at crying and when I'm depressed I need to cry. The pressure from that builds up and I think is part of the trigger for cycling into mania. This week I finally cried and so combined with the sedation from both med changes I haven't been doing much besides sleeping or just plain laying down. Boring, but better than the alternative.

On the other hand I have started having to work to stay out of the hospital. Nobody is completely sure I can do this alone. I had to go through some of the worst humiliation I've encountered in a while when I had to arrange for someone to make sure I've eaten and taken meds etc., because of fear I'll forget. I've also had limits put on what I'm allowed to do because what is dangerous now is apparently a little more broadly defined thanks to my body shaking from the lithium toxicity, my not-wonderful judgment, and my mood swings.

Those things were horrible. It has been a long time since I felt like I was so mentally ill that I even needed to think someone else has to make decisions. Now I'm having to adjust to knowing that I can't see myself all that realistically. Yet I hear different things from different people about how sick I am. So I am having to trust that they'll work it out and reach an agreement, and that the agreement will be right for me. This is not easy since I am not that good at trusting.

If I disappear for a while, that would probably mean the hospital has gotten me. I don't think that's going to be the outcome, but it well could be. If it does, I will return. Probably with stories I don't even want to think about.

Things to Do When Manic

Because of my profession (exactly what that is I don't want to reveal because I don't want to be easily identified and there are few people in my profession with bipolar disorder) I have a firm belief in trying to convert the energy and emotions of these periods of my life into actions. I handle it better if I am very busy. I have to watch though as I will get overly caught up in some project and do it all night or without consideration for quality. When I decide I want to do something I have to ask myself if I really want to do it, if this is the appropriate time to do it, if I can complete it, etc. I also have to sometimes try to decide later if what I've done was something good for getting through the moment or if it was valuable; I've made some ugly crafts in my day.

Anyway, this episode has been really interesting because every day I feel depressed and don't want to do much. The night comes and I can't shut up, I can't stop moving, I can't make myself tired enough. So I'm working on a lot of projects to burn energy as much as I can all day long, hoping to sleep at night. (Last night I slept 8 hours--praise God!!!) I thought I'd try to list the things that work. This may help someone else, and I'm sure it will help me because I get to the point I run out of ideas.

1)Gardening---I've killed every weed in my neighborhood. I have a tree I'm trying to kill by digging it up; that didn't work although I got a nice tour of the root system. Now I'm trying to cut it down. I need to buy a better saw though.

2)Landscaping---I'm trying to plant bushes. Every time I start to dig it starts to rain.

3)Cleaning---I've cleaned up the kitchen a few times. I have the car partly cleaned out, but I ran out of tolerance for the sun after a while (it was really bad) and haven't been well on a dry day since. That's still several hours of project. I've scrubbed the entire bathroom, including walls and woodwork. I've done laundry more than required, even changed sheets with silly frequency.

4)Cooking---Hard since my stomach doesn't let me eat much right now. But I've cut up vegetables, made dip, made homemade soup I promptly hated (anything I throw up becomes my enemy and I've thrown up about 2x/week for 6 months), made banana bread (mushing bananas was the best part of this), and done the usual (ok, unusual due to only eating a few foods) day-to-day stuff.

5)Assembling---I've put together an exercise bike that has been sitting in the basement for over a year. I am done to the point that takes two people; I did some 2 person steps but this one I'm not tall enough to do alone. Too bad, because it's almost done and EXERCISE would be nice. (It will not be appearing though because right now my main option is walking and with litihium toxicity I get suddenly exhausted and might not be able to get home easily. At my mother's house where I have alternatives walking works well). I also put up a hammock in my unfinished basement because it is quiet there and I sometimes can't take hearing another car drive by.

6)Fighting---This episode has come with a lot of anger. I've felt like hitting and kicking. I did a lot of searching and found a toy punchbag that looks like a person and bounces back (sort of) after being hit. Blowing him up took 2 days of hard work. He's great to hit, but I have to keep him put away because he scares me when he's in my peripheral vision. (I think he's real.) This is only an option for smaller people because if you're very tall the toy is too short. Real punchbags are an option but require more installation than I wanted.

7)Shredding---I complained to the psychologist about not being able to sit still because my hands need to be busy. He suggested shredding a phone book. I've almost finished the white pages in just over a week. I also have a blister from this--my shredding injury. This works very well though allowing me to watch TV and movies at night so that eventually I calm enough to sleep.

8)Ripping things Up--This is the latest project. I realized today that I have a lot of time, a lot of energy that needs to go places, and a disgusting basement. I think for $75 I can have a non-smelly, clean, usable space. So tonight I ripped out horrible carpeting in the bathroom, removed the padding, threw away all the decor, partially removed the wallpaper border, and was amazed at the difference. It can only get better too. I may actually be willing to use that toilet in the next few weeks. All that is left in there is removing the carpet tack strips (have to buy a tool), cleaning, and painting. There is another carpeted small room down there which needs de-carpeted (first I have to remove this scary black moldy bugnest thing), cleaned, and painted. I have no idea what purpose that room will serve, but the painting will kill the smell so it's getting done. Then there is a big room with glued down carpet. I spent a long time today learning about pulling up carpet. I didn't know I could. But I'm making slow progress, and it's hard work that takes lots of muscle, and that is EXACTLY what I need. This carpet is gross beyond description. Clouds of nastiness come up and it smells like the previous owner's dog pee. (It's much better than when I moved in though). There is brown stuff I have decided IS chocolate on the wall and the dust clouds actually were leaving marks on the wall. When the carpet is up (which is a lot of work and may be December) I'll have to do a hefty cleaning job, paint the walls, and do something with the floor. So the whole thing is a lot of work, but the major expenses will be bleach and soap for me. (I still feel disgusting).

Other plans: Clean the garage, upstairs painting if I ever stop shaking from toxicity, and who knows what. I'll try to keep this updated. And I'll take suggestions! (although not other people's dirty work, I've already had 3 showers in 24 hours)

No Overdoses for Me

I've always said that the only way I would be able to hurt myself would be via overdose. I considered the cutting thing once and when I noticed blood was involved and that it hurt I decided that was not so interesting. The thing is that I have to be very open about this because I have enough medical background to easily come up with a dangerous cocktail. But I have been very successful in learning how to nearly totally avoid suicidal thoughts for 3 years and counting, (to come in a later post because my way is sort of neat and has been very effective) so it's not much of an issue.

I have now learned though that lithium overdoses are evil. I've got an accidental toxicity, which happens sometimes with lithium and is why patients on lithium have blood drawn every few months. Thanks to an unfortunate series of events involving throwing up too frequently to get enough medication in to have a level drawn I am way overdue. And so finally we know why I've been sick for so many months.

My level was nastily high on Tuesday. Wednesday I found this out and was careful to stay well hydrated and I took a lowered dose as the doctor instructed. I spent that night so sick. I had no idea how horrible lithium could really be. At one point I was vomiting so hard I wet my pants while I was crying. I called my family doctor and my psychiatrist and left messages with both at 4:30 AM. (Everyone needs to know about my vomiting first thing!).

It wasn't until Saturday that I was able to walk straight and even then I've been off balance. The cognitive things are incredible. I can't remember anything. I can't follow books or movies or anything where I have to know characters and plots. I forget words. I type and the wrong word appears. Even time is disoriented, although that's probaby related to spending time on disability.
I just had to make a med list because I keep forgetting to take one or more.

I've been off of the lithium for a few days. Tonight I restarted a small dose. I'm very nervous about this. I have a medication for nausea now if I need it, but I'd rather just not get sick. I'm tired of this.

There are so many other symptoms of toxicity. There is not one that is pleasant. Well, apparently you're supposed to be tired, but I got to do this while I'm having manic symptoms, so I am too tired to blink but unable to stop doing things. I just changed and washed my sheets for fun. That is usually my least favorite household task.

Anyway, I've now had a preview and I'm pretty convinced that I will never die by lithium overdose.

Meet Ms. Mixed Episode

In the last few days I've realized that I'm even sicker than I've been thinking. Mixed episodes (symptoms for a full depressive episode and a full manic episode are present together)are never, ever good. My last post was about hitting the severe mark. Worse than severe is a label for "with psychotic features". I'm not psychotic, although if I don't sleep soon I think that will happen. But for now I'm about as severe as I know how to get. Severe enough I'm scared, and while this illness isn't exactly routine, I am used to it now and it rarely scares me.

So, here's my life right now: During the day I tend to get depressed. I sit in the psychologist's office barely able to hold my head up. As the day progresses I get more and more agitated. I try to do big projects, like assembling things, gardening, digging, etc. during those times. By night I'm barely able to sit still and so tired and I can't imagine doing anything else. That's when I have to start dealing with wanting to hurt myself. I won't; I don't really want to, it just starts sounding like something to do.

That means I have to have alternatives. I can't tolerate very much noise; in fact if a neighbor mows their lawn I have to wear soundblocking headphones and play white noise. I'm almost done setting up an exercise area to burn off energy. Very late, when I can no longer stand to do anything, sometimes I can watch short segments of a movie if I keep my hands busy. So far the best way to do that is shredding a city phone book into 1/4 inch chunks. I do that about 2 hours a day.

The most I've slept in 3 weeks is 3 hours solid. Otherwise I sleep in chunks. Last night it was 45 minutes, then up about the same, then 45 minutes. This is becoming painful.

I finally talked to my doctor for a long time a few nights ago. I started an antipsychotic tonight. Unfortunately it looks like I'm going to have to give up the medicine that has given me the most stability for 4 years. The goal is for me ultimately to have some medicine that makes me stable enough to qualify for a last-resort no-medication surgical treatment for depression. In the meantime I'm hoping to be one of the first people on a new antidepressant patch. It doesn't come easy, the patch has potential issues, but for people like me who do not respond to traditional meds it is possibly going to be a huge product.

Work stuff is very stressful because all the paperwork that needs to be done for me to be on disability is not getting done and nothing is being communicated. I need things to go through first so I can calm down about it, and second because I need my disability pay. I'm now 6 days into no pay, and my disability pay starts now, but without paperwork I will not get a check. It's also scary because I left work thinking this was a few weeks, and now it's looking like a few months. I'm too far from better for anything to think of my returning. And of course every day I'm gone something is being lost that I've worked to establish. Not to mention I miss work.

I've just really scared myself this time. I thought I could judge this so well, and that I had come so far, and I was wrong. I won't be trying to make some decisions without more safeguards for a long time. I thought I could do something normal--work overtime for a while--and because I did this my life is going to be messed up for a long time.

I've hesitated over the months to write when I feel bad. I don't want this blog to be the place where Just Me whines. I have um, other places for that, and some of them are getting paid a lot of money for all the sessions right now. But, this IS supposed to be about life with bipolar. Not every patient with bipolar has mixed episodes, and I also am having substantial rapid cycling with this one (literally I am way up and way down every single day), but in some way this is what bipolar is about. Also, this is my blog and I need to use it this way. One of the really scary things I've done this time is not admit how sick I am. First I didn't admit I was sick at all for weeks, just "starting to not feel good", and then "I'll be fine if I rest", and then finally "uh-oh". So, I need to document what this is like because next time through maybe I'll not lie so much and get the treatment I need faster.

296.62

That's my number. It's the number used to describe my diagnosis. Broken down it's bipolar I, mixed episode, moderate severity.

I watch that last number bounce around. Every so often it's a 1 (mild). Sometimes, several times per year, it's a 3 (severe). A 1 means it's time to celebrate because that probably won't last long. A 3 means it's time to hide.

I seem to have hit a 3. I knew things were getting out of control for a while and blamed it on exhaustion, working too much, stressful people, not being able to meet my own expectations, and near the end, not taking my meds because they were making me sick. So I started disability leave, fully expecting to be anxious to return after a week. It's been almost 2 weeks and there is no sign of that happening soon. Instead I'm working on getting back on my meds, starting to eat again, resting, and doing anything that helps reduce the agitation. The psychologist currently has me tearing up phone books, which sounds stupid but really helps. I need semi-destructive, yet safe, ways to take out some of the aggression.

So, at least now I can't say I don't have time to write. I have some ideas. I have something done in fact but I'm not sure I want to post it. But I'll be working on things now.