Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth." Genesis 9:13

Wednesday, January 30, 2008

Diabetes Insipidus and what people don't know

I had a lot of time today that I couldn't stop thoughts of this new diagnosis out of my head. As I said yesterday it brings together a lot of things that have just not been right of late. Even my daily headache now makes sense as I was probably getting dehyrated during my busy hours and then drinking more to help it and just peeing that right out.

I also was much more aware of how incredibly frequently I've been peeing huge amounts. That seems sort of surprising, because you think that you'd notice that your bladder is completely full every 45 minutes, but not me. I had wondered fleetingly why I no longer had vitamin pee, but I thought that was something my body was used to the vitamin. I also have been whining ever since I went back to work about having had to buy bigger pants but the big ones are too baggy. I constantly am retying pants. Turns out that when I pay attention this is because my bladder gets big and full, then empties, then is full again.

At the same time I'm now overly aware of the whole thing. I want answers and I won't be getting those until my next bloodwork. I'll probably get some ideas when I see my psychiatrist next week, but because I've got an established pattern of feeling much, much worse off lithium I want to be allowed to try and to deal with this as long as possible. However I repeatedly read last night that if it is lithium induced the only treatment is removing the lithium. What I don't know is exactly how hard on the kidneys this is. I know lithium causes kidney issues, especially after longterm use or toxicity. What I'm unclear on is whether this is step one of that.

I also need to call my doctor and find out if this new diagnosis is going to mess with my drug test. Somehow I have it in my head that they check urine and don't accept overly dilute urine as it's a possible way to mess with the test. I don't wish to explain how I have this, but I suspect it's better to be honest upfront.

Today had weird moments of discussing mental illness and everyone else discussing how it must be so hard to be like that, and how hard mania must be. This woman has been so manic and driving everyone crazy and it's hard to listen to the things people say, even professionally said things. It's hard because they have no clue that I'm just that ill underneath all these meds. That's a blessing, but it's also a curse.

A huge wave of tired just hit so I guess I'll be peeing yet again and going to sleep. More tomorrow.

Tuesday, January 29, 2008

I didn't need this

The focus of my counseling sessions of late has been my anxiety problem. At this point anxiety symptoms far overreach bipolar ones, and in general anxiety practically rules my life. The thing is that for various reasons anxiety isn't something that I have ever not had, so we're starting in a very difficult place where I'm learning to recognize it and then respond appropriately. To add to this we're working on my being a bit more trusting, one person at a time--therapist first. Which means I'm going to be practicing believing him (not laughing at him) when he says to not worry.

For the last month or two I've spent a lot of time and effort monitoring my thoughts and stopping any thought beginning with "what if". I've actually done pretty well with it, and that's a big deal because my anxiety is typically really horribly bad.

Yesterday I had an appointment with my therapist. I won't see him for 2 1/2 weeks now as he is leaving the country temporarily (a good example of how panicky I get: my last therapist left the country, which left me nervous about that happening again, despite the uncommon circumstances the last time. When this therapist said he was going to this other country I automatically assumed he meant forever; instead he was just mentioning it). I have been really looking forward to a break, because I rarely have one. Usually I have trouble if it gets too long between and just when I was ready to reduce my visits in the fall I got manic. So of course now I have something that makes me really anxious.

I had a physical for my new job today. While there I complained about my ongoing constipation and lack of success with drinking more, eating fruits/veggies, Colace and Miralax. This plus other signs led to a urinalysis and a diagnosis of diabetes insipidus. It's better than it sounds but not good for maintaining the status quo, as I may have to go off lithium. The one good thing is that I'm not falling totally apart; I've been blaming many weird things on seroquel and it turns out probably it was ok.

So now I have a long time to work on not worrying all by myself. Combining this with the thing where I had screwy liver functions last month, and I'm as calm as the sky in July.

I'm glad we found this. I would guess this is just another kick in the butt for not treating my toxicity for so long. But I'm also sad and mad and worried, even though I'm trying not to be.

After all, life isn't fun without a major med issue at least every 4 months (I'd find examples but am too tired)?

Sunday, January 27, 2008

Last full week

I start my new job 2 weeks from tomorrow. I only will work 7 more days in this job. (I'm done on Tuesday of next week). I'll be cleaning out my stuff as I get time this week. That is so, so weird feeling. Most important for me to remember is that I only have to go to the place I don't like 4 more times.

I've done so much better than I thought. My hours have been reasonable. I'm even doing fine with treating more than one patient at a time, which has always been tricky for me. In fact the other night I pulled off simultaneous evaluations, which I'm pretty proud of. I have a pre-employment physical this week. Yippee. I'm actually looking forward to it because I want to try to talk my doctor into more thyroid medicine since my last level was borderline.

I'll be so glad to get my 3 days off between jobs though. So, so glad. I'm TIRED. I went to bed Friday at 7 and slept until 10 AM.

I've also sort of taken advantage of my insurance. I needed new prescription sunglasses because I lost mine and my pupils are so dilated from meds that they are a medical necessity; I am in pain without them and driving isn't safe. This plan from my current job is really good. So I used it to buy prescription glasses and then will use my new plan for this year's exam and lenses for my real glasses.

Otherwise, just hanging on. Bound to get more interesting eventually.

Britney Spears: The Time has Come

I rarely to never discuss current events on this blog. I especially try to avoid celebrity gossip because so much of it is just gossip and it is so often slanted unfairly.

However, I'm tired of the disturbing trend I see with Britney, and now that her sister has announced her teenage pregnancy there is even more speculation.

Britney Spears has problems. I'm not sure why nobody has assumed this would go right along with major stardom and all that goes with it at such an early age. So much is expected of these kids who are into show bisuiness so young. If I'm right Britney was pretty popular at 13 or 14 years old. She was living an adult life at that age, and no matter what her family life was like it couldn't be normal.

Britney obviously has a major set of issues. It sounds like she may well be part of the bipolar club. She nearly definitely has substance abuse issues. These things are making her parenting skills essentially absent.

But people are throwing around soooooooo many ridiculous statements about hypothesized situations. After Brittany's sister announced her teenage pregnancy I've seen several people note "see, bipolar like her sister". First of all, we don't even know she's bipolar. Second of all, bipolar or not, whatever drives Brittany's bad decisions clearly hurts. Third, being related to someone, even someone with bipolar, does not mean you will share this. Jamie Lynn gets to make her own bad decision. Teen pregnancy happens. When I was in high school it was so common that nearly half the girls in my class had babies by graduation.

This kind of thing makes me so angry because it is defining bipolar by the acts of someone who isn't even DIAGNOSED with it, causing many, many bad things to be assumed and publicly stated until people believe them and then generalize them to cover all of us.

The thing is I'm bipolar. Maybe you're bipolar. But our illnesses are certain to be different, and neither should define the other. This whole Britney thing has brought out more negative statements about mental illness than there have been since the entire Tom Cruise war a few years ago.

I cannot even begin to imagine what Britney's life is like. I can't imagine facing such private issues so publicly. No wonder she has struggled so much; every move she makes is criticized and blamed on conditions people start making hard remarks about, when she's never even been diagnosed with those conditions.

There seems to be a problem here.

Friday, January 25, 2008

Time to Rest

A new marker of when it's time for a weekend: finding oneself trying to microwave Cheerios.

Enough said.

Thursday, January 24, 2008


This time back to work one thing has been noticeably different. Each time I've been off work I lost a lot of the physical strength I generally have from lifting people. But both of the other times I worked on regaining it before I returned to work. This time I was still not feeling up to much at the time I returned, and I'm still needing a lot of sleep time. I'm regaining strength but it's so slow.

It's a strange feeling to know I am not as strong as I usually am. I know that the woman who I lowered gently to the floor I could have prevented from going down 6 months ago. In fact 6 months ago I stopped the same thing from happening with someone who was trying even harder to go down, and I held her propped up while people responded to my yelling for help.

It's so weird to compare my new and tenuous mental strength with my physical weakness; it feels like a role reversal.

It's also weird here on this blog because I'm getting less and less hits now that I'm back. I have noticed a trend over the past few years: if I am doing well I get less hits than if I'm sick. I am sure this is partially because I write more when sick, and it's more interesting when my moods are wild than while I'm simply working on believing I can feel good, but that doesn't mean that doesn't seem odd.

I got my W2s for taxes today. I can't believe the small amount of money I lived on for 4 months. I lived on less in grad school, but if you consider my monthly bipolar expenditure is nearly $700 (or more at times) it's impressive.

And the best thing: 4 more days at the place I don't like!:) (Oddly, I really like the therapists, but hate the facility).

Wednesday, January 23, 2008

9 more days

I've now completed 2 full weeks back at work. I'm proud; it hasn't been easy. In fact I'm plain old exhausted most of the time.

Today I got a lot of confirmation that leaving is right. I'm learning that the newer place really isn't a good fit for me. I do not handle doing therapy in a place where the facility believes nursing should tell me what to do and I'll do it. I am the therapist, not the nurse. I have extensively more training than a nurse (it is rare that I work with even one BSN, much less and MSN). I am all for team decisions about care, but when it falls into my expertise I will do it my way or I will not do it. I've been other places like this before. One I transferred out of; the other I made a lot of commotion that I would quit before I let it ever happen again after the first time and it improved.

This new place is just nuts. They want to control everything. It starts with the whole lab coat nightmare and just gets worse as they try to dictate treatment plans and how various situations are handled, rightly or wrongly. The lab coat thing alone is killing me because it is so, so hot. I have to wear shirts under my scrub tops or it's a free for all peep show. So that means 3 layers. I start looking medicinally overheated quickly.

I'm so glad to have only 4 more days there.

Tuesday, January 22, 2008

Rock amidst Chaos

I'm writing this while eating chicken and biscuits with the broken off end of a plastic fork. I'm too tired to get another one from the kitchen. I never bothered with a snack today and I'm very hungry.

For the last many years I have often lived in chaos, yet it was so bad for me that I avoided it at all costs. During the times there have been chaos I've tended to hide from it. Change throws me for a loop. Just something as simple as not knowing what to expect has been known to cause terrible anxiety and cycling. I've tried to learn to handle it with minimal success. More and more that's a treatment focus, and in a few more months of stability I probably will be changing to a more potent anxiety med, although there just isn't anything that meets my real needs (ie won't combine with the current meds to knock me out, can be taken once daily, etc).

Things are not easy. Yesterday was one of the most chaotic days I've ever had at work. Among the highlights was cutting my hand on a wheelchair (ick) and then breaking out from the bandaid. (Told you I'm allergic to EVERYTHING--I've suspected I was developing an adhesive allergy for a while because I get red marks from tape when I have blood drawn. This proves it..). Then I thumbtacked my finger to the wall. My pop got spilled on my new winter coat. Etc. I am now doing more driving than I thought I would be and I don't have any idea what any given day will be like until I'm in the midst of it. The pace is very fast.

I keep counting down days. Two weeks from right now it will all be over. Yet that makes me sad. However, the truth is that over the spring we had many deaths at the place I've always worked and I don't know and love most of the people who filled those spaces. That helps a lot. I got choked up when one of the women I've enjoyed time with pulled out her memory book I made her and showed me she loves it enough she carries it with her all the time.

Things are even weird with my therapist. For the 2 years I have been seeing him (almost 2 years) I've rarely been anything remotely like well. I've hit not too bad a few times, and last spring for about a week on Lamictal and then for several weeks in the summer I was good enough we were celebrating, but major, major problems were still evident. And there were times in there where we had some really hard discussions because I felt he thought I wasn't trying hard enough, and I really think he's only now understanding because I can now verbalize it that I'm not ignoring him when he says I have severe anxiety, I have no clue what not being anxious feels like and I can't stop what I don't have a concept of. Now I'm learning to sort that out. But things are so weird. He is so used to thinking that whatever I say is a negative statement I'm finding I have to remind him I'm joking. We talked about that last night and that I have to give him time to adjust to a different me. This kind of hurt, even though I initiated it. The truth is that I have a long history for various reasons of being kind of spoiled by people who have treated me, and to have one who is willing to say "yes you're doing well, but you still aren't acting normal" or whatever is hard. Good, because the goal is for me to control that stuff so I fit into the world a bit better, but hard.

One of the things he always does is warn me very far ahead and very repeatedly when he'll be on vacation. That has a lot to do with I do not miss appointments. I reschedule if a holiday interferes or I'm sick, and often when I go out of town, if possible. Generally the only weeks I miss are his vacations. One of those times is coming up and because it coincides with the week I start my new job and switch my therapy day to my day off work mid-week I'll go 2 1/2 weeks between appts., which is a record. And I'm actually GLAD and looking forward to a break. After 6 years of therapy this seems fair, but it's a big step that I'm ready finally.

So the truth is that things couldn't really be crazier if someone was trying to make them so. But I'm managing. I'm managing things I never thought I'd manage again. May it please continue.

Sunday, January 20, 2008

How I quit my job

Last week I was feeling pretty stressed about what is the correct way to resign one's job after the company kept the job open (sort of) for months of illness. I wanted to make sure they understood I was leaving for the lower drive-time and other stress-reduction, not because I wanted to be mean to the company I work for. I ended up writing the most detailed resignation letter ever, but it worked. They were very sympathetic about it all.

I'm going to alter a bit of my letter and include it here so that maybe it will help someone else who is resigning for health reasons someday. (Resigning for health reasons felt so touchy because I don't want anyone to think I'm incapable of doing my job. I'm not. I'm incapable of commuting 2 hours a day and doing my job well.)

So anyway, here's the Master of Irony approach to resignation:

To whom it may concern:
I am regretfully submitting my resignation, effective February 5, 2008.
When I was hired by {Company} I was working in {Very Rural County} and was told I eventually would primarily work in this county (which is where I live). I accepted this offer because I needed to reduce my commute time, which at that time was 75 minutes each way. Instead we lost the contract when {nursing home corporation} went to in-house therapies, and that has resulted in my commuting a long distance. I’m back to commuting a minimum of 45 minutes each way and on days I am needed at {specific nursing home} it is back to 75 minutes each way . I have been willing to do this because {Company} is a good company I am proud to have worked for.
However, this fall my health issues worsened and at this time I need to reduce the stress on my body. I have an opportunity to reduce my commuting by a minimum of 50%. After careful consideration I have decided I need to take advantage of this.
So that you understand, my days currently follow this cycle: wake up, go to work, work, drive home, eat supper and take 30 pills (most of which are sedatives that I need to sleep off before safely driving so I must take them early), and then I go to bed and sleep 10-12 hours. I literally have no time to relax, to clean my house, to go to the store, some days even to pick up my mail from my PO Box. I explain this not so you feel sorry for me but so you understand why I must move on so that hopefully I can have some semblance of a normal life and thereby maintain my precious health. At this point I also do not feel I could be the best employee possible for {Company} because the driving takes away the energy that should go towards patient care.
I regret this time has had to come. Unfortunately {Company} simply doesn’t have any facilities near where I am and my personal life is not such that I can move to be closer to {Company}.
I am willing to do anything needed to make this transition as easy as possible over the next 3 weeks.
Just Me, MS, OTR/L

So there you have it. It seemed to go well enough so I guess that's a good way to resign.

Saturday, January 19, 2008

Crazy, fat, and dumb (yet also something neat)

Yesterday was maybe not so great. It overall was fine, but I managed to get holes gouged in my heart. Usually I'm not particularly sensitive to patients, but they hit on things that I am sensitive about right now. They also hit when I've got PMS with my normal issues. And for male readers, PMS plus bipolar is bad.

It started when patient A started talking about working at a local psychiatric facility. Generally I enjoy that kind of conversation as some of my psych facility patients would have been their patients, and most psych employees truly love what they do. This person, however, apparently had a very "us" versus "them" approach to mental illness. In about 4 seconds I was totally infuriated and struggling not to say something I'd regret as the patient went on and on and on about how crazy people shouldn't have rights and should be locked up and on and on. Then they called me fat, to my face. I've gained weight and I'm well overweight, (and truth be told scrubs add to the perception of overweightness because they are baggy and layered) but I'm not THAT big. Sure, size 10 would be better than 18, but there's a lot of sizes beyond 18.

Then patient B said something about not seeing me a long time. I explained I was sick. Patient B's daughter asked if he remembered me. Patient B said "yes, you're dumb".

Thanks? I know not to take these things seriously. I know better and really rarely care. But I think it was just a little much at once since it all happened in 10 minutes. Also the patient calling me dumb was, and to my knowledge still is, a very sweet man. So I'm not sure why he did that.

On the other hand, back in the summer I started a project where I was working with a few women (women tend to like these things more) and making them memory books. I interviewed them about things they liked and had done, searched their charts for facts about their lives, and made little one sentences pages in one of those small plastic photo albums. Each page said something like "you're birthday is August 4, 1920." "You live in room 18." "You played softball as a girl. You say you were a very good fielder". Etc. The books were calming and helped distract the women.

One of those women always carries a minimum of a handful, usually a bagful of stuff with her and wanders for most of the day. Part of her stash is a notebook that her kids enter information about their visits for her to remember. She carries all sorts of things in that notebook, napkins and a washcloth and sometimes things like spoons, and candy. She also is carrying that book I made her around everywhere. I did something good...I know if she didn't like that book it would be long gone.

That pretty much made up for the crappiness of hurtful words. As did a LOT of sleep. I can do this. I think I can, I think I can....

At least this time I'm not leaving with the paper crisis of last time. For those who don't know that story, in 2006 my assistant was fired. At that time I was doing evals and supervision for 2 buildings totalling 300 patients and treatments for any patients receiving therapy in 150 beds. I generally had 10 patients and then maybe 5-6 evals. I was busy enough they were going to hire a part-time to full-time assistant to float between the buildings. It is very hard to find OTs and the manager I had at that time was lazy and a liar. She kept telling me she had help coming when she simply didn't. I was working 60+ hours/week and my doctor is very firm about 40 or less. I didn't have time to do paperwork. I'm talking I didn't even have the bare minimum evals done and that's a major legal issue. The manager told me not to worry about it, they would let me do it when I had help. So this HUGE amount of paperwork piled up since I went weeks with not help. Then I got really sick and was on disability for 4 months. The last few days before disability I got the evals written out and some notes. But I still came back to something like 6 inches of paperwork. Mixed in was stuff I had to deal with from as far back as 2 years ago, when I didn't work in that building. I arranged to come back about 2 weeks earlier than my doctor would have let me go back to my physically strenuous job because she said I could do paperwork until caught up. That was another lie, I quit, eventually she got fired, and I wound up doing paperwork right up to the day after my last day, on my free time. Never again.

Thursday, January 17, 2008


I just published a thing saying I'm too tired to think, but this is too good to forget. Are you ready all you bipolars?

Someone found this blog searching for "Is bipolar boring?". Um NO. That would be why I've got nearly 450 posts....For the love of all that is good bipolar is NOT boring.

I hate it with a passion, but I will say that it prevents anything in my life from being boring. Even meetings at work aren't boring because I have to work so hard to focus.


13 more days

I'm beginning to be very, very tired. I am doing the working/sleeping/nothing else dance. I'm simply too tired to post. I'm reading some blogs, and Sarah thank you very much for the lovely promotion that I haven't managed to get a screen name to thank you there but I will someday when my life isn't all one big run-on sentence.

I can't even remember this week. I know that I will always remember this birthday as the day that I had to set my patient down on the floor. I cannot begin to explain how that felt. It was because she was acting out, but I also know deep inside that it was because I'm not at my usual strength level yet. If I were stronger I might have been able to hold her and yell for help, or to throw her into a wheelchair. I will remember today as the day I discovered I still owe the dentist nearly $400 for my crown because I accidentally was out of network for surgery.

So anyway, I'll write this weekend if I'm awake at any point, and in about 2 weeks everything will return to normal. Or a new normal anyway. Whatever that shall be.

Tuesday, January 15, 2008

Happy Birthday

Today I am 32 and my blog is 2. I've been totally unimpressed with my own birthday; it barely registered in a very busy and stressful day. We'll celebrate this weekend and I will care more; for today it has meant little except that I kept dating things 1/15/1976 rather than 1/15/08. Oopsie.

I resigned my job today. I'll work out 3 weeks notice and then have 3 days to get back on track before starting the new job. It turned out that this was the least stressful part of my day. The worst was later when a patient who can get a little uncooperative put herself in a position where she couldn't hold her balance and wouldn't correct it. I couldn't hold her up for very long because she is big and much taller than me, so I eased her to the floor. That means lots of documentation and I feel guilty, even though I know very well that I did everything I could.

Anyway, the blog is what I really feel something about. I'm glad I started this thing on my birthday. Birthdays have always been hard for me and this has given me something happier the last few years.

When I started this thing my ideas about my illness were so wrong. I just had no clue how sick I could really get. I started this when I was feeling good. However the same night I started it I overdosed on caffeinated iced tea that I thought was safe. I was manic for a couple weeks. When I came off the high I immediately hit rock bottom because my therapist announced she was leaving the country in a month. I spent that month crying and picking a therapist and deciding against the first one she recommended because I thought I wouldn't like her approach, and then meeting with the man I see now. After she left I took a few weeks off to adjust to the new therapist (and to use up a surplus of PTO days). Then my assistant was fired and I got very manic trying to handle things. Then there was lithium toxicity and the summer I learned to cry, sort of. Then I changed jobs, went through a lot with my new job, was very depressed, was stable, was manic, was stable, went back to the job, and today I resigned.

Two years ago I thought I had answers. I think I took a lot more credit for how well I do overall back then. Now I know that doing well is just part of going with the flow. I'm trying to learn to not fight so hard when it's time to handle a cycle. I'm not good at it, but I am trying.

When this thing started I hoped that I would meet others who were mentally ill and working in mental health. I haven't really, and my own career has moved away from psychiatric patients too. In my new job I'll do a lot of dementia work, but that's still different. It's funny though, that I find I'm actually more sensitive to co-workers talking about psych stuff now than I was back in my psych OT days. Maybe that's because I'm pretty sure that these people now KNOW and they still say obnoxious things. Yet I know they do because I am very willing to laugh. I just want everything, I guess.

Anyway, my age is showing and I must be getting to bed. Tomorrow is another big day and unless I'm incorrect I'm looking at yet another day without stopping. Saturday can't come too fast....

Sunday, January 13, 2008

Why doesn't Hallmark make cards for this?

So I'm having a hard time finding the right words for the resignation letter I will be turning in on Tuesday. I have decided to turn in the notice and work it out because I handled last week just fine. I was no more tired than before the additional sedation, so it was basically difficult but not impossible. I feel better about myself this way.

The truth is that I'm resigning for a reason nobody would have questioned in May: I worked part time at least down here (and had been told it would be FT eventually although it didn't take long to not believe that) and when our contact expired it would have been a normal time to say that I didn't want to drive to the city and to get another job. But there weren't any jobs listed that I knew of around here then, and as per my usual (but hopefully former) system of thinking I thought "it's ONLY a little bit more". That's just not so true. Those miles add up and the new job will be about 6 hours less driving/week. Maybe more. Not less.

It's just weird. I didn't go back to a sympathetic situation, but Friday in the place I used to work 5 days and now work 2 I felt at home. Which made me decide to do this. The awkward part is the letter. And if they're mad that too could be awkward, but any anger is me projecting my fears and that doesn't benefit anyone.

But I think there should be pre-printed forms to prevent some of the awkwardness. Who doesn't like a greeting card after all?

Saturday, January 12, 2008


See below post for a good example of what I mean by having good doctors......

As I wrote we talked today about my tremors. The plan was to give it a little longer, probably until my next appointment, while my doctor researched a drug and I had a little time to get back into using my hand muscles for things like writing. Treating the tremors has a lot of risks because it is introducing a new med into my cranky old body, the meds used to help with tremors are not gentle except one that we know I can't take right now.

Left to my own devices I probably would complain but not treat it. So tonight I started taking my depakote dose. I take 6 pills with 2 of them cracked in half in a pill splitter. I got the lid off and started to pick pills out of the bottle. My hand jerked and pills sprayed across half the room. Depakote are so large and I take so many that my monthly prescription is in 2 bottles; I spilled 3/4 of a bottle, meaning 2 weeks of dirty pills. And I have to hope none are lost because my cats should not eat Depakote, and because it is too expensive to lose.

Guess I'm going to have to face facts.
Today was my psychiatrist visit. As has been the common experience lately she thought I was doing really well. She said after seeing such extremes this last year in both directions it was nice to see no mania. I agree 100%.

She had ordered an imipramine level to see how I process that, as part of trying to monitor how all of my meds are processed since poor processing seems to be part of my issue. That's what has finally worked, figuring out that I process them even more poorly than we knew and going for high doses and in the case of depakote we've changed things around until my level stayed at 120. As expected my level was low, but I get manic if much of that is added. Still, if I get depressed we know I can go up further, which I've tolerated in the past. My thyroid is still not great and she thinks my family doctor will give me more thyroid meds. This is good because I truly think my thyroid is the reason behind my feeling exhausted. Some of it is my meds, but it doesn't have that sleepy med feeling to it. I am not sure I know the difference but I think I do.

The kind of bothersome thing is that I've had a lot of tremors and some jerky movements of my hands and mouth. Not anything like the EPS I've had before, but she made a "gotta watch that" face and now I'm trying really hard to not think about it. If it happens it happens. I'm going to probably start an older med for it since I can't take the typical tremor remedy (inderal) because Seroquel has dropped my blood pressure pretty low. She wants to avoid Cogentin as much as possible. So do I. I'm so tired of strong and scary meds.

Once again, here's an example of HOW PSYCHIASTRISTS AND PSYCHOLOGISTS OUGHT TO BE: My psychologist says my anxiety issues are very severe. I've not done well learning the things he's tried to teach me, or at least not all of them, and not the ones that might make a bigger difference. Some time ago he asked me to have the doctor change my anxiety med or increase it. At that time I was taking ativan and had difficulty tolerating a morning dose because it made me sleepy. So I switched to atarax (same family as benadryl), but it is tricky because I have to remember to take it in the morning and mid-afternoon. I do take one AM med but I take it before I'm fully awake, often at 5 AM, and if I took anxiety meds then I would not wake for work. So that means remembering two extra med times and as responsible as I am with meds I have never succeeded with that. We've moved meds and changed to long-acting versions of things over the years to try to help that by putting all meds possible at night. (Thyroid meds have to be taken in the morning). So that worked ok as long as I took both doses but I stink at that. And now I am really too tired still to handle the late dose so I've moved the AM one to noon. Anyway, I was asking about what I knew was the next option in the anxiety line to see if I would get away with one dose. No luck, but the psychiatrist is going to call the psychologist again to talk about this and they can decide together how to treat it. That leaves me out of trying to figure out how bad it is when I know it only as how life has always felt.

I'm too tired to remember more. But it is 2 months without med changes (although the tremor med may happen and the other doctor may change my thyroid meds), and that's a very, very big deal.

Thursday, January 10, 2008

Lab Coat

I forgot. Lab coat update (see Therapy Cat post). After buying one, dying it blue, bleaching it white, and being careful to wear the stupid thing to work because heaven help forgetting it, nobody actually wears them. I'm not sure what the deal is; they said I had to have one. But it's like as long as you physically own one in the room you are allowed to live. Which is good because it is HOT in there.

But why did I shell out $15?

Sensory Dysfunction-and more

I have finally found the PERFECT example of what sensory integration issues are like. People talk a lot about it feeling like being aware of the seams of your clothes. That's true, but I've found a new really big issue. Teeth.

In the past 2 years I've had a ton of dental work done. As I've mentioned before dental work is very hard for me and I simply didn't do it for a number of years. The one time I tried I bit the hygienist accidentally when she gagged me and she was kind of mean about it. (Understandably I guess). However I had too much vomiting over the years from meds, and it damaged my teeth. So last year I had veneers (I think that's the word) on several front teeth, and I also had several old fillings replaced. Since my dentist does cosmetic dentistry and I didn't really know what that even involved I was thrilled when he fixed my teeth. The day he did the front teeth he kept grinning and telling me it would be worth the discomfort of getting something like 6 teeth worked on at once. It was. It really, really was. I love it.

The thing is that there are a few places that I can feel the seams. I have had a tendency ever since the first ones were done to rub them with my tongue. I'm finally used to them, but I still am aware they are there.

On Monday I got a crown placed. While it is really great to bite without the pain that has been in that tooth for at least 18 months and which was getting worse and worse so that I never knew if anything I bit would hurt, the crown itself is somewhat driving me bonkers. I cannot keep my tongue away. It doesn't feel like a tooth; it is very smooth and just different. I'm aware of it.

And THAT is sensory dysfunction--awareness of a tooth.

(Although I should add for the sake of honesty that I also am very concerned about any oral movements after having EPS once. When that started I was too embarrassed to say anything at first and it wasn't until even people at work were asking me about why my tongue kept coming out of my mouth that I admitted there might be an issue with Geodon. Duh......If your tongue moves constantly, you're on an antipsychotic and you're not pretending to be a snake on purpose you need to talk to the psychiatrist ASAP).

As for the more.....Two days down. I'm a bit concerned because my regional boss left a message on my home phone to call her. I'm confused about this since the logical place to reach me during the day is at work. It's another thing my stress level could do without. It's unusual, to say the least, for this to happen.

Anyway, time to get the last night med, pack a suitcase so I can stay in the Big City tomorrow for my psychiatrist appointment Saturday, and get to bed. More as it unfolds....

So tired

I was asleep before 8:45 last night and slept until 7:30 this morning. And I am wiped out. I can't believe how tired I am after that much sleep. It's not like I've not been here before, but wow.

Day 2...here goes nothing. I'm hoping that I get the same patient mix today, which should get me out a little early. Yesterday my day was extended by a meeting and orientation. Today I hope to just get through and leave. Not sure what they planned for me. They don't seem interested in a gradual start though.....

Wednesday, January 09, 2008

Two more days

Today was hard. But I actually did better physically than I thought I would. I got extremely tired, in part due to extra walking while I tried to learn where my patients were. I also was very hot due to the stupid lab coat requirement which added to the tired.

The drive was "only" an hour in the morning and maybe an hour 15 minutes in rush hour going home.

I am dealing with a lot of guilt. Every time someone says "and now we're fully staffed" I cringe.

I also heard from the new job and there is short term disability. Thank God.

The best part of the day was that when I was driving to work there was a rainbow and it wasn't even raining. I really needed that lovely reminder that God is in control.

And now I shall be going to bed.


Tuesday, January 08, 2008

Therapy Cat

First, please see below post if you haven't. Much more important than me freaking totally out.

I have 3 cats. One is considerably older than the other two and we've been together a long time, and we've been through a lot together. We are pals. She was with me during my pre-diagnosis years, and learned how to best react when I am crying without stopping for 2 days, when I'm yelling at the wallls, when I can't get out of bed, and when I can't stop pacing. She's also very sensitive to my stress level and when I'm stressed she always climbs up and tries to calm me. Tonight she's very busy with her job.

I am going back to work tomorrow. I'm scared. I've been feeling so great and if I were going back to a good situation I'd be a little less scared, but I'm not. The first thing is just that I know working is really hard on me and I'm not likely to feel this good after working a couple of weeks. But I'm not going to a good situation. I haven't said much about this because I have a fear of retaliation if the wrong person reads it, but really not much can happen that is worse than what I'll probably be doing in a few days. My company is politely saying "leave you crazy lady". I've been reassigned to a place an hour and a half from home, a place I've never been. I am not capable of driving that far. I'm not sure anyone really should do that. I have; it was hard. I've also heard it's a tough place to work.

I have another job lined up. I can start as soon as I can start. But I have to quit first, and well, that's sort of ugly. Too complicated to explain, but therapists generally are asked to serve long notices (this one is 3 weeks). I seriously doubt my ability to work so far away that long. So I'm going to have to just quit. I'm hoping my doctor is going to say it's a medical thing and that this sort of protects me a bit from the fallout. We'll see.

The new job is only 30 minutes from here and is 8 minutes from my mom's house. It's in the city I hope to move to (which of course is even further from the psychologist and psychiatrist). I was able to get a 4 days per week deal and that will improve my life immensely. It has a better productivity requirement and better meets my needs in a ton of ways. It won't be perfect, no job ever will be, but at least they want me there.

So today I was trying to get ready for all these changes. Unfortunately the day just stressed me out. I got the employment packet. I have to sign a thing allowing a very thorough background check, at their discretion, including things like a credit report. That's the kind of thing my paranoia doesn't handle well. Small thing. Then the benefits papers don't show short term disability as a benefit. It's listed on the webpage, so I imagine it's there, but that frightens me. I also still haven't been able to determine if my psychiatrist is a provider or if I'm going to be out-of-network. I won't quit seeing her, she's been my doctor for 5 years and she's awesome, and I already pay a huge amount to see her, but still--stress. I'm trying to eat healthier at work so I bought a bunch of 100 calorie packs, peanuts, and salads to take along. I bought caffeine free pop for lunch and I'll drink water otherwise. No snack machines. I have to get a drug test. I'm on no narcotics, but it's just weird to think what if one of my meds triggers. They're prescription, so it's ok, but I don't want to start off with a conversation about my anti-psychotic. I had to buy all new scrubs so I washed those earlier. I also had to buy a lab coat for this new place. (I won't go into my feelings about being forced to wear long sleeves when getting hot is bad for me). I threw it in with the scrubs and it is now pale blue and soaking in a soup pot full of bleach water. When the scrubs come out of get-the-starch-out-wash-cycle-2 it will have to go back in. And since it needs bleached and I just did laundry it will be all alone and therefore wasting water.

And yes, that's all a bunch of run-on mumbo-jumbo, but I'm freaking out. Or I was. Better now. I just have to handle 3 days. Anyone can handle 3 days. I'm sure I can go to work tomorrow just like I've not been desperately ill, even though it's pretty reasonable to have a little time to ease in. Of course this company didn't even give that at the beginning really.

Soon I can move on and eventually we'll come back to a discussion of "how do you keep working when it is not good for your company to employ you?". I do understand their situation. I really do......

Monday, January 07, 2008

Bipolar Bloggers Unite

OK, you can scroll down if you want to see tonight's entertaining story of being bipolar. But there's something we all need to do. I've done it; the rest of you can do it your own way.

Back in November for a few days I kept getting a ton of searches about whether bipolar patients are dangerous. I believe this was because I once did a disgruntled post about a stereotypical portrayl of a bipolar on Roseanne.

I realized there were clearly not enough pages saying no, we are not dangerous unless certain bad circumstances arise. So I wrote this.

I still get way too many searches on this. It seems pretty clear that a lot of people believe we are to be feared.

Please, write a post about how we are just people. People who are more prone to extremes, and sometimes violence through that, but people. It makes me hurt to think of the number of people who think we are all violent. The only way we'll ever get to live free from stereotypes is to counter them.

I'm begging you. Mine isn't the one that should pop up so often, it isn't anything special. If everyone says something we'll cover this more fully and the question might even go away.

Why manic cooking has limits

Back in late September I was extremely manic. Hadn't slept in a month, had to be busy every minute of every date, couldn't shut up, the world is spinning a million miles an hour manic.

When I am manic like that I tend to try to find projects to stay busy. My therapist hates this as I tend to choose things that involve knives. Last year he made me give him my carpet knife, despite my promises I could use it safely. (Note: I could not. I am far too shaky on a good day to use razor blades.) It took a good month to earn that back and another to admit he was right. This year I found a way around him: cooking. I pointed out that he couldn't have all the knives in my house and he had to trust me for something. I guess I was technically right, and my mom did supervise the most dangerous parts.

Anyway, I did a lot of canning and freezing. I froze 16 pints of applesauce. In making the applesauce I learned that peelers and I aren't friends; I had 4 fingers bandaged for a week. But the end result was worth the pain.

Until tonight. I finally started eating at 9:45, bland foods for my angry stomach.

My first bites of applesauce were the usual delectable yumminess. And then there was the weird bite. Turns out I had mixed in one of those "quality sealed" things and frozen it. Yummy.......

Sure hope nobody else has found weird things...

Sunday, January 06, 2008

Here goes

This is Sunday. Tomorrow I get the rest of my tooth crowning procedure. Tuesday I have some errands scheduled. Wednesday I go back to work. Thursday I start working in the place far from home.

I have a stomach virus. So far it's not vicious, I just have a fever, upset stomach, headache, body aches and fatigue (just what I need).

Can we say not what I need?

Friday, January 04, 2008

Just Stuff--and see if you can read between the lines

This has been a big few days. Yesterday I drug myself to the hospital for my thyroid check. I'm so sure that I'm feeling so tired because of that. My therapist confirms he didn't see signs of depression. I feel no depression. I am just exhausted. There are other things. My hair is back to falling out. This time it's a bit alarming as I've been more aware of how many gray hairs there are. I had my first noticeable in the mirror at all times grays a year ago, and if you look closely they are always there, but now I have a lot more in just a short time. Of course the last 2 years have been really stressful in general and stress does that. I can't believe that in 2 weeks this blog (and the coincidental story of how my life fell completely apart for a while) will be 2 years old.

Last night I needed to take on clothes shopping yet again. I should have a bunch of scrubs here any day but I have no casual or dressy in any way clothes except for one sweater and khakis. I wore those to a meeting last week and since I had another meeting this week with the same people it seemed wise to get new clothes. I discovered something: I've felt terrible shopping down here in Cow Pastureville because there are no clothes or selection for overweight women or for young overweight women especially. And even if I found something it invariably did not fit properly.

I went to the Kohl's in the City and lo and behold, a real women's department. Complete with things that I liked and which fit well and made me look nice. I finally felt remotely attractive for the first time in months. Wearing clothes that are falling off you does that after a while, you feel like a blob.

I talked to work about my return next Wednesday. I learned that I've been essentially reassigned to a facility even farther from home than I already drive. I'd anticipated this as a possibility and after today's meeting things will work out. I may have a really, really hard month ahead though before things change.

Read that as you will. I can't say specifics. Details to follow on the 16th. Assuming I survive that commute that long...

Wednesday, January 02, 2008

How your treatment could hurt you

This seems to be my week of public service announcements--my how to find a doctor post has gotten more response than any previous post initially has. Since that was written in response to people posting elsewhere and this issue is from the same group of topics, maybe someone else can benefit.

This is another topic every bipolar patient should know. No matter what. And it's one of the reasons I'm against family doctors trying to treat bipolar; it is not something they often take into consideration. I don't think they often even know it.

It is very important that we all are aware that antidepressants can cause cycling. Further, if used for a long time without mood stabilizers or even with mood stabilizers that aren't working 100%, antidepressants can make you worse.

By the time I was diagnosed I had been on 11 antidepressants. With all but one I would take it for a few weeks, maybe get some response, have the response diminish and find myself even more depressed. I was on every dose of nearly all of those 11 antidepressants, plus routine ativan and lithium by the time I was diagnosed.

The day I was diagnosed the doctor closed his laptop and said "You've been on a lot of antidepressants. You don't have to do that anymore". By that point I had found out the reason for this, but it was one of the most comforting things I heard that day. (Although I actually wound up back on antidepressants eventually).

Antidepressants can trigger rapid cycling in susceptible people. The more rapid cycling you have the more it can increase your cycling, both in severity and frequency. I cycle so rapidly that it is often apparent that I go through 3-4 cycles in a therapy session (1 hour). This is probably because of the ridiculous expose to antidepressants. The rule of thumb is that if you have a patient who has had bad responses to 3 ADs, then they need to be evaluated for bipolar.

When you are beginning treatment it is ideal to be off all antidepressants. It is best to be stabilized with mood stabilizers first. Some are more useful for depression, some for mania. Lamictal is the best for depression; in some people it will act too much like an antidepressant and can cause some activation. That happened for me this spring when I was on it, although I was on an antidepressant as well. In my case I just lowered the antidepressant a bit. Lithium has a quality of being protective against suicide. It also has cognitive protectiveness. It is more for mania, but those 2 things fall on the depression side for me so I tend to think of it more as a "both sides" drug.

Over time you'll find the right mood stabilizers. I get so upset when I read how badly people are still hurting because they're still on the first drug combination tried, or something close to it. If you feel your drugs aren't working they probably aren't. There is nothing that says med changes can't be ongoing; mine are nearly monthly, sometimes sooner. As I've said I change some of my meds within parameters at will. The only reason for not trialing different things is a doctor who isn't doing their job.

I re-started antidepressants about 2 years into treatment because I'd had a severe depression and the med that saved me (Geodon) also gave me extrapyramidal syndrome, which is something you don't want if you've never had the pleasure. I had a history of doing very well on remeron for most of grad school, which were my early sympotatic years. So I took it for about 18 months until there was a side effect issue, then switched to imipramine. We trialed not using it since Seroquel is supposed to help depression; that was a no go. The funny thing for me was that I'd been on essentially all antidepressants available. The doctor hesitantly said "well, we could try imipramine but it's older and no more likely to work than all the others." Turns out imipramine has been magic for me, at tiny doses.

I take the antidepressant with a lot of care. It is definetely one that I must monitor. If I start getting manic for any reason the dose goes down. I take an absolutely bizarre dose that we've custom determined. To get the dose I feel best at I take 4 small pills rather than 1 big one because 10 mg matter to me. My dose goes up and down in a 30 mg range throughout the year (I have to be even more careful taking ADs come summer).

The point of all this is, if you are taking an AD and have never had a serious trial of coming off the AD and attempting stabilization with one or more mood stabilizers then you haven't had a treatment in line with what the bigwigs suggest. It's fully possible you're like me and need an AD. Emilja uses mood stabilizers to allow her to take higher dose ADs than she could without because of mania without the stabilizers. We're all so different.

But if you're on an AD and have never gotten the feeling that your bipolar is controlled, take control. Don't take yourself off; some of them are buggers to get off, but work with a doctor. As always, the best doctor you can find, even if it creates inconvience.

Tuesday, January 01, 2008

What shall this year bring?

I have realized just over the past 2 weeks or so exactly what 2007 was for me. 2007 was really hard a lot more often than it was easy. Nine bad months to about 3 better ones.

At the end though is an answer. I have fought bipolar tooth and nail from before the time I was diagnosed. As I keep saying it has been over 11 years since I've felt this well. One third of my life lost in a battle for a wellness that I couldn't have.

Last year I learned that bipolar is a significant disability, that I don't get to be "normal" and that pretending to be "normal" is dangerous for me. That was oh-so-hard.

In 2007 I came a lot further. In 2007 not only did I finally accept that I was sick and that I couldn't pretend or ignore it into submission. As I gradually started to learn that I notice something in my writings, here and elsewhere. Around the time that concept became concrete I started being absolutely perfect in taking my meds. I do not forget. Ever. And I think that has made a huge difference. Strange since I really was good before, I maybe missed a dose of something once a month, but since I've been really forceful about it (and I quit fighting taking a LOT of meds) I've gotten better and the cycling leveled off.

The big lesson of this year though has been that I finally took a look and I get it. I don't just have an abnormal form of bipolar, I have a very severe one. I feel like I often don't fit in even with other bipolar patients because my illness isn't the same. Between some symptoms and my med reactions I've had to go through more than most bipolar patients. I'm just now understanding that it is ok to acknowledge this. I've always felt like I shouldn't try to explain the differences. I thought that acknowledging this wasn't fair because bipolar sucks no matter how serious the case. Now I realize not accepting my own circumstance isn't fair to me. Often that is true, but I'm understanding now that if I try to put what I've experienced into words sometimes I find someone else who has been there too.

Who knows what comes with 2008? I'm due for a year that is easy. I'm praying for a year without disability leave. I suspect that what happens there is going to play a big role is figuring out my working future. I may or may not have a happy thing coming in a few weeks. More on that later. I definetely am finishing the oral surgery of 2 weeks ago. I cannot wait to not bite down on things that bring tears to my eyes.

We shall see.