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

Monday, October 18, 2010

Bipolar: What NOT to do

As is probably fairly obvious I have been taught my cognitive ways to control my illness as well as medications, lifestyle management, stress management, etc.  I know a lot about it, I know that I have to monitor it all the time, and I know when to react.  I know how to talk myself down from panic when I know I have symptoms, and I know (more or less) when I need to react simply by making one of the (many) med adjustments under my control and just notifying Dr. Brain, when I need an extra visit with Dr. Mind, when I just need rest, when I need to give it 3 days to see a pattern and when (today) I need to decide that those 3 days don't matter, I can tell what is going on and I need to do things to fix it NOW.

I am also supposed to be careful of where I let myself go.  After talking about gynecological visits in my last post I'll continue that example.  Until now those visits have been so painful and unless the doctor happened to be good at keeping me focused (until the current doctor that would be one out of the say 6 I've seen; I've never gone back to anyone because the only one who was not horrible and awkward handling my PTSD moved away before I could see her again) and engaged in what was happening now and not what my mind might be bubbling up that we simply knew they'd be traumatic.  Now I have one coming and we'll prepare, but not like it used to be because I feel a lot safer knowing I'm not in for horrible pain and an uncomfortable doctor (how a gynecologist could be uncomfortable with sexual abuse/assault is one of the great mysteries in life), but until now those appointments have required about 3 months of off and on discussion, usually 2-3 cancellations before I made it in because I have to be in the right place to handle it.  Essentially I have to be aware of myself.  I have to be ready to do it, and I have to be ready to back away if it doesn't work.

What I'm saying is that I need to pay attention to myself and my symptoms.  I also need to pay attention to what my reactions are.  When I knew Friday I was overreacting to things because I was so exhausted I did 2 things wrong. One was that I didn't pay enough attention.  I didn't think "Is this symptoms?" because I had multiple things I assumed it was instead.  I thought that it was too soon to have symptoms, despite the fact I was at risk because I reduced my Seroquel dosage last week back to normal with the additional PRN.  I thought it was tired and stressed about money/job change/buying cars, and that resting some this weekend would help.  Even during the weekend when I had a dream indicating I was worrying way too much about something and that it was the kind of excess that means "needs meds" I ignored it.  The second was I reacted wrong.  Friday night I got home and fell asleep without meds.  That shouldn't have happened; I shouldn't have done anything until meds were in me when I was that tired and overwhelmed.  Dr. Brain has said before that if I'm having or recovering from the kind of episode I just had and can fall asleep unmedicated when my brain is used to the HUGE hit of meds then I am completely exhausted.  Completely exhausted is not where I should be, even though some of it wasn't my fault (see motel stay with middle of the night call and clock set to the wrong hour tricking me into being awake at 3).  Then when I was so exhausted I was right to rest, but I did not pay attention and so was up very late (mania, not just whatever distraction I thought it was; there is no distraction so great as to surmount my meds, on purpose) before I thought to take the extra Seroquel.

So what's now happened is that my symptoms are back.  Under control because I reacted today, and monitored because I've let Dr. Brain know both "my sleep is screwed up" and then later "I am screwed up" and so I'm immediately back on the increased dose of Seroquel which I will not be likely allowed to wean down from for some time now.  I've been worse.  Much, much worse, but even the last several months have had plenty of "worse".  But I am very tired and my patient made me cry after I left his home and I don't want to go back there and I don't have a choice.  He just makes me SO. TIRED. because he basically thinks that it is my fault that his recovery hasn't been faster (it's ahead of where I would guess it would be on average for this condition with this severity) and that I haven't helped at all, yet it is my responsibility to achieve 100% recovery and my fault if that doesn't happen.  I can't ever promise anyone that.  You can break your finger, wind up in a cast, have difficulty pulling up your pants after you pee and I can not promise you it will be exactly like it was before.  So I have to go and humiliate myself tomorrow asking people to back me up.  This patient really has a good outcome to date and I am beginning to fight to believe that it really is true because the patient has me believing I have destroyed their life.  Oh, and I'm allergic to something like I've never been allergic before.  No runny nose, but my face and neck are burning and itchy and blotchy and my eyes puff up and I have made my face bleed scratching at it.  I'll take zyrtec tomorrow, I can't tonight because I took a derivative of it earlier to stop the itch when it was all I had, but wow.  I don't know what it is, I've never had fall allergies like this.

And now it's time to sleep.  I even left a patient note for tomorrow.  Granted it will take 10 minutes, but I'm just too tired to do it tonight and so I'm convincing myself I can do 10 minutes of it in the morning.

Gonna be a long week......

1 comment:

WinnyNinny PooPoo said...

I sympathize on the itchy hives. I'm a hiver big time.

About your patient - I understand.
My BIL has results from a major stroke and he has a hard time (in fact make that impossible) always remembering what is wrong and that things like a wheelchair WON't make his legs work again like they used to. It's hard on him and hard on everyone else because we don't always know what he has internalized as a belief about his condition. He and my sister have worked very hard to get where he is now (with a hemiplegic walker he can walk across the house to the kitchen, bedroom, and bathroom) but it has taken 3 years of extremely difficult therapy.