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

Tuesday, June 21, 2011

Continuing education-not

I have  the lowest caseload I've ever had right now so I spent part of the afternoon on continuing education stuff.  I had several behavioral health courses to take and decided to get them over with, knowing they were likely to have parts that annoyed me.  They did.

They had one part that made me nearly laugh aloud.  The general statement was that bipolar sometimes manifests in mixed states, explained what they are and why they are dangerous as well as I've seen this done, and then stated that people in mixed episodes generally need to be hospitalized and have limited potential for benefitting from treatment while mixed.  I actually had to stop myself from going to show someone to laugh at this.  I have been in a mixed episode for most of the last 10 years or longer and the only time I've been hospitalized it was for one of the rare times I was "only" depressed.  And I have benefitted greatly from treatment while mixed; I think one of the criteria used by my doctors for pushing hospitalization not benefitting in therapy while feeling horrible.  Granted it was not quite the type of therapy our agency provides and I will admit that at times it becomes necessary for treatment to be more supportive than anything else (have I been showering? paying bills?  getting sleep?  taking meds and using PRNs to make myself sleep even when I don't want to). How am I coping with _____?  Therapy is basic usually while mixed, but not always; it was during a long mixed episode that I learned to trust Dr. Mind sort of, to cry without panicking and forcing it to stop, and how to communicate to him how I felt.  I learned to use guided relaxation while mixed despite failing at this many times before that.  And I work mixed a lot.  So I think they need to check their facts.  I'm sure it has to do with there aren't a ton of people who have the severe, long, combined with rapid cycling mixed episodes that I  do, and so I've learned to live with them more than someone who has one every few years which is more what the course was describing.

The other part where I wound up laughing was when I scrolled into the medication section.  One glance and I thought  "lithium" and sure enough it was.  The funniest part is there are 3 forms of lithium: capsules that are regular release which I took for many years until I'd thrown up so much lithium that even smelling the capsules made me gag; Lithobid/generics thereof which is time release; and Eskalith/generics thereof which is also time release but slightly different, I think it si not as gradual or controlled as lithobid.  I've been on all of them and for whatever reason when I changed to Eskalith to get the dosage that it is available in only in eskalith, thus saving me from cutting pills when I wasn't well it turned out that I tolerate Eskalith better than either of the others.  I think that's mostly association; I think I was using the capsules when I got toxic, and was  on lithobid during the months of fighting to get a dose I could tolerate  once we knew I had to be on lithium to manage even  at a tiny dose, and then eskalith started as an attempt to get a more precise dose and has worked out to be the best way for me to take it.

Regardless this all made me think about if I was given a bowl of psychotropics I could probably identify a majority because of being on so many.

Falling asleep, better go.


Jean Grey said...

I think that the problem is not that people in mixed states can't benefit from treatment, it is that 1- most doctors are too scared of them to want to treat them, and 2- they are going to make the kind of short term gains that insurance companies want to see. I have been through a lot of therapists, and it is the rare therapist who can see me through my really bad times and be helpful and not try to get me into the hospital. But I've had a couple who have been really helpful.

Jean Grey said...

That is, they are NOT going to make the kind of short term gains that insurance companies want to see.