It's all relative

This last week I've been pretty quiet. I'm struggling and tired and just don't want to talk about it much. It's so very, very hard to consider even mild depression. Which this is. I just don't want it to be possible. Years ago when my diagnosis was "recurrent major depression" my psychiatrist wanted me to remain on antidepressants longterm without any trial off them after 6 months of remission, as is usually suggested after an initial severe depression with medication treatment. This was because of the severity of the depression, some of my risk factors, and because I had been through several other fairly severe depressions without treatment because I refused it. I insisted on trying it because I might fall into the small percentage who did fine forevermore. With bipolar I know perfectly well that each episode and each good period are not going to be the magical time that the bipolar goes away forever, but a tiny hope always remains.

However, after having had the year I have had it is very hard not to be sensitive to any sign, even if it could be normal. For example, I have been working long hours and work has been emotionally hard. Therefore it is normal to be tired. In addition, my new med can cause tiredness at first, although I've been on it 3 weeks now at a low dose and probably am out of the side effect zone. I am EXHAUSTED. So is this normal, or is this depression? My work hasn't been very good, but I'm tired. Normal or depression? I'm cranky. Normal or depression? Nobody can tell me how I feel, and I'm not even all that used to worrying about things at this level. If I hadn't been feeling so great lately this might be considered good. It's all relative. And that is confusing.

So anyway, after sleeping many, many hours last night and still feeling pretty low and tired I've now determined that I am depressed and that it's enough to warrant asking for some medical treatment.

Posting may continue to be sparse. Or not. Who knows. Hopefully though in a few days I'll get the meds changed. Again.

Christmas Sensory Integration/Bipolar Disorder Style

I tend to get grumpy this time of the year. Partly this is because it is a busy, stressful, time, and partly it is because it is a time filled with a lot of sad memories of abuse, divorce, craziness, and associations having nothing to do with nativity scenes or Santa Claus. But partly it is because this is one big overload for me. Everywhere you go there is more and more sensory stimulation: bright lights, often blinking. Crowds. Music. Noise. Chaos.

I manage my sensory overload issues by tightly controlling them. My house is kept extremely quiet. I watch tv occasionally, but only if I can handle it and only certain "safe" shows at a low volume. There is never music. I run the dishwasher on a delay while I'm away or sound asleep because it is intolerably loud. I sometimes have trouble tolerating the noise of the water heater of the basement dehumidifer. Even a shower can be too loud and some days I don't take them.

I knew that this would be hard. It always is. I went prepared with a lot of earplugs, but I left them in the basement where I couldn't get to them all day. Stupid.

So today as I progressed through the day I realized how much effort it was taking just to handle the sensory input. I have learned to use more coping tools to handle this in the last few months, but they aren't really socially appropriate, so they stayed home. So, this was the day in review.

I got up per my usual procedure and took a shower with my carefully selected scents. I got dressed in a very soft sweater and new jeans. I loaded the car, dealing with crinkling paper and banging doors. I drove to my mother's.

At my mother's there were many, many more food odors than I am used to. That alone bothered me. I was cooking and touching many textures, and again this added stress. I had to manhandle all my presents again, with more noise. And my sister's dogs were there, although my sister and her husband weren't yet, so it was loud. Normally my mom's house is an extension of my own and I feel pretty safe there, but this was the beginning of overload.

Not too long into it my jeans starting buggling me. I knew they were loose, but they felt tight and bunchy and like they were poking me. They were itchy and I was more and more aware of discomfort through the entire front.

Then I got hot. Nobody else was hot, but I was miserable. Eventually I put on my mom's shirt, which felt too small and tight as well.

We opened presents. That too was loud. Too much paper. I handled it well though, and only needed one ativan this year. (last year I was into the ativans before the unwrapping started). Interspersed with presents was cooking, so it was like noise, textures/smells and noise, noise/visuals, intermingling with no recovery time. And of course my pants. Oh those pants. I finally had them undone, thinking they didn't fit or something and all I wanted to do was rub my fat belly, which isn't exactly attractive. And my bra started poking me. I hate this bra, but since it is the same size and style as my others (just newer and therefore should fit better) I keep trying to convince myself I can wear it. Guess not.

Then there was eating, with more noise and now a lot of tastes. Since I tend to eat one course meals a lot this also is excessive; I am very aware of taste and smells, and other people's noise.

Then clean-up, with a new bunch of noise. This is where I lost it. I kinda yelled at my brother for yelling. Oh well, somewhere in here my family needs to learn to respect that I have issues. I guess.

I then had to get home to take meds, so I packed up and drove home and now am enjoying the blessed quiet and anticipation of my weighted blanket in about 3 seconds.

What a big day.

(And my poor belly is all red and broken out because my body hates new clothes).

Merry Christmas

Merry Christmas to all, and to all a good night (from one who has slept most of the last 36 hours away)!

Not gone too long

I'm back, for a moment. Except not really to say much except that things are getting really hard. The stress this week was pretty unbearable. Yesterday we had 2 patients die in a couple hours, something I have never seen before. To make it worse, one was in a medical emergency situation and it was just traumatic. I don't want to go further than that, but essentially I saw someone die yesterday in front of me, and not peacefully like 99.9% of nursing home deaths are.

I've also had issues with either too many hours of work and not enough me, or misunderstandings about hours to be shared and variations on that theme. I have cried twice at work. Not a good place to cry, especially when it wasn't related to the deaths. Today it was because I worked really hard to re-arrange today and work tomorrow so I could get a haircut tonight. Somehow my assistant left me an extra patient to see today who had to be seen today, so I had to cancel my appointment. I can't get in for another week, not to mention they probably hate me because I cancelled so late. It was just so frustrating and disappointing, because I NEVER take time off early for myself. I juggle things around for doctor appointments and that's it.

I still have a lot of wrapping to do and no desire to do it. And I have a lot of busyness ahead. I work tomorrow. I have Sunday off; Monday is Christmas. I work next Saturday and New Year's day. I expect to go to the psychiatrist the following weekend. The weekend after I have plans. Which means I don't get to have a "just me" weekend until January 20. On the plus side though, I have vacation for a few days in February and am going somewhere warm. I'm getting more and more excited.......

So anyway, I'm very cranky here. This is really hard because in all honesty I think what I'm feeling is normal for my circumstances. But any deviation from good is scary right now because I'm so afraid of getting sick again.

So, hopefully the next post will bring lots of cheer. I'm sure it is in here somewhere, probably behind the gift wrap and boxes......

Just so you know

When I was a senior in college I was severely depressed my last semester. Thank God I was down to only a few classes I really needed, and I was able to cut my schedule down to basics. I did a lot borrowing other people's notes, taking tests at later dates, and getting lectures about how this was wrong from a certain professor who I still resent, and who is allegedly quite popular for his caring and understanding with students. Not my experience, he was actually rather mean and non-empathetic to me, but whatever.

Anyway, I wound up on an antidepressant that was pretty heavily sedating, which just made things worse because I wanted to sleep all the time and do little else. It made me sleep through things for the first time in my life and I became somewhat paranoid about this.

When finals rolled around I had a few classes that I really needed good grades. Because I was never a very good test taker I had rarely been in that situation, relying on papers and labs to increase my grades long before finals. So I studied even harder than usual for those tests that were for 4 classes strategically arranged in my scheduling plan to be easy. (I had a dual major so I planned very precisely as a freshman what classes I'd take when and then took very full loads each time except that last one; I had planned the last semester which I wouldn't have needed if I had only done one degree to just finish the last 2 classes for the major that came easier to me and allow me a few electives/grad school pre-requisites.)

My very last final ever happened to be the very last possible time slot. We tried so, so hard to study for that final. We did. But somehow we found ourselves doing all sorts of crazy things until later than my medication usually let me stay up if I wanted to be awake the next day. (For example climbing on the roof of the old student union building....) So I had not been asleep terribly long but had fallen into a very deep sleep, the kind of sleep that feels like it has gone on for weeks, when my roommate came in about 2:30. I woke up, saw the time, began screaming at her at the top of my lungs about why she had let me sleep so long, didn't she know I had a final, and throwing on clothes. I was fully dressed before she was able to push me down on my bed and inform me it was 2:30 AM and I had 12 full hours before my test.

That kind of stress always feels like "finals week" to me. Probably it always will. And every year in my profession Christmas week is finals week. There is crabbiness and stress and between now and Christmas day someone will die (this year I sadly think it's going to be 2 people, one of whom I love), and the hospitals will send every person who is not on a ventilator home so the doctors get the day off and I will have to do evaluation after evaluation, often on very sick people. People get more emotional, and this wears on all of us and so we do too, and then the other Christmas stuff adds in there. And for me I have my own personal Christmas issues.

So far this week I've been gone at least 12 hours/day. I still have a lot of wrapping to do. I am very tired. I don't see a lot of posts coming, and if you made it to the end of this I'm impressed. Things should settle about the middle of next week. I'm sure I'll be back before that, but I've been posting pretty regularly lately and doubt I will be for now, so just know I've not fallen off the earth, I'm just taking the finals of life.

Back soon. Hopefully with good grades....

Holiday Angst

Back last spring at the height of my illness I worked very hard with my psychologist on letting out much of what I was feeling. I am good at showing positive emotions and horrible at showing negative ones most of the time. This had, over time, caused me to not do a very good job of dealing with a lot of the sadness and anger that went with my diagnosis. So, I spent many, many hours this summer crying in the psychologist's office while talking about so many things that bipolar has taken away from me. In effect, I learned to cry.

One of my problems with crying has been that I know it helps. I have panic attacks, and a really good way to have one is to let the pressure build up. This is my current problem.

I don't have time to cry. I also don't seem to have the ability to just cry, and possibly not to cry unless it starts with the psychologist so that I know it's safe. I seem to be unable to handle something that feels so scary unless I know that it is occurring in a window of time which is finite and with someone who can help me stop. I learned to do it some this summer, but I did not apparently manage to take what I learned and apply it to when life is more normal and protected than my months off. Which is turning out to not work so well, but at this point I really need to just deal with feeling sad about things at this time of year. I need to have that outlet to handle frustration, because this time of year is frustrating and hurtful at times in my field.

This is further confused by feeling like I am risking losing my precious, fragile control if I experience "bad" feelings, nightmares, or the like. That would be now.

I have an odd problem of being capable of handling constant pain from bipolar, but when the bipolar isn't an issue I have no idea how to handle "normal" problems that ordinarily just flow right into the general mess. I am so used to forcing myself to try to "handle" day to day problems that I am no longer good at allowing them to be the main event.

I really need to cry...

Courage

One of the lessons of this last year has been that courage has many meanings.

This week has been harder. It's been more difficult to survive the last 4 days than the last 4 weeks. I'm extremely tired, unbelievably busy, and not sleeping well at all. I went to see the psychologist for an extra time today because I am too afraid to let anything slip.

Calling to get that appointment was really, really hard. It's been a big thing how long I've gone without extra time, and now that must re-start. But that wasn't the hardest thing I did this week.

Something I rarely speak of on this blog is the effect of my illness on my faith. I don't speak of it because it can be hard for outsiders to understand and I have been very, very badly hurt by people thinking they were correcting me. I am well aware I am not strong enough to be open to debate. However, the effects are profound. I can't go to church because it is too stimulating, requires too much attention, and I can't read the Bible. It is too far beyond my cognitive skills. I can't understand it, focus on it, etc. I can use OT skills to break down many reasons why, but that doesn't matter. Regardless, something I want and believe in and NEED in my life isn't there and I have suffered because of this.

For some time now we have discussed the possibility of my switching to a children's Bible. Coming to terms with this need has been harder than I thought, and I never thought it would be easy. Even hearing the suggestion hurt. Then as I started shopping for one I learned that I had to go to an even lower reading level than I thought to get something I knew would work. It took a while, but this week I bought it. It was my Christmas present to myself.

Tonight I started reading. It took some doing. I removed the dustcover so it looks less childlike, but the title still makes the target audience clear. But it's at my level, and I was glad.

I just am amazed at how much harder it can be to conquer pride than adversity.

Yippee

Blogger now recognizes I only speak English again!!! It turns out that full immersion in a language must teach it, as I speak no Spanish and somehow managed to unmire myself. There is NO WAY I had accidentally changed that particular setting.

No real update tonight. Lots I want to say, but this is my busiest time of the year, I am totally exhausted and hurt from head to toe (literally as my head is pounding and I stood for about 6 hours), this med change is making me very tired and I'm having nightmares to compound that, and I need to rest.

On the very big plus side, I'm handling it. I did call for an extra psychologist appointment after one too many nights of violent nightmares, but worse things have happened.

More tomorrow. Or someday soon.

Details changed to protect the innocent/Espanol

One of my facilities admitted a patient today who frankly they aren't qualified to handle. This happens a lot to psychiatric patients, they get shunted from facility to facility because some places aren't so good at admitting they aren't qualified to handle all problems. This patient is one of those, and actually has built a reputation for being difficult to manage. The patient has a history of exposing others to bodily fluids in a sneaky way, and knows that this is especially bad because of a history of something contagious. (Sorry for the talking around, it's hard to maintain the level of privacy I feel is deserved). So I already wasn't very sure that this would be a good idea, especially since the last patient they insisted they could handle is running around screaming and hitting things because of paranoia regarding the placement of an exit sign.

Then we have this doctor who thinks he is God. I first encountered him when I was using a chart and was called and told to bring the chart back immediately. I apologized and he actually GLARED at me and did not acknowledge that I was speaking. I really, really disklike him.

So today I started reading his evaluation of this new patient. The first sentence reads "This is a psych patient with a history of _______________". OK, now, that makes me so, so angry. Yes, there is a psychiatric diagnosis and accompanying inappropriate behaviors. However, the psych issues are low on the list of serious/lifethreatening issues, and in fact aren't even the thing that we are least qualified to manage. It's much like saying that I am "a psych patient with hypothyroidism" when I'm at the doctor's office for thyroid medication. To me, if I must be a psych patient outside of my own mind, it is during the times I am seeing my psychiatrist or psychologist.

I feel we give patients we psychiatric diagnoses no chance. "You shall forevermore be schizophrenic", etc. But why? Why do we not try for med and psychological management and not use the diagnosis to somehow explain the whole person?

And why is the setup of my blogger now in Spanish?

296.65

I've been so anxious to get to a computer for the past 9 hours. Guess that tells you how crazily I'm attracted to this blog thing. But this is where there are people who understand what this feels like too.

I have been diagnosed with bipolar for 4 1/2 years now. I started lithium close to 5 years ago and have had severe symptoms nearly constantly since March of 2000.

During that time I've learned a bunch of ways to guage how I'm doing, from what others tell me, to how fast I read, to what I watch on tv, to what I have written to others. Another thing I have learned to check is the diagnostic codes on my lab sheets because part of the coding tells the severity from the psychiatrist's perspective, something I choose not to routinely ask. I discussed this a little here.

My severity is generally moderate, sometimes severe. I remember it being mild for a little bit 2 years ago.

Today it was a totally new number that I would have had to look up if the new hospital didn't kindly spell it out "bipolar I, last episode mixed, partial remission".

Me. Remission.

Lithium Toxicity Part The End

Over the last 2 weeks I was having more and more nausea and trouble eating. I didn't even realize until now that one of the things that happened with the lithium was that as the trouble was building each time I was becoming pickier and pickier about what I would eat, and how much. After a dose reduction and still spending Monday so nauseous I couldn't eat anything I decided enough was enough.

I called the doctor and left a message that I was doing this unless told not to. She called me back and said it was ok, and if I wanted to start another med to call. I have been feeling ok so I've been holding off until I see her Saturday. I think I want to at least get a script for it so that I'm ready to go immediately if/when I need it. I suspect I'll be on it within a week because I'm hyperaware of every mood swing and afraid that THIS is the one that throws me overboard. I think I'll feel more secure with the extra med, although I really want to try without.

It's been interesting. I've been phenomenally tired, which is partly from overdoing the last few weeks and apparently partly from going off it. I guess after nearly 5 years my body was pretty used to it? I'm not sure, just hoping it ends soon. Today is better though. I am starting to notice that my levels aren't so high, as suddenly today I peed many fewer times at work. I also am experiencing thirst a bit differently. Suddenly "I need a drink" isn't a panic inducing, must-handle-this-now situation.

Now I am left with two things. One is great, great joy at swallowing my entire nightly course of medication, 6 pills, (as opposed to a usual 13-15 in the last few years and a high of 23), in one swallow. The other is wondering if I will get to lose some of the lithium weight or if depakote will counterbalance that effect.

I just hope this works......

This is not right

I've heard this complaint so many times about meds, but now it applies to my life, plus I hadn't looked at it carefully.

I take a medication called Provigil which is really a narcolepsy drug. It is a stimulant that helps the body wake up without being as stimulating as ritalin or the like. It can cause mania, but operates differently so that it's not as big of a risk. In my case I monitor the dose very carefully and have been able to notice very quickly if it did anything bad when the dose changed. I don't take it when manic or if I haven't had depakote to counter it. If it does make me manic I take an ativan immediately.

I wasn't allowed to try this med until the first time I stabilized a bit and had stayed pretty good for several months. It changed the quality of my life immensely. I was able to work 2 or 3 hours earlier, letting me get home before bedtime. I needed less than 20 hours of sleep per day. I did not have to sleep the entire weekend away every weekend. Fun re-entered my life.

At first my insurance just covered it. Then my doctor had to fight for coverage, but when she won it was lifetime approval. However, I have been through 2 companies (3?) since then and need to fight again.

There is a list of conditions it will be approved for. Bipolar is not one of them, which I can understand as its use is controversial with bipolars and I'm sure some doctors would not allow me to take it.

However, guess what is easier to get than this med that literally allows me to have a LIFE? V*iag*ra. It takes a generic diagnosis to get that without the doctor having to fight, but for me to get a medication that lets me stay awake means my doctor is going to have to fill out multiple forms.

This seems unfair.

Still doing so well

More good stuff. I probably sound like I've sort of become Pollyanna (well, except for yesterday), but so much of this feeling good stuff just needs to be celebrated. Things that I know are small are so important to me because I have missed out. Just a year ago I was absolutely miserable. Ok, just 2 months ago I was miserable.

The big thing today is that I have officially finished my Christmas shopping. Pretty much, anyway. I need to pick up a gift card or two and some pet toys. Wrapping is another story, but this gives me a lot of room for that. Wrapping can be sort of difficult because of the noise of the wrapping paper. It also is frustrating because my hands shake from meds and so I'm not as neat as I'd like. In recent years I've had to have help to put on bows, which used to be my favorite part. But it will happen. I was so proud of myself because I went to the mall yesterday. I was there around 2 hours and I did fine. I got overstimulated in the food court, but mostly I was ok. I even went to 2 stores I didn't plan on because I felt ok. I may even go back one evening this week because I found a sweater I really like and may have talked myself into buying it. I know it's an odd time to buy clothes for myself, but I need them badly. My wardrobe sadly reflects my inability to be in a mall at all for over a year as well as my hatred of shopping in general, and the fact that generally I wear scrubs. I think I have 2 sweaters. It may be wise to have a few more. Plus I have money to buy clothes for the first time in a very long time. LOVE this new job and the benefits....

The other really cool thing is that sometime this week I'll hit the point where I've been back to work longer than I was off. Since those months felt eternal and most of the last 7 weeks have flown by I am amazed this has come already. Maybe now I can start to trust that disability isn't lurking. I know it can occur again, and quite likely will, but this time is over.

I found a note I'd written in October documenting for my boss a number of things the seriously bad assistant had done that I was upset about. Over a 2 day period I had aquired a 2 page list of valid complaints. No wonder I was so miserable.

Now, there are certainly things I don't like about work. But for the most part, this job is 85% better than the last one. The worst thing is that I am still just too tired to do much besides work, but I think I am going to ask the doctor about trying to reduce my sedation a little more for the time being. I went a year without ativan once before, and I'm sleeping like a log now, so maybe I can try sleeping without it (I still have lots of sedation).

So that's my story now. If I can feel so positive after getting through a hectic Monday and Tuesday this week we'll be in great shape.

And you got fat--a rant

I had to work today since I had that vocational rehab meeting the other day. I figured I'd pop in and out of one building without seeing anyone, but that wasn't to be.

There is a SEVERE shortage of therapists in this part of the US, especially of those specializing in geriatrics. If you want a career with seemingly endless job security (literally I have been in two situations where companies refused to fire people doing really wrong things because they couldn't replace them), become an occupational or speech therapist. Physical therapists are in high demand too, but less so than OTs and STs. For proof, remember that I was able to get a new job totally wrapped up in less than one week from deciding to quit my last one, and I was offered much more money than I used to make without negotiating, much better benefits, and a large sign-on bonus.

All those things are positives, and I love what I do. However, it means putting up with some really obnoxious people sometimes. Today I ran into one from my past. She's a speech therapist and she shares a first name with me. That wouldn't be bad except that there was an instance where a patient complained about HER and I got in trouble until I went to talk to the patient and calm her down and she explained she meant the OTHER Just Me. Oh.......It made me look fabulous.

I knew she was at my facility 3 days a week, but hadn't seen her. I had, however, heard at least one story of how she had made the nursing assistants mad. That is NEVER a good idea.

So today I literally ran smack into her, and she instantly recognized me and we were polite for a few minutes. Then I was reading my patient's chart and mumbled (I guess louder than I meant) "like THAT'S gonna work" because a treatment ordered was just a joke for this non-compliant patient. Anyway, she laughed at that, and then looked at me and said as loud as she could (so all nurses, psychologists, patients, families, etc around could hear) "You are absolutely not old enough to be doing this".

Now, I look young. I look about 12 years younger than I am based on people's average guesses. I still occasionally have someone guess I'm a teenager. I pretty much can't help this; I just have a small frame that combines with things like curly hair and a fair complexion to make me look younger. I wear scrubs, it's not like you can do much with that to change how you look.

I'm ok with being told I look young, being asked about it, having my experience/knowledge/ability to know anything about life questioned, but this woman knew me THREE YEARS AGO. So really, the time for this comment was then. Or not in public.

I have 6 very hard earned years of experience. I remember how awful it felt to say I had only one week of experience, and I cherish the knowledge experience has brought. But I don't see exactly why it's necessary to use how I look to put me down in front of others, others who really have not had time to form opinions of me.

I so wish I had nerve to tell her she got fat. She did......Sometimes, and only for brief moments, I miss the manic periods back before I was on enough medication when I would get angry and say anything that came to mind.

Vocational Rehab

I had my first appointment for vocational rehabilitation services today. It was weird. Nothing came of it, they won't make a decision until they have more stuff from my doctors, but emotionally it was weird to be asking for help. It's hard to accept that it takes more than usual amounts of support for me to manage.

In case you have no idea what I'm talking about, voc. rehab is a state program that provides assistance to people with disabilities to allow them to get or keep jobs. The assistance varies from fairly little things, like the computer I'm requesting, to lift vans to vocational training, and all sorts of other things.

I toured the facility in the county where I went to school twice in a few months period, and mainly registered it as not what I was interested in doing, back in grad school. I had no idea that 7 years later I'd be a consumer.

It just felt sort of unreal to be there, like there was no way that this was for me. It's weird to read what my doctors are being asked to fill out and see that in some fundamental areas I'm going to be less than fully functional. And that I actually need them to emphasize the negatives in a way this time.

One helpful thing is knowing that if this job doesn't work out I can re-open my case and they will assist me in finding another job that meets what I need. That is a good deal although I can't imagine how hard that would be as giving up my current specialization would be so painful.

Now we'll just have to see I guess....

Tightrope

Writing won't show the emotion that goes with this post. I'm not sure what to even call the emotion, except that it is strong.

First and foremost, I still feel great. Every day now I wake up, think "still ok?", and then upon deciding it is, enjoy the day in a way I so rarely get to do. It's so hard to explain how much joy comes from knowing that for another few hours I get to enjoy things without trying. It's also hard to explain how much joy can come from tiny, tiny things after 2 years of feeling miserable.

I talked to my doctor today about my lithium problems. She agreed it sounds like my body doesn't like lithium anymore. She asked what happens if I'm not on lithium, and a great fear settled over me. I don't know. I have been on lithium nearly 5 years, since a few months before I was even diagnosed with bipolar (it was supposed to make my antidepressant work better-ha) and I truly don't know what happens if I'm off it. I'm barely on any now and doing fine, so what we know is that I no longer need as much as I used to.

The thing is that I can't live with the symptoms of toxicity. So I'm going to go to a really tiny dose and see what happens. Hopefully I'd just be ok. If I still seem toxic we'll go even lower until there is no choice but off. If my mood gets out of line then we'll try the only mood stabilizer I have not tried (aside from 2 antipsychotics that I am adamently opposed to trying).

I'm trying to be positive, but I'm also scared. This break from being sick is the best thing I've experienced in years and I can't stand the idea of going back to the bad place so quickly. The strong, positive me reminds myself that maybe I actually will break free of lithium and some of the ugliness associated with it, but I also know that lithium has been a constant in my life through this whole illness. Until a few months ago one of the easiest ways to change my moods was to alter my lithium dose a bit. Nothing else is so effective (except lowering my depakote is pretty sure to make me moodier) and so versatile.

But only time will tell what happens next.

Hope I didn't screw up too badly

I've been doing so well, yet I have had so very much on my mind. And I just don't always read, process, and remember. Which I'm not good about always accomodating because it makes me angry.

Anyway, several weeks ago I applied for vocational rehabilitation services through my state. Hopefully they will be able to help provide some assistance in making work a little easier for me and making it more possible to be adequately productive (without working hours for free as I did 2 days this week because otherwise my productivity was beyond atrocious). I'm hoping to get a computer. My appointment is this week and I just filled out the paperwork.

I thought I was on top of what I needed. I even had an extra eye doctor appointment this week to get some papers from him because I have an unusual eye problem that adds to my slowness with paperwork. I'm accepting any and all additions to this begging of mine.

Except I didn't read the letter correctly and I think I'm supposed to have letters from everyone treating me.....I can get the psychologist to handwrite something Monday night, but there is no way I'll get something from the psychiatrist that fast. Realistically I doubt I would have gotten anything from her in the couple weeks I've had the letter because she just changed to a new and very involved job and I'm having trouble reaching her at all, but I really hope they are willing to be patient while I get something from her.

The thing is I had just totally misunderstood that they would be getting medical records themselves, when that is just not true...

So frustrating.

Lithium Toxicity Part Two

I posted part one of this a few weeks ago and have never returned to it, mainly because I've had my mind on happier things. However, I suspect another chapter in this story is going to come before I finish this one, so it's time to move.

When we left off I had just been informed I had toxicity and that my thyroid wasn't working properly. I was to lower my dose and have blood drawn again in several days. I made an appointment with my family doctor to check on the thyroid for the next day. And then I had a fairly good day. I even felt like eating some, and rejoiced in that.

I was not sleeping at that point, so at 1 am I was working on a continuing education course. I suddenly felt extremely sick. I started doing everything that had ever worked to control the nausea, but nothing helped. Soon after I completed my course (and passed, one might note), I was vomiting profusely and in a way that was different than the worst illness I have ever had.

After about 2 hours I was vomiting so hard I was peeing my pants and not caring. At that point I realized I was very dangerously ill, especially because I couldn't get any fluids in to replace what I was losing, which would just make the levels stay high. I was fairly sure I needed to be somewhere there were IVs, but I couldn't get there. The nearest hospital that is capable of running an immediate lithium level is in the city my mother lives in, 30 minutes away and in the opposite direction of my psychiatrist. It didn't seem helpful to call my mother, wake her, scare her, have her come take me back down to her hospital, and then risk being where my own doctor couldn't help me if I could manage a few more hours.

Somehow I managed to develop a plan. I called my psychiatrist and left a calm message that I was very ill, needed feedback, would see my family doctor in the morning and if she wanted him to do anything to please call him, etc. I did not even think of paging her (after all, it was the middle of the night), which I suppose would have been a little more rational but truthfully, she couldn't have helped. I started sipping a very specific amount of water each hour and increasing it by a few tiny sips if that stayed down. Controlling that water intake was incredibly hard as I was very, very thirsty, but it took 3 hours of tiny sips before the sips stayed down.

After about 4 hours of vomiting and sobbing in terror on the bathroom floor I realized I was sicker than I had been admitting to myself and so I left my psychiatrist another message. This time I think I let my panic show more. I also left a message at my family doctor's asking to move my appointment up.

A couple hours after the vomiting stopped the doctor's office called and said to come immediately. I threw on clothes and drove in. He determined I had managed to control the dehydration well enough to avoid an IV (I believe this was a "for now" but am not sure), took a lot more blood and some urine, gave me medication for the nausea, and told me to stay on pedialyte for 24 hours. I remember him telling me that the nausea medicine would make me very sleepy and that I would need to wake up to sip fluids. I also was told to not do more than sip, even though I would want to. That urge only got worse, and the first popsicle I found was the best food I have ever tasted, even though I only ate part of it.

The psychiatrist called and gave me a lithium break and a new schedule to resume it.

Over the next few days I started to feel better, and eventually was able to increase my lithium. Very quickly it was clear that it took less to have a level close to the old one, which was higher than I could now safely take because it was too close to the toxic line (1.3 can be toxic, my old levels were 1.1-1.2. My highest measured level was 1.9 or 2.0. I've heard of levels over 4 but that is ICU and dialysis territory).

As the summer progressed I learned that I was more sensitive to heat. Always before if I got hot I could feel the side effects, but now I plain was sick. I was worried about this affecting my ability to work so we lowered the dose again. I did well on this dose, but eventually needed to try to increase it because my mood wasn't doing well.

That didn't work well (see Oct. 30 post, sorry I don't know how to link) and I recognized the early warnings very quickly and the dose was immediately lowered. At least I have now learned the specific bad feelings to watch for. That worked until the last week when things seem to be not going so well again. I'm waiting to follow up with the doctor to say more.

So, coming soon: Lithium Toxicity Part Three: Another Statistic, or Just Me Conquers a Pill?

Thanks

I simply have too much to be thankful to list it all today. But so much is starting to be so good, and so much that is good has happened over the last year that it seems wrong to let it go without saying. My metamorphasis into the "real me" who I only get to be a minority of my life has come at just the right time to allow so much appreciation of this season. I'm so grateful to be alive, to be able to laugh, to have eaten a holiday meal, to feel so well for the first time in so long. I'm so glad my prayers that fear of what will eventually happen to feeling good are being answered, and I am able to stay present in this moment and enjoy. I'm grateful that I have not vomited in 6 months and 12 days, the longest time by far since I was diagnosed. I'm grateful for my wonderful new job, where I'm learning what it feels like when *I* count, not just how much money I make counts. I'm grateful for the people in my life who make it possible for me to live the life I do, and this includes you if you're reading. You have no idea how much you readers mean, for reasons I'm not even sure of. Each of the 802 times someone has come to this blog, even if it was accidental or for 1 second, has made me feel like someone knew I existed. In a year that didn't always feel true at all, it has meant a lot.

Rather than reading my further thoughts on thanks, think of your own. I'm pretty sure if I can be thankful for some of what has happened to me lately then there is hope for us all.

Oh I love the internet

One of my most hated things in the world is shopping. I can't stand noise and crowds. I do everything in my power to avoid these things. I go so far as to grocery shop for huge quantities at scarce intervals, order everything possible online, and at this point I am pretty sure I've not been in a mall since March.

I think I just finished about 75% of my Christmas shopping without leaving this chair. I can't tell you how much anxiety is relieved by this.

I may survive the holidays after all. If you'd known me a year ago you'd know why this is such a miracle that I can even think it.....a year ago I was in such bad shape that my psychiatrist called me on Christmas to make sure I was ok. I had my first ever spontaneous recovery from a severe episode soon after Christmas, followed immediately by the decline that makes up most of this blog.

And now, the best present in the world is that I am ok. For today. But for at least that long, I get to be me.

Achievements

Big things are happening......it's hard for me to talk about them because after years of starting to feel better only to have your moods change in minutes you tend to become fearful that getting excited will tip the balance away. This time though I'm trying really hard to assume that the upswing is going to last a while. I am certainly due, and the last time this happened like this it did last a few months.

So.....I'll share. It started with suddenly finding I could watch a movie about a month ago. It had been a couple years since I'd done that, so this was a big deal. This weekend I was actually able to watch a football game from beginning to end, which is an even bigger deal because of the multiple stimuli, the length, and the intensity. Doing that was a huge deal, not because football matters so much, but because being able to do something so normal as watch it matters.

Also, today was the 5th week in a row that I have seen my psychologist only once. That's an enormous change from the twice a week pattern of the entire rest of this year.

And it was the third week that his note started with "doing well". And since the week before that I was off meds and out of control, this is a huge contrast.

So, superstitions about saying this aside (and this is one of my two superstitions I hold tightly, the other being what any healthcare worker can tell you is true about behavior changes with the full moon), I'm doing well!

Blast from my past

In 2003 I began working in a small nursing home in the rural area I would eventually call home. In fact I purchased my home with proximity to this place in mind. I was there about 8 months when I was placed on disability leave for six weeks after starting an antipsychotic for a mixed state and having a very bad reaction. While I was off, my assistant (who was an evil little thing and everyone knew it) told everyone in the facility exactly what was wrong with me, including some embellishments, one of which was that I was hospitalized when instead I had simply had a night in the emergency room. So I returned to find everyone believing that I had had a psychotic episode and been hospitalized for a significant time. While there would have been nothing wrong with that having happened, and it certainly could happen at any time, it was not the truth and it wasn't a rumor I found it easy to dispel.

I continued doing my job, but the director of nursing who is also evil, was bent on getting rid of me. She made a lot of very ugly comments in open settings, which I didn't find out until later. My favorite was "what does she know, she's crazy?" when I rightfully wanted to treat a patient. She and I began having a lot of conflicts regarding who was in charge of therapy decisions. I was not very effective in arguing with her about this, because I didn't learn to be assertive until about 2 months ago, and so ultimately it got so bad that my company pulled me out of the facility. The next day I was told I was being totally transferred as my other facility was owned by the same company and that company had decided that they did not want me in their facilities. Ever. For any reason. They would give no reason, my company questioned them very specifically about my clinical skills, etc. and all they would say was "we just don't like her". This was particularly odd since they said I was fine as a clinician, I was fine with patients, and the person saying this had never had a conversation with me and had only been near me 3 times. Later she told someone that doing this was a "mistake".

I should have sued them for discrimination, but I didn't. I didn't want to come out to the entire world that I am bipolar. I didn't want money, I wanted my job and my confidence in my abilities back, and neither of those things would happen with a lawsuit.

Over the next few years I learned to believe in my abilities again. For a long time I thought that I was only good with my psychiatric patients, but time has proven this is not so.

I never considered what would happen if I encountered people from that other place again. But with this new job I have. One of the floor nurses from the old place has completed her RN and is now the director of nursing at one of my new buildings. I have no idea what she knows, heard, or remembers of me from before, only that she does remember that I was there. I also know that she is acting just like her previous boss.

Tomorrow I am going to have my first real battle with her in the "you do not tell me what to do" war. She's not qualified and the things she tries to make me do are plain old stupid, but she's very insistent. We're not doing therapy that way. I will leave first. But we'll battle it out before that comes up. The thing is that I know she learned from the woman who I truly consider to be evil on earth. That woman defeated me and I will not lose again. Yet I don't know if I even have a chance.....

So-called Mental Illness

Since I took this new job I have discovered a new medical diagnosis: Mental Illness. I have now had 2 patients with this diagnosis. I thought that mental illness encompassed specific illnesses that it might be wise to name so that those treating the patient know what is going on, but apparently I was wrong.

The worst of this is that I'm pretty sure that "mental illness" is this doctor's way of saying "bipolar". One patient has bipolar symptoms. The other is on a big dose of medication often used for bipolar. In fact it is a HUGE dose of the med.

I am now expecting that all people with heart problems, orthopedic problems, hearing problems, arthritis, etc. will be coming to me diagnosed as "physically ill" and then I can sort that out too.

There is a problem with this picture.....

If You Want to work with psych patients

There are a bunch of psychology students from my alma mater (9 years this spring!) visiting through a special arrangement with a professor I suppose I now owe something.

I should have posted this last night, but I was wrapped up thinking about something else, and as I keep telling work, I don't think 2 ways at once. So, I've missed some of you, but if someone still reads this, or if you come back and see it, please think about this and share it.

There is one thing I want people to learn from this blog. I write for many reasons, but there is one main goal. That goal is that as you become a mental health professional you will learn many statistics. By the end of your master's degree you will be a walking heap of numbers and generalizations. It becomes so easy to assume that people fit into these categories. I came out of school with so many beliefs that wound up making my own illness harder because I fought for nearly 2 full years to avoid being diagnosed because I thought it meant that who I was would change. Bipolar patients used drugs, went on impulsive spending sprees, were suicidal, and had trouble holding down jobs. I didn't want to be those things so I avoided diagnosis. And then I was diagnosed and learned I was still me and that my own version of this affects me differently. I learned that some of the things I hate, like being monitored for suicidal thinking, I have to deal with because I am at risk. But compared to others, I am so blessed in that area and so it's less intense monitoring than it could be.

Even after I was diagnosed though I have found myself trying to pigeonhole. I do it much less than most healthcare workers, but I have attributed something to a psychiatric diagnosis when something else was wrong. Once I watched someone die of a painful disease and we had all thought she was just acting out when she complained of pain, because she did that. By the time the cancer was found she only lived three weeks.

But what I ask is that as you go through school and your career, as you memorize and then work with all the statistics and generalizations, please remember me and people like me. I live with severe mental illness every day, and I often must prove how sick I am because it isn't seen at the surface. And I'm not the only one.....

Several things

1) Sarah B. asked for links related to sensory integration. I'll look for some good ones. I haven't been on much of a search of it for a long time but I do know there are good ones. Not sure if any relates to bipolar. I certainly haven't heard of a lot of people doing it with mental illness, and the main reason I did was because I knew it would help me (why I didn't do it for myself for years is another story).

2) Another thing I have recently purchased that is helping me is a daylight simulator. This is a gadget that hooks to a lamp and is set to cause a sunrise at the time it would occur in the summer. Mine also can be programmed to do sunsets, and that is actually better for me as it helps me fall asleep much quicker than ever before. You can vary how long the sunrise/sunset lasts, and mine also gives a lot of options as a clock, nightlight, reading lamp, etc. I am not waking like I probably would if I weren't so sedated on depakote every night, but I also drag a lot less than in previous winters in the mornings. This too was worth what I paid. Mine came from http://www.truesun.com and is the Morning Sunrise Alarm Clock.

3) I am doing really, really well. So well that I am whispering this. So well I'm not sure how long ago I felt so good but it was probably over 2 years ago. And nobody else is finding me manic, or if they are they aren't speaking up. I always react to these precious times with fear that it will end too soon, and anger because I know that reaction just sets up a fall and prevents me from fully enjoying feeling good. This time I am literally afraid to breathe too deeply. I see things that aren't perfect yet in my recovery from being so ill (like getting frustrated very easily) and they freak me out, but really, right now is a good time.

4) I'm a little freaked out from my counseling appointment this week. It was very different than usual and some topics that are on my list of things I try to hide from were discussed, probably more than I've ever discussed them. I'm thinking hard and so may not have a lot to say here for a couple days, as it's not stuff I really want to go into here at this point. There are some parts of this illness I live with and know how to live with, and I know that it is because of the illness, and yet I will never get past the embarrassment and desire to hide it. Right now I must recover because horror of horrors, I spoke of what-is-not-to-be-mentioned. I also had a good conversation about what I want in my more unusual role of being a patient yet also being a professional. It's hard, because I expect those who treat me to respect that I have knowledge. But I also need to be a patient. I need to be treated as if I'm going to make bad judgments and not know how manic I am or that I am endangering myself. Yet I can't say I really enjoy that.....But in dealing with all the things that went wrong in the last 18 months, one of them is that I did not listen to people I pay to tell me when I'm not ok. That was a big mistake.

5)I'm falling asleep at the computer so if there was anything else it will be in a later post. Good night!

Sensory Integration and Bipolar

This is a post I've put off writing for a long time and really shouldn't have. I suspect it is a bigger issue for a lot more bipolar patients than me, and it is making an enormous difference in my life. Since I have had the tools to address and diagnose this for many more years than I have had a diagnosis, I really regret that I never stopped to try it soon.

Back to basics first: As I've admitted here before, I'm a therapist. Specifically I'm an occupational therapist. One of the theories OTs are trained in is called Sensory Integration. I was very interested by this theory in school, so I have had extra training in it and have used it successfully in mental health practice. In very short this theory involves helping the body have increased awareness of itself which is calming to a nervous system that is hyperaware or less aware of where it is in space, what it is feeling, etc. A person with a disorder of this type either avoids feedback (will only wear certain fabrics, refuses to wear shoes, etc) or seeks extra feedback (chewing on things, rocking/bouncing, wearing many layers of clothes). It's sort of hard to give a great description because it is a pediatric theory which I manipulate to work for adults and it's hard to get some of the basics into an adult example.

Anyway, I have known for a very long time I had issues with this. I knew long before I knew about bipolar, like on the day it was first explained to me. I attributed it though to side effects of having been abused, for the most part.

About a year ago I started really using this with psychiatric patients. When I used it with a few who I knew had issues very similar to my own and I had incredible success I knew it probably would help me. So I decided to try it.

One of the greatest issues I face is that I become overstimulated extremely easily. The more manic I am the worse that is. Tiny noises make me crazy, as I've discussed. Things in my peripheral vision have nearly caused me to wreck my car. I generally lose control of my moods if I'm overstimulated too long.

At the worst of my illness this year I needed nearly total sensory deprivation at times to feel ok. I've described this as well, back in May. I used earmuffs designed for hunters to block sounds. I put up a hammock in my basement where almost no sound penetrates and the light is dim. I rarely left my house and avoided stores. I continue to use these things as needed. The hammock also is soothing as rocking is soothing. I plan to get a hammock chair for my living area eventually.

My greatest gift to myself ever has been my weighted blanket. I have had such horrible insomnia for the past 12 years that doctor after doctor gave up on fixing it. I had accepted I would always have trouble sleeping. Since I got the blanket, which weighs 9 lbs and helps the brain know exactly where the body is while under it, I have had insomnia ONCE and that was the night I was deciding to definetely quit my job. This has been 4 months now and I am routinely sleeping 6-8 hours per night.

There is more, but I'm out of time. I just wish I had tried to use what I knew to work sooner.....

Hopefully in 6 months I'll be better than this

In the last year so much of my life has changed. Not only have I had a lot of physical change, a major change in my overall condition, but I also have had a lot of change in my perspective. Many of the changes are good, but they also are still new. I'm still learning to feel that I fit my own life.

I'm sure I've mentioned before here that I hate change with a passion. This has not changed....

Today I saw my psychiatrist at her new hospital, in her new office, and I'm having a hard time with that. The stupidest things being different really upset me. I think my concerns about being able to reach her are probably lessened (we'll see, that means) but her use of a computer instead of paper notes bothered me. Sitting across a desk from her bothered me. I think at least that one I understand; the last time I was in a psychiatrist's office set up like that it was a bad experience, and this office isn't really a psychiatric office, it is an internist's office used by psychiatry at times. Changes in the routine of the questions, even though they were mostly the same questions, felt wrong. New questions were added to her routine I won't like. I just figured a way around answering the most hated question the psychologist asks that he is willing to accept as an answer, now I have new hated questions.

It was also hard because for almost 4 years she has been very involved and because I see her frequently my chart is a pretty cohesive path through my life. Eventually she will have that chart again and this will feel like a routine, but today it felt like what I imagine it would be like if I were to switch to a more typical every 3 months schedule: pure confusion. The 3 months schedule has never and isn't an option for me because my condition changes too rapidly. Even 6 weeks between visits results in my feeling totally overwhelmed trying to summarize how I've felt because 6 weeks is too long for me to not have had some significant changes. And really for the last 6 months I've been in touch with her more like weekly until the last few weeks. So today felt more like meeting with someone I only sort of know in a place that is totally unfamiliar. (And so confusing.....I was told to go to floor 3, suite B, and arrived to find that door marked internal medicine, check in at suite C. I assumed I remembered floor 3 wrong and checked out much of the building before deciding in desperation to try internal medicine, which was where she really was hiding. That start did not make me feel ok......)

I don't lie to myself about my dependency on both of my doctors. Hopefully the time will come when seeing them very routinely and having them both very much in my life will come. A year ago I was doing badly but I could safely miss a week of counseling, which is currently an idea that terrifies me. At one point I could even risk 6 weeks between psychiatric visits, which is another idea that causes huge panic. Having to change therapists started this I think, and being so sick finished the development. Relaxing is a part of healing, but I'm still at the point in healing where I'm pretty happy saying I've had a good week even when I'm using lots of assists to get that good week. And this was my best week in a very long time.

Sometimes it is when I see myself struggling so much with something that I know is not really a big deal except that it is a HUGE deal to me that I can see how much the illness affects my thinking and perceptions and reactions. I know that this is all something that is not that important to begin with, that it will work out, that I can talk to the doctor about it, etc. Yet it's been enough to make my mood go from good to quite anxious and upset. I even cried over this. And again, I KNOW it's not important and that not one of these reactions help.

I'm not really sure where the end of this post is. Somehow I have a feeling the end is somewhere down the road when I'll find this and realize that I no longer am the least bit confused by any of what is so bothersome today.

Feeling Quiet

I haven't been feeling like writing a ton lately and my hits are down, so I guess everyone is feeling like quiet time right now.

I'm actually doing well. In many ways I'm in a pretty "normal" period and since I was sure that would never happen again I'm very appreciative.

I'm frustrated though how easily things affect me still. I'm dealing with some insurance issues that scare me and am very stressed about it, even though I know my new insurance starts Monday and this should be pretty minimal. Unhappy interactions stress me out beyond belief. I'm still in that transitional stage of not really knowing what my pay with my new job will be like, and that's scary too. My doctor changed from private practice to a huge hospital, and seems to have not followed through with the appointment she was supposed to schedule for me. I can't get her to respond and calling there was frustrating as they acted like I was stupid to have listened that she would schedule it. That's after a lot of time on hold, impatience in their voices', etc. And of course she didn't call back. That message is probably marked such low priority she'll see it sometime next century. Nonetheless, I'm FREAKING OUT about this. I have a long history of falling apart without seeing her regularly, and I need an appointment sometime before next spring. At this point I don't know if I could get her staff to communicate anything to her or even get a refill request through since I'm not a patient of the hospital. I do not matter....Not good in my situation. And I have no idea if her old email works or not; she hasn't responded to it since her move.

I hate when I get like this. I know I'm being negative and making it worse. I know this is the edge of some depression and that I can talk myself straight into it. But it gets so hard. I need more ativan probably but then I sleep too much.

I think someday I will quit therapy and design meds that work exactly as much as needed and not one drop more....:)

How to Look Really Dumb

I'm discovering all sorts of ways that my newly decreased memory can embarrass me. It seems focused on mistaken identities. Today was the worst though.

A man walked into the therapy office and started asking about how a patient was doing, noting she is insistent on going home soon. I explained I hadn't seen her recently, started looking for paperwork, and politely asked if he was her son.

Turns out that this is how I met the medical director of the facility.......Duh.......

This one may be frighteningly honest

This is something I need to think about, and here is as good a place as any. I find I like thinking here. Somehow I like knowing that nobody I know sees these thoughts, even though I often share them with friends anyway.

Today my psychologist told me that his goal for me is that ultimately I'll be able to manage independently. I didn't clarify how independent he meant; I doubt he meant without constant participation in therapy and obviously I am not ever going to be independent of meds. But this simple thing really hit hard.

I used to think I could manage. I thought I managed without help much of the time and that I managed my bipolar myself. I thought I was so good at that. Then last winter and spring it because so clear that this wasn't true. I wasn't managing, I was holding myself together by a thread.

Then I had to go through the stage of turning everything over to my doctors. That idea was so hard. It's been odd knowing that I would have easily let either of them influence my decision to change jobs; had they said to wait I would have. Yet that was a good decision.

But if I'm truthful, I don't know that I want to move on from where I am now. I'm making decisions but having a lot of support. I feel safe and protected from myself and my own very bad decisions. It's also restful when it has been so very hard to do anything.

Yet this goes so far against how I've always perceived myself. I always thought I was so independent, so brave. Of course I want to manage myself. I'm just scared silly to think of it now, and it scares me even more that the idea scares me.

This last year has changed me in so many ways, and in degrees I cannot begin to understand. And that is the scariest part of all.

So that's the problem

As regular readers probably know, my career is governed by productivity. Currently 85% of what I do is supposed to be billable. This number keeps going up at an alarming rate while companies push us harder and harder to meet or exceed it. It leaves little to no time for paperwork, screening people to see if they need therapy, driving between buildings (I'm penalized for this), etc.

I try and try but can't meet this standard and I find it exhausting. I also get so frustrated because it keeps me from doing things that I feel are necessary for good patient care.

But just now I figured out the real problem. I'm allowed 108 nonproductive minutes in my day. (Keep in mind I have probably 2 hours of paperwork). Thirty minutes are taken by driving. And I just realized how I spend another 30-40 minutes/day.....Lithium makes me pee. A lot. If you say a bathroom trip including walking to and from and getting a drink on the way is 3-5 minutes, I'm using nearly half my "free" time to pee.

Now I KNOW this should be accomodated.

Asking for Help

Funny, a few years ago I was incapable of asking for help. Now it seems to be so much of what I do. A few years ago I literally had to be prodded each time I had a medication question. Now I email my doctor at least weekly. It's not necessarily easy, and I still feel really guilty sometimes that I need so much of her help (in fact she once admitted that my chart doesn't even get filed because there's so much communication and change), but I've accepted it.

Today I asked for help in a new way. With much, much encouragement from the psychologist I contacted the department of vocational rehabilitation and applied for services. I'm hoping that they will be able to provide me with a few modifications and suggestions to make working a little less like being a perpetual motion machine just so I can keep up, and so that I can have enough time to adequately think through my decisions. I'm hoping that I'l eventually leave work and not feel like my head is about to explode.

Filling out the application seems weird. I'm not the typical candidate and it felt like there was such an odd contrast between the help I was asking for and some of the other information, like education and source of income. It's hard to admit that I think in stereotypes, but I do I guess. It just seems like this sort of thing isn't for someone with a master's degree. Yet truthfully in some ways I need it more, as I have very high educational loans to pay off and without help I don't know how long I can maintain a high paying job. Nonetheless, it's weird to learn that I think this way.

Another thing that is weird is that when I was in graduate school everyone seemed to think we needed to tour vocational rehab. So two or three times we were dragged on this tour. I HATED it. Both classes I remember doing this in were specializations I knew I'd never have anything to do with. I guess this is more proof of never say never..

Always, Always Read the Label

I am not allowed caffeine. I used to be allowed one can of pop per day if it was early in the day, but after admitting to using caffeine to maintain the mania that got me through March and April I'm not supposed to have any. I translate that into bare minimum, what the psychologist doesn't know won't hurt him, and using have on caffeinated drink per week.

Today I drank a Coke at work, which I never do, because I was dragging. So I already broke the rules.

Then after work I bought 2 bottles of juice smoothies. If I buy pop or tea or coffee I make sure I get decaffeinated, even if I don't like it much. But fruit juices I never thought to check. So I was just lying in bed thinking how very healthy I am for selecting this when I read that each serving has a bit of caffeine. And I've had 2 2/3 servings.

Drugs, drugs, everywhere drugs........

Life sentence? Or just a bad day?

I'm having a hard time knowing what to write. It seems like everything was slowed down by my lithium level being messed up this week. That's pretty much ok now, it's down to just causing me to be extremely thirsty. Thirsty I can deal with.

It's just that I feel like I've messed up in some of my responsibilities due to not thinking as well with the lithium thing. I have felt like I was moving underwater, and my actions have reflected this.

I'm worried about work because I worked as hard as I physically am capable to get a barely acceptable (maybe) productivity score. If I hear nothing but productivity this job won't work out. My doctor's note informed them that I can't meet normal standards, but they informed me they can't alter the standards. And I have no idea who wins in the accomodation battle. I just don't understand why we can say we are providing good healthcare when in fact we are attempting to provide rapid healthcare. I also do not understand a profession that is supposed to be all about ACCOMODATING DISABILITIES and yet is unable to accomodate mine. Someday I'm going to write an article about this. I just keep waiting for everything to stabilize.

I'm also going through some grieving again. I spent a lot of summer facing for the first time (I'm slow) how drastically and permanently my life is affected by this. A movie on Lifetime a few days ago made me think about this even more. I realized that in my professional life I have come to characterize illnesses as "big ones" and "that's hard but you'll be ok" situations. I think some attitude like that is necessary because how I approach treatment with someone who is terminally ill or just diagnosed with something really serious is different than how I approach someone recovering from pneumonia or something else that is transient.

Until yesterday, despite my years of working in mental health, I hadn't thought about which category these illnesses fall into. By the time my psychiatric patients were my patients it was clear that they fell into the "your life will never be remotely normal because of this illness" category. But then I thought about it yesterday. Atlhough I have never wanted to admit it, for me bipolar is like that. It could be worse, sure. I am so blessed to be able to function as I do. But at this point there is no treatment that is likely to give me much improvement or stability. I have taken meds for 4 1/2 years and I will continue to do so for the rest of my life, and at this point nothing indicates that the bipolar symptoms will really resolve. Even many types of cancer, as dreadful as the treatments are, have remissions and even cures. This form of bipolar (and I emphasize that, because I am a rare non-responder to treatments along with having an appallingly bad set of symptoms; my doctors tell me treating me is pretty much a one of a kind treatment), does not. I will always be a suicide risk at times. I will always have moods all over the map. There is not a point where I can say "if I make it 5 years I will be cured".

These ideas are sort of huge right now. I'm not sure what they mean, if they mean anything. I do know that it's giving me a lot to think about.

The Next Lithium War

I increased my lithium dose after a careful discussion with my doctor last week. We only raised it by a tiny, tiny amount, but 3 days into it I had symptoms of toxicity again. Thankfully I caught it and asked if that was it or if I had flu and was freaking out. It was determined to be lithium, and now I'm letting it get out of my body by taking a low dose for a few days. I really, really could have skipped that and been happy. I guess I needed a reminder of how little what I want regarding lithium matters, but I was pretty sure i had it figured out.

I want to understand why having lithium toxicity 6 months ago makes me more susceptible now, even at a dose that is about half of what I used to take. I just don't get it.

Lithium is such a friend, such a lifesaver, and it scares my socks off....

Mania: Up and down and around and over and through a hoop

What a day. For complicated reasons I had to start at the place closest to the Big City where the psychologist is. Then I had to drive back toward home to the other place, then back to the Big City again for my therapy appointment. I had to deposit the checks to fix my bank account before the therapy appointment, stuff something into my face, run to the specialty pet store to get the fancy-pants cat food that my spoiled animals require due to severe obesity in one and vomiting in another. (Some of it was on sale! Yippee!!!) Then I rushed to the counseling center and had a very long (both in time and content) session. Then I rushed to get enough gas to get me to the pharmacy, got to the pharmacy with 5 minutes to spare, grabbed my meds and a couple things I was out of, took my depakote in the parking lot so they would start working a little sooner, rushed to another gas station to actually fill up, and then got home just before 10. And I'm too manic and wound up to sleep, so now I'm trying to calm down.

I did something stupid today. I told the psychologist about the thinking about hurting myself, because that's part of a promise I made a long time ago. Except that I meant to tell him early on, but somehow it didn't come out until I was picking up my coat to leave. This did not go over well. And it shouldn't have because I know I'm supposed to be honest about that. It is just so hard to have to go through the process that surrounds this. 15 questions to prove I really don't want to. Three or 4 questions about where I have help available if I need it. 10 more times of me saying it's just nothing. Questions about whether I am safe to go home and can I be alone. And then knowing I'm going to be watched for several weeks like a hawk.

I just hate the whole thing. I understand it totally, but I hate it. I've had to go through asking those same questions myself, twice, and I understand how hearing someone say they want to self-injure is terrifying, and when I've heard the patients have been in a very safe setting. I hate how it makes me feel. I hate feeling that there is a threat of the hospital, which I am afraid of.

The thing is that I can tell a difference in really scary thinking and this. This is just a suggestion that I can hear is not coming from my own rational thinking. It's like a whisper in my brain. It's hard to explain. When I've truly been suicidal I've been thinking very clearly about this and this and this are the things I need to do. This and this and this must be done first. Etc. This doesn't persist nor is it anything more than annoying.

But my stupid hiding of it (I really think I hoped he would ask, as he usually does when I get way up but I'm not sure he knew how up I am) now means more discussion about this stuff being very important, etc. And yet every time I admit this sort of thing I feel more powerless. Last spring when I was forced to surrender sharp objects in my possession I was suddenly forced once again to face "wow, right now I am THIS mentally ill". I know that he was right to take that from me and that he was correct and I would have hurt myself. Giving it to him was really my decision because if I would have promised to not use it I could have kept it. But from that point on I wonder exactly what else he'll take from me. I was quite honest with him a long time ago that pills are what he'd need to watch for because I know meds well enough to know what to take. (No lithium overdoses here though!) But he can hardly stick those in his desk drawer.....unless I guess he wanted to dole out a week's supply at a time.....which is probably not going to happen. But one of the reasons these impulsive thoughts are safe enough is that they are more violent things and I do not have the stomach to do that. I tried once and learned that I can remain very calm in the face of any injury except my own self-inflicted kind. I barely had a scratch before I was done with that forever.

This is not coming to any natural conclusion and I need to go do my relaxation tape and try to sleep. So here we shall end.

Good night.

Lithium Toxicity (Part One)

Please Note: There's another new post after this one. I thought I was setting this to post with a delay but I was wrong.

I spent half of this year with undiagnosed lithium toxicity. I honestly thought that was something that would never happen to me. I'd been taking it for years, was well educated on all the things to avoid and all the things to do. I did everything right, even exceeding my daily water requirement every day. Yet when it hit it did so in a way that nobody saw it until it was severe. After it was diagnosed I started looking for information and discovered little was available, and most of what was available frightened me. This is my more hopeful story of recovery from lithium toxicity. Regular readers may find this somewhat repititious (if you were able to sort this out as it went, I don't think there were specific posts because I was too confused at that time to write them), but I'm hoping this one may reach someone else who is desperately searching for that search term.

I was very unlucky in how the whole thing presented. I had had frequent vomiting episodes off and on for years, attributed to difficulty taking pills after lamictal was a bad experience. (It had a bad taste and I just learned to throw up if I tasted it). My lithium level was always high but stable and never dangerous.

In January I was due for my 6 month labs. I got the slip from the doctor and before I could have them drawn I had stomach flu. That meant I had to wait 5 days to get a stable level again. The problem was that I had taken on some additional work and just did not have time to get a level done. Because the level has to be done 12 hours after the pill is taken and my lab is a long way from my old work, sequencing the thing is very difficult. Since I'd always been ok I didn't think much about putting it off.

By the end of January I was under huge amounts of stress. My therapist was leaving the country permanently in a month. I'd had a euphoric manic period for a week which always throws me way off kilter. I was so upset about the therapist that I wasn't eating. That seemed a reasonable explanation for the nausea. Without being able to eat I couldn't take my meds, so they just went by the wayside. We all thought when the therapist transition was over I would eat again and get back on meds. I even arranged a very long vacation to allow time for this; the entire vacation was centered on adjusting to the new therapist and getting on full and consistent doses of meds.

After one week of meds I felt terrible again and stopped eating. I went to my family doctor who thought my gallbladder might need removed. I had an ultrasound, and the day of the ultrasound was the first time I really acted lithium toxic, except I did not know it. I was told not to drink or eat anything after midnight but to take my pills. The test was scheduled for 11 and wasn't done until after noon. That is an extremely long time to not have water with my lithium dose. Now I know better. So I spent the morning sort of confused. For example, I had backed out of my driveway when I realized I was wearing slippers, not shoes. I kept getting lost at the hospital. I backed into something. I felt vaguely confused. And oh, the nausea...so bad.

When the gallbladder test was negative I was just treated for nausea for a while and given ulcer medication. When that didn't work I went on super-ulcer medicine. By that point the doctor was pretty sure I had 3 distinct little ulcers because he could always poke precisely the same places and get pain. I really didn't want to have a scope done to verify because I knew from experience I'd have trouble with the sedation.

And so I went on, losing weight, vomiting, and not eating. I lived on water for about 2 months. I lost a total of 30 lbs. from not being able to eat.

During that time work was awful (refer to March 2006). It still seemed reasonable to attribute my illness to stress, at least to me. Others were beginning to wonder but I wasn't listening. My logic was deteriorating quickly. Yet that seemed to make sense as I was not taking meds. Every time I tried, and I did try repeatedly, I just threw up more than I already was.

Ultimately I wound up on disability. I truly thought I could get some rest, get back on meds, and be back to work in 2 weeks. Nobody even tried to argue. I was really upset and shocked when 3 weeks later all I knew was that I was worse, not better. But I was holding the meds down. Lord only knows how, but I was. The goal was to get to full doses of both depakote and lithium for 5 days so I could get a level. I made it. While I was getting to that point I noticed the psychologist watching me walk and trip and looking concerned but not saying anything. By this point my speech was no longer fluent and I had to stop to remember about every 5th word. I sometimes cried because sentences wouldn't come out. The psychologist contacted the psychiatrist with his suspicion that I was toxic. I had no clue and in fact one thing I remember clearly was stating that I thought my level felt low.

The day after my labs I had gone to the greenhouse to pick up a mother's day gift. I had a message on my cell when I got back to the car. I was surprised that it was the psychiatrist and I believe she was equally surprised that I was well enough to be out doing errands. But her news that my level was quite high explained much.

And so a new chapter of my life began.......And to keep this post from being a book, you will have to see Part II for the next part of the story. In fact, there may even be a part III to keep it all divided up.

It's hitting me now

One week of the new job down. I haven't said much about it really, have I? It's a good job, and I'm happy with many parts. I am especially happy that nobody seems to be doing overtime and that it is just, well, it's an easier job. I am not going to run around saying that at work of course because nobody wants to hear it, but it is. The company is easier (thus far), the patients are beyond easier (I was not hit or otherwise assaulted or threatened once in an entire week!), and my assistants listen. It's so far much easier to do what I must learn to do and keep my work separated from my life.

At the same time I think it really hit me what the last 2 months were like. I'm exhausted and moody and even having occasional thoughts about hurting myself. I will not and they aren't even real thoughts that mean this is what I want, they are just the disease throwing curveballs. I am totally safe and am very good at handling much worse using a technique I helped create that works very well for me. But the thing is that when I have this kind of thought I get to remember that I have less control than I think I do.

This time this is further complicated because my meds are messed up. I needed to refill my depakote on Friday, so I called it in. The store usually says 20 minutes but this time asked for an hour. I killed the time and realized I didn't have my wallet with my debit card. So I tried to pay via check. Except that they wouldn't TAKE my check because I didn't have my driver's license. So I had to leave without it. Then when I checked my bank balance later it turned out that I was overdrawn because I have neglected to deposit some checks and then have had some unusual expenses. With the mania I've had I just haven't kept track well how much was left, and so I made a big mistake. And I can't get the checks deposited until tomorrow, so I can't pick it up until tomorrow. Unfortunately depakote is my heavy hitter med and I can always tell when I don't have it. On top of that we increased my lithium dose slightly to try to stop the continuous cycling of late. And to ice the cake I got a flu shot Friday and have had minor symptoms. Nothing bad, just an itchy bump where the shot went in (I'm guessing I'm allergic to some component although it's not eggs, but they do ask about an antibiotic (gentamycin) this year so perhaps I'm allergic to that) and a headache, but it was enough to make me sleep a lot.

So, I'm finding myself just wanting to wait a few more days before going to work. I made an enormous mistake not taking last week off and resting.

On the other hand, I can go to work each day knowing I'll be home what seems EARLY and that I will have a good day........

Post 106

I read somewhere that the 100th post is supposed to be that 100 things about me thing so many blogs have. My 100th post came right in the middle of ending my job and so I glossed over it. But I had been working on this for a while, so instead we are celebrating post 106.

I am not into trends and would ignore this, except that I realized I've been writing this blog for quite some time now and talk about many personal things and yet share very few of the mundane things that make me myself. Some of you very faithfully come here every day and yet have no idea about anything in my life except my illness. And yet the whole point I want to make by writing is that I am so much more than bipolar disorder. So, we'll see how many of these things I can come up with without giving too much away.

1. I love animals. When I was a kid I had up to 14 pets at a time.
2. Now I only have 3 cats.
3. Almost everyone in my family is a teacher.
4. I've had laser surgery to remove a birthmark twice. It didn't work.
5. I have a talent for home repair although I know my limits due to size and strength
6. I can often eat an entire can of vegetables in one day
7. I have listened to a radio in over a year and have no idea what music is popular
8. I listen to so many books on tape the library has to order new ones for me
9. I was a camp counselor for three years. My campers are all grown up now.
10. I grew up 45 minutes away from any fast food restaurant.
11. When I am depressed I crave tomato products, especially tomato soup.
12. I work in such a rural county that sometimes I drive past more Amish buggies than cars.
13. I have wild, curly hair that I can't control. I love it.
14. I kept this hidden until I was 25.
15. I attended a "stone cold sober college" and 2 "top 10 party schools" in the same year.
16. I hate wearing shoes. They come off as soon as I am home.
17. In college I was a vegetarian because I worked in the cafeteria and was digusted by the huge slabs of greasy meat.
18. I was a camp counselor at a camp for children with disabilities. They called me the "bug lady".
19. I have never smoked a cigarette. Or anything else.
20. One of my cats is scared of people. He is 4 years old and I have held him in my lap 4 times.
21. One of those times was today and I feel so special.
22. I haven't watched a current primetime network TV show in 2 years.
23. I didn't miss a single episode of the first 10 years of ER.
24. I often spend more per month on medications than I do on groceries.
25. I haven't seen my father in 10 years. It only bothers me when I fill out medical histories with "don't know". Except bipolar. Definetely bipolar.....
26. Since this blog started I feel like I am a totally different person.
27. I define myself and my illness very differently. That will be my anniversary post.
28. My "about" section is about to change dramatically.
29. I've never been further west than Iowa but I've been to northern Canada.
30. I've also been to Florida several times. I can't really enjoy warm vacations anymore because of meds.
31. I've never been out of the US and Canada.
32. Once I wanted to travel to many places and hoped to do it professionally. Now that's not realistic.
33. I really wanted to spend time in Alaska. My sickness will likely prevent that.
34. Reading is by far my favorite thing to do in the world.
35. I'm having fun re-reading books from when I had lithium toxicity because I don't remember a word of them. Double my money!
36. I don't have a favorite food. I live by cravings. Right now my favorite are veggie burgers.
37. I loved to be covered up. The more clothes or blankets I have, the happier I am.
38. When I was first a therapist I surprised myself with a talent for mechanical work.
39. I anger slowly but when I am angry I am unpleasant.
40. I love gardening. This year I did my whole garden without help for the first time.
41. I can't whistle.
42. I had to fight to do a thesis in my graduate program because it was too much work for the professors.
43. My grad school program had strange priorities regarding our learning.
44. Sometimes I still need to know things they insisted weren't important.
45. I don't wear makeup. I think it is itchy, no matter what kind I try.
46. When I get sick I usually have a mixed episode.
47. I have tiny veins and only one is easy to draw blood from. Between being in a clinical trial with constant blood draws, years of med levels, and my toxicity this year I appear to have track marks, but only on one vein.
48. I've known since I was 16 that I'd need a knee replacement someday, probably sooner than later although I have no problems now aside from the previous damage.
49. For some reason if I tell patients recovering from knee replacements this it makes them feel better, sort of like it helps to know I'll be in that pain someday too.
50. I love to suck on ice and eat popsicles.
51. I'm not a big fan of ice cream though.
52. In fact I don't eat many sweets.
53. One of my favorite things to do is to visit zoos. I've been to a lot of them.
54. I've had patients say they wanted to kill themselves twice. It taught me a lot about paperwork.
55. Working with psychiatric patients and secretly being one myself has taught me to think very differently about why patients might choose to do the things they do.
56. I have also learned to stand up for my rights as a patient because I have seen how often a psychiatric diagnosis results in poor care.
57. I have eaten a jar and a half of pickles this week.
58. I am not pregnant.
59. Today I hugged someone while she cried because she knows her husband of 69 years may die soon.
60. Nothing describes that.
61. I once went on a "Skyblaster" on a dare. This is a chair shot into the air on a bungee cord system.
62. I was extremely manic at the time but not yet diagnosed bipolar. It is how I know I'm bipolar though, that I did something so stupid (I'm terrified of heights!).
63. I earned an undergraduate degree in biology even though I hated much of it and it was far too difficult for me because I was too proud to quit.
64. I get a lot of hits for people who seem to want to prove that bipolar makes people evil. This annoys me.
65. I babysat triplets while in grad school. It was the best job I ever had; I was paid to play at a time when I really needed to play.
66. Until then I hadn't babysat in a long time because my last babysitting job the kids picked the lock on a gun cabinet and I stopped them just in time. I was scared out of wanting to be with kids.
67. I've had to learn to accept and forgive child molesters during my years working with quite a few of them. It was not easy but I learned some are not as evil as others.
68. I've been spelunking in a fairly small, easy cave. It was a lot of fun and I learned I'm less claustrophobic than most people.
69. Sometimes I run out of things to say and give up.....
70. This is one of them.

So far......Anxiety! (yet so good!)

So far, so good. The new job is way, way less chaotic than the old, and it seems that there is less pressure to do a zillion things at once. I'm not sure this will always be the case, but at least this week it's ok. The biggest thing is remembering a new way to do paperwork.

On the other hand I feel very odd about the bipolar thing. In the past I have always let employers know but never had specific medical details in my chart (having restrictions in a human resources file means that if they defy them I can sue). Since that didn't work so well over the last year or two and because I have become more susceptible to getting sick over that time I decided to use the preemptive strike method.

In the past I've always dealt mainly with the managers who were beyond local regarding this issue. It seems that this company may separate "lower" staff more or something. Who knows? Anyway, this left me dealing with the managers at the local facilities. Neither one jumped up and down yelling "yay, you are bipolar!!!"...I truly don't know what I wanted, but what I got kind of scared me. One of them seemed ok enough, but then when she talked to the higher up manager today she made reference to a fax she "couldn't discuss" (ie in front of me) and something else that just made it sound like she more than likely was talking about this. I may or may not be feeling totally paranoid. And then the other one talked to me about some of it very reasonably, but sort of in a way that made me want to scream I know more than you do about how to handle this. And one assistant asked questions that I didn't have answers for. The other I haven't told yet.

And some of it is hard. I have to get back in the swing of non-psychiatric patients. Someone got kind of upset with me today. I handled it ok, but in retrospect I'm not sure my approach was right. It would have been with my psych patients, but maybe not in this case. Only time will tell.

Another aspect of my job is predictably difficult. There's this other therapist who well, she just isn't very good. But she does take a lot of work. Therefore I've followed her around most of my career. And every time I've dealt with her evaluations which are so very wrong in many ways. I'm doing that again, and it's already getting old. And it will take a month before I'm done with her stuff, and probably one more before all the patients are fully on my treatment plans.

One place is also odd because many of the staff used to work at the place where I was discriminated against. I know that many very ugly things were said about me very publicly there, and so I wonder what rumors are going around. I really don't want to start with everyone knowing my diagnosis, nor do I want anyone to know some of the false accusations that were made against me.

For the most part though, things are really, really good. I just need to get past freaking out and expecting bad things to happen at every turn. I also need some serious rest. I should have taken time off between jobs. I need to quit believing I need to see 700 patients/day.

Most of I need to celebrate, because I got home before dark. And that was after doing errands! I don't remember the last time I could say that....

The Story of Us

Get a snack, this one is long....

I guess that this story really goes back as long as I was with the former company (They Who Didn't Work Out (TWDWO). Conveniently that nearly exactly corresponds with how long I've been with my psychiatrist (actually I think it is exactly the same), and she says it started at the beginning.

I was honest about my diagnosis from the day I started. I felt that it was best not to make a big deal about it and so I didn't. I never formally requested accomodations or anything. And for 2 years it was mainly ok. I had the episode of being discriminated against (hmm, don't seem to have ever mentioned that. I'm a contract therapist, meaning nursing homes contract with the companies I work for to place therapists in their buildings for financial reasons. I've never been employed by the place I work, which means that I have less ADA protection. A few years ago a very nasty company I would happily name if it wouldn't locate me kicked me out due to my diagnosis), but TWDWO was actually very supportive with that. The biggest thing that they did was that they were very willing to use guilt trips to get me to do more than I could, or to make me feel I should push myself to behave as though nothing were wrong. Generally though things were easily controlled by threats of written statements from the doctor. They knew written limitations had to be followed and so they would back off.

Eventually I ran into a supervisor who wasn't very nice. She would say I was doing things out of bipolarishness when I truly wasn't. She would disagree with something I was doing or would have done it differently herself (despite being an assistant in a different kind of therapy than I do and therefore not really qualified to judge) and report it to my superiors. This was reflected on my annual review. However, even though my review wasn't very good I was given a large raise, which was basically a buy-off for not suing during the discrimination.

Somewhere in there my company was purchased by a larger, much more money oriented company. The personal touches suddenly weren't there. And suddenly I was being assigned extra work because I wasn't making money at the rate they wanted. This was regardless of the fact that much of my work time that was not making money I did free, on overtime, because I knew it was related to my difficulties with thinking and paperwork. Suddenly I was fighting with supervisors and demanding to know if I needed neuropsychological testing to prove what anyone in our profession should know, that bipolar causes cognitive impairment and therefore I would always work more slowly, but that this didn't mean I couldn't do a fine job. Again, no documentation was needed, I was reassured.

Big mistake.

I was doing fairly well, I thought, so that's when I got into the whole sequence of events of last winter and spring that can be read in the archives. That all started with my agreeing to do a little overtime, which I wasn't really allowed to do but I was doing so well it seemed ok for a few weeks. And then people just kept not listening to me saying I couldn't continue working like that.

When my last assistant left in March I told my supervisor very specifically that I would fill in until I started to feel sick, but the minute I felt sick I had to stop. When I told her that time had come she lied to me and promised me help in a few days. When that didn't happen and I said I couldn't do it she kept ignoring me. And so I felt like if I didn't keep forcing myself to work that my patients would suffer, that Medicare rules would be broken, and that all sorts of things would be my fault. The guilt was tremendous. And my powers of logic just weren't there. There had been one day I had insisted I needed to have off: my friend's wedding. I desperately wanted to go to that wedding. Instead I worked until 11:00 that night. My lying supervisor was at the wedding and never even asked about where I was, despite my empty place at the table she sat at.

During the summer I spoke to her every few weeks per policy. She never expressed any sympathy or caring. I made some arrangements to go back to a very limited workload (paperwork only) and was allowed to go back sooner than I would have been otherwise. She really wanted me to cut to 32 hours but couldn't force me to because that's illegal upon a return from disability. It made me feel pretty worthless though.

Once I went back I found out it was all lies. That part I covered some. What I didn't cover were the huge number of other problems. The assistant issues were horrendous. She refused to help with that and lied about what she was doing. But I had no help to deal with anything. I had a 4 inch stack of paperwork I had been told in the spring to just not do until I had help. Now I had assistants but was still being given no time to do the paperwork. Many other issues came up, and I honestly don't even remember them now, except for her starting to push for me to make more money very soon after I returned, when I was only supposed to do a limited amount of billable stuff anyway.

I knew when I went back that I didn't have a great chance of success with this company. I was commuting 2 1/2 hours/day and that alone was a big factor. The psychiatric environment, while something I love, is very loud and stressful (and loud!) and therefore maybe not the best for me. I knew I was going to have to decide whether this was a healthy job, no matter how much I loved it. I had planned to decide in about a month. It took exactly one month.

After I had decided the company reacted to 3 of us quitting at the same time and ultimately removed the bad manager. I was offered my old job back several times but nobody could take care of the things that were most problematic. Things have gotten better in some ways with the new manager, but as you can tell from my last posts, things have been horrible with the assistant. The stress has been incredible. The time at work has been ridiculous and without any regard for my limits.

So the separation is official and the divorce decree has been issued.

Now to see what the future holds...