Ouchies

My psychologist says I take on projects impusively. Which is true, I just am not sure if it matters much of the time. However, my new dental project.....maybe moving too fast. Really wishing for an Advil. If I can do tomorrow's work I'll probably be in pain again, so posting may be slow the rest of the week.

Bravery

I wrote the post below and then realized there is something good coming of this fear. I am gaining courage to do other things I normally avoid because I have to do something, and perhaps I get a sense of control out of conquering less frightening things than my future.

So, last week I went to the dentist for the first time in 8 years. For a long time I simply didn't have insurance. After I was diagnosed with bipolar and started being nauseated all the time I just couldn't tolerate anyone's fingers in my mouth. Then I spent so much time vomiting and it damaged my teeth. So I spent 5 hours there last week and this week will spend about 6 more getting fillings and cosmetic work done. And although I never thought I cared much, I feel so much better with my pretty new teeth.

Next I am going to get the first good haircut I've had in years. I hate being descriptive of myself, but I think it's safe to admit that I have the kind of curly hair most women are envious of. I love it, but I'm also self conscious about it. (Nobody ever describes me without mentioning the hair, and it's the kind of curly that if someone says curly headed woman then of all the curly headed women in my workplace people are pretty sure they mean me). It's hard to get a good haircut because some people just aren't good at cutting curly hair. Over the years I've gotten so wary I kind of gave up. But I've had the same hairstyle for 6 years now and I'm tired of it. So as kind of a treat for surviving this summer and managing all the dental work I am going to go to one of the nicer places around here and shell out more money than I want to think about for a good cut and maybe even highlights (if I can find that much courage).

I think that I have this need to look as good as possible when I go back to work as some sort of confidence thing. I looked terrible when I left in April, and at least now I look healthy, but I will still have to prove myself. It's going to be really hard to go back and have people constantly asking where I was and what was wrong and only being able to give them a convoluted answer that some will know has major gaps in it. I do not have much confidence about how I look because the meds have distorted my body so much, and so feeling good about my head at least gives me confidence about something.

On the other hand, perhaps I should just shave my head and get it tattooed or something. That might take care of people being overly curious about where I was......

I want a crystal ball

I'm entering the home stretch of this leave. Four months after getting sick I'm finally able to be awake for normal amounts of time and perform a reasonable amount of activity without exhausting myself. In a pinch I could have gone back to work this week probably but my doctors are on vacation for the next 2 weeks and we decided I'll be safer with hands to hold when I am returning. So instead I am spending a few weeks continuing to get stronger, practicing waking earlier than I have in years, sticking to a strict schedule with meds, and gradually increasing my activity levels. After months of doing very little it is amazing how low my endurance is.

Tomorrow I am going to be negotiating with my supervisor about how many hours I will work. I am trying to arrange things so that I have a 4 day schedule, even if it is a full-time work week. I'm very nervous about this as somewhere deep inside I believe this is going to be really important.

And then I'll go back. Going back means that the most scary thing will or will not happen. I'll find out in the next 6 months or so whether or not I can do this job. Doing this job is one of the greatest loves of my life and if I have to admit that I am unable to do it due to my disability I am going to have to face resentment like I haven't imagined (and I've been quite resentful of thing thing before). I'm also going to face serious financial issues. I earned a master's degree to do this and am used to a salary equal to that, added to being paid in the upper range for what I do because of the lack of qualified people willing to do it. (Rural county, rural region. I drive to the next county to work and don't know their numbers, but my county which covers a big region although it is rural, has only 6 people with my qualifications. Quite a few more are needed to fill the minimum jobs here based on the number of facilities required to hire us). On top of that I have huge educational loans. Losing my job would likely mean having to give up my home and live with my mother, at least long enough to learn to do something else. And I don't want to do anything else.

I know that nothing is going to change what happens. There really are middle areas that I probably will be able to try. Unfortunately one of those scenarios is what I suspect will happen. Currently I work a long way from home in a more stressful and demanding environment than I necessarily need to (the psychiatric part). If things don't work I can request a transfer to a different location that better suits my needs, or I can get a different job. This of course means leaving the company I've really liked working for over the majority of my career, and even that brings up the frustration and resentment. I just want things to work the same as they always have, and I know that not only are there definite changes in place now already, but any sign that my disease has progressed scares me.

So, for the next few weeks I pretend I'm not thinking about this. It's just one of those things you wish you could hurry up and get over. If only I could make it be March 2007....what would we see?

Chosen Infertility

I grew up in a difficult situation. My family had more problems than there are grains of sand in a sandcastle, and was about as crumbly. There was little stability in my life until I was an adult. As I grew up I spent a lot of time babysitting and seeing what "real" families were like, and all I wanted was to experience that myself.

I grew up in Appalachia and parenting starts early there. By high school graduation nearly half the girls I grew up with had babies. I'm now 30, you can imagine how far off the curve I am from that group. I then attended a Christian college where most of the girls plan to graduate, get married and have babies. After 8 years many are on their 3rd kid.

My path was different; I was in school until I was 25 and certainly wasn't having children then. But I was sure that someday it would happen. Then I found out about bipolar and that my meds made pregnancy dangerous for the baby, while pregnancy without meds would be dangerous for me. So that door slammed.

It wasn't until later that I realized how big a piece of my heart got slammed in that door. I gave up dating totally years ago and part of the reason why is that I don't believe in dating without a future, and that means that early into a relationship I have to find a way to tell someone that they need to know that continuing the relationship means heading in the direction of marriage with no chance of having children. And there won't be children from adoption either; nobody would approve me to adopt and I couldn't handle it anyway.

The hardest part of this seems to be watching other people. I was shocked once when I stumbled into a blog written by an infertile woman and so many of my feelings were described.
I read several more infertility blogs and came to understand that my feelings are essentially the same, the same feeling that something has been taken away by an ugly power beyond my control. And the feelings of sadness and jealousy are the same. Yet my body might be able to produce a baby. Getting it there would be a hard thing, and I wouldn't handle it well when it arrived, but if I were unfair to that child, maybe I could have one. (Maybe not, one med causes infertility). Yet I will never do those things. So I have named what I live with "chosen infertility".

Today I became a 2nd cousin for the first time. Throughout the pregnancy I have been dealing with conflicting emotions, and I was surprised how very jealous I am. I'm not even sure I know how to write the note I need to write. It helps even less that my cousin proclaimed right up until a few months before she got pregnant that she never wanted children, and so it feels sort of like our roles were reversed.

Tonight I feel old and lonely. I know that the decisions I've made are right, and I know that I never could handle pregnancy or motherhood in any way that I would want, but I'm still so sad because I know I should be happy. And I'm angry. I just wish it could be remotely as easy for me as it was for her.

Welcome to the world Emma.

My new discovery

As my life gets back on track I suspect I'm going to be writing a lot more about my role as a caregiver to other mentally ill individuals. It's going to be interesting to go back to that (19 days!) now because for the first time I've come to understand that my serious illness is more like theirs than I thought. I used to believe that when the doctors said I was seriously ill they meant because I tend to not respond well to meds, I'm a very rapid cycler, I have severe mixed episodes and these are all factors that statistically put me in the "not good" category. The truth though is that I was diagnosed as "high functioning for severity". I never paid attention to the fact that this meant I too had severe illness and just was able to do well. Instead I thought it meant I got out of the things I associated with severe illness.

Well, now I've been through a lot of them. And more may come in the next months. My realism forces me to know that getting sick soon would be a bad thing and would mean changes in my life.

I've also realized that things that help my patients may help me. So many things I've never wanted to try before because having things to help in the house would mean I needed help. But this time I've tried more things like soundblocker headphones/earplugs, a white noise machine, and a few other things I forget. But my greatest discovery has been my newest. I bought a blanket which has areas that allow you to add weights. You can wrap up in it or sleep with it and the weight is soothing. I just got it yesterday and can't believe how much I love it. I wish I had tried this years ago.

From now on, I'll be taking more ideas from the seriously ill side.

Why I love my doctor

Throughout all this illness, I've spoken often of my doctor. I have been so lucky to have her. As I've described earlier in this blog, I had some really bad psychiatrists. Then I was in a clinical trial and for 6 months had incredible, world class doctors. At the end of that I couldn't find a doctor who would take me that was on my insurance. The doctors at the study said they would keep seeing me and work with me on rates I could afford but I was moving and 2 hours was too far to drive. So finally my therapist at that time worked out a deal with the psychiatrist that works 3 days per month at the clinic I go to, that she would see me monthly, knew I needed extra availability because of how quickly I cycle and how severe that can be if not stopped, etc.

I liked this doctor from day one because I felt like she was really listening, cared, and was treating me respectfully. One of the assessments she used was something I've given a hundred times and I told her this. Instead of making me do it anyway despite my ability to recite the answers she modified it into something equally hard but different and I saw for the first time that I really have some cognitive deficits, even in just general fund of knowledge. I was so surprised by that.

Over time she always listened to me and what I wanted. There are a few meds I truly fear and she knows that I don't want to take them unless all else has failed. She is totally respectful of that, and also of my reasoning that I am around psychiatric patients and I am able to see what med A does versus med B in a majority of our patients. She also is respectful of my medical knowledge, something not all doctors are. And she has never, ever expressed frustration despite how hard she has to work to keep me stable for even a few months at a time. Even now, when things have gotten bad enough that we're adjusting my meds in increments not usually used, she is totally patient with this.

When I'd been a patient for a few months I started a med that did something I didn't like--gave me a rash, made me sick, something. I left a message. That night at about 10:00 I was shocked when the doctor herself called me and then spent time talking to me, to change things around. Over time I learned she was going to call me a lot.

During recent months talking hasn't been my best form of communication. I was simply too confused there for a long time, and for much of it if I got frustrated or was talking about something frustrating or anxiety producing I would cry and cry. So she told me to email. And in 3 months I have probably emailed with her 25 or 30 times. She has to make time for this, it's not something she gets paid for. And yet she never complains and in fact responded immediately when I emailed today to tell her just that I was doing well and things look like the worst has ended.

My doctor has helped me feel like a person, like I deserved to be taken care of while I was sick. In my work I have seen the same thing I have experienced, that some (many) doctors treat seriously psychiatrically ill people as if the goal is to control the excessive outward symptoms the doctor most doesn't want to see (ie outward signs of psychosis), but they will ignore the patient's request to help them FEEL better. One of the psychiatrists where I work does this all the time. Patients complain of depression, and he'll give an antidepressant, but act as if it is so secondary it doesn't matter. Once the patient's mother had just died, she was dealing with the loss of the use of a limb, and I was the only person she was confiding in. I know she was depressed. But because he didn't read my notes he noted one month that she was grieving and the next that the grief was resolved. It wasn't, and she was still depressed. I know that with my doctor that this never will happen to me.

Well, this isn't the topic I started to write about today. I had something else in mind and when I typed the title this is what popped out. So tomorrow there should be good stuff. Actually, tomorrow is dentist day and I have an absolute horror of the dentist so there may be a lot. And sometime I'll write about the psychologist too. I mumbled something about the existence of this once to him so I'm more uneasy saying much about him; somehow I'll have to change features or something.

I'm Back

Where have I been? Sleeping! All of a sudden my body tricked itself into thinking about sleeping. So I've been working on pushing towards a normal sleep-wake pattern. Which is almost a joke if you know what mine has been like for years, but right now it is extremely exciting. So that means I'm really trying hard to stay physically busy so I am more tired. Today I've been moving furniture all day.

The happy news is that I'm back to being pretty close to myself. Still tired, and changed in ways I don't know the permanence of, a little more realistic about my life maybe, but I'm smiling and laughing and having fun again. I'm being sarcastic, which is a major part of who I am. I'm missing my patients and anxious to see if anyone remembers me. I didn't say goodbye to so many people because I really thought I would be back in 2 weeks. That was 3 months ago.

I need to go set up to take my meds. I need a snack that appeals. Somehow I keep not buying snack food that I like. I think I'm not used to eating that many snacks at home because when I'm working I don't. But with this heat I've been wanting and needing salt, and I am just not good at picking salty snacks. But it is SO nice now that my night snack with my pills is just "food to eat with pills" and is no longer "food to eat with pills/BRIBE to swallow them" because then it had to be something I really liked. Now I mainly stick to string cheese :).

Don't Leave Me!

My visit numbers are dropping off. Either I'm getting boring or I'm not posting enough. The last few days have been a combination of trying to resolve the annoying sleep issues and having my first full day of normal activity.

Which I'll talk about tomorrow because I need to get to sleep if I can. I have a psychiatrist appointment and have to wake up.

I'll be back!

I am so proud of myself

As I've said before, right now is all about little tiny steps. The last couple days have not been my best because my sleep decided to go crazy again and I'm tired. Then my meds and heat are not a good combination. So I have not been spending much time doing anything that is going to get me better. Which makes me crazy, because I just want to get better.

One of my daily assignments is to exercise. I'm supposed to walk, which also gets me out of my house. The other day I was excited to have walked a mile. Well, tonight I walked more like 3. I can't believe how out of shape I am in, I have sore muscles everywhere, but nonetheless, I did something really good for myself. (I have to be physically in pretty good shape as my job has significant physical demands and plenty of days I don't sit down all day long).

Now, if this only puts me to sleep...

In which I am Unfair

Feel free to disagree as you wish. I know I'm not being all that fair, but I'm mad, and this is my space, and I'm bipolar and as we all know bipolar patients are prone to wildness, and so I shall say what I think.

I am SO VERY TIRED of people who have simple depression discussing it. Not discussing depression in general, it is a hard thing to deal with. In fact, having just been solely depressed for one of the first times in many years for a while I was surprised at how badly it hurt. Specifically I am tired of the "and so THEN the psychiatrist said I might have bipolar, and I was all kinds of mad because everyone knows that only CRAZY people have bipolar and I am a totally normally person who just...". A quote today from someone said "I had rather thought that if I were bipolar I'’d be out all night gambling or having sex with shop clerks in dressing rooms. I kno ''I’m generalizing, but sheesh! If youÂ’re going to call me manic-depressive, canÂ’t I have some fun first?" Now, I'm sensitive, but I REALLY resent generalizations like that because I have gone to some huge extremes to control whatever impulses when manic, and I'm very resentful when someone assumes I have made bad decisions just because I have mania. That's where dangerous assumptions like "bipolar people shouldn't be allowed to _____" start, and I think that is stupid. I think what any bipolar person can do is pretty specific to that person and the time period. For example, I know that I absolutely cannot have children. Not only do my meds make it dangerous to a fetus, but I am completing 4 months of barely being able to care for myself. Not so good if I were a mommy. Another example is caffeine. When I was first diagnosed I was encouraged to give it up for a substantial time, like 6 months, then I could try small amounts again. I learned limits with it quickly and for the last 4 years have been able to have 1-2 cans of pop daily. Prior admitting to this last illness I was using it to get the manic energy I needed to ignore how terribly ill I was. So now caffeine will be an extremely rare treat for me.

The truth is that I have a nicely established history at this point of handling myself very well when manic. I have never purchased anything that I was not at least moderately considering and which was not useful when manic. The weirdest thing was 2 kittens, which I had sort of planned for, and sometimes I am more relaxed about prices than normal. So the rule is that I just don't buy things when manic. There was a period when I was first diagnosed that I spent hours daily walking through stores to burn energy. Even then I didn't spend money. In fact "No major decisions when manic" is recited around here like a mantra. The closest thing to a sexual error I have made was trusting a guy and thinking I could have a relationship with him despite signs he was going to hurt me. But I ultimately stuck to my real beliefs and punched him instead. (oops).

It is true that I will kill you and smile while doing it when manic. I will get my feelings hurt if you look at me funny, or if you don't look at me enough. I will instantaneously lose my temper if I even suspect you of crossing me and you will know it. But I just don't do what everyone thinks bipolars do and laughs at us for doing. And I'm sorry, but I don't find it funny. At all.

I've written before about my feelings about how bipolar is getting all popular, and this is exactly what I mean. The woman I mentioned above? Her doctor gave her a script for a mild(er) (it kicked my butt with a year of puking every morning at 10:00 but everyone else thinks it's mild) mood stabilizer and sent her away. And she hated it, because let's face it mild mood stabilizer isn't exactly Disneyworld, and so now she won't take anything. And I'm no diagnostic expert (nor do I know her), but I bet she merely has depression.

I think medically it is possible to treat more of these situations where people don't respond well to antidepressants, or where tiny signs of bipolar are present, because there are so many more meds for bipolar available now, but I think also there are situations where it is probably appealing to diagnose a low end bipolar disorder. Some insurance doesn't exactly promote seeing psychiatrists for common depression, and bipolar is common enough to keep people coming back. At the other end of the spectrum nobody wants patients like me; I take up way too much time. I am very, very blessed to have a doctor who is willing to spend an hour or more a month with me and responds to many emails as well. Before I saw her I was refused by every doctor my insurance at that time listed in my city (the Big City, not Cow Pastureville). I am constantly afraid she'll move to Canada or something.

Some realities need to come together: Bipolar is not common. It's not. Some people, probably lots of people, have slightly bipolarish features to their basic depression, but full blown bipolar is not common. On the other hand, all people with bipolar are not alike. There are plenty of people with bipolar who are (gasp) able to read and are hurt by the ridiculously common jokes. I have taken people off my list of blogs I regularly read because of bipolar jokes, more than once. And it's not like these blogs have anything to do with mental health which might give them some right. I have also forgiven jokes that didn't hurt so bad or hit on a bad day, more than once. The thing is, I have bipolar patients and spend a lot of time with bipolar people. And I laugh about things they do. I know people have laughed at me. I have laughed at me, because every so often I've really gotten into funny situations. But never, ever have I laughed because I thought I was too good for something. And when someone is laughing because they know they are too smart, too educated, too together to be bipolar and they could not possibly have the illness that tries to wreck my life on a daily basis, then that is where the world seems wrong.

In the meantime, people who think they know what my life is like without having my diagnosis, well, they can come help me start my 3 weeks of cleaning up detritus am much as I can during the hot, hot days we're about to have.

It's all in the eyes

I was born shy. My early life just made me more shy, and so as an adult it's been a long and conscious battle to beat shyness. I've had to learn to trust people, to talk to people, to shake hands, to control my posture, everything. Something I have never learned well is to make eye contact, especially with men. I link men to abuse and I try very hard not to fear them, but I do to some extent even when I know it is irrational. Even with the men I trust the most I'm always just a little afraid.

The only time I'm not afraid and can consistently manage eye contact is with patients. As a student I worked extremely hard on this and became very conscientious about it. However, I haven't seen a patient in 3 1/2 months. In fact, I've barely left the house in 3 1/2 months...So that skill is just not so good.

Last week I suddenly started, without trying, making eye contact with my male therapist. After a time or two he asked me about it. I don't know why. But suddenly I'm able to do it a lot more. It's odd to be so aware of it because now I am aware of it about 80% of the time, and I'm used to trying to do this, but not it being so constant.

This is so good though because it is progress beyond just my moods. My moods are improving slowly and steadily, and I'm no longer afraid I'll never get better. But it is really nice to randomly progress in an area that I didn't even care about.

Baby Steps

I am coming to terms with my need to let myself heal slowly. The problem is I don't accept doing small things as progress. And I get mad at myself for sleeping a lot, even though I know this is probably also related to the physical symptoms of hypothyroidism, and that medicine won't start working for at least 3 more weeks. And we're still adjusting my fall-asleep meds and that plays a role. Plus when I work I take a medication that helps me wake up; I've not had it for months now because I have to be more stable or risk mania. Hopefully I'll be able to start it soon.

So today I had lunch, read until I fell asleep, had a nap, loaded the dishwasher, cooked a full meal (this is a big deal), walked a mile, worked in my garden for a few minutes, and began to figure out how to fix the toilet. Oh, the toilet.....I found out the only thing more frustrating than lithium and the need to pee is lithium + need to pee + toilet that has to be kept shut off at the main valve and turned back on for all flushes. We won't go there, it's not been the highlight of the last few days.

I'm also trying to spend more time on the couch instead of bed so that maybe I'll stay awake better. Those who treat me would probably squawk if they knew how much time I've spent in bed, but the truth is that if I'm in my living room which is a single space with the kitchen I am very focused on my messy kitchen and I get upset. The mess in the bedroom bothers me less for some reason (I guess because laundry isn't as gross as dirty dishes).

Anyway, the big trick now is not being angry at myself for moving slowly. And remembering that I have 4 weeks to get better and that is a LONG time. My hope is to feel well enough to maybe enjoy the last week I'm off since it will be a long time before I have vacation again after this.

But we're getting there.

A good day

The last two weeks have been kind of hard with sleeping issues. If I take meds I sleep all day. If I don't I can't fall asleep then I want to sleep all night. On top of that, the holiday changed my schedule with my psychologist around a lot, and good or bad I'm very dependent on him right now. So all I could see was bad in almost everything. I knew I was better, but the most I'd had was several good hours together and I know that's not good enough for much of anything.

Thursday I cried and cried about needing a good day. It's really hard because I am going back to work knowing that I'm going to find out a lot about whether I can continue in my profession. It's possible that it is too much for me and I'll have to find another job. Which I don't want to do, for one thing, and would almost definetely mean a huge salary cut for another, which would mean a lot of lifestyle changes I don't want to consider. So everything feels like it is leaning on getting better and staying that way, and yet it hasn't exactly happened the way I wanted.

So we talked about how getting better will be slow. Somehow I hadn't thought of this in context. But I left with assigments to do yesterday, and doing them felt good. And I did them on little sleep. Last night I got very little sleep and had a morning psychologist appointment. Yet today has gone well. I'm tired but have done quite a few little things, and that's what I need to do. I've tolerated noise and even fireworks AGAIN (long story), and I'm ok. Now I suspect I will in turn sleep before 4 am.

4th of July

Didn't think that through so well....My town is one of those that spends tens of thousands of dollars on fireworks and attracts people from hours away to our display. As I understand it, during fireworks there are more out-of-towners than residents of Cow Pastureville here and it takes hours to empty out. Fortunately I have a great view from my patio. Normally this is fun.

This year I have been getting increasingly stressed as people play with firecrackers. Yet it didn't occur to me what this day would be like. Just to get through the last 2 hours has taken a double dose of ativan, an hour plus in my gross, smelly but nearly soundproof basement, and earplugs.

And I am still so jumpy it's probably externally visible. I think I have about 10 more pops in me before someone eats a firecracker....(not really)

Latest Drama

Now I got paperwork from work that means I owe nearly $1000 in benefits, which I've been asking about for months and not getting answers. Yeah, sure, got that sitting around.....

Even worse, it appears I may have to go back to work nearly a month sooner than anticipated. Like in TWO weeks. I'm not ready.....But it looks like the leave has more limits than I (or my doctor) thought. Hopefully that will be a misunderstanding. Or that they calculated wrong (possible). Or that they have a way to extend the leave that the government forces them to give me, realizing that it would probably take more than a month to find someone qualified to do what I do where I do it.

I'm scared though. I don't want to go back too soon and wind up unemployed in a few weeks. I don't want to go back too soon and get sicker. I just need time now and I'll make it, but I have to have that time. I wish I could prove this is no vacation.......

Three? Ha

I saw a headline several times today indicating that if 3 antidepressants don't work, more probably won't either.

I'm not sure why this is big news; I've known this factually for years. It's even known that this is a sign that further evaluation for bipolar disorder should be done. But, I just wonder what might have happened if someone had ever PAUSED when I hit 3. Let's see, excluding the first one that gave me a full body rash, that would be wellbutrin, and oh did I fail on that one. I felt terrible, was suicidal, and got worse by the day. (Ironically, the next thing that happens if I don't get my depression controlled is a trial of wellbutrin with moood stabilizers).

Overall, before I was diagnosed with bipolar I believe I had been on 11 antidepressants. When I told the expert doctor that during my evaluation he just laughed and said I didn't have to do that any more. Unfortunately that's not true, because I seem to need some form of antidepressant going along with my mood stabilizers (with a lot of control so they don't make me manic, which has happened, or stop working which also happens; I think we play with my antidepressant about 90% of the time), but if only I'd only tried 3......

My funniest search ever

As most blog readers know but I'll explain because once I wondered for a long time how this was done, there are freebie programs that you can get that are coded into your blog and through a separate page provide the blogger with a geographical (not very specific) region, how you were referred (if you stumble in or bookmark it it's unknown, but if you come in from a link or a google search that's specified). It tells you how many people come when, etc. I get a lot of joy out of watching this grow via this program.

It's also a fun sport to watch how you sometimes come up in search categories. I've come in funny sometimes, but never enough to want to share. This time though, I have found a weird one.....

I am proud to declare myself #310 (and yes that means they looked that far) if you search the SWEDISH version of Google for "site:blogspot.com *"i wet my pants"* OR *"i wet myself"* OR "i peed on myself" (*'s added to slow down other perverts?)

So yes, yes I did and PROUD OF IT? (Also known as YOU try driving an hour after drinking a gallon and taking lithium and geodon, both of which have incontince as side effects)