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........