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.