I have the mother of all headaches and it won't go away. I am so tempted to take 1/4 of a vicodin but I'm scared it will knock me out and I have to work in the morning. Tylenol isn't cutting this at all. I want so badly to take ibuproferon, but that can increase lithium levels. My dose is so low that this might not matter, except that I am so susceptible that it also could matter a lot.
Headaches are part of starting Lamictal. I remember from the other time I was on it that I had the worst headaches I'd ever had in my life during the first weeks. This time I've had one or two per week, and they have been unpleasant for sure. I'm much tougher about side effects now, so it's not the worst thing ever, but it hurts.
I hate Tylenol. (watch this become a search term that I am listed high on)
Monday, April 30, 2007
Sunday, April 29, 2007
My psychiatrist
I was doing some reading of other blogs today and realized something I never knew. I have a bizarre relationship with my psychiatrist. I knew I was very fortunate to have her because she has treated me well, always had creative ideas to help when my medication issues arose, and was always willing to be giving of her time and general caring. I knew that having a doctor actually make a committment to you and work to keep your life easier instead of making you accomodate them was pretty rare.
What I didn't realize is how differently she treats me. From this website I heard many, many people describe how their doctor tells them "this is what I suggest" and then they take it or not. My doctor rarely, if ever, has told me to do anything. Usually she asks what I want to do. The most directive she ever is would be to give me 3 or 4 options and let me decide, but even then I help determine the options.
When I saw her yesterday was a fabulous example of this. We discussed what I feel all the different changes lately have done. We decided it is time to let it ride a little bit and see what happens. And we talked extensively about what happens next. She was 100% respectful of my fears of my remaining medication options (Seroquel, Zyprexa, and Clozaril) and why. She understands that my fears go far beyond the normal issues with these meds (which are not to be scoffed at), and even admitted that with my history of really bad and often rare reactions to antipsychotics these drugs could be bad as well. No one knows.
I told her that after a lot of consideration I have a strong preference for any treatment that does not include those meds. I will of course try them, and I know they are a last resort and that last resort is coming, but I really would rather do something totally unheard or non-medication than take those meds. I told her that if ECT is an option I will do it, noting that ECT is not something I ever thought I'd be asking for. She is checking into this and a few other non-invasive, non-pharmacological possibilities.
But along with that, she brought other ideas to the table. She's doing some research, and then I may begin getting frequent labs for a period so that we can see if my med levels vary, causing my problems. If that is so I could boost or lower my meds as needed.
At the beginning of this I never thought I'd say someone could have as much of my blood as they wanted. (OK, I started off exactly that way because the clinical trial took a ton of blood, but aside from that).
But I had totally forgotten about psychiatrist visits being like regular doctor visits where you describe a problem and they fix it. Those days were so long ago. I am so lucky.
What I didn't realize is how differently she treats me. From this website I heard many, many people describe how their doctor tells them "this is what I suggest" and then they take it or not. My doctor rarely, if ever, has told me to do anything. Usually she asks what I want to do. The most directive she ever is would be to give me 3 or 4 options and let me decide, but even then I help determine the options.
When I saw her yesterday was a fabulous example of this. We discussed what I feel all the different changes lately have done. We decided it is time to let it ride a little bit and see what happens. And we talked extensively about what happens next. She was 100% respectful of my fears of my remaining medication options (Seroquel, Zyprexa, and Clozaril) and why. She understands that my fears go far beyond the normal issues with these meds (which are not to be scoffed at), and even admitted that with my history of really bad and often rare reactions to antipsychotics these drugs could be bad as well. No one knows.
I told her that after a lot of consideration I have a strong preference for any treatment that does not include those meds. I will of course try them, and I know they are a last resort and that last resort is coming, but I really would rather do something totally unheard or non-medication than take those meds. I told her that if ECT is an option I will do it, noting that ECT is not something I ever thought I'd be asking for. She is checking into this and a few other non-invasive, non-pharmacological possibilities.
But along with that, she brought other ideas to the table. She's doing some research, and then I may begin getting frequent labs for a period so that we can see if my med levels vary, causing my problems. If that is so I could boost or lower my meds as needed.
At the beginning of this I never thought I'd say someone could have as much of my blood as they wanted. (OK, I started off exactly that way because the clinical trial took a ton of blood, but aside from that).
But I had totally forgotten about psychiatrist visits being like regular doctor visits where you describe a problem and they fix it. Those days were so long ago. I am so lucky.
Saturday, April 28, 2007
In memory of a friend
I had a patient who I grew really attached to beginning when I first met him 3 years ago. He was very, very schizophrenic and lived a very tormented life. He gave everyone he liked their own nickname and refused to use real names. My name was "Virgin Mary". I had to do some pretty painful things to him and trust was a huge issue for him. So we developed a lot of rituals to help. Every day we loudly sang "Home on the Range". We agreed that screaming was ok, but it was best to wait until I wasn't in a position where I could jerk and make the pain worse. After days of practice he understood this and it helped immensely. The most important factor was that with much practice he came to understand that I would never hurt him without telling him first. I always count to 3 before hurting patients so they know and with him I made it very exagerrated, training him by counting to 3 before I touched him and not moving past that until he stayed relaxed. Ultimately he was so good at this technique that I could say "ok, it's time for (the thing that hurt)" and he would chant "do not resist, do not resist, do not resist, ONE....TWO...THREE".
After months of working with him he wasn't on my caseload, but I still visited frequently. Then one day devastating news came. The facility he lived in was closing. He was on the list to be transferred away, to another set of facilities. I kept praying he could be transferred to one of our facilities. After several weeks I learned I had gotten my wish and he would be moved within several days.
By that time only maybe 20 patients were left in the building. They had tried to consolidate them to one ward but this man was terrified of one of the other residents (for good reason) and so he and one or two others were in another ward. I happened to have a few minutes and saw him watching it rain, so we shared a Coke and talked about how "teak is the hardest wood, Virgin Mary. Teak is the hardest wood". I remember being grateful for having that time because normally that was a night I had counseling and I wouldn't have had any free moments. We also had a conversation that was strange, where he seemed to fully believe I was the real and true Virgin Mary, and he was talking about his past sins and his sadness about how he had lived. Unfortunately he had a terrible history of abuse and he had gone to jail for murder as a very young man, and he believed himself to be evil. We talked that night about how he was a good person, that God forgives, and that he was loved. I hope he knew that I loved him too.
I took that Thursday off for a psychiatrist appointment and saw my therapist that day. I even mentioned to her that I was glad for the schedule change because it had allowed me to have that neat time.
Friday I went back to work and was so excited to learn he had been moved to my primary building. I went to see him around lunchtime. He didn't seem himself, but he knew me and talked to me. Mainly he seemed afraid of his new roommate, who was having some behavior challenged moments (ie beating up staff). I started a treatment with him and left it on for some time.
Four hours later I went back to remove it. His door was closed. No big deal, I had to talk to someone else. I did that, came out and his door was still closed. I started to go to it, figuring I'd have to wait for them to finish changing him or something, but a friend stopped me and told me I needed to go say good-bye, that he had just died and she knew I loved him. I didn't believe her for so long and kept making her repeat it. It was true. He had a heart attack at supper and died. I was moments from having been with him; they were still preparing the body when I nearly walked in on that. I did not want to say good-bye; I realized he had done that 3 days before in an eloquent way.
I did run from the building. I have never fled work like that, and have never been affected like that by a patient death. I cried all night.
That was 2 years ago today. He had no family, no known friends. He was cremated and buried as a charity case by the county. I doubt anyone else alive remembers today that this is the anniversary of his death. So to give him some memorial, I love you and miss you Norman. I'll always be your Virgin Mary.
After months of working with him he wasn't on my caseload, but I still visited frequently. Then one day devastating news came. The facility he lived in was closing. He was on the list to be transferred away, to another set of facilities. I kept praying he could be transferred to one of our facilities. After several weeks I learned I had gotten my wish and he would be moved within several days.
By that time only maybe 20 patients were left in the building. They had tried to consolidate them to one ward but this man was terrified of one of the other residents (for good reason) and so he and one or two others were in another ward. I happened to have a few minutes and saw him watching it rain, so we shared a Coke and talked about how "teak is the hardest wood, Virgin Mary. Teak is the hardest wood". I remember being grateful for having that time because normally that was a night I had counseling and I wouldn't have had any free moments. We also had a conversation that was strange, where he seemed to fully believe I was the real and true Virgin Mary, and he was talking about his past sins and his sadness about how he had lived. Unfortunately he had a terrible history of abuse and he had gone to jail for murder as a very young man, and he believed himself to be evil. We talked that night about how he was a good person, that God forgives, and that he was loved. I hope he knew that I loved him too.
I took that Thursday off for a psychiatrist appointment and saw my therapist that day. I even mentioned to her that I was glad for the schedule change because it had allowed me to have that neat time.
Friday I went back to work and was so excited to learn he had been moved to my primary building. I went to see him around lunchtime. He didn't seem himself, but he knew me and talked to me. Mainly he seemed afraid of his new roommate, who was having some behavior challenged moments (ie beating up staff). I started a treatment with him and left it on for some time.
Four hours later I went back to remove it. His door was closed. No big deal, I had to talk to someone else. I did that, came out and his door was still closed. I started to go to it, figuring I'd have to wait for them to finish changing him or something, but a friend stopped me and told me I needed to go say good-bye, that he had just died and she knew I loved him. I didn't believe her for so long and kept making her repeat it. It was true. He had a heart attack at supper and died. I was moments from having been with him; they were still preparing the body when I nearly walked in on that. I did not want to say good-bye; I realized he had done that 3 days before in an eloquent way.
I did run from the building. I have never fled work like that, and have never been affected like that by a patient death. I cried all night.
That was 2 years ago today. He had no family, no known friends. He was cremated and buried as a charity case by the county. I doubt anyone else alive remembers today that this is the anniversary of his death. So to give him some memorial, I love you and miss you Norman. I'll always be your Virgin Mary.
Thursday, April 26, 2007
"We're" doing great
Sarah noted she feels my lamictal journey is a "we" experience. Trust me, that's a good feeling, because if it had been/becomes worse you'll hear all the gory details.
Thus far though, not so bad. I just took the last pill for week 4. Week 5 is the last week of increasing, then my doctor will determine what happens next. I think probably we'll hold at that dose for now because I'm feeling pretty strongly that it is time to let my body process all these med changes.
The only downsides have been some headaches, some mania that I fixed with adjusting doses of other things, and I threw up once and gagged pretty hard once. That's not bad, especially since in the same time I've done the lamictal I've gotten back on a touch of lithium, then increased that dose by a smidgen that only my body would care about. I also increased my depakote dose to the staggering 2500 mgs per day, requiring me to swallow 5 pills that are around 1/2" long each. I've come a long way because I can swallow all 5 at once. There was a long, long time I couldn't swallow the tiniest pills together or without hiding them soft foods.
The other things that are side effects are things I used to be really bothered by but now am so used to they are normal. I've gained a little weight, nothing major. I'm not sleeping well but there could be other reasons for that. I am waiting for my thyroid check; I won't be amazed if that med needs increased a tad. I have some fine motor tremor. The worst is that I've had a few times I've gotten very dizzy when I've not had enough to drink and am hot. That's not going to work well.
So yes, we're doing great. Hopefully I continue to tolerate this stuff and get benefit out of it; it's one I don't get a lot of room to play with the dose because my dose is limited because it is affected by taking depakote. It's also going to be interesting to balance this next increase if it can be balanced because each increase has meant a new period of mania that I've had to adjust something to accomodate. I'm very reluctant to further reduce my antidepressant (imipramine) which is the major way to do this. We'll see.
Saturday is psychiatrist day. I should have lots of new information then because I'm going with lots of questions. Hopefully I can be as tearfully honest as my recently resolved hopelessness has been making me be with others.
Thus far though, not so bad. I just took the last pill for week 4. Week 5 is the last week of increasing, then my doctor will determine what happens next. I think probably we'll hold at that dose for now because I'm feeling pretty strongly that it is time to let my body process all these med changes.
The only downsides have been some headaches, some mania that I fixed with adjusting doses of other things, and I threw up once and gagged pretty hard once. That's not bad, especially since in the same time I've done the lamictal I've gotten back on a touch of lithium, then increased that dose by a smidgen that only my body would care about. I also increased my depakote dose to the staggering 2500 mgs per day, requiring me to swallow 5 pills that are around 1/2" long each. I've come a long way because I can swallow all 5 at once. There was a long, long time I couldn't swallow the tiniest pills together or without hiding them soft foods.
The other things that are side effects are things I used to be really bothered by but now am so used to they are normal. I've gained a little weight, nothing major. I'm not sleeping well but there could be other reasons for that. I am waiting for my thyroid check; I won't be amazed if that med needs increased a tad. I have some fine motor tremor. The worst is that I've had a few times I've gotten very dizzy when I've not had enough to drink and am hot. That's not going to work well.
So yes, we're doing great. Hopefully I continue to tolerate this stuff and get benefit out of it; it's one I don't get a lot of room to play with the dose because my dose is limited because it is affected by taking depakote. It's also going to be interesting to balance this next increase if it can be balanced because each increase has meant a new period of mania that I've had to adjust something to accomodate. I'm very reluctant to further reduce my antidepressant (imipramine) which is the major way to do this. We'll see.
Saturday is psychiatrist day. I should have lots of new information then because I'm going with lots of questions. Hopefully I can be as tearfully honest as my recently resolved hopelessness has been making me be with others.
Tuesday, April 24, 2007
Feeling Better????!!!!
I think the worst is over. That was a fun 3 months....ha. I still have one more increase on the Lamictal starter and then that's over. Hopefully it won't cause mania again, because moving my antidepressant dose again would be a pain in the butt.
I saw my regular doctor today for my thyroid check. He asked how I was doing and I told him I'd been having a rough spell. He then noted my rather impressive number of med changes since I last saw him in February. I guess it has been a lot: I added lithium, added lamictal, changed my antidepressant dose, changed my provigil dose, and I think went off some other mood stabilizer.
Emotionally I still have a lot to work out, but it feels like the mood whirlwind is subsiding, which will let me do my thinking. I finally do not feel so hopeless. For so long I've felt as hopeless as I've ever remembered feeling, and that scared me. I've also been so afraid. Now those things aren't so magnified, and I think with time, and of course the psychologist I've chained to my wrist, I can find my way through the scary parts.
What is so hard is that for so long I thought if I tried hard enough there would be plenty of areas of my life unaffected by bipolar. Until last summer I thought I could make myself appear to be "normal". The psychologist won't let me continue that because that's what leads me to trying to do things I can't do. Fine. I then tried to go about life trying to isolate the parts that were affected by those that weren't. I tried to decide what would and would not be affected. That didn't work so well either. These last months I have been working so very hard and trying so very hard and well, it did not work. I've been exhausted and depressed and thinking I can't. Truthfully, if this is the way it is, I can't. But if I can work without so much force involved I can. For the last few months I've been operating on this "something must give" feeling, yet barely managing to glue things together. Now I have to sort out how to relax in different ways different days so I can have a more balanced life. I wasn't great at that before I was so sick last year, and I have become truly hideous at it since.
So finally I'm getting my break. I'm so grateful for the sunshine. I'm sure that alone has a great deal to do with this.
And in true bipolar fashion, now I just have to hope it lasts.
I saw my regular doctor today for my thyroid check. He asked how I was doing and I told him I'd been having a rough spell. He then noted my rather impressive number of med changes since I last saw him in February. I guess it has been a lot: I added lithium, added lamictal, changed my antidepressant dose, changed my provigil dose, and I think went off some other mood stabilizer.
Emotionally I still have a lot to work out, but it feels like the mood whirlwind is subsiding, which will let me do my thinking. I finally do not feel so hopeless. For so long I've felt as hopeless as I've ever remembered feeling, and that scared me. I've also been so afraid. Now those things aren't so magnified, and I think with time, and of course the psychologist I've chained to my wrist, I can find my way through the scary parts.
What is so hard is that for so long I thought if I tried hard enough there would be plenty of areas of my life unaffected by bipolar. Until last summer I thought I could make myself appear to be "normal". The psychologist won't let me continue that because that's what leads me to trying to do things I can't do. Fine. I then tried to go about life trying to isolate the parts that were affected by those that weren't. I tried to decide what would and would not be affected. That didn't work so well either. These last months I have been working so very hard and trying so very hard and well, it did not work. I've been exhausted and depressed and thinking I can't. Truthfully, if this is the way it is, I can't. But if I can work without so much force involved I can. For the last few months I've been operating on this "something must give" feeling, yet barely managing to glue things together. Now I have to sort out how to relax in different ways different days so I can have a more balanced life. I wasn't great at that before I was so sick last year, and I have become truly hideous at it since.
So finally I'm getting my break. I'm so grateful for the sunshine. I'm sure that alone has a great deal to do with this.
And in true bipolar fashion, now I just have to hope it lasts.
Sunday, April 22, 2007
Oops
In the last few weeks my blog has been pretty high on the search list for non-compliance with meds, and I've gotten a ton of hits off this term. During the same period I've been pretty proud of my close to perfect if not perfect compliance while not feeling well (I think I missed some once because I fell asleep too early).
Yesterday proved sometimes trying just isn't enough. I wake up at 4:00 AM to take 2 meds. Usually I barely open my eyes, just pop the pills in, drink something, and go back to sleep. Sometimes I'm hungry and grab a small snack.
Saturday morning I must have been hungry. I must also have been really sleepy. I pulled back the covers to go to bed last night and found 2 pills lying there. I realized I must have laid them down and gone to sleep. Then I looked further and found a hardboiled egg, wrapped in a napkin, neatly laying beside me in the bed.
I tried....
Yesterday proved sometimes trying just isn't enough. I wake up at 4:00 AM to take 2 meds. Usually I barely open my eyes, just pop the pills in, drink something, and go back to sleep. Sometimes I'm hungry and grab a small snack.
Saturday morning I must have been hungry. I must also have been really sleepy. I pulled back the covers to go to bed last night and found 2 pills lying there. I realized I must have laid them down and gone to sleep. Then I looked further and found a hardboiled egg, wrapped in a napkin, neatly laying beside me in the bed.
I tried....
Saturday, April 21, 2007
Dear "Want to be manic",
You found my site searching for this term. Trust me, you do not want to be manic. Maybe it sounds fun. Maybe it sounds like some drug-induced high (ok, maybe it is, I wouldn't know). But really, no. Mania is humiliating. You do so many things you'd never do when not manic. I've yelled at people, cursed at them, made bad decisions, fallen in love with terrible people, and on and on. And I'm fortunate because in the bad decision arena mine have all been minor.
Mania also just doesn't feel good. It can feel good for a while. I think some people get a lot more enjoyable highs than I do, but I'm speaking of myself and since my site was on of the top 10 on this and the others concurred, I think it's generally true. I live my life in a perpetual moderate-severe mixed state with very little time better than that (maybe 3% of my life is less than moderate mixed, at best). A mixed state means you are both depressed and manic simultaneously. Therefore, 97% of my life I have manic symptoms. I know them very, very well.
What mania usually is about is feeling like the world is moving way too fast. Sure, it's fun in a way to think faster than everyone, and it used to make me appear smarter than I was because I could reach conclusions faster than others. But now my thinking is much more muddled. Rapid thinking is overwhelming and intrusive. It is impossible to focus, and unfortunately most of life requires some degree of focus. The best example I can think of is to take a double dose of sleeping pills in the morning and then go to work and make the biggest presentation of your career (or take the SATs if you are a teenager) while under the influence. Although mania is much more energetic it is the same inability to focus that this would produce, plus it is combined with the absolute embarrassment that everyone can see you absolutely can't sit still. When I am like this I try to remind people that I am like this taking HUGE doses of meds to calm me down; this is somewhat impossible to comprehend, I've discovered.
I've heard it described as too much caffeine. That doesn't even come close. I remember grad school, living on caffeine and then drinking enormous mugs of frighteningly black coffee at night to keep us awake to try to learn neurology. That feeling wasn't like mania. That was the little brother of mania. That was the "oops, now I can't sleep" feeling as opposed to "I haven't slept in 3 days and I worked 12 hours on my feet and I'm still pacing around Walmart even though I don't need anything because I can't stand my apartment because it is so small I'm afraid I'll kill myself just to get more space".
Mania is experiencing every sensation far too acutely. I have very curly hair and if my bangs are a certain length they curl into my eye slightly. I have had to cut this piece of hair off at work before because it was making my life miserable and I couldn't tolerate it one more minute. It is hearing noises from 5 houses down the street. It is jumping at every little noise. It is having permission to turn your therapist's white noise machine on and off as needed.
Mania is so ugly that it makes you glad to take medications that make you slow and fat and tired. It makes you thankful to take meds that can and do harm your kidneys, liver, and thyroid. You just smile at the warnings to take birth control with this med each month, thinking that this reminder is on all your pills. You don't blink at forking over $250/month for meds. For me, mania is so ugly that in a week I'll know if I can add electroshock therapy to my treatment list, something I've decided I may prefer to my remaining treatment options. You can be pretty sure something is not fun if you are willing to ask someone if they please will give you general anethesia, stick a thing on your head, zap you, cause you to have a seizure, and then repeat the process a bunch of times.
I could continue, but I just don't want to. The point is though, no, you do NOT want to be manic. EVER.
Mania also just doesn't feel good. It can feel good for a while. I think some people get a lot more enjoyable highs than I do, but I'm speaking of myself and since my site was on of the top 10 on this and the others concurred, I think it's generally true. I live my life in a perpetual moderate-severe mixed state with very little time better than that (maybe 3% of my life is less than moderate mixed, at best). A mixed state means you are both depressed and manic simultaneously. Therefore, 97% of my life I have manic symptoms. I know them very, very well.
What mania usually is about is feeling like the world is moving way too fast. Sure, it's fun in a way to think faster than everyone, and it used to make me appear smarter than I was because I could reach conclusions faster than others. But now my thinking is much more muddled. Rapid thinking is overwhelming and intrusive. It is impossible to focus, and unfortunately most of life requires some degree of focus. The best example I can think of is to take a double dose of sleeping pills in the morning and then go to work and make the biggest presentation of your career (or take the SATs if you are a teenager) while under the influence. Although mania is much more energetic it is the same inability to focus that this would produce, plus it is combined with the absolute embarrassment that everyone can see you absolutely can't sit still. When I am like this I try to remind people that I am like this taking HUGE doses of meds to calm me down; this is somewhat impossible to comprehend, I've discovered.
I've heard it described as too much caffeine. That doesn't even come close. I remember grad school, living on caffeine and then drinking enormous mugs of frighteningly black coffee at night to keep us awake to try to learn neurology. That feeling wasn't like mania. That was the little brother of mania. That was the "oops, now I can't sleep" feeling as opposed to "I haven't slept in 3 days and I worked 12 hours on my feet and I'm still pacing around Walmart even though I don't need anything because I can't stand my apartment because it is so small I'm afraid I'll kill myself just to get more space".
Mania is experiencing every sensation far too acutely. I have very curly hair and if my bangs are a certain length they curl into my eye slightly. I have had to cut this piece of hair off at work before because it was making my life miserable and I couldn't tolerate it one more minute. It is hearing noises from 5 houses down the street. It is jumping at every little noise. It is having permission to turn your therapist's white noise machine on and off as needed.
Mania is so ugly that it makes you glad to take medications that make you slow and fat and tired. It makes you thankful to take meds that can and do harm your kidneys, liver, and thyroid. You just smile at the warnings to take birth control with this med each month, thinking that this reminder is on all your pills. You don't blink at forking over $250/month for meds. For me, mania is so ugly that in a week I'll know if I can add electroshock therapy to my treatment list, something I've decided I may prefer to my remaining treatment options. You can be pretty sure something is not fun if you are willing to ask someone if they please will give you general anethesia, stick a thing on your head, zap you, cause you to have a seizure, and then repeat the process a bunch of times.
I could continue, but I just don't want to. The point is though, no, you do NOT want to be manic. EVER.
Thursday, April 19, 2007
Do-It-Yourself Mania Diagnosis
In my last post, about an hour ago, I said something about stripping wallpaper and how doing this may indicate mania. Well, I'm sure now. The ONLY time I can attend to something like that is a project inspired by mania. This one is ok so far, because it is something that does need done, I'm controlling the time spent on it, and it's not costing me sleep, but the manic feelings are there. It's so hard to stop because it FEELS SO GOOD. It's something I can control when my world is out of control. What's more, stripping wallpaper, I have found, is deeply satisying, like peeling sunburn. Ask me in 2 or 3 months how I feel, because hours of work have only uncovered about 8 inches of the bottom half of one wall. But the incentive is there: this room is to be my quiet place, my room that is soley devoted to relaxing. I can't wait.
Holding my breath
I feel decent again today. I don't know if it's the meds or my attitude adjustment via patient, or eating better or even the stupid vitamins my psychologist told me to take. Whatever it is, two better days really have helped. The trick now is that I have to always be wary of good days. In a week I can begin to trust this. Until then, until I have gone a while without that feeling of absolute hopelessness I've been feeling for so long, I have to stay on edge. Even while feeling good I know that right now this may be too much. I'm feeling good but I'm also peeling wallpaper off and it's a really tough job I've put off tackling for a long time (two layers of that stuff for kids rooms that is really adherent with two layers of borders at the top. So that means up to 6 layers of chemicals and scraping, all the way down 2 walls, and then there is another border at the ceiling that I'm hoping comes off easier (ha). Working on this kind of thing often means I'm borderline manic.
Oh well, two days of feeling ok. That's a cautious celebration and really the thing I have been praying for.
Oh well, two days of feeling ok. That's a cautious celebration and really the thing I have been praying for.
Wednesday, April 18, 2007
Huh
Turns out I still have the ability to feel ok. Today was a much better day. I felt slightly less hopeless and more interested in life than I have in so long I don't remember. I realized there is something I need to do that probably has to come before the whole accepting that my illness did progress quite a bit over the last year and I need to live accordingly. Somehow as I'm coming to terms with that idea alone I'm feeling a little more peaceful, because I'm starting to realize that I truly can't handle things the way they are, and that I am not just quitting. Giving in to the illness has always seemed like giving up, so this is a big change in thinking for me.
The discussion I had with my patient yesterday also gave me a lot to think about. The last weeks have scared me because I have felt totally hopeless, something I'm not used to feeling. It has felt this episode was non-ending, that nothing would ever help again, and that nothing would be ok ever again. That discussion reminded me that there have been plenty of times I have thought about whether I wanted to live or die and I've always chosen to live. This time I didn't feel like I wanted to make that choice, I felt it was made for me, but that it was nothing but bleak nothingness ahead. Which is hardly what I want. Hearing my patient yesterday was an important lesson in yet another thing to consider before considering suicide. It made me realize that I want to live. I'm scared because I just don't see much that I can predict in my future, not even the normal things people rely on, but at the same time I have the things I need to let me fight a little longer until something works, and I can try again to trust that something will work.
Here's to joy tomorrow....
The discussion I had with my patient yesterday also gave me a lot to think about. The last weeks have scared me because I have felt totally hopeless, something I'm not used to feeling. It has felt this episode was non-ending, that nothing would ever help again, and that nothing would be ok ever again. That discussion reminded me that there have been plenty of times I have thought about whether I wanted to live or die and I've always chosen to live. This time I didn't feel like I wanted to make that choice, I felt it was made for me, but that it was nothing but bleak nothingness ahead. Which is hardly what I want. Hearing my patient yesterday was an important lesson in yet another thing to consider before considering suicide. It made me realize that I want to live. I'm scared because I just don't see much that I can predict in my future, not even the normal things people rely on, but at the same time I have the things I need to let me fight a little longer until something works, and I can try again to trust that something will work.
Here's to joy tomorrow....
Tuesday, April 17, 2007
Someone who knows
I have this patient who from the day I met her has said I look and sound so much like an old friend of hers. She's talked a lot about how much my laugh sounds like this person. She has also talked about how my hair is so much like hers (the patient's) when she was young (my hair is wildly curly).
At some point she told me I reminded her of her daughter. She wasn't doing very well then, and I was confused because I was pretty sure she didn't have a daughter, and sure enough, no daughter is listed in her chart. When she said the same thing to another therapist the therapist reminded her she didn't have a daughter. The patient told her that she meant I was like the daughter she always wanted and never had. That alone melted my heart.
Tonight she told me the full story. She did have a daughter. A daughter who looked remarkably like me, sounded much like me, and even walked like me. A daughter who was mentally ill, spent time in the state hospital, and eventually killed herself when she was still young.
I've certainly never told this patient my story. I'll never admit my illness to her, especially now because I know it would hurt her. But she knows.
At some point she told me I reminded her of her daughter. She wasn't doing very well then, and I was confused because I was pretty sure she didn't have a daughter, and sure enough, no daughter is listed in her chart. When she said the same thing to another therapist the therapist reminded her she didn't have a daughter. The patient told her that she meant I was like the daughter she always wanted and never had. That alone melted my heart.
Tonight she told me the full story. She did have a daughter. A daughter who looked remarkably like me, sounded much like me, and even walked like me. A daughter who was mentally ill, spent time in the state hospital, and eventually killed herself when she was still young.
I've certainly never told this patient my story. I'll never admit my illness to her, especially now because I know it would hurt her. But she knows.
Monday, April 16, 2007
Count the flowers
I keep trying to get an honest and direct assessment: "This is exactly how bad you are". Sort of like on a scale of 1-10, where is my bipolar? Nobody is going to give me this, of course, and that's probably a good thing.
I have ascertained several things now. One, I'm not as sick as I was a year ago. Good to know, didn't think I was, but hard to be sure sometimes because I remember so little of the first few months. Two, I'm experiencing some of what I maybe "should" have when I was diagnosed. Back then I refused to accept how big some of the loss was. Now I get to do that. There are just things I refused to accept that I should have accepted. It hurt tonight to be told that sometimes people don't fully recover from the kind of episode I had last year. I know it, but I've avoided that kind of thought for so long. Three, I'm feeling sorry for myself. Not sure anyone expects differently right now, I think I'm still allowed for a bit longer, but some of this is my attitude.
So that's my new assignment: counting flowers. We're having a weird, weird year with ugly weather recurring over and over, yet the flowers keep popping through.
This better make me feel better.....
I have ascertained several things now. One, I'm not as sick as I was a year ago. Good to know, didn't think I was, but hard to be sure sometimes because I remember so little of the first few months. Two, I'm experiencing some of what I maybe "should" have when I was diagnosed. Back then I refused to accept how big some of the loss was. Now I get to do that. There are just things I refused to accept that I should have accepted. It hurt tonight to be told that sometimes people don't fully recover from the kind of episode I had last year. I know it, but I've avoided that kind of thought for so long. Three, I'm feeling sorry for myself. Not sure anyone expects differently right now, I think I'm still allowed for a bit longer, but some of this is my attitude.
So that's my new assignment: counting flowers. We're having a weird, weird year with ugly weather recurring over and over, yet the flowers keep popping through.
This better make me feel better.....
Saturday, April 14, 2007
The heart of the topic(s)
I figured out what bothers me so much about the whole "i'll never date someone who is bipolar/schizophrenic" thing. It's generalization. Every single person who said that, and very often nearly anyone who says they won't ______ because someone is bipolar seems to have a commonality: they are basing it on their knowledge of ONE person with this disorder. Bipolar is rare, and obviously severe bipolar is more rare. Not everyone will ever meet someone with severe bipolar. Naturally some people with bipolar are not so great. Some people with no disorder at all are not so great. But bipolar sticks out and so people do this thing of assuming the one bipolar person they met is the only way it can be.
I did this too. One of the reasons I wasn't diagnosed for so long was my terror of the diagnosis. My father is bipolar as well and not treated and he is not a pleasant person. I refused to admit I was anything like him.
The thing is, in most ways I'm not. I am bipolar, and I have some of the same characteristics he did. He was a rapid cycler, although not as severe as me (probably because my treatments early on worsened this). He had mixed episodes. But he also had psychosis, and not just the rare auditory hallucination I've had. He was much more impulsive than I am. And most importantly, he lacked insight. Insight is my gift; I'm not supposed to be able to but I am able to understand and re-learn behaviors. My psychologist told me once that this is a weird trait of mine, that insight isn't supposed to be a particularly effective tool, but for me it works.
And that seques nicely into life's next issue for me....
I'm starting a very, very hard process. I have existed at a level of "I know my illness is very bad and that I am doing better than I should. I am grateful for that. I know what is bad, but I do not know how bad in specifics. I believe that knowledge is detrimental". I knew it was very unlikely I would continue to maintain at that level forever, and that eventually I'd have to admit that I needed to function more in line with the severity of my illness. That time has come. Unfortunately first I have to learn what the severity is and accept it because it is pretty clear I can no longer continue working the way I have been. This very painful and scary. I'm asking for patience as I go through a rough time while already functioning at a low enough level my psychologist's homework this time was to buy and eat something healthy.
Which I now need to make space for in the refrigerator.....
I did this too. One of the reasons I wasn't diagnosed for so long was my terror of the diagnosis. My father is bipolar as well and not treated and he is not a pleasant person. I refused to admit I was anything like him.
The thing is, in most ways I'm not. I am bipolar, and I have some of the same characteristics he did. He was a rapid cycler, although not as severe as me (probably because my treatments early on worsened this). He had mixed episodes. But he also had psychosis, and not just the rare auditory hallucination I've had. He was much more impulsive than I am. And most importantly, he lacked insight. Insight is my gift; I'm not supposed to be able to but I am able to understand and re-learn behaviors. My psychologist told me once that this is a weird trait of mine, that insight isn't supposed to be a particularly effective tool, but for me it works.
And that seques nicely into life's next issue for me....
I'm starting a very, very hard process. I have existed at a level of "I know my illness is very bad and that I am doing better than I should. I am grateful for that. I know what is bad, but I do not know how bad in specifics. I believe that knowledge is detrimental". I knew it was very unlikely I would continue to maintain at that level forever, and that eventually I'd have to admit that I needed to function more in line with the severity of my illness. That time has come. Unfortunately first I have to learn what the severity is and accept it because it is pretty clear I can no longer continue working the way I have been. This very painful and scary. I'm asking for patience as I go through a rough time while already functioning at a low enough level my psychologist's homework this time was to buy and eat something healthy.
Which I now need to make space for in the refrigerator.....
Wednesday, April 11, 2007
Am I wrong?
Another blog I read has me thinking a lot. Because I'm me and I live my life and probably because of my experiences with psychiatric patients I have a very strong, firm belief that some, not all, but some, severely mentally ill people can live extremely normal lives. I know that it is possible to respond to meds even after psychosis and live a fairly normal, medicated existence. I know from my own life, it's possible to have a lot wrong and still live normally.
I've been kind of stunned to learn from this blog (not one related to mental illness) that all the readers who have discussed this in the comments think that severe mental illness automatically means it is going to be very hard to have a good relationship with someone and they laugh at the idea of dating someone with mental illness.
But what makes a mentally ill person totally ineligible to be loved that way? Am I missing something? Because I know that for me there are certainly mentally ill people I would not mix myself up with, and I actually had to very forcefully eject a friend from my life because her mental illness caused me too many huge problems, but there are many, many people who are without any mental illness who I would stay far, far away from.
Right now I feel like I've just learned that there is no hope for yet another thing in life. And I find it so unfair. I asked and I wanted honest answers, but I didn't expect that NOBODY would agree that there is any chance I could be worth dating. Which makes me wonder how far that goes. Does that mean I'm not worth being friends with? Not worth talking to? Is it scary to share space with me? Where does this stop?
I've been kind of stunned to learn from this blog (not one related to mental illness) that all the readers who have discussed this in the comments think that severe mental illness automatically means it is going to be very hard to have a good relationship with someone and they laugh at the idea of dating someone with mental illness.
But what makes a mentally ill person totally ineligible to be loved that way? Am I missing something? Because I know that for me there are certainly mentally ill people I would not mix myself up with, and I actually had to very forcefully eject a friend from my life because her mental illness caused me too many huge problems, but there are many, many people who are without any mental illness who I would stay far, far away from.
Right now I feel like I've just learned that there is no hope for yet another thing in life. And I find it so unfair. I asked and I wanted honest answers, but I didn't expect that NOBODY would agree that there is any chance I could be worth dating. Which makes me wonder how far that goes. Does that mean I'm not worth being friends with? Not worth talking to? Is it scary to share space with me? Where does this stop?
Tuesday, April 10, 2007
Current state of affairs
Manic. Mind going too fast to trust. Cranky. Practicing irritable remarks aimed at certain co-workers. Not sleeping. Really miss sleeping. Trying to adjust meds a bit. Work killing.
Threw up this morning. May or may not be lamictal. Ick.
Threw up this morning. May or may not be lamictal. Ick.
Monday, April 09, 2007
Dear Just Me
Sarah asks:
Dr. You-I have a confession; I have been very bad about taking my meds lately. I am non-compliant and it sucks. I have realized that though and am going to get better about it.Do you think that having a reward system (took all my meds for a week so I can buy a new book) is an okay idea ... it would probably work for me, but I don't want to depend on a "reward" system for actually taking the medications I need to feel like me. Help?
Ugh. I doubt there is any bipolar patient out there who has not struggled with this. I certainly have. I probably struggle much less than most people, for several reasons, but it is very hard. The first reason I do better is that I've worked with psych patients enough to have seen how much meds help and I force myself to remember this. The second is that I cycle so rapidly that it is not unlikely for me to be suicidal several times per year. I know that the only way to avoid feeling like that is to take the medication. Even though I don't remember from time to time what that feels like, I remind myself as often as needed that I know it is a dark place. Third, and most pathetically, I'm so sensitive to meds that I deal with horrible side effects all the time anyway.
There have been two times in my 5 years of this illness that I've had the most trouble. The first was about 15 months into diagnosis, when my meds were still very out of whack and I was rebelling against the entire "lifetime"-ness of the whole thing. I was having side effects that were unpleasant (vomiting daily) and felt irritable and miserable all the time. Along with that I had just bought a house, moved, started a new job, and was watching a friendship I thought was going to last forever crumble over my illness. Instead of working with my doctor I rebelled, but I quickly learned she wasn't going to take me off meds because I refused to try. When I took them again very regularly and I was still sick she got me off quickly.
The other time was last year with all the lithium toxicity. I simply couldn't keep things down, and everyone reassured me it didn't count as med non-compliance because I was trying. However, after we determined I had been lithium toxic for months and had missed a crucial blood test, my psychologist began pushing me to be compliant with both meds and bloodwork. Having him stay on my case does motivate me, because he is not very forgiving even if I've only missed one dose.
On the other hand, things happen. Just tonight, for example, I got distracted and can't remember if I took 2000 mg of Depakote. Obviously I'm not doubling that dose so probably I'll have had a missed dose tonight. I'll know when I try to sleep.
As far as what helps, I like rewards. I'm not sure I've ever used this for myself for meds (although certainly for many other things), but I have with patients. I remember one lady in particular who I sent home with a pill box full of Hershey's kisses. Each time she took her pills she got a kiss. She was a bipolar very much like me but with more psychotic features when unmedicated and she was fine as long as those stabilizers went in. Oh, and pill boxes are a HUGE help. Not only do they keep things straight but you feel really guilty if there are pills where there shouldn't be. They also make these bubblepack things that you can fill for a month that I've wanted to try but I'm not in a stable enough place (ie my meds change more often than monthly still). I've used rewards with patients for lots of things with great success.
I'm not sure using a reward, especially in conjunction with something like a pill box, to help establish a routine is a bad thing. Perhaps you can set a length of time to use the program so you know going in that it is limited. However I will say that I have always treated myself to dinner out on psychologist nights and lunch or dinner out (often a nicer place) for psychiatrist visits. I (still) get anxious on those days, and a treat helps.
As a final thought, having been off meds last year because of my toxicity/ulcers/constant vomiting for 3 months, I can tell you it is so not worth it. Meds are a pain in the butt and side effects are worse. But as I learned the very hard way, it is even less fun to feel horrible and be forced to rapidly start your meds. It feels awful. I was a hideous mess. I fought hospitalization but I now understand why that was so nearly involuntarily imposed upon me. At one point I was having to keep track of meds and meals with checklists because I literally couldn't be trusted to eat or take meds accurately.
Hmmm, liking this advice thing....I get to sound all smart.....Maybe a weekly feature where I'll make things up or something.....Just Me talks to Just Me.
Dr. You-I have a confession; I have been very bad about taking my meds lately. I am non-compliant and it sucks. I have realized that though and am going to get better about it.Do you think that having a reward system (took all my meds for a week so I can buy a new book) is an okay idea ... it would probably work for me, but I don't want to depend on a "reward" system for actually taking the medications I need to feel like me. Help?
Ugh. I doubt there is any bipolar patient out there who has not struggled with this. I certainly have. I probably struggle much less than most people, for several reasons, but it is very hard. The first reason I do better is that I've worked with psych patients enough to have seen how much meds help and I force myself to remember this. The second is that I cycle so rapidly that it is not unlikely for me to be suicidal several times per year. I know that the only way to avoid feeling like that is to take the medication. Even though I don't remember from time to time what that feels like, I remind myself as often as needed that I know it is a dark place. Third, and most pathetically, I'm so sensitive to meds that I deal with horrible side effects all the time anyway.
There have been two times in my 5 years of this illness that I've had the most trouble. The first was about 15 months into diagnosis, when my meds were still very out of whack and I was rebelling against the entire "lifetime"-ness of the whole thing. I was having side effects that were unpleasant (vomiting daily) and felt irritable and miserable all the time. Along with that I had just bought a house, moved, started a new job, and was watching a friendship I thought was going to last forever crumble over my illness. Instead of working with my doctor I rebelled, but I quickly learned she wasn't going to take me off meds because I refused to try. When I took them again very regularly and I was still sick she got me off quickly.
The other time was last year with all the lithium toxicity. I simply couldn't keep things down, and everyone reassured me it didn't count as med non-compliance because I was trying. However, after we determined I had been lithium toxic for months and had missed a crucial blood test, my psychologist began pushing me to be compliant with both meds and bloodwork. Having him stay on my case does motivate me, because he is not very forgiving even if I've only missed one dose.
On the other hand, things happen. Just tonight, for example, I got distracted and can't remember if I took 2000 mg of Depakote. Obviously I'm not doubling that dose so probably I'll have had a missed dose tonight. I'll know when I try to sleep.
As far as what helps, I like rewards. I'm not sure I've ever used this for myself for meds (although certainly for many other things), but I have with patients. I remember one lady in particular who I sent home with a pill box full of Hershey's kisses. Each time she took her pills she got a kiss. She was a bipolar very much like me but with more psychotic features when unmedicated and she was fine as long as those stabilizers went in. Oh, and pill boxes are a HUGE help. Not only do they keep things straight but you feel really guilty if there are pills where there shouldn't be. They also make these bubblepack things that you can fill for a month that I've wanted to try but I'm not in a stable enough place (ie my meds change more often than monthly still). I've used rewards with patients for lots of things with great success.
I'm not sure using a reward, especially in conjunction with something like a pill box, to help establish a routine is a bad thing. Perhaps you can set a length of time to use the program so you know going in that it is limited. However I will say that I have always treated myself to dinner out on psychologist nights and lunch or dinner out (often a nicer place) for psychiatrist visits. I (still) get anxious on those days, and a treat helps.
As a final thought, having been off meds last year because of my toxicity/ulcers/constant vomiting for 3 months, I can tell you it is so not worth it. Meds are a pain in the butt and side effects are worse. But as I learned the very hard way, it is even less fun to feel horrible and be forced to rapidly start your meds. It feels awful. I was a hideous mess. I fought hospitalization but I now understand why that was so nearly involuntarily imposed upon me. At one point I was having to keep track of meds and meals with checklists because I literally couldn't be trusted to eat or take meds accurately.
Hmmm, liking this advice thing....I get to sound all smart.....Maybe a weekly feature where I'll make things up or something.....Just Me talks to Just Me.
Friday, April 06, 2007
Don't be bipolar in California
I found a really neat new (to me) site which discusses legal issues related to severe mental illnesses (bipolar and schizophrenia). I am reading it slowly, but already it has triggered a lot of thought about this.
I believe that there is a level on which patients have a right to choose treatment. I know very well how harsh the treatments can be, and how frustrating it is to not have them work as well as hoped yet still have all the side effects. I know that there have been times I have not been very compliant with certain parts of my treatments because I didn't like something about them.
I can't really imagine being bipolar and having well times, but I imagine if I did I'd push rather hard to be allowed to try significant med reductions/trials of being off meds. I did this when I only had a depression diagnosis, and although it wasn't what my doctor wanted it worked for me and made me feel I had tried everything when I did need the meds again.
In the situation I'm in I do have certain meds I have requested not to take. One of these, Zyprexa, is likely to help me, but I really do not want the side effects. Another of my online finds lately has been this which I plan to fill out and distribute to my mother and doctor's as soon as I'm well enough to trust my own decision making.
Which is the point. I know that at times I can't make any decisions for myself that are healthy. If I am unwell I want those meds forced on me no matter what. I already actually wish that my meds were available as depot injections (shots that give a month's worth of meds). I'd rather gets shots than worry about missing doses, etc.
I've seen many times what non-compliance with meds does. Anyone who has worked in psych has. Many, many of the admissions have not been taking meds properly for a very long period of time. As they are given meds on a consistent schedule and monitored while they take them and all stops are pulled to get those meds in consistently, the patient sometimes becomes a totally different being, capable of so much more than would have been anticipated upon arrival.
So, I now will make sure that everyone understands that I give up my right to refuse meds when I am too ill to live outside of a psychiatric facility. I never thought that wasn't obvious.
I believe that there is a level on which patients have a right to choose treatment. I know very well how harsh the treatments can be, and how frustrating it is to not have them work as well as hoped yet still have all the side effects. I know that there have been times I have not been very compliant with certain parts of my treatments because I didn't like something about them.
I can't really imagine being bipolar and having well times, but I imagine if I did I'd push rather hard to be allowed to try significant med reductions/trials of being off meds. I did this when I only had a depression diagnosis, and although it wasn't what my doctor wanted it worked for me and made me feel I had tried everything when I did need the meds again.
In the situation I'm in I do have certain meds I have requested not to take. One of these, Zyprexa, is likely to help me, but I really do not want the side effects. Another of my online finds lately has been this which I plan to fill out and distribute to my mother and doctor's as soon as I'm well enough to trust my own decision making.
Which is the point. I know that at times I can't make any decisions for myself that are healthy. If I am unwell I want those meds forced on me no matter what. I already actually wish that my meds were available as depot injections (shots that give a month's worth of meds). I'd rather gets shots than worry about missing doses, etc.
I've seen many times what non-compliance with meds does. Anyone who has worked in psych has. Many, many of the admissions have not been taking meds properly for a very long period of time. As they are given meds on a consistent schedule and monitored while they take them and all stops are pulled to get those meds in consistently, the patient sometimes becomes a totally different being, capable of so much more than would have been anticipated upon arrival.
So, I now will make sure that everyone understands that I give up my right to refuse meds when I am too ill to live outside of a psychiatric facility. I never thought that wasn't obvious.
Thursday, April 05, 2007
Reality
It's been a while......Still just not feeling so good. The good news is that I have finished one week of the Lamictal starter. In about 4 weeks I'll be at a better dose.
I'm continuing with the odd combination of anxious and exhausted. Today I was so tired I slept through my alarms. I didn't go to work until nearly 2. I'm having trouble eating because nothing really appeals, and what does appeal tends to be junk. I'm eating the junk, knowing something is better than nothing at this stage, but it bothers me because it's another deviation from my normal.
The reality is that my life just isn't so together right now. My kitchen floor is disgustingly dirty. Trash needs gathered and thrown out. I need to take garbage out on trash day. The bathroom needs scrubbed. I have so much dirty laundry I'm not positive I have clean scrub pants for tomorrow. I don't really care; if I don't find any I'll put some that don't really fit out. Yeah, I care a lot..... I'm out of the kind of soap I like and will have to use perfumed soap, which I avoid because it can bother patients. I have new pillows that I haven't used because it's too much effort to put the covers on and change my sheets.
I'm just tired. I'm trying so hard to learn that I can't aim for "normal" because I'm not going to get there. I think that now I'm ready for a new step and am going to start asking the people who treat me to give me a more realistic picture of my illness than I've wanted before.
It's not all bad, even though I sound like that. I have happy moments every day and there have been times in my life I did not. I am sleeping and that is better than insomnia. My patients make me smile and laugh. But mostly this just isn't what I expected.
I'm continuing with the odd combination of anxious and exhausted. Today I was so tired I slept through my alarms. I didn't go to work until nearly 2. I'm having trouble eating because nothing really appeals, and what does appeal tends to be junk. I'm eating the junk, knowing something is better than nothing at this stage, but it bothers me because it's another deviation from my normal.
The reality is that my life just isn't so together right now. My kitchen floor is disgustingly dirty. Trash needs gathered and thrown out. I need to take garbage out on trash day. The bathroom needs scrubbed. I have so much dirty laundry I'm not positive I have clean scrub pants for tomorrow. I don't really care; if I don't find any I'll put some that don't really fit out. Yeah, I care a lot..... I'm out of the kind of soap I like and will have to use perfumed soap, which I avoid because it can bother patients. I have new pillows that I haven't used because it's too much effort to put the covers on and change my sheets.
I'm just tired. I'm trying so hard to learn that I can't aim for "normal" because I'm not going to get there. I think that now I'm ready for a new step and am going to start asking the people who treat me to give me a more realistic picture of my illness than I've wanted before.
It's not all bad, even though I sound like that. I have happy moments every day and there have been times in my life I did not. I am sleeping and that is better than insomnia. My patients make me smile and laugh. But mostly this just isn't what I expected.
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