The internet teaches me much

I'm always a bit surprised at how many people find my site with certain searches. After I was so open with leaving my last job my most common searches by far are people looking for information about quitting jobs, usually in conjunction with mental illness. I seem to have spurred the world into action.

When I get questions that seem like something people would benefit from knowing I try to answer. Today I had a referral from someone looking for whether lithium can hurt you if you aren't bipolar. This links to another question that people ask, so today I'm answering both.

For some reason many people seem to think that lithium can be used sort of like a "test" for bipolar. If lithium works you must be bipolar, if not you're fine. Not so. In fact, one of the best ways to boost depression in someone suffering severe and med resistant depression is to supplement with lithium. That is actually how I got on it and then found that it made my cycles extremely clear. For me lithium works but it does not work alone.

If you take lithium and you aren't bipolar, of course it can hurt you, but there's no more chance of it than for us. If there is no clinical reason to be on it I wouldn't recommend it, it's not a fun drug, but it's also a wonder drug. We bipolars don't have some special chemistry that lets this salt help us but makes it poisonous to others. We are helped by the salt for some magical reason, but we are just as susceptible as anyone to the ugly effects. Ask BipolarLawyerCook, who is recovering from early toxicity. It is not pleasant.

It's funny sometimes how people think EVERYTHING about the mentally ill patient is different....Sometimes I feel like telling people that the greatest differences are the things only I see. But if they don't get that, probably they never will...

Celebration

I've known this for a while but have had trouble up-loading because I don't know computers. So finally I've decided either this works or we have no picture.

Anyway, I have been given a blog award by Sara (whose link I'll fix later). This is my first, so we're really excited around here.

I then shall nominate Emilija, Cranky Amy, and BipolarLawyerCook. Plus if you've been hanging around a long time without saying anything (Columbus OH person), you too, although you're very quiet.

Daydreams

It's funny sometimes how the things I miss most are things I've never actually done, yet know I really can't do. Like going to my town's Fourth of July celebration. I am still sad about that and it's nearly a year later. It just is a place to put my resentment of my heat intolerance.

I've been listening to the CD of a new John Grisham book, called Playing for Pizza. It's about a 3rd string NFL quarterback who leaves Cleveland in disgrace and winds up leading an Italian team through an exciting season of Italian national football, a sport few Italians know about. It's a very good book and it has made me desperately want to visit Italy through wonderfully descriptive writing.

I always wanted to travel. Yet I'm now kind of stuck in this time zone. I barely can handle daylight savings time; I can't imagine what would happen if I changed more than an hour. I would strongly hesitate to even try to visit one time zone away unless I could stay on my own time the entire visit. Fortunately there's good stuff in this time zone. But again, something on my "I wish" list is going to go on as a wish forever, a dream I've achieved never.

I'm too happy to be well to really care that this is true, yet it is a bit sad. I really wish there were a day that I clearly would find something (besides seeing the psychologist and psychiatrist and all these fun kidney testing people) that this adds to my life instead of limiting.

Oh well....

Peace

One thing is so very good with my new job. As I settle in there are of course ups and downs, and I'm having some trouble with a co-worker being a bit of a jerk, something he apparently does to all the new people. There are good things and bad things with the whole place. It's not even necessarily the best nursing home I've ever been in; in fact the care is not very good in a number of areas. However, the therapy department is really, really good and we have a reputation for this. In fact, patients come and tolerate the care they know is less that superb for us. It's nice to hear.

I love things like I am given the appropriate level of respect in my leadership. I don't want to ever be the dictator, but I do want my treatment plans followed, etc. I also like having control of who has what caseload: I assign so I don't get trapped in the never having a patient who was going to get well pattern of my last job.

The best part of the whole thing though I never would have anticipated mattering so much. The best part is that I know and always have known that this is my last job in this arena. If I'm miserable I leave and that's that. My last job I was prepared for it to be the last job, but then Seroquel worked so well I got a reprieve.

I decided though that this one is it. I'll find another arena to work in if this fails. Maybe not even therapy. The decision feels so right. I'm not even sad about it because this last job is a gift I didn't anticipate. So every day I go to work knowing that I need to enjoy it because there isn't a good reason to waste time doing what I love so much, yet is so hard on me.

I'm amazed at how much good this does. I don't get nearly as upset about stupid things. I think knowing that if I talk myself into being super-upset about something just takes time away from how long I survive here has a positive effect. Knowing I need to fully appreciate every moment certainly is good. And I'm refusing to get caught in small things. That too is new to me, and so very calming. If I can't maintain my productivity, well, I'm trying and if makes them want rid of me then so be it. Etc.

I told several more people this week. It's best if the therapists know. Not all will here, only the ones I'm closer to. But they all handled it well, although every time I tell someone they tell me they think they are too. I don't think they quite understand how sick I'm talking about.....But that's no surprise. Especially because now I just pretty much act quiet but normal.

Hopefully this place will last a long time. If not, I'm determined to leave with happy memories.

Lots of bad luck

I'm still alive. I moved on from being sick from the antibiotic to having trouble meds and nausea to having a really hard day Saturday that included the grossest incident in my entire career (you do not want to know, just say there was a lot of bleaching of shoes and it's still worse than what you are imaging).

I talked to my doctor after the infection symptoms only partly receded. He ordered an ultrasound for next week. That should take care of my new deductible nicely on the 3rd day of coverage.

Now I have thrush. The pharmacist recommended something and it really hurts to treat it. So now I'm going to eat ice cream instead.

Better post brewing about what I'm learning in this job. Good stuff.....

Failure/Success

One of the hardest things of all for me with this illness is that I have to reduce what I do to match my energy level. I'm very good at telling myself "oh, I can do that. I'll just wait and rest _____." But by the time ___ occurs I'm too tired to do anything.

Generally I must have one weekend day to do nothing but sleep, read, and maybe do laundry. Sometimes I do something the other day, sometimes not. Now that I work a 4 day schedule I usually use part of my day off to do errands and things, leaving me free to rest all weekend if needed (usually a couple times/month).

Sadly, this year Easter came in a week when I already feel crummy. Not only do I have the UTI symptoms, I get nauseous every time I try to eat anything but cereal, a lovely side effect of the antibiotic. So I had to choose to skip Easter dinner. Which hurt my mother. I didn't really even choose, my nap didn't end until partway through. I had considered it, but was waiting until the lunch nausea subsided when I fell asleep.

I know why she is hurt. Bipolar dictates far too much about my life and it affects other people and what they want.

At the same time I know I did what was right. Being sick is enough stress on my body all by itself. Being sick and forcing energy to appear where it isn't is a really bad idea for me. Really, really bad. And today wasn't just a day I could hang around here and then go there; my shoes came home in biohazardous condition last night and had to have a bleach soak (probably should replace them but can't at short notice like this). So laundry is mandatory.

I just wish I could live up to expectations...

I really didn't need this

I'm still sick with the UTI. My training was cancelled yesterday so I spent the day seeing a few patients and drinking cranberry juice to excess. Today I cancelled and will go in tomorrow. I'm really tired and really uncomfortable.

The first night I fell asleep without meds and learned a hard lesson about how much Seroquel helps. I had the most horrific nightmares I've had in many months. Some was from fever, but I'm quite sure some was from lack of the med that takes those away. I guess at least I'm not facing losing it. I started to type of the high dose Depakote, but that's not true, I am supposed to get a liver level repeated that may force that change too.

At least my liver doesn't hurt.....I forgot the tylenol in the car and don't feel well enough to want to go get it. But I have reached a point of no choice. I need sleep and I can't sleep between the fever and achy back and belly. I have never been quite so aware of the exact location of each kidney, ureter, bladder, and urethra.

I'm so glad to know.

UTI

Title says it all. On antibiotic, up half the night with fever. Worked 12 hours yesterday and today is a 5 hour training with 4-5 hours of driving. Fantabulous. Nobody better touch my kidneys.....

Your questions answered: Psychiatric visits

I had a blog search for what a psychiatrist visit should entail. I think a lot of people are so used to crummy care that they don't know, so here's the run-through.

Each of my visits follows the same format although there are variations. My allergy alert always pops up when she signs into my chart, so that always takes a minute. Now that I'm on several meds for my thyroid and kidneys and constipation and reflux (some of those should help resolve others) and I have a few meds I can adjust we make sure her list is what I'm taking. I have flexibility with several things and I generally email her from time to time so she knows what I've done. We also communicate about labs and things like my kidney issues via email as needed, so usually she pulls the most recent email and we make sure it's accurate.

Some things don't happen every single visit, but close enough. We always talk about work, since that is both my biggest stressor and my greatest area of success. We talk about how therapy is going and I sometimes pass info back and forth between the doctors. We discuss any questions or concerns I have. Often we try to figure out how to reduce some side effects while keeping me at high doses. We check what labs are due (although in theory labs can be every 6 months I get them more frequently. I'm getting one set done every 2 weeks to be sure my kidney med is ok and I get Depakote levels as often as every 2 weeks. I also have to repeat a liver level from my last 6 month set because it was elevated). We talk about where my mood is and how stable/unstable it has been. Usually I have to rate my mood, which I hate doing. Most times, unless I'm in a truly incredibly great place she runs through the suicide questions. I think when I'm doing well she sort of alternates the suicide/psychotic symptom questions.

Throughout the visit my thoughts and questions are welcome. It will take an hour to 75 minutes. There is no pressure; if I'm crying and needing more she'll give it to me. Once she was with me 2 1/2 hours.

That's an ideal situation, but it's something everyone should search out until they find. My life would not be nearly as good as it is without her.

Major first

My psychiatrist appointment was totally worth it. I talked to her quite about how tired I am. I've cut my daytime anxiety meds out, I'm taking Provigil at a full-dose after a careful upwards taper, and I tried unsuccessfully to get my antidepressant to make me just manic enough to have more energy.

At first she said I could try reducing my Seroquel a tiny bit. (25 mgs). But then we realized that I'm taking anxiety medication still, and while I need anxiety meds, I may be on too much for now. So I'm allowed to cut back by one or two pills.

I've been on these meds 6 years. Nobody has ever said I was doing well enough to cut back. The only times I've come off have been when a problem came up.

So happy.

And some days are harder

Today was a very, very busy day. I had 4 or 5 evals plus my usual caseload. I met with my manager for a bit about caseloads and my productivity, etc. It was very, very cool to be pulled aside and asked if I thought I could keep another half-time assistant busy. I have never been asked for that kind of opinion. That part was great.

I also was really proud of myself because I THINK I handled something well. I'll find out, sometimes I have bad ideas that seem good. I'm the last one out, so I straighten the gym with my last patient. It's no big deal, usually I have time she's working (I schedule a specific lady) although that's sort of changing. But there's straightening and there's straightening. People are always leaving trash in there, like dirty tissues on the floor and empty/partly empty foam coffee cups. I get tired of cleaning them up. Then the treatment tables don't get returned and some days equipment is left out. Today I even cleaned up e-stim pads, something that needs special care to protect the gel from breaking down. So I put up a note in the office reminding people that I don't mind straightening but the dirty tissues etc are a bit much. I kept it sort of funny and I think it's ok.

But the hard part did come......Last week I was supposed to go to the BIG CITY to see Dr. Brain. Thanks to the snow and being stuck I cancelled. I emailed her that I was probably ok to go a month (for the first time ever) between visits. We've always been very careful to not go more than 5 weeks because every single time we've spaced 6 weeks between visits I have had an emergency. My meds just need adjusted on that 4 week basis. Anyway, I was pretty sure that I was ok to go until next month. About 2:oo I walked in and my cell was ringing. It was her office, telling me she had an opening tomorrow and would like me to come in.

I'm glad she cares. I realize how incredibly lucky I am that she does. I respect it if she feels I am not ready to go quite so long. And I'm sure I'll benefit from the check-in tomorrow. It also gives her a chance to say anything she wants the nephrologist to know about lithium and my kidneys.

However, I'm also a little sad to know that of all the people on her cancellation list, which is always plenty long, I made it to the top. I'm still sick enough to need her.

And my appointment isn't last, which means I'll also have some guilt because it takes so long to go through my meds since I'm on so many and to do the standard check-up that she always schedules me for 2 appts and I'm last most of the time. This way people will be waiting forever for me, and while that's part of her policy (know you may wait forever but she'll spend as much time as you need too), I still feel sorry for anyone who thinks I'll be out fast.

Ack. It's nearly midnight and I haven't been home long enough to eat anything or take meds. And I need to be asleep so I can wake up for tomorrow's adventure in driving.

Many, many things

This new job is certainly taking a toll on my blogging. I am still adjusting to the schedule of working 4 9-10 hour days. I'm also forced to take a 30 minute lunch, so if I want a full payday I have to work 30 more minutes, despite the fact that I work through my lunch pretty much daily and that lunch breaks are not required in this state. My company is national and I'm sure the policy exists because some states do require it, but I hate it. I've never been subjected to it before. The time change also threw me for a loop, as did last week's blizzard; by the end I was snowed in until Monday and then only was out because I borrowed a truck for a few days. So, overall, things haven't been going all that smoothly.

On the other hand I am doing very, very well. I'm doing well at not absorbing other people's stress and making it mine. I know that this job is my last in longterm care, and quite possibly in therapy. I've been trading jobs on average once per year and that's not good (although better than once per day as that originally read!). I'm trying very hard to establish a routine and boundaries about how much I can handle. The job requires a good bit of paperwork and administrative stuff, so I have no desire for them to think I'm going to be superwoman.

I had a patient yesterday tell me that she wants ME specifically to treat her. I've had many patients I was really close to before. One of them would hide from anyone who tried to cover from me. I've had a number who preferred me because they did not want my assistant. But I've never really had enough of a caseload consisting of cognizant patients who had a choice (for a long time I was the sole OT where I worked) so that someone liked me best. It feels good.

I also won a game of Scrabble during the storm. That's 2 in a row. I think some of my cognition is back. Actually this is showing up more and more; I can concentrate with noise and even music around. I have a better memory. I can sit and write paperwork for 4 hours and be ok.

I found out today that my 24 hour urine test showed I am peeing far too much. But my bloodwork was fine, so I can take a full dose of the medicine to help. I've lost 10 lbs since starting this so I'm hoping the new dose will be as successful.

Hmm, what else? I had a weird moment the other day. I was evaluating a somewhat confused but very sweet lady. About 10 minutes into it she was looking into my eyes while we talked and she just suddenly said "there's something wrong with your eyes". I couldn't believe it. I DO have a couple problems with my eyes; my left eye drifts left and doesn't focus with the right. I don't see a ton out of my left eye and my right eye prescription overcorrects to help with this. It's mild, enough so that it wasn't diagnosed until I was an adult. I have problems with depth perception sometimes and am not good at reading across grids. I have no idea how she saw this. I can't wait to ask my eye doctor.

That's about it. I just dug through the closet and my desperate search turned up one last pair of pants. I'm having a big old party about that. Too tired for laundry.

More later.

Short

I hate daylight savings time. 
 
The end.

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Remote post

I've been stranded by severe weather for one night earlier this week and am now at 2 days from further and even more severe weather.  We were sent home from work yesterday (a first in my career except for 9/11 late afternoon) and I couldn't get even close to home; I'm at my mom's apparently semi-permenently.  Fortunately I was supposed to be out of town Friday and Saturday and had a suitcase in the car with my meds included.
 
Anyway, that's why I've not been posting or commenting.  I have no idea what things are like at home, but if I get there tomorrow as hoped I'll be back with the world tomorrow.
 
 

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Work knows

I didn't plan to tell my managers about my diagnosis until my 3 month review. I pictured something like being told I was a fabulous therapist and then saying "well, there is something you need to know...". Instead today I realized it was time.

I've probably said this before on here, but mental health is a precarious area if you have reason to be sensitive when people talk about mentally ill patients. Mental illness causes funny things to happen sometimes. The truth is that my love of my work is because I am with so many people who have mental illness, dementia, or mental retardation and I find joy and enough variety in life from these people to keep me from ever thinking work is boring. I sit and tell funny patient stories just like everyone. However, I am really careful to remain respectful.

Some of my co-workers aren't necessarily so careful. Words that are insensitive if you've ever happened to endure severe mental illness get tossed around. I've noticed this since day one. It's bothered me more and more, and today I decided it needs to stop because I'm starting to worry about it and there is no reason to be stressed about something that needs stopped anyway. So I told the managers.

They were 100% supportive. The one who I have heard say a number of insensitive things flushed and I think I handled it ok, because I didn't want to make her feel bad, I just want it to stop. But they offered me essentially anything I need to function. I even am able to trade the manager desks and share a small quiet room with just one other therapist. For now I'm not doing that because it's easier to be with my assistants, but I'll be getting a key to that room so that I can work there if I'm having a bad day.

So, that's done. We'll see what happens now.

The end result

I turned in my urine sample this morning. All in all I didn't do it right so I really missed a few hours. The total was 3250 mL.

Normal people collect 700 to 2000 mL per day. Diabetes insipidus patients collect 3-15 L. That puts me in the lower range, but I doubt I'll hear good news based on this test. I think if it shows good concentration of electrolytes I'll come out ok, but I am pretty sure that won't happen since it hasn't happened in numerous tests. Plus, the day that this was initially diagnosed I wasn't thinking in any way about how much I peed. I hadn't been drinking any special amount; if anything I had had LESS to drink because of where I was working. So I did nothing to affect the results unconsciously. I always doubt myself about this kind of thing, mainly because my father was pretty mean about it. This one I don't think there is much chance of my affecting anything.

I called the doctor about the blood issue from Friday. I didn't hear back. Hopefully that means all is well, instead of he's just waiting for the test results.

I'm also completely stressed because my doctor has been working with a specific nephrologist and it turns out that this is NOT the nephrologist I've been scheduled to see. The nurse said not to worry, but I am because I know that the one my doctor has been talking to has agreed to work with my lithium and has heard the whole thing about I will be faithful with meds, etc.

Anyway, I'm worn out. I did paperwork for 6 solid hours today. I'm off Thursday as per usual and at a training 2 1/2 hours from her Friday, then I have to travel a long, long way from there to the Big City for an appointment with Dr. Mind. I've not really had supper. And my cat litter MUST be changed. Now.

My day: Peeing in an orange jug

So today has been really, really fun. I woke up at 8:30 and peed normally, per instructions. I took my pills and slept a few more hours. At 11:30 I put the little "hat" thing in my toilet and began trying to figure out how to aim. Every drop counts here and I have NO desire to repeat this.

The first sample was 20 ounces. I knew I pee a lot each time I go, but as the day has gone I've been suprised at how there's a pretty solid correlation between what I drink and what comes out. Which is in line with the diabetes insipidus.

The whole thing with not spilling and having to pour and having hand tremors is a bit nerve wracking, especially as the bottle fills. I may sacrifice a funnel when the thing is more full.

At this point I'm on track for the diagnosis, but it may come out on the upper edge of OK. Diagnosis requires around 3000 mLs and I'm at 1500 or 2000 (forget). So I might actually be ok, but I do a lot of peeing at night, so probably it will hit 3000. I hope not; bringing 2 jugs of pee is just a little excessive.

I actually gave in and used my fridge. I cleared out an area so nothing is remotely near the jug of nastiness and have been wiping the jug with disinfectant as needed.

Really it has gone pretty darn smoothly. I'm hoping against hope that this turns out a negative. My urine does consistently have color, which is a good sign. Except that I take a lot of vitamins that probably are the cause.

Drama

I've been trying hard to keep the drama level in my life down as it takes all I've got to adjust to the new job. Learning about the pee-in-the-fridge urine collection sort of increased it, partly because I find it humerous in a sick way, partly because it's just one more icky thing to do thanks to stupid old bipolar.

But now I have more reason to worry. The whole thing so far has been that my kidneys have this diabetes insipidus problem but are handling it fine, aside from blood in my urine that pre-dates anything like lithium.

Last night the blood in my urine was visible. Not much, but it was blood where it did not belong. So now I have to call the dr. Monday and let him know and I have a feeling I'll be wishing for the "simple" 24 hour collection test.....