I Need Some Sleep

I’ve just been to see my doctor and we’ve made some major changes because I’ve stopped sleeping.  After all the trouble we went through to get me onto zeldox I hoped that regime would have lasted longer but nope.

The whole thing started last Monday when I had a follow up appointment with my inpatient psychiatrist at the hospital but I showed up having not slept at all the night before.  I explained to her that I took my PRN temazepam and it didn’t work so she got me some seroquel from the hospital pharmacy and told me to take that.  I did, and it worked after a couple of hours.

I showed up at my psychiatrist’s office and she said she had received a letter from the hospital doctor detailing my sleeping troubles.  I told her what had been happening – my sleeping had been varied, but generally I’ve been getting to bed late, or waking up at midnight and not being able to get back to sleep.  I feel that my mood is suffering because of it.

She told me what I had been dreading, that we had to start regular seroquel again.  I had really been wanting to avoid this because I gained so much weight on it last time I was taking it, plus previously I;ve been super sensitive to it and it has knocked me out for about sixteen hours at a time.

She said that weight gain on seroquel was not a guarantee; just because I might get an increased appetite doesn’t mean I have to give into it.  But to try and assist me she raised my topamax from 50mg a day to 100mg because of its appetite suppressant properties.

She also reduced my zeldox from 160mg to 80mg and ceased my valdoxan.  The only reason I was on so much zeldox was to sleep and it wasn’t working but I still need some for my anxiety.  Valdoxan, the melatonin tablet was originally prescribed when I wasn’t on any antipsychotic but starting on lamotrigine caused me to stop sleeping.  That clearly isn’t doing its job, and may be contributing to some bipolar symptoms so it had to go.  And considering it isn’t on the PBS and was costing me sixty-five dollars every month, I can’t say I’m sad to see it go.

She told me to come back in two weeks instead of my usual six to update her on how the sleep situation is going.  If I’m still not sleeping on 50mg of seroquel, she said we will have to consider hospital again.

I will post again in a few days to update on how I’m going on seroquel.



Mental Illness and Metabolic Syndrome

So as I have documented on this blog I was in hospital recently.  While I was there I made use of the hospital dietitian’s information groups because I had been neglecting that facet of my health recently by drinking instead of eating (bad Mac.)

In one of these groups the dietitian said something that I found interesting; that having a mental illness is a risk factor for developing metabolic syndrome.  He didn’t go into too much detail on how you get that or what it entails, the general understanding being that it happens when you neglect yourself.

I had heard of metabolic syndrome before thrown around as a cautionary tale as a result of a shitty lifestyle.  But I had never heard the mental health angle so I decided to do a bit of investigating to see a) what it is b) what the risk factors actually are and c) whether I am at risk.

Metabolic syndrome seems to be not related directly to your actual metabolism, but rather a collection of risk factors to developing lifestyle disease such as high blood pressure, large waist circumference, high cholesterol and high blood sugars.  Apparently around 35% of Australian adults have it, which I found surprising and a bit alarming.

The causes aren’t known but being overweight and inactive are risk factors.  This has me thinking I might not be a high risk case – I’m not overweight and pretty active, but that could change as I get older.

I found a few different figures for metabolic syndrome in people with a mental illness.  One website said 50% of people with a mental illness will have it, while this article said that in a case study the prevalence was found to be 54%, but people with bipolar disorder had a higher rate of 67% (oh crap) followed by people with schizophrenia at 51%.

The article goes on to say that while the prevalence of metabolic syndrome in patients with schizophrenia has been researched it hasn’t really been in other psychiatric disorders, so those numbers for bipolar disorder might not hold too much weight.

It does make sense; there is a relationship between mental illness and obesity plus other cardiac health risk factors such as smoking and drinking.  In my stays at the hospital I’ve observed that compared to the rest of the population, a much higher proportion of patients smoke, and a much higher proportion of patients are obese.

So where does that leave me?  As I said I am not obese.  I exercise through sport and running.  On the surface it would seem that I am not a huge risk factor but I don’t eat the best and I still drink a bit too much.  These things can and will affect my heart if I don’t reign them in.

So I guess the moral of the story is take care of yourself.  Even when you don’t feel like it.  Even when it feels too hard.  It’s easy to push your health to the back of your mind but developing a serious lifestyle disease is not the wake up call you want to have.


I Can’t Do Funerals

I went to a funeral for an acquaintance from my sports club this week.  It was a brief, tasteful service followed by lunch at the local RSL.  All of us from the club came wearing our jerseys.  I think his family would say the day went well.

Except I was a mess throughout the whole thing.  There weren’t enough seats available so I stood up the back with Pea and spent the service trying not to break down, wiping tears away on my jersey.  At one point in the service everyone took turns to place a rose petal on his coffin.  When it was my turn I went up with my head down because I was embarrassed at being so upset.  Our friend had more to do with Pea than me and he wasn’t crying.

I’m like this at every funeral I go to.  It doesn’t matter who it’s for, how well I know them – not at all in some cases – funerals turn me into a mess.  I get upset then try to hide my being upset because I worry that people will think I’m being inappropriate crying over someone I didn’t know very well.  And if I do know them well I still question the appropriateness of my grief.

As a person on the spectrum no event makes me question my behaviour more than a funeral.  Am I grieving too much?  What do I wear?  Do I talk to the family or do they want to be left alone?  Should I even be at this funeral?  Did I have enough to do with him to earn a place here?

I’ve got to remember that death and everything around it is awkward for literally everyone.  When I went to this funeral no-one said I shouldn’t be there.  Several people in fact said they were happy to see me.  And as we had lunch at the RSL exchanging stories and memories a sad day turned into a good one.

After all, nothing brings people together like a funeral.

The Rehab Diaries Redux – Week 3

I’m home now so this will be an account of my final week in hospital.

My regular doctor came back and was not impressed with the medication change imposed by the other one. She removed the diazepam and changed the fluoxetine to 15 mg instead of 20.  This means I need to split the tablet into quarters as it only comes in 20s, which I have been trying to do on my own with not much success.  I need to find one of those pill cutter things.

I feel like my mood resolved a bit but my activity hit a low. All I did from when I got up at 3am (yes that’s still happening) to dinner time is watch Dragonball Z.  Anyone familiar with Dragonball Z knows there’s enough of it to sustain my inactivity marathon for weeks.  I find myself getting frustrated with it though – it’s so drawn out.  I can watch the same fight go on for about ten episodes and still not have closure.

Maybe next admission I’ll get into Bleach, ha. You won’t see me for months.

The dietician I’ve been seeing outpatient also works for this hospital so I had an appointment with him this week to get a free one in. He tried to encourage me to exercise – I’ve still been playing sport but in hospital they have a gym which I could be using but I’m not.  Would rather be watching Dragonball Z.

We also talked about something that has been concerning me, maintaining a healthy diet when I move in with my boyfriend. Our eating habits go to shit when we’re together – we hardly ever cook, we snack together watching tv and tend to influence each other’s drinking habits.  The solution, we agreed was to start cooking more.  He promised to bring me some print outs of healthy recipes for our next session.

I only went to two group therapy sessions this week. One was a dietician’s group in which I encountered more judgement from other patients but this time I wasn’t keeping quiet.  It happened during this exchange, where this girl who was about my age asked the dietician if walking was good exercise to lose weight:

Dietician: Well, all physical activity is good, but to lose weight you need to do something that gets your heart rate up.

Girl: Well I can’t go to the gym, they’re too intimidating. And who plays team sports at my age?

Me: Excuse me, I do.

*cue crickets*

Dietician: Yeah and Mac plays a very interesting team sport, don’t you Mac?

I told her what it was (a contact sport) and still she had nothing to say. The other patients took over with the usual comments I get for disclosing that I play that sport “wow you must be so tough!” etc.  But I didn’t hear from that girl for the rest of the group.

The other group I went to was another addictions group. I was hoping that the people who were in it the week before would be there so I could tell them what a bunch of dickheads they were but didn’t go.  Instead it seemed to be a bunch of patients who were just there for something to do.  I got sick of them asking too many self serving, irrelevant questions and walked out.

Well I’ve been willing to give my therapist a chance even though we have bad chemistry but in our final session of the admission she convinced me that I never want to work with her again. The session lasted 15 minutes and she spent it telling me how difficult I have been to work with and that I should seriously reconsider trying to get a job in admin because I’m too socially inept for it.  I challenged her to give me an example of a job that didn’t have face to face contact and she couldn’t.  I don’t know what she expects me to do, just sit at home watching Dragonball Z all day for the rest of my life?

I understand that, as someone on the spectrum, my personal presentation can sometimes leave a bit to be desired. But I would have thought that a psychology professional would have the knowledge to be accommodating of that.  I’ve worked with many therapists over my several admissions at that hospital and we’ve made great progress despite my being ‘difficult.’  Unfortunately she pulled this one after my last session with my doctor so I won’t be able to complain about it for a long time.

My discharge went smoothly. They gave me my papers over breakfast and I had them signed and handed back immediately.  The hard part is waiting around for my medication and scripts, which can take hours, but only took half an hour that day.  Then my boyfriend took me home and I arrived ready to face life sober.

Until I get admitted again (so ages away hopefully)



The Rehab Diaries Redux – Week 2

We’ve reached the end of week two. The original plan was for me to go home after two weeks but considering I’m still fantasising about nailing myself with vodka as soon as I go home I decided to stay on for another week at least.

I have still been feeling low and unmotivated. I am supposed to be looking for work but I haven’t been motivated to do that.  I have a recruitment company looking for work for me and they got me a job interview that I had to go on leave for.  Obviously if I got the job I would have to discharge myself, but I didn’t.  They couldn’t give me any feedback except to say that I interviewed well but they needed to cull some applicants.  The whole thing sapped my mood even more.

The AWS assessments seem to have stopped. I was told at the beginning that I would be breathalysed after going on leave but that hasn’t happened yet.  I haven’t got any of the withdrawal symptoms mentioned in the assessment but I’m told feeling low can be one.

My regular doctor went away and I have been seeing the same one I saw when she went away during my last admission. Previously I’ve been frustrated with him because he has a conservative approach to treatment and is hesitant to make any changes but this time he put my antidepressant up when I told him I’d been feeling low and prescribe 2mg of diazepam to combat any agitation that might cause.

He also pointed out that this is a regular private mental health facility; there is no alcohol specific programs. We discussed whether my aim is to cut down or stop completely and I said I wanted to cut down if I could; I wasn’t ready to cut it out.  He said that most alcohol programs are abstinence focussed, and I need to look at controlled drinking programs.

I continue to fight with myself to eat properly. The food is heavy and often unappetising and so far I have gained 2kg in here despite sometimes only eating a bread roll for dinner.  The 5pm dinner time is still throwing me off.  I’m lucky that my boyfriend is here most nights to take me out for dinner.  Come to think of it, that could be responsible for the weight gain.

Sleeping has been surprisingly easy; I usually take two hours to fall asleep after taking my night meds but here I have been falling asleep after only one, despite having a room across from the dining room where most of the patients hang out at night and make the most noise. Only problem is, I have been waking up early.  Like, really early.  I wait until 6 to eat then take my meds with food, as advised, and fall asleep at 7.  When I do this at home I will wake up at 5 or 6am but here I have been waking up at 3am.  All I can do is get out my headphones and watch the tv shows my bf downloaded onto the computer for me.

I have been making myself go to group therapy to fill in time because left to my own devices I would just watch my shows all day.  Trouble is I have heard most of them before and end up sitting there bored out of my mind and getting annoyed with the other patients oversharing or interrupting with their ‘hilarious’ comments.

There was an addiction specific group and I thought I’d go along to that, but I left feeling more annoyed than ever. The other group members were very judgemental – one guy was a former smoker and said that all smokers are losers.  That’s right.  He came to an addiction group and called people with addictions losers.  Are.  You.  Fucking.  Kidding.  Me.  I wish I had said something but I was to appalled at the time.

Another girl who was there because she was worried she had an addictive personality but no actual addictions (I wanted to shake her and tell her to get a grip) said that she didn’t want to associate with her friends because they drink and do drugs and she thinks they will ruin her reputation. Well how am I, a problem drinker, supposed to feel comfortable sharing after that?

I went over the session with my inpatient therapist who happened to be the same therapist running the group. She helped me realised that the underlying emotion to that annoyance was shame, and the comments from the other patients triggered that and made me shut down.

I’m still not sure about my connection with this therapist who I have never seen before this admission but apparently she is good for tackling addictive behaviours. I have had three sessions with her so far and I feel that I am opening up more but I still don’t have the same chemistry with her that I have had with others.

I will be seeing my regular doctor again next week and if all goes to plan I will be writing week three’s edition from home.



The Rehab Diaries Redux – Week 1

So I’ve been here a week and not much has happened. As I posted earlier we got off to a shit start when the admitting CMO fucked up my medication chart and it took an emergency phone call to my doctor to get me my regular meds.  She had to come in to the hospital the following day to change my chart to what it was supposed to be.  Next time I get admitted I will bring a list detailing exactly what I take morning and night in what strengths.

The changes to my chart must have rattled the staff too because for the next three days I was getting the wrong meds and sending them back. The other thing the CMO did to piss me off was to chart a new pill without telling me – a thiamine supplement.  This is apparently given to alcoholics to reduce the chance of brain damage leading to things like Korsakoff’s psychosis.  Not that I’m not happy to take it, I just don’t think it’s unreasonable to want to be informed of changes to my medication routine.

The staff have been doing the alcohol withdrawal quizzes with me but so far I haven’t experienced any of those insidious withdrawal symptoms. I was drinking a lot – think blacking out regularly a lot – but I guess I haven’t been doing it for long enough.

I was getting cravings though, and for very specific things. Like one morning at 6 am I was craving a long island iced tea of all things.  I’m not sure if I would have succumbed to that craving at home given the time of day, but that’s a dangerous thing to want.  I’m embarrassed to say that on my benders I would make myself two of those and go from there.

The other thing I want is vodka. I was getting that craving watching cartoons in the evening, when I would normally be drinking.  It was so strong I could half taste it.  I told my doctor about these cravings and she put me on naltrexone.  It’s a drug that won’t make me sick it I actually drink so it’s good for cutting down rather than cutting out.  She was worried it would make me sick but so far I’ve had no side effects, and no more cravings.

Even though the cravings are gone I still miss drinking. I told my doctor that I still have the attitude of “if I wasn’t here I could be drinking” and she told me that probably means I need to stay here for a few more weeks.  I’m not sure I can last here that long but we’ll see how we go.

I’m struggling a bit because of boredom. At home I was bored too because I’m unemployed at the moment but I have more limits on me here.  At home when boredom was getting to me I could get in my car and go to the shops or the beach.  Here I’m stuck unless someone takes me out.  My BF has tried to help by bringing a hard drive full of my favourite tv shows but you can only watch so much tv in a day.

I think the main reason I’m struggling is that I’m not really unwell. My mood is a little low, maybe from coming off alcohol, maybe from boredom but I’m not feeling distressed all the time like I have been on my previous admissions.  On all of them I have been starting new medication regimes and most of my time was spent sleeping off the side effects.  Now the only two new drugs I have don’t seem to have any side effects and I’m wide awake all day.

As per usual there are several group therapy programs a day going on here and I have been going to a few to fill in time but they’re a bit different to last time I was here; they are more discussion based and less skill based. I find them socially exhausting and I get uncomfortable when other patients overshare.

I’m trying to get used to the meal times here, particularly dinner which is at 5pm when I’ve barely digested my lunch. The food is very heavy so I try to go on leave for meals where I can.  My meds need to be taken soon after food; normally they give the night meds out at 8pm but I’ve been asking for mine at 6pm.  That means I go to bed at 8pm, which I don’t mind, but I’ve been waking up at 3 am when I would normally wake up at 6am at home when taking meds at the same time.

Not sure if it was my anxiety or my mania but I was a cantankerous bitch last time and literally everyone in the hospital annoyed me. Now that I’m not really unwell – except for the drinking thing – I find I’m more tolerant of the other patients.  There are a few that grate on me – like the one who’s singing loudly underneath my window right now – but not enough to waste my time thinking about.

My doctor has gone on leave starting yesterday so have to see a different one for the next ten days – although truthfully I don’t think I’ll last that long – the same one as I saw on my last admission when she went away. I’m apprehensive about what he will make of this new issue of mine as I found his approach a bit conservative last time.

And so I’ve made it one week without climbing the walls. I’ll be back next week detailing my experiences with this new doctor and group therapy.



The Rehab Diaries Redux – Admission

So, I’m in hospital again.

What went wrong?

Well, I was actually doing really well but then I was faced with some major life changes and instead of dealing with it in a healthy way like say, hashing it out on this blog, I started to drink.

Alcohol has never been a problem for me. I used to joke that I had a relationship with alcohol that I wish I had with food – it could sit in my fridge for weeks or months waiting for a special occasion.  But no more.

I’ve only been drinking heavily for a couple of months but it’s taken its toll on my health and I’ve had a couple of incidents that gave me pause for thought. One day I passed out in the toilet and bit a chunk of flesh off the inside of my lip, then the next day I nailed myself while my boyfriend was over and passed out.  He had to hunt for my key to let himself out of my place.

I woke up the next morning covered in vomit.  Have you ever woken up covered in vomit?  It’s a low moment.  As scrubbed the remnants of last nights spaghetti out of the carpet, trying not to hurl again from the combined scent of vomit and omo, I realised that I needed intervention.  I could still keep going.

It just so happened that I had an appointment with my psychiatrist that day. As soon as I sat down I told her “I think I need to go to hospital…” and explained what had been going on.  She cancelled my ritalin because apparently it promotes addictive behaviours and agreed to write the referral.

The referral process took the longest this time than it ever has before, including times when my referral hasn’t actually gone through and I’ve needed to get another one. It was two weeks between getting the referral and getting the call to come in to hospital when before it’s been an average of one.  It may have something to do with the time of year; for some reason I usually go to hospital in the summer.  To be there in June is a first for me.

I was admitted yesterday and there are a few changes to my care plan because I’ve never been here for a drinking problem before. I have to do an AWS questionnaire every six hours – I think that stands for alcohol withdrawal symptoms – which scores you according to what withdrawal symptoms you are experiencing such as anxiety, tremors, agitation etc.  If you score highly they’ll give you valium.  So far I’ve done it twice and scored zero but I’m told it sets in after three or four days.  Also one of the rules of admission is no alcohol and as a problem drinker I will be subjected to random breathalysing.

I saw my inpatient psychiatrist and she said she wouldn’t change up my meds as yet. She asked me if I was looking to reduce my alcohol intake or stop it altogether.  If I wanted to stop she would put me on antabuse, that drug that makes you violently ill if you have any alcohol.  I said realistically I was looking to cut down.  She said she would wait to see if I started craving alcohol and if I did, she would prescribe me naltrexone.

I saw the ward CMO who went through my medication and ordered the standard blood work. I thought everything was fine until I went to get my medication that night.  They tried to give me half of what I normally take.

The problem was, I take 160mg of zeldox, 400mg of lamictal and 50 mg of Topamax in a day. That’s how doctors read it out when they’re talking about my meds and that’s how she read it out to me so I agreed with her.  It actually is 200mg of lamictal and 25mg of Topamax in the morning and 200mg of lamictal, 25mg of Topamax and 160mg of zeldox at night.  She wrote down 50mg of Topamax, 80mg of zeldox and 200mg of lamictal in the morning and 200mg of lamictal and 80mg of zeldox at night.  When they called her to get her to fix it she wouldn’t change it.

I was livid. These aren’t freaking skittles I’m taking, these are strong drugs with many systemic effects.  Without the right amount of zeldox I don’t sleep.  The staff saw how worked up I was and broke protocol to call my psychiatrist at home and have her change it.  I took the right meds last night but it isn’t fixed properly, my chart is still wrong.  I have to see another doctor today to sort it out.

I don’t know how this admission is going to go because I’m not nearly as unwell as I was during my last one, apart from the problematic drinking. I’m expecting to be here for about two weeks, I don’t expect it will become as long as my last stay (because I was climbing the walls by the time I left.)

I will be doing a rehab diaries though so stay tuned.