Sleeping and Seroquel Update

It has been a while since I’ve blogged and I will give an update on my life shortly but today I want to talk about the sleep issues I’ve been having lately.

So as you know if you’ve been reading my blog I was previously taking a maximum dose of zeldox to get to sleep and that worked for about a year, but in October last year that stopped working, and so did the temazepam that I had to take on nights when it didn’t work.  I happened to have an appointment with my inpatient psychiatrist after one of my sleepless nights and she gave me 50mg of seroquel to see if that would help.  It did, and when I saw my regular psychiatrist later that week she prescribed seroquel to be taken regularly.

For a while that worked well.  I was sleeping for about ten hours a night and waking up refreshed with no hangover drowsiness.  But it wouldn’t last.

It started with a few nights where I would have to boost my dose of seroquel to 100mg.  Bizarrely the 50mg of seroquel seemed to not work when I had a full stomach, so I had to watch how much I ate.  I’m aware that increasing your medication without notifying your doctor isn’t a wise move but I do know a bit about my medications and 100mg of seroquel is not a high dose.

Then a few months ago I began waking up during the night at around 3am.  Sometimes I would go back to sleep, sometimes not.  I don’t mind being up in the middle of the night too much because I wasn’t tired and I could have some quiet “me” time.  However is was very disruptive for Pea who is trying to sleep while I’m moving around, watching youtube videos on my phone (albeit with headphones) eating snacks etc.

The waking up was getting earlier and earlier until I was only getting about two hours of sleep.  Sometimes when I woke up I would take another 50mg of seroquel but I was in denial that we had a problem.

Then I started having to take an extra 50mg when I hadn’t eaten too much, or hadn’t woken up.  I would take a 50, lie in bed for a hours trying to sleep, give up then take another 50.  Suddenly 50mg wasn’t putting me to sleep any more.

After going a whole week of needing 100mg to sleep I was willing to admit we had a problem.  Then on Sunday I took 100 and it didn’t work.  So I took an extra 50.  Nothing.  I took another 50 again putting me at 200mg of seroquel.  I went to sleep and woke up feeling pretty flat.

I was despairing of the prospect of seroquel working at all the next night by that point so I called my psychiatrist and told her what I had done, and said I didn’t know what to take that night.  She told me to come in for an emergency appointment.

In the appointment she said that seroquel is used as a sedative but it is primarily a mood stabiliser and when you are taking in regularly the sedating effect will wear off.  Also apparently seroquel does not have a greater sedating effect above 200mg so me taking more than that out of desperation won’t do any good.

She said she will keep the seroquel in my medication regime because I need it for my mood disorder, but she prescribed a new drug for my sleep disorder, gabapentin.  I was surprised because I mistakenly thought this drug was for people with parkinson’s disease.  But apparently it’s used for epilepsy, mood disorders and sleep.

She told me she wants me to get to 300mg of gabapentin a night, but to start with 100mg, go to 200mg the next night then 300mg the night after that.  If 100mg that night didn’t work by midnight, she said, I could take another 100.

I went home and did wh

at she said and even though I was incredibly anxious about whether it would work or not it did and I didn’t have to take that second 100.  I went up to 200 the next night and 300 last night and have enjoyed long unbroken sleep with no hangover effects.

Before I left she told me to call her on Thursday – today – which I will do, and update her on how I went with it all.  I will do that, and keep you updated.

 

Mac

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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.

Mac

The Rehab Diaries Week 5 – Hitting the Wall

I’ve hit the wall, and hit it hard.  To think it only took me four weeks.

My anxiety is spotty.  It’s kind of on and off but when it’s on it’s intense.  I’ve had days where I spent hours just pacing and ruminating.  Leaving the hospital is still making me feel sick.  Le boyf is making me go out, and is getting concerned over how I’m somehow not getting less shaky every time we do go out.

It seems to be spiking at night.  At night, anxiety is just on.  I guess it’s because it’s the time of day when the zeldox levels in my system are at a low but I just run in circles around my room, so dizzy and shaky, trying to wear myself out.

I have an agitating factor at night time; there’s a very real issue that can prevent me from sleeping.  My neighbour’s.  Fucking.  Snoring.  It has to be heard to be believed.  And it can be heard through the wall with the door shut.  They gave me ear plugs which do work, but they’re uncomfortable and I don’t like wearing them.

The rational part of my brain tells me that I shouldn’t be expecting to not be a competent, non agoraphobe in just a few short weeks.  The depressed all of my brain asks when I will ever not be an incompetent agoraphobe.  Suicidal ideation is back.  I just can’t do this for another fifty-odd years.

I had to make the decision of whether to return to my regular inpatient psychiatrist who was returning to work this week.  This was more complicated than it sounds.  On one hand, I’ve seen the regular doctor for five years, we work well together and it’s important to keep her in the loop.  On the other hand, I’ve come to realise that these two have very different philosophies.  While I was frustrated at my current doctor to begin with, I came to realise that his comparatively conservative approach isn’t always a bad thing – bringing up my drugs slowly allowed me to tolerate them much better, and adding them to my chart as PRN rather than standard gave me greater control over when I increased the dose.

The deciding factor was whether I would have to change therapists.  Each doctor has a different psychologist working under them, and I was concerned that if I went back to my old doctor I’d have to change my therapist as well.  I just wasn’t prepared to change both at this late stage.  When I asked him though he promised that he’d fix it so I could see my regular doctor and his therapist.  So it was settled.  I’d leave his care and move to hers.

I was worried about this appointment, not because I’m scared of her – as the staff kept teasing me – but having explain my entire case summary to a new person is exhausting.  Plus with her less conservative approach to medication I was afraid that she’d effectively blow up this current regime and put me straight on a different cocktail which would make me violently ill, and keep me in hospital for several more weeks.

Despite my fears she did no such thing, but explained to me that she would normally be treating anxiety with a certain type of anti depressant.  Which as we know, for bipolar patients, is problematic.

She contemplated prescribing lovan, which is apparently a safer class of the drug but I know I’ve been on that before, I just can’t remember when or for how long.  If it was for a long time, that would indicate it was working.  She promised to dig through my files to see if it was in the last five years, I promised to check with my parents because I suspect it was long before that.

She also made the morning zeldox a permanent addition to my medication chart, so I don’t have to explain to the nurses every single morning why I need PRN just after I’ve woken up.  Taking it in the morning is definitely getting easier but I’m still struggling some days where I end up doing sweet FA all day really.  I have what my dad would call ‘bed days’ when he talks about his nursing home patients, where I just lie around and watch tv.   Of course dad would say that bed days are reasonable in elderly folk on their last legs who have slowed right down, not a young person like me.

Another addition to my anxiety is the demographic shift in the hospital’s residents that has happened suddenly this week.  I’ve noticed over my admissions that the hospital does go through stages of being either mostly young or mostly older folks over periods of several weeks. And there never seems to be a whole lot of inbetweeners like myself.  Maybe because they tend to assign themselves to one of the groups and manage to blend in but I’m not interested in either.  Although there are a few who, like me, do keep to themselves.

Anyway up until now, including over the holiday lockdown period, it’s been a decidedly old timers scene.  But this week has seen an influx of youngsters and whenever this happens the hospital turns into a giant sleepover party.  Shrill laughing, gossip, cliques, running in and out of each other’s rooms.

That last part I find particularly anxirty inducing.  I know that seems irrational but truth be told I would never go into another patient’s space.  And I would not tolerate them coming into mine.  In fact it’s against the rules to have another patient in your room.  Even if it wasn’t I would be enforcing that as a personal boundary.

The nurses don’t appear all that concerned; certain rules aren’t strongly enforced when nothing is being hurt except maybe the sensibility of personal boundaries.  One good thing about the youngsters is that they all want to hang out the smokers area so at certain times of the day the hospital completely clears out when they want their nicotine fix.  I do appreciate the quiet.

Something that has made a huge impression on me in my personal therapy journey is the importance of appropriate personal boundaries.  Generally – there are some exceptions of course – the older crew are totally on board with this idea, as many have been in therapy for years but watching the current lot is good for meditating on that concept.

I’m not saying that all young people suck at boundaries but, as I said seeing certain ones running into wach others rooms and jumping on their beds makes me wonder.  I could do I could do a whole other blog post on the topic but the gyst of it is, we are told that while socialising in here is fine, we are discouraged from maintaining friendships once we get discharged.  And after being admitted with certain people a number of times you often come to understand that despite presenting well freinship with them can be exhausting.  I include myself in that description, I suck at maintaining friendships.

Some food for thought might not be a bad thing, hey?  Anything to distract me from the anxiety.

Mac

The Rehab Diaries Week 4 – Holiday Time is Over

 

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Finally, I got to see the new doctor.  He was a pleasant character and after a few leading questions I found myself pretty much telling him my life story, including how I had applied for medical school this year, and missed the UMAT cut off for my school of choice my just a couple of points.

He was supportive, saying that he had several patients who had gone on to careers in medicine, and some much older than me.  He tried to decipher my doctor’s notes – apparently he has typical doctor’s handwriting – and it appears that he eventually intends to supervise me onto 100mg of Zeldox, which would indicate 2-3 more weeks of rehab.  He told me that he would be putting it up to 60mg this week.

When mum picked me up for leave that afternoon I passed on that information and her reaction was one of despair.  How could I be there for a month?  Don’t my doctors understand the havoc I am wreaking on my family yet again? Thanks mum, real helpful…  (Actually I’ve been there for five weeks before but I think this admission will top that.)

If last week was the week of agitation, this week is the week of anxiety.  I’m still experiencing racing thoughts, racing through everything I could possibly be anxious about.  Just leaving the hospital makes me feel so ill.  BF and I were going to the beach last week but that’s out of the question now.

For some reason thinking about moving home is triggering me badly.  It’s just the whole moving process being such a pain in the butt, I just want it over with.  We’ve been going to my place to get bits and pieces and that’s so hard.  For some reason being in my suburb is giving me anxiety over the fact that it’s a super rough area.  Which it is, but I’ve lived there for two years and never been broken into or had any such trouble from the residents.  The drama stayed out of our house and on the street but still I can’t help agonising.  It sucks.

I’ve been catastrophizing something dreadful.  My mind latches onto a dreadful idea, and I can’t relax until I’ve been able to confirm it.  For example, while I was on leave one morning I became convinced that someone had gone into my room and stolen my contraceptive pill.  Which is ridiculous, right?  That’s a horrible thing to do and I haven’t even talked to the other patients enough to infuriate someone to the point where they would do that.  But I couldn’t let it go.  I ended up calling the nurses’ station and making one of the nurses check that it was in my drawer.  Which it was.

I’ve had many ‘ideas’ like this.  When I have them I make sure to tell the staff so that my irrational thinking is going on record because this needs to stop.  Of course the fact that I’m aware that these thoughts are irrational bodes well for me but it’s still eating me alive.

And then to add a poisonous olive on the side of this paranoia laced anxiety cocktail, I woke up one morning and the double doors between ward one and two had been thrown open.

Holiday time is over.

“Oh yes, we’re back to normal functioning this week.  Prepare for fifty thousand admissions.”  My nurse confirmed cheerfully as she brought my morning tablets.

I later found out that this number is actually closer to seven.  Admissions generally happen two days of the week, so they were able to stagger the patients coming in.

The advantage of course is that all the staff are running at full capacity, including the therapists.  Group therapy is back.  I gave groups another chance, and the first one I went to left me feeling positive – the therapist allowed us to check in, so the self pitying ramblers were not allowed to talk over anyone or hog the air time.

I’m certainly not above talking too much, and it’s something I’m very self conscious about; I’ve noticed in group therapy that those who talk the most tend to apply the skills the least and I can’t possibly be the only one.  I always cringe and swear I’m going to pass ever time they start going around the circle to check in but let loose when it’s my turn.  Those damn therapists sure know how to ask leading questions.

I was also eagerly awaiting the return of my therapist this week to finally start unpacking all this anxiety but my excitement was premature.  I saw her once before she had to go on leave for a week for surgery.  LAIM.  Am I going to get any kind of decent interpersonal therapy before I get discharged?

We’ll find out next week I guess.

Mac

 

The Rehab Diaries Week 3 – Oh so quiet, just not in my head.

 

 

justmymind

 

My brain is resisting sleep.  Getting out of bed is hard but getting in is harder.  My anxiety is so restless even though I’m on more than ever before.

I was bouncing off the walls.  A good proportion of my dad was spent pacing back and forth.  I was hiding in my room to avoid human contact.  Even though the ward was closed and there were hardly any patients in, as we know I still found everything and anything to be irrationally enraged at.

My trichillomania had been triggered as it often is in times like this but bizarrely instead of pulling out my own hair, it has been transferred onto my boyfriend.

“Can you talk to the doctor about this?”  He asked jokingly, pointing to his scabbed up face.  I cringed.  Once he put it out there it seemed to be no joke at all.  Popping his zits is something I do a lot – be honest ladies, you know you do this – but my attacks on his face had gotten harsher.  Patches of hair from his beard were missing too, as I kept saying I “just want to get rid of the weird hairs.” I had to keep checking for grey hairs, or split hairs, or hairs thicker or thinner than the others.  And if I found one, it had to go.

BF had been saying that he wanted to meet the doctor to get a better understanding of my illness.  I asked the doctor if him sitting in for a bit was ok, which he agreed to but once the door closed, stage fright struck.  We asked BF if he had any questions and he kept saying he didn’t know.  After a few minutes of this I grew impatient and threw him out.

The doctor was sympathetic to my claims of elevated mood from the previous week, even though it was maddeningly settled that day so he couldn’t observe it in consultation.  He admitted that the increased melatonin may have overshot the mark and scaled it back to 25, increasing my zeldox by another 20 at night because previously when I had been taking 20 morning and night I always needed a nap at midday.

My med woes were not over however, as later that night a nurse came running into my room absolutely beside herself.  “It’s no good, Mac.  We’ve messed up your cycle.  You need to start used protection because if you get pregnant because of me, I’ll never forgive myself!”

She explained that there had been a communication issue regarding the dispensing of my contraceptive pill.  A few days after I arrived another nurse gave my pill back to me and told me to manage it myself.  I thought that was fair enough.  But that night, I saw a little Yaz in with my normal pills.  Silly me just assumed without questioning that they’d changes their minds.

Apparently it hadn’t been recorded that I was managing it myself, so depending on which nurse was doing the medication rounds, some nights I was being given the pill, and some nights I wasn’t.  And stupid Mac was just swallowing whatever she was given without checking.

After apologising profusely she launched into a lengthy lecture about safe sex that left us both ruffled and red-faced.  Do I have access to condoms?  Will BF wear one?  Will I make him wear one?  Can we abstain?  Is it hard for him?  Hard for me?

I’m going red again just thinking about it.

Her concerns turned out to be unjustified as I got my period a few days later.  Maybe that explains my mood.  I’ve had to deal with all the delightful extras that come with that, including the cramps.  My cramps are nasty at the best of times, and the only thing that really helps is heat.  Unfortunately heat packs are not allowed due to the risk of self-harm so the staff loaded me up with panadeine and I had several hot showers a day.  The temperature of the showers is set to a maximum of pleasantly warm so we can’t burn ourselves.

On the increased zeldox my brain became settled enough to make one major decision – I have decided to move back in with my parents.  My health has been so bad for so long I’ve had to get real about what I actually need and at this point I feel like living in my parents’ house is the best option.

The configuration of the house will have to be changed to give me acceptable independence.  My parents have tasked me with working it out and it has shown to be a good way to keep my mind active.

New year’s eve fell on this week and it had me really worked up.  Maybe because it was so hot, maybe because my mum and I had an argument over the way I cleaned the bathroom on leave but I was ready to go without dinner – and let my boyfriend do the same – after I called around several take out places for dinner to find they were all closed and had a ‘fuck this I’m done’ moment.

After a pep talk from mum I called one more place – which was open.  My anxieties about traffic and crowds were completely unfounded, while the restaurant was located in the middle of town it was deserted when we got there at 5.30.  And the pizza was fantastic.

I’m not really one to get worked up over FOMO, so I wasn’t keen for grandiose new year’s plans and BF is the same.  But I was a little bummed about not being able to do the midnight kiss.  See, normally the clinic doors lock at ten so we have to be back by then when we’re on leave.  The staff were willing to make an exception for new years eve but legally we had to be back by midnight.

So we went to 9pm fireworks which were fantastic…so fantastic that I had a brief seizure!  I’m epileptic, even though my seizures are very rare I am changing meds at the moment so it’s not that big a deal.  I notified the staff when I got back to the hospital and that was their impression as well.

My doctor was off for the rest of the week and I was supposed to see one of the others but I didn’t realise that he works on a different schedule to mine, who works Tuesdays and Fridays.  The fill-in works Mondays and Thursdays so I went out all New years day thinking I would be seeing him on Friday, but no deal.  Oops!

With only the one tablet being increased it’s not that big a deal; they can’t bring it up faster than once a week anyway.

I would have to wait until the next week to see him, when the ward opened again…how would I be handling that?  You’ll have to wait until the next instalment to find out.

Mac

 

 

The Rehab Diaries Week 2 – Christmas On the Closed Ward

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Exactly a week before Christmas a note slipped under my door warning me of changes to the ward over the Christmas break, which would start in a few days and last two weeks. I was aware the ward shut downs to half capacity over Christmas, but I had never been in hospital during that time before.

One of the hospital’s two wards would be closed off completely.  This happened to be the one I was admitted to but I didn’t have to move because the wards are separated by a set of doors, and my room is one of three that are on the other side despite being under care of staff of ward 2.

No more patients are supposed to be admitted during this time, although there were about three more admitted over the next few weeks whenever someone discharged themselves prematurely.  Which happens, it’s a voluntary clinic after all.  Many discharges were planned for that Friday before the closing, so in the end the staff were caring for about a third of the usual patients.

Many staff were forced on leave as well by the hospital, including all of the therapists.  That meant no group or private therapy for two weeks.  No one was thrilled about this, least of all me.  Part of the reason I came to hospital was to have some intensive psychotherapy to unpack why I spent the second half of last year in a constant state of mental breakdown.  The timing of this admission is unfortunate.

Also going on leave against his will was my doctor.  After feeling frustrated with his apparent unwillingness to make a decision last week I explained the kind of pressure that I was feeling.  He explained once again that usually the way to treat my anxiety symptoms would be to add an antidepressant but that my bipolar made that a risky move.  He suggested doubling my melatonin pill, which could help my depression and anxiety and fix my broken sleep in a less risky way than a classic antidepressant.  I agreed.

His going on leave was another cause for concern.  This would be yet another doctor to haul out my life story in front of, who would no doubt have a different therapeutic philosophy and I had no way of knowing what kind of changes he might make.  It’s kind of disturbing really how so many staff said they wanted to stay on – especially the therapists.

As it turned out however upping the melatonin was not as risk free as we may have thought.  My mood swung, and it swung high.  And hard.

My thoughts were racing.  I was shaky, ruminative, anxious.  Irritable.  I spent much of the day pacing about my room and feeling murderous toward my fellow patients.  It just so happened that at this time there were several patients who liked to play instruments.  And just hearing them play sent me into the most unreasonable state of irritation.

There was a lady with a flute, a guy with a guitar and a nurse with a ukulele who liked to join them.  They had timetabled daily sing-alongs but guitar boy could be heard strumming away contemplatively at all hours of the day and for some reason my brain equated that with being unreasonable.

I know, irony.

I got so irritated that on closing day I ended up in the nurse unit managers office having a cry about how annoyed I was.  I thought she would laugh me out of her office but she was sympathetic.

“Why do you think I timetabled these music groups?  They annoy me too!  I was hoping they’d get it out of their system in the allotted hour.”

She jokingly assured me that most of them were getting discharged that day.

The ward closed but it wasn’t a happy place.  Christmas is a triggering time for many people.  I’m lucky not to have to deal with the family dramas that a lot of the other patients were trying to cope with and they struggled.  There was many, many meltdowns.  The short staffed nurses did their best to cope but some therapists certainly would have come in handy.

As for me, my mood just kept on climbing.  On Christmas eve I my mum came and picked me up to help prepare the house for Christmas and when I jumped in the car I stunned her by immediately covering ten different topics in two minutes, occasionally stopping to cackle manically.

“Oh my God…take a breath.  You’re acting a bit manic.”

“My thoughts are racing.”  I admitted.

“oooooooooook.  We’re going to working keeping a nice calm environment today.”

I was worried about how I’d handle Christmas Eve mass and dinner – when the mood’s up, anxiety tends to be up as well – but in the company of my family I was able to relax and go with the flow of the evening.

On the day itself my anxiety was intense- event though I was woken up by a nurse leaving a box of chocolates on my bedside table.  I thought getting out of the hospital was going to be hard and I was right.  The nurses were stressed out trying to get meds for ten patients at once as we all had to go out at the same time.  Some of the patients were getting agitated and taking it out on the nurses and that was hard to take.   I made a mental note to bring a box of leftover candies back with me that night.

After my extreme high the day before I was tired for most of Christmas day and spent most of it on the couch pretending to mind my cousin’s children as they wreaked havoc in front of me.  For the most part everyone left me alone and I got a few good presents out of the day, so I can’t complain really.

If you read last week’s entry you may be wondering…did I speak to the nurse my boyfriend unloaded on last week?  Yes I did – eventually.  She wasn’t in for a week after the incident but on her first shift back I asked for her version of events.

The way BF told it, he’d appealed to her for help after I refused to engage him but she remembered differently.  According to her this guy – the boyfriend of a patient, remember – came up to her and gave her a brief history of BF.  It’s not a happy history.  She asked him if he was seeing a psychologist – which he is – and rightfully delegated that conversation onto him.  Then I suppose he asked her what to do about his wilful girlfriend problem.

How bizarre.

He didn’t deny any of this when I told him what she said, and did end up seeing his therapist soon after, saying that he felt better equipped for it.  I wish I understood what it was about my depressive episode that made his whole life flash before his eyes though.

Until next time,

 

Mac

The Rehab Diaries Part 3 – Week 1

Finally, we touched ground at the clinic.

The first thing they do, after you fill out the paperwork and pay the gap, is take your vitals and take a picture to put in your file so the staff coming in on the next shift can match names to faces.  I’ve had several pictures taken over the years to account for aging – and my hair being a different colour in each one.

In all my previous pictures I look either depressed or agitated but in this one I was concerned that I look inappropriately cheerful.  There’s a good reason for that though – after I’d had my medical and was awaiting the nurse with my admission package, BF ducked into my bathroom.  The nurse came in while he was doing his business.

She apparently didn’t hear him flush the toilet and wash his hands while she was setting up the camera.  When he threw open the door just as she was pressing the button, she startled so badly that she jumped and we had to take the photo again.  The second one came out but it was obvious that I was trying to supress my amusement.

After BF left, I was to have my admission appointment with a doctor who I hadn’t worked with for five years, as my regular hospital psychiatrist was away.  I was a little nervous about this meeting; I had been a difficult patient to deal with at the time but was having a lot of trouble expressing what was wrong with me, and took a lot of frustration out on my care team.  As a result I was told again and again that they had no idea how to help me.  I harboured a deep distrust of mental health professionals for a few years after.

My communication skills have improved since then and bearing in mind that I didn’t get along with my current psychiatrist when we first met, I was willing to give him a chance.  I figured it was a better option than starting with yet another doctor who I don’t know at all.  I was relieved to find that he was willing to give me another chance too, and after the official admission business he asked me what I hoped to achieve with this admission.

I explained the deal with my current medication.  The mood stabilisers seem to be struggling on their own.  The efficacy of Topamax is unclear.  My anxiety is out of control.  I probably need to be on antipsychotic drugs as well as mood stabilisers – as many bipolar patients do – but we’ve had trouble sticking with one so far because of side effects.

He listened, and conceded that this would be worth a try…and if I left it with him, he would come up with something.  Wait, what?

Turns out I didn’t have a good appreciation for how gung-ho my regular psychiatrist’s approach is.

In our next appointment three days later I found my frustrations from five years ago resurfacing somewhat.  The doctor seemed unwilling to make a solid decision and kept throwing the conversation back to me, asking me if I had other ideas.  Um, why go through three years of psych residency if it were that simple?

I pressed him and he listed off some antidepressants to treat my low mood which was met with an (admittedly ungracious) groan from me.

“Pristiq?  PRISTIQ??? Don’t you remember what I was like when you put me on pristiq before?”

“remind me?”  He quipped innocently

“kinda nasty.”

He suggested Cymbalta, saying that some of his bipolar patients had seen improvements on the drug but I was hesitant, maybe unfairly due to the number of people of mental health forums I’ve been haunting despairing over side effects.  I said I would ask my dad, also a doctor, for a second opinion.

Finally he printed out some information on the natural supplement SAMe, explaining that it could be a cheaper way to regulate my sleep and depression.  Oh great, now we’ve exhausted all our pharmaceutical options I thought glumly as I left.  Clearly he thought he was giving me greater autonomy over my treatment plan but at the time I felt like I had all these decisions on my shoulders that I’m unqualified to make.

I spend a lot of that week in bed.  I was low, in mood and in energy.  BF normally cares for his mother but she had been in respite for a few weeks so he was with me constantly.  Whether I liked it or not.  All BF all the time.  I just didn’t have the energy to entertain him and I was getting more annoyed by his presence because I felt like he was just doing it to ease his own guilt, rather than because he thought he was helping me.

On one such day he said he was coming over.  I told him no, I wasn’t up for company but he turned up anyway.  In the mood I was in I told him that if he must be here fine, but I said I didn’t want to talk so I wouldn’t.  And rolled over and went to sleep.

I napped most of the afternoon while BF lay on the floor playing candy crush, every now and then being woken up by an overdramatic look-at-me sigh from him.  About two hours in when sighing his feelings out got him nowhere he got up and stormed out.  I’m not sure how long he was gone for as I was asleep in between but he came back with my nurse who looked a little perplexed.

“You should get up.” She turned to him “She hasn’t eaten today.”

I pulled the covers over my head. “Too bad.”

He yanked the quilt off my bed. “Nope!  We’re going for a walk.  Even if I have to wheel the bed out the front door.”

After some protests from me – and a threat to roll me off the bed that probably would have been carried out – we did go for a walk to the nearby lake, and ate Thai food in the sun.  My mood improved for about five minutes.

I was hoping to debrief with the nurse over whatever my boyfriend said to her, but she wasn’t in for the rest of the week.  If he wants to be around and harass me fine, but I don’t want him annoying the staff.

That was a conversation I wasn’t able to have until week two.

So you’ll be hearing about that in the next instalment of the rehab diaries.

Mac