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)

 

Mac

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.

 

Mac

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.

Mac

Some Travel Anxiety

I am leaving to go away for a week tomorrow and I’m really nervous.

This trip has been planned for months; it’s a sports trip. I’m going over with a team to play a team from a sister club in New Zealand.  I signed up for this trip because on paper it sounds like an amazing experience that I knew I would be grateful for afterwards.  But leading up to it I’ve been worrying more and more.

It’s a week spent in close quarters with twenty other people, some of whom I don’t really care for, playing a gruelling game during the day against super fit and talented people, and partying until the early hours of the morning, while I know my boyfriend wants to be up early for sightseeing – hello sleep disturbance!

I’m worrying about how I’ll handle myself with so much socially exhausting activity going on. I’m worrying how I’m going to sleep – sleep, as we know, isn’t my friend.  I’m worrying I’ll get injured.  I suppose I shouldn’t worry too much about that last one because I do have travel insurance that covers me for sports.

My boyfriend has been away with the club before and assures me that on his first trip he was nervous too, but found it a great way to get to know everyone. Friendship is forged on common experiences and all that.

When we last spoke this morning he signed off by saying “Remember, money, passport and meds – everything else is optional.” Because oh god the packing.  I haven’t even started yet.  I made myself a list which took about twenty minutes just to make sure I haven’t taken my 3DS and not brought a charger or something.

The medication issue is pertinent. I’m on six different scripts so try organising a week’s worth of meds out of that.  Very entertaining.  And I’ve got to include spares for if I lose a dose.  I’m worried because I forgot to get a psychiatrist’s note for my meds and I don’ t know if I’ll need one at immigration.  The last time I travelled overseas with meds was to the states in 2014.  I was on a lot less meds then though.  I did have a note from my doctor but they didn’t check it.  I’m considering getting my GP dad to write one on the off chance that I do get pulled up because of it.

So I’m anxious, ruminating and…probably going to have a great time. I’ll report back in a week, unless I fall down a hobbit hole or something.

 

Mac

Antipsychotics and Me

Finding the right medication is often a balancing act between how well it works and how many side effects you can take.  While I’m aware that I have to live with some effects – there’s no such thing as a quick fix in psychiatry after all – I’m still holding out hope that I can find medication that works and doesn’t pile weight on me, or zonk me out all the time, or give me such bad memory loss I’m blanking on my personal details.  I’ve been through quite a few now and I’m really hoping that this current one is the one that sticks.

I started on Zeldox in December last year.  I had been on it before, and it was a disaster because my doctor put me on 40mg straight away and I was violently ill for weeks.  This time we started with me taking 20 mg to start with, with my psychiatrist aiming to have me settled on 100mg.

I talked about my experiences getting on the new medication regime in the rehab diaries, but the complications with my medication didn’t end once I left hospital.  There have been side effects that only became problematic later.

So, back to the end of my hospital stay.  I’ve just been discharged and I’m taking 80mg of Zeldox – 20 mg in the morning, and 60 mg at night.  I persisted with the daytime dose for about three months but midday drowsiness was a persistant problem, and is a problem for me for any antipsychotic medication I’ve taken.

I’d take the pill at about nine a.m.  I’d feel great for a couple of hours, then start feeling a bit seedy around midday.  Generally I couldn’t get through the day without a midday nap.  For those eight hours between the nap and night meds however I can’t deny I felt fantastic.

I put the problem to my psychiatrist in an appointment scheduled when I would normally be napping.  She agreed that I appeared over medicated, and put a stop to the morning Zeldox.  But, would I mind trying to take all of it at night?

So I did.  Still on 80mg of Zeldox but all at night.  While I was much more animated during the day, and could go places without worrying about crashing suddenly in public, not taking the drug during the day did see my productivity go down.  I had trouble focusing,  I was restless, and just generally more anxious.

Then came something that every happily medicated person with bipolar disorder dreads: I stopped sleeping.

Generally when this happens it’s time to change up the meds but I was not prepared to give up on Zeldox just yet because….well, I’d been losing a lot of weight on it.  That might sound petty but I’m willing to hold onto any drug that doesn’t push me in the other direction.

I went back to my doctor and told her what was happening – and had her despair over my continued weight loss – and she agreed that we should persist with Zeldox for now.  While my weight loss has been bothering her, I previously gained 20kg in a couple of months thanks to other antipsychotic drugs.  She’s very mindful of not putting me on anything likely to repeat that.

So to fix the sleeping and other positive anxious symptoms she decided to jump from 80mg to 120mg of the Zeldox.  She told me to try taking 40 in the morning and 80 at night, but to switch to all at night if the daytime dose was knocking me out.

That worked – for a week or so.  Eventually my sleeping became problematic again, and taking 40mg during the day was making me drowsy.  Though again, in the afternoons I was feeling fantastic.  But life isn’t forgiving of a need for a siesta so I started taking it all at night.  I still wasn’t sleeping, and my anxiety symptoms returned during the day.

So at my most recent appointment she told me to jump 40 mg again so that I was taking the maximum allowable dose, 160 mg a day.  Because I do seem to do better when I take it during the day she told me to split it 80 mg at night, 80 mg in the morning and to persist with this for a while just to see if we couldn’t make it work.

I tried to make it work.  Taking 80mg of a sedating antipsychotic as soon as I got up had me feeling like I had been hit by a train for the first half of the day (and of course feeling fantastic the second half.)  I persisted for a few weeks but it just didn’t get better.  I tried setting an alarm for 4 am to take it, hoping to be able to sleep the sedation off before I had to be anywhere but it still lasted until about 11 am.  It was so strong that if I had to be anywhere before that time, I had to get someone else to drive me.

So now I’m back to taking it all at night.   I have been sleeping fine, still a little drowsy in the mornings but not scary sedated.  While my mood might be more stable on a daytime dose of the antipsychotic it looks like taking something at that time just isn’t realistic.  I can’t deal with the sedation.

I wish I could be one of those people who gets on a particular dose of medication and stays on that dose for years but medicating me is like a game of jenga – carefully building a complex structure and taking pieces away, hoping the whole thing doesn’t collapse.  Which it inevitably does.

Mac

What is CBT, and how will it help me?

So in my absence, I’ve been attending a weekly CBT group therapy session.  The decision to refer me to this group was made when I was discharged from hospital back in January to tackle my anxiety.  I went onto a waiting list then a spot opened for me in April.

So what is CBT?

Cognitive behavioural therapy is a problem based, action focussed form of psychotherapy – it identifies problematic behaviours and thoughts, challenges them and encourages you to form new ones.  It has been proven to be effective in treating many different mental illnesses but in this group was focussed on depression and anxiety.  It can be done individually, or in a group setting.

I’ve done group therapy before but that was DBT, a therapy more oriented at reducing problematic behaviours in people with personality disorders.  I had to do the group something like four times before the therapists decided that they were done with me.  What can I say, old habits die hard.

With that in mind I was apprehensive towards CBT.  I was hoping it wouldn’t attract the kind of drama that comes with a DBT group, where you don’t tend to end up unless your life is well out of control.  My own life was pretty chaotic at the time, and I’m sure there were plenty of people in the group who got sick of hearing about me getting into the same dramas over and over.

My brother in law also tried individual CBT to treat his depression and didn’t like it.  Which is fine, not all therapy styles are appropriate for every individual but he really felt it was too impersonal.  He likened it to treating his brain like a computer that needs rebooting.  Which is interesting because I find that to be an appropriate metaphor for how my anxiety works.  It’s like my brain is programmed to dread unspeakable horrors at all times for no goddamn reason and if reprogramming is what CBT can do for me, then I’m all for it.

So I went along to this group.  It runs for three and a half hours, separated into three sections, sharing, mindfulness and doing worksheets.  When we first arrive we take turns sharing situations where we struggled with our anxiety and/or depression, and where we have done our homework from the last week which generally consists of identifying some problematic thought patterns and connecting them to our behaviours

After sharing – which usually takes twenty minutes or so per person – we have a twenty minute break, then go back to do a mindfulness exercise lead by the therapist.  This is the part I struggled with; I can’t keep my head clear to save my life.  Intrusive thoughts are a big deal for me.  I can do some mindful deep breathing but I’ll guarantee I’m also thinking about my favourite Archer quotes or something.

We then spend the last hour and a half working through the info and exercises on our handouts for the week.  If you follow me on Instagram you’ll notice I’ve been posting them as I get them; they are separated into two seven week modules, one on anxiety and one on depression.  Each week we explore some aspect of thoughts and behaviours that might be shaped by both.

Even though I was put in this group for anxiety, I found the thought challenging exercises in the depression module to be more relevant to me.  I love to catastrophise and obsess over possibilities – and I have a double whammy of autistic spectrum disorder and paranoid delusions from mania facilitating that – and I found the exercises grounding.

So about the people in the group…obviously I can’t share details about them, but was I right in assuming that they would be less dramatic than our mates in DBT?  The answer is yes…mostly.  People with anxiety as opposed to personality disorders tend to be higher functioning I’ve found, but there’s always some individuals who can’t not escalate any drama they get into and don’t want to help themselves by using the therapy tools to challenge their behaviour.  But one of our group rules is accepting that everyone is at a different stage of their recovery journey, so I just have to take it for what it is I guess.

After all, One of the benefits of group therapy that they’re too polite to tell you about is that there’s always something to be learned from other people’s mistakes.

Mac

Bipolar Disorder Feature On Australian Story

This week the ABC’s Australian Story did a feature on the Newling family’s journey with two out of three children diagnosed with serious mood disorders, with two very different outcomes

Watch it here:

Or read the article on the younger brother Nic here

This feature provides an insight into the way kids with mood disorders are treated in the Australian system; Nic had access to more help than most but getting the right diagnosis is still so difficult.  Like me and so many other teens with bipolar they persisted with a depression diagnosis and feeding us anti depressant drugs that that just make us worse.

Getting a timely diagnosis for bipolar is difficult at any age but it’s so important because generally the longer we go without treatment the harder it is to control.

This story does have a happy ending for Nic and I feel so much more motivated just for having watched it.

I hope you all get something positive from this

Mac