bipolar medication

Cracking the Breakfast Dilemma

Mac the Disordered diet , ,

Oh hey, long time no blog post.

Solving this breakfast problem has been ongoing over the past year. The problem started when I began taking the antipsychotic Zeldox and mood stabiliser Topamax which supressed my appetite.  I can’t remember what I was doing for breakfast before that – I tended to sleep in until past midday so I probably wasn’t having it, although if I stayed up late enough I would get Macca’s breakfast before I went to bed.  Is that breakfast?  Or dinner?  I don’t know.

Anyway so I’m on this new cocktail of drugs and between the nausea and low appetite, I’m not eating much. When I do eat, it’s usually the wrong kind of food – something fast and easy.  And it’s usually in the middle of the day.  I never ate breakfast, even though on these meds I developed some more reasonable sleeping habits (mostly.)

So I lost a lot of weight. After about twenty kilos lost my psychiatrist referred me to a dietician to help me develop a healthier diet.  And of course when I gave him my first food diary the first thing he noticed was that there was no breakfast anywhere.

His first solution? Drink Up&go.

up&go

It’s quick, easy and much easier to stomach than solid food when I first get up. So I started having the up&go in the morning, every day until it became a habit.  I bought up on the supersize 12 packs in the strawberry flavour – has to be strawberry, can’t do any of the others – and that became my staple breakfast.

This went on for months. Then recently the dietician tells me that up&go isn’t good enough anymore and I need to start eating ‘real’ food for breakfast.  The up&go has too much sugar.

Habits are hard to break for me. I was in the habit of not eating breakfast, then I was in the habit of drinking these up&gos instead of breakfast.  It was only meant to be a stepping stone onto something more acceptable but I found that transition difficult.  When I get up I just don’t feel like going to the trouble of preparing something.

He had a few suggestions of what I could do instead. Poaching an egg – I’m useless at poaching so that’s out – or some cereal because he wants me to take in some milk, or yoghurt with fruit.

So for a week I tried eating cereal. I ate low sugar cheerios, which aren’t that great but were the best option we had in the house at the time.  And I gained weight.  I couldn’t believe it!  How could cereal affect my weight like that?  Did I eat too much?  I doubt it because I was eating out of a mug for portion control.

So cereal is out. The next idea I had I got from this blogger, I figure she looks super fit so whatever she eats must be all right.  She uses chobani yoghurts to make overnight oats which looked super easy so I thought I’d try it.  I liked it, although it took me awhile to eat.

So far the overnight yoghurt oats are a winner. The problem with up&gos is eventually my appetite started to come back and I started getting hungry midmorning but with the oats that doesn’t happen.

I’m still working on myself and working toward eating a proper balanced diet and will continue to pull apart the puzzle one piece at a time. So far breakfast is looking close to solved, and I’m happy with that for now.

Mac

Antipsychotics Update

Mac the Disordered Uncategorized ,

The Zeldox saga continues.

At my recent psychiatrist appointment we were discussing my Zeldox dosage again.  My BF came with me because he was unhappy that I’ve been taking both doses at night – he read up on the drug online and came across this from the NPS website:

“Unlike most other atypical antipsychotics, ziprasidone must be taken twice daily with food. Absorption of ziprasidone may be significantly reduced if taken without food”

He interpreted that to mean that I shouldn’t be taking both doses at night and complained to my doctor that he thought it wasn’t safe.  She assured him that it’s perfectly safe, and that loading me up at night is the best thing to allow me to sleep.

Also, my sleeping has improved a lot now that I know I have to take it with food.

I asked her if I could have a script for maxolon due to some nausea I’ve been experiencing in the mornings and she refused – apparently zeldox can interact with maxolon and cause dystonia.  I’ve been told to go to a health food store and look into natural therapies for nausea.

She also sent me to get an ECG to make sure I have no abnormal rhythms which is a risk for the drug.  Not going to lie, that has been bothering me ever since.  I got my ECG that afternoon and haven’t seen the results yet, but this is just another example of my mental health messing with my physical health.  I did some more reading on the nps website and found this:

“A small but increased risk of sudden cardiac death has been observed for all antipsychotics — consider the individual’s cardiovascular risk profile before prescribing an antipsychotic”

Yikes.

I know it’s a small risk but it’s just another thing to worry about.

Mac

Antipsychotics and Me

Mac the Disordered Uncategorized , ,

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

The Rehab Diaries Week 6 – Get Me Outta Here!

Mac the Disordered Uncategorized , , , , , , ,

I’d started getting restless.  It was obvious that I was getting overcooked.

I’ve heard staff and patients carry on about the evils of becoming institutionalised.  Getting used to being taken care of.  I don’t know that I’ve ever experienced that but I do know that after a certain amount of time in hospital I start feeling very anti-institution.

It’s not that it doesn’t happen – for the long term unemployed chronically unwell, particularly the youngsters, hospital seems be their primary social outlet.  I’m sure I don’t have to explain why that’s problematic.  But me, I’m independent by nature.  Even six weeks in I’m struggling to take set meal times in good humour.  Breakfast at 7.30-8.30.  If you sleep in like a normal person who hasn’t got anywhere to go, bad luck it gets cleared away and you miss out.  Lunch at midday.  Dinner at 5.

I miss being able to go for a walk without signing out and specifying a return time.  I miss driving.  I miss having the freedom to choose what I eat.  I miss baths.  I miss shaving.  I miss being able to watch more than an hour of youtube videos before I’ve used up my downloads for the day.

I’d established on fluoxetine and had seen definite improvements.  My irritation had toned down a lot and I was feeling general good will to those around me.  Even hearing guitar boy mindfully strumming away down the corridor didn’t make me uneasy at all.  I know my irritation towards him has been unfair; he keeps to himself and refuses to participate in the drama and politics of the other youngsters on the ward.  I can respect that.

To test my anxieties I went on leave one night with BF for a dinner and movie date.  A few weeks ago that would have been impossible but with the improvements I’d been seeing I was keen to try some regular world stuff again.

It went well.  I sat through it, even though it was a long movie and the cinema was very crowded.  I’m still hyperaware of the movements of all people around me so when there’s a lot of people in one space I get overwhelmed.  There were no meltdowns in the cinema that night however.

After last week I finally felt that I’d had some quality time with my therapist.  I was talking with her on the Tuesday of that week, saying that I was doing so much better in just one week and that I’m totally ready to go home.  I was prepared in my doctor’s appointment that week to ask for a discharge appointment on Friday.  She reminded me that, being a voluntary private clinic, I can actually leave whenever I damn well want.

Generally when a patient has reached the end of their treatment plan discharge planning begins a week or two in advance.  We talk about the support systems that we have in place, which outpatient therapists we’re going to see, whether or not a referral to day programs is appropriate.  The doctor has to record a final diagnosis (which in my case is practically a paragraph) and fax a bunch of discharge summaries to our various community care providers.  The number of appointments is usually planned around the patient being discharged on the day of the last appointment.  As we know however, patients can abruptly decide to check out without discharge planning.

I hadn’t had those conversations with my doctor yet.  I like to think that discharge planning for me isn’t hugely complicated; my care team is well known to my doctor and hasn’t changed much in the last few years.  I believe she was waiting to see how I established on fluoxetine before she started talking about it but in our appointment she accepted that I was doing better.  I told her I wanted to leave tomorrow.  I expected her to be taken aback but she said she was willing to support that, and set about writing discharge summaries.

Given that I’ve mentioned patients checking out without discharge appointments several times now, you’re probably wondering…how does this happen?  Well, all it takes is to inform the nursing staff and they’ll bring you the discharge papers.  My doctor ordered them and that evening a nurse sat with me and asked me a bunch of questions from a sheet of paper like, did I have accommodation? (yes.)  Who would be picking me up? (BF would.) What is your plan for the next few weeks? (moving house.)

I signed off on my details again, and when they provided me a feedback form, I wrote about the Christmas fiasco, saying I think everyone would have coped better with some more staff on.  That was that, and she left me to pack my things.

The morning of my victorious exodus discharge I was really only waiting for one thing before I could leave – scripts.  And the CMO took his sweet time with those.  BF arrived at 9.30, we got kicked out of my room at 10 so they could clean it for the next patient.  We finally got hold of him at 10.45

And by then I’d started feeling unusually drowsy.  While we were waiting for the scripts the nurse unit manager burst in and asked me if I noticed anything different about my medication that morning.

As soon as she asked I realised what must have happened.  I take 80mg of zeldox a day.  60 at night, 20 in the morning.  This morning I’d taken the 60.

My nurse came in at 8 as I was preoccupied with trying to force my running shoes into my carry bag (how do I end up leaving with double the clothes I came in with?)  This particular nurse hadn’t dealt with me and my meds before.  I took the cup, swallowed it without looking and got back to work.

I couldn’t remember if there were extra pills in the cup, but I did think it went down harder than it usually does in the morning.

The nurse was trying to say that my meds couldn’t have been wrong because I would normally question them if I saw something odd.  And it’s true, after the contraceptive pill debacle I always looked over my meds before taking them.  This mornings, of all mornings, I decided to make an exception.  ARGH.

So my return home wasn’t the joyous occasion it should have been because I rolled straight into bed and crashed, leaving my poor BF to work on his laptop instead of celebrate.  Then I couldn’t sleep that night because I could only take a 20mg tablet to balance the overdose out.  Nurses, take note.  Double check what you’re giving out, just because it’s not life threatening, doesn’t mean this shit doesn’t matter!

So that’s it.  My rehab journey this time around.  I may do a post talking about what I’ve been up to since I’ve been out –  I haven’t been overly interesting but there has been some changes.

Mac

The Rehab Diaries Week 5 – Hitting the Wall

Mac the Disordered anxiety, bipolar disorder, depression, rehab diaries , , , , , , , , , , , , , , ,

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

Mac the Disordered anxiety, bipolar disorder, depression, mania, rehab diaries , , , , , , , , , , , , , , , , ,

 

2015-02-19 16.47.53

 

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.

Mac the Disordered anxiety, bipolar disorder, depression, rehab diaries, rehab problems , , , , , , , , , , , , , ,

 

 

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 Part 3 – Week 1

Mac the Disordered anxiety, bipolar disorder, depression, mania, rehab diaries, rehab problems , , , , , , , , , , , ,

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

 

Topamax. It ain’t tops

Mac the Disordered anxiety, depression, mania , , ,

Ha…ha…punny.

Things haven’t been great for awhile, so my doctor decided to mix up my medication.

 I’d been subsisting on a mood stabilizer and melatonin antidepressant to regulate my sleep. She was iffy over the melatonin and suggested removing it. I cried. She changed her mind.

 She did decide to supplement my mood stabilizer with another one – topiramate, or topamax. I take an extra pill, tiny pill that must be no more than three millimeters across, every morning and evening.

 She took me through the potential side effects, of which one really stood out –

 Appetite suppressant.

 See, in my experience that should read as:

 Heinous nausea.

 I wasn’t too worried otherwise, because my current mood stabilizer didn’t give me any side effects even in the beginning worse than some broken sleep and mild constipation.

 The day after the night I started, we had a party in the evening and I was running around trying to clean the house in dreadful heat. If I was feeling washed out that day, I put it down to that.

 The next day though I hit the wall hard. Well, I would have if I’d been able to get out of bed. Heinous nausea did indeed make an appearance. After the first few days it’s reduced to being around only three hours after I take it but trying to fall asleep feeling like I’ve just downed a three course meal is a challenge.

 My mood was stabilized all right. Stabilized in a very bad place.

 My depression over the past two weeks has been dreadful. I spent hours in bed staring at the ceiling, with even my thoughts slowing to a plodding pace. Plodding over things that happened ages ago that are suddenly at the forefront of my mind and I can’t get them out, trying just wears me to tears.

 On top of that I’ve been getting headaches. Which is ironic because as well as mood stabilization topamax is supposed to stop migraines. I’ve never had a migraine in my life and I hardly think that these are as bad but they’re still nasty. Paracetamol and ibuprofen don’t help. And funnily enough it’s localized to where that bloody Frisbee attacked me…

 I saw my GP a few days after I started and as soon as I slouched into her office she told me she was concerned. The fact that I was low – more specifically that I hadn’t showered in some time – was clearly evident.

 I told her I had started topamax and she looked surprised. “Topiramate? I’ve only ever seen that used for seizures” – I raised my eyebrows – “but these psychiatrists always find alternative uses for drugs in practice I’ve found.” She added quickly. “come and see me in a week, if you’re still feeling gross I’ll give Dr *psychiatrist* a call”

 I continued to be low with bouts of irritation that haven’t gone away. I can’t leave the house, except near the middle of the night to do my grocery shopping. I can’t stand the sound, sight, touch of people. I fought off intrusive thoughts compelling me to commit violent acts toward my self and other people. This is a symptom I associate with a manic episode.

 I’m not sure if my out of control moods are as a result of the meds not working yet, of them not working at all, or of them interacting and cancelling each other out. After a particularly violent episode of intrusive imagery I left a message for my psychiatrist asking for emergency advice. I will put up with a lot while adjusting to new meds but being bombarded with violent imagery isn’t something I want to deal with for too long if I possibly don’t have to. As yet, I haven’t heard back from her.

 I saw my GP again yesterday and happened to have the first good day I’d had in two weeks. So she’s decided that I’m doing better. Now I’m back down again and no idea where this is going.

 I’m still certain that this is going to cumulate in a hospital visit and I’m ok with that. This medication business needs to be sorted out…not once and for all because it doesn’t work like that but at least for a long stretch.

 

Mac.

Jessica Marais’ Bipolar Disorder is Not About You

Mac the Disordered bipolar disorder , , , , , , ,

I’ve always been interested in how the topic of mental health is handled by those in the public eye.  While celebrities might live lives far removed from our own, their take on complicated matters like a bipolar diagnosis tends to be both influential and reflective of the views of society as a whole.  Every now and then you see a story about a celebrity coming out of the ‘mental health closet, and I’m always all over those like a rash.

So when I saw the story about Jessica Marais’ interview with Woman’s Day appear on my news feed, I fell down the rabbit hole exploring every facet of it.

Here’s the news.com.au story, which summarises the Woman’s Day one:

Click here

And here’s one published on Mamamia, which goes a bit more in depth and takes opinions from other people living with bipolar disorder

Click here

If you can’t be bothered clicking, here’s the abridged version:

Jessica Marais, 29 year old mum of one, has struggled with bipolar episodes from age 12

She has a family history of the disease

She chooses not to be medicated and feels that her condition is controlled well

She has done cognitive behavioural therapy and says it was beneficial

she feels her toddler can “pull (her) out of” depression

The author of the Mamamia post reached out to the Black Dog institute for comment.  They supplied an overview of bipolar disorder but refused to comment on the specifics of Marais’ case.

There was an undercurrent of uncertainty in the Mamamia article because the author wasn’t sure how to feel about Marais’ revelation, because some of the things she said do seem to be controversial on the surface.  They ended the article with a selection of comments from bipolar suffering readers, which ranged from congratulating her on her bravery for coming forward to condemning her irresponsibility for (apparently) suggesting that all bipolar can be controlled without meds.

I don’t love the way this story has been approached.  Bipolar disorder is only discussed on an in dividual level, rather than acknowledging sufferers as the diverse population that we are.  All commenters used their own experiences as a measure of how well Marais was managing her condition, and were critical of her when they found that her experiences and management strategies were different to theirs.  Which is wrong.

Because guys?  Jessica Marais’ bipolar is not your bipolar.  It is not my bipolar.  We have a disease that presents on a spectrum that varied widely in presentation.

I suspect that the reason the folks at Black Dog didn’t want to comment on Marais case was because they didn’t want to present her as a single embodiment of all bipolar sufferers.  She isn’t, and I can’t find any point where she claimed to be.

I have bipolar disorder.  Like Marais, it appeared around age twelve and has been a major feature of my life ever since.  My experiences are widely different than what she represents hers as, but I don’t think that’s due to any lies or irresponsibility with management on her part.  Since I was properly diagnosed at age 20, I’ve read up extensively to educate myself on the disease as a whole, not just what it means for me.  So with that in mind, I’ll be offering my perspective on the story.

I find it interesting that she mentions her family history.  It’s been proven that there is a genetic link for the disease.  I know my family has enough problematic mental health genes to supply material for a whole psychiatric conference, but the only person apart from me who has been diagnosed with bipolar is my paternal grandmother.  I remember my dad talking at length with my doctor when she broke the news about my diagnosis to him at my request.  After he was done, he put down the phone, turned to me and said sadly “I supposed I should have expected it in one of you”  I think anyone who has been recently diagnosed should do a little digging in the family closet.

The major issue people have with her interview was where she claimed that she doesn’t need meds because she’s done CBT.  I have to admit, when I first read that I groaned out loud.  I know when I skip meds even for a few days it’s a pretty rapid descent into cray-cray town.  I can understand why it garnered such a negative reaction from the public because remember the last Australian public figure with bipolar who claimed he could handle himself off his meds?

Because I do:

465883-matthew-newton

via http://www.news.com.au

…yeah.  Sure hope he’s changed his mind.

But in the midst of my not-another-Matthew-Newton despair, my wise mind kicked in and I remembered what I’ve learnt about bipolar as a spectrum.  Her bipolar could well be more manageable than mine, I just don’t know.  A lot of bipolar people I was in hospital with were involved in group therapy for CBT, DBT and interpersonal therapy and responded well to it.  Jessica would have learnt about distress tolerance, self talk, diversion tactics amongst other things which once she’d practiced enough to make it second nature, could help take the edge off when she’s having an episode.

She also talks about self awareness which makes me think that she is actually controlling it without meds, or is well on the way to at least.  If you’re experiencing mania or depression, recognising those episodes for what they are will help you be more proactive in overcoming them.

There are bipolar people like me who will likely rely on meds for the rest of their lives but many people with a mental illness diagnosis won’t.  They may need them to be on and off to overcome rough patches but with the right kind of support and therapy they may cope just fine off them.  Once again – bipolar disorder is a spectrum.  For some it’s heavily debilitating, others are towards the lighter end of the scale.  Marais is likely one of those people.

She doesn’t say that meds are unnecessary for all bipolar patients, she was simply stating what works for her.  And quite frankly, there just isn’t enough talk about what a huge fucking difference behavioural therapies can do for people with mood and personality disorders.  Many people who need it don’t get it because they’re suspicious of and there needs to be more people who’ve done it publically talking about how it helped them.  So for singing the much deserved praises of behavioural therapies Jessica, THANK YOU.

The last point which I found interesting was where she says that her kid has been beneficial for her depression.  Now I don’t think she’s saying that to cure depression you should up and start reproducing, but it was a surprise to me because I’d assume that someone with a bipolar diagnosis would be a heavy risk for PND.  Then again, I’ve had more than a few friends who’d struggled with depression tell me that they actually saw improvement when they started a family.

Why is that, I wonder?  If I were to guess, I’d say a kid is a sure fire way to keep you busy.  My hospital psychologist was fond of saying that the best cure for depression was to do the opposite of what you feel – lying in bed doing nothing, not stimulating your brain is perpetuating the imbalance in your brain.  I’d imagine that finding motivation to get out of bed and face life is much easier when you have a little human screaming at you to do so.

If you could take anything away from this article, it’s that I ‘d rather you not look at a mental illness diagnosis as a one size fits all profile.  No treatment plan is going to be perfect for everyone and if someone is happy and healthy we should trust their ability to do right by themselves, even if we don’t agree with their methods.  This is why I love celebrity mental health stories – the more different experiences that we see, the more we will come to understand that the mentally ill community is one of diversity, and different experiences should accepted, not condemned.

Rock on, Jessica Marais.  You’re not obliged to share your personal life, but I’m glad you did.