Did I mention that my medications were adjusted in the hospital?
I haven’t talked about meds in quite a while, other than to whine about still being on Zyprexa after eight months. They continue to be the mainstay of my treatment, and I think I’ve finally accepted the fact that I am going to be on a cocktail of psychiatric medications for the rest of my days. I can’t imagine a life without them now. I don’t want to imagine a life without them…..God only knows what a train wreck I’d be if I didn’t have my meds. Perish the thought!
But yeah, they got tweaked when I was inpatient, though it wasn’t as extensive an adjustment as I’d feared. The Zyprexa was bumped up to 7.5 mg and Lamictal up to 400 mg, which is pretty much maxed out. I still have hopes of going back down on the Vitamin ‘Z’ someday, but I’m not going to hold my breath for it. And I don’t know what will happen if the Lamictal stops working…..then it’s lithium, I guess. That’s the drug I dreaded so much that I avoided seeing a doctor for over a decade after realizing that I was probably bipolar. I didn’t know much about BP in those days except that lithium was the primary treatment for it, and since I knew what the side effects were, I wanted no part of it.
Lithium is scary because it can kill your thyroid and cause kidney problems. It also can be poisonous in certain circumstances and ineffective in the case that the dosage is too low. You also have to have blood tests periodically to see if the level of lithium in your blood is what they call therapeutic. If you catch a stomach virus and get dehydrated, you can become toxic and even die. On the other hand, it’s saved thousands of lives since it became the gold standard of bipolar treatment in the mid-20th century, so it still has its uses despite the hassle.
Hopefully it won’t come to that, but I’m not as firmly opposed to lithium as I once was. For one thing, it might make anti-psychotics unnecessary, and for another, this disease has caused me enough misery that I’ll do just about anything to tame it. I am so over this I could scream. I know it’s illogical, but sometimes I wish I could go back in time to the way things were before I was first diagnosed. I wish I could be blissfully ignorant of this illness like I was back then. But then, I would probably have kept getting worse and not understanding why, and I wouldn’t have learned that there were remedies for it that weren’t as intimidating as lithium.
Even so, I sometimes toy with the idea that medications might have made things worse instead of better. I existed for 53 years without anything but Ativan and an anti-depressant; I don’t remember having to fight so hard for my sanity, nor experiencing this many ups and downs. Then I remember that I was getting worse for several years before I finally saw a psychiatrist, and that I no longer throw screaming fits, go after people with garden implements, or spend every dime I have on worthless crap. Who knows what might have happened if I’d never gone on meds—for all I know, I could have wound up in the state hospital, or even prison.
So I’ll continue as I have for the past 33 months, taking my medicine faithfully (well, I forget every so often, but those times are few and far between), getting enough sleep, and doing my therapy with the great Dr. Awesomesauce. None of those things is negotiable—they are almost as essential to life as breathing. And I want to live.
An online friend of mine named Sarah, who blogs over at bi [polar] curious, once wrote a post called “The Denial Relapse”, about why we BPs tend to be so resistant to accepting the fact of our illness and how we end up in trouble because of that. Every so often I go back and re-read that post, which I have bookmarked for easy reference, and now that I’ve had the game-changing hospital stay and new diagnosis, it holds a different meaning for me.
I can look back at several instances when denying my bipolar-ness either led to or exacerbated mood episodes. Oh, I knew intellectually that I had a problem that was not going away, but somehow I always found a way to attribute it to something else, like an existential crisis or seasonal affective disorder. I talked a lot about having/being bipolar, but some small part of me resisted the label right up until that night in the hospital, when I sat at the nurses’ station reading my online chart and saw the words bipolar I disorder with depression.
It was as if all the cosmic tumblers clicked into place at that moment. If I’d been a cartoon character, you would’ve seen a light bulb come on over my head. I will never know why it took those words to break through what remained of my denial, but it was just like that defining meeting in AA years ago when a fellow member asked me what it took for me to get a “buzz”. I told her about half a case of beer. She said, “Good God, Maria, what do you consider a ‘buzz’!?” and at that instant I realized that I really was an alcoholic and not just a problem drinker.
I’ve never had another drink. I’ve been sorely tempted to many times, and there was that one time that I overdosed on Ativan, which was pretty much the same thing; but not one drop of alcohol has touched my lips in almost 23 years. Not even Communion wine. So how come it’s taken me almost three years—and five words—to fully internalize the fact that I have this illness too?
I don’t know. I may never know. And it probably doesn’t matter. A friend of mine tells me I need to re-frame my thoughts so I can turn what I perceive as a negative into a positive, e.g. OK, I’m not working, but look, I don’t have to commute and put in 10-hour days anymore. Of course, in a sense it’s just another type of denial, but it sure makes me feel better when I do it.
Now, there’s no guarantee that accepting, and even embracing, my diagnosis will preclude going back into denial mode. Sarah says it happens to a lot of people, where they think they’ve got their disease under such good control that they’re fooled into believing it no longer exists…..or that they never had it to begin with. That’s been my downfall, too. And there’s nothing like a challenge to make me think I can shake off my illness—particularly if there’s a chance it may benefit me financially.
For now, however, I’m borrowing a page from AA’s Big Book and taking things one day at a time. I can’t look ahead any farther than that. And that’s OK.
Another visit with Dr. Awesomesauce has come and gone, and once again I am left to ponder the discussion and extract the pearls of wisdom from it. I do this every time I see him, because there really is a lot of substance even in the joking and teasing interspersed between the serious talk.
As I expected, I got my ass handed to me for not calling him immediately when my depression spun out of control. “You scared the hell out of me,” he said, “and if you ever do that again you’ll get a size-10 boot planted in your backside!” He was only half-kidding. I told him I’d given Will permission to call if I started sliding—or zooming—which mollified him somewhat, although he reiterated that he would be seriously pissed (and very sad) if he had to attend my funeral.
We went over my hospitalization and he was pleased with the progress I’d made in there. But he made it clear that one of the things I’d been working on still needs improvement, and that is my tendency to take on other peoples’ problems…..in no small part because it allows me to not deal with my own. I’ve done it all my life, and it’s hard to remember “not my circus, not my monkeys” when I’m in the thick of someone else’s situation.
But remember it I must, for I have plenty of my own business to take care of. Something drove me crazy enough to want to commit suicide; it was all the crap I’d allowed to build up over time until it nearly crushed me. I’ve allowed myself to get sucked into the vortex of others’ drama over and over, trying to fix their problems and feeling guilty because I couldn’t; in the meantime, my personal stressors were mounting and I wasn’t paying attention to them. The combination of these was what led to the collapse of all my defenses and landed me in the hospital.
So I’m having to draw boundaries, which is NOT easy for me. I can love people and listen to them when they’re going through things, but this is one of those times when being an empath does not serve me well and I must resist the urge to ignore my own needs in order to try to meet theirs. If I’ve got a handle on what’s going on in my life I can be a little more helpful, but I still need to maintain my boundaries. Or, as Dr. A so delicately put it: “don’t smell the shit in someone else’s yard when you’re up to your neck in your own pile”.
Not my circus, not my monkeys. He liked that expression and we had a good chuckle about it. Then he grinned and said, “You’re laughing—that’s a VERY good sound.” It was nice to know that he had missed my laughter, like Will had. Our last several visits have been sober and serious, and this one felt more like the old days when we’d spend a good part of our sessions cracking each other up (and sneaking therapy in between bursts of giggles). We talked about Australia and how stinky koala bears are and how the tame ones will hold onto you just like a baby. He showed me pictures of his recent trip to Florida and told me about the jellyfish he’d accidentally touched (“ugh, it was just like touching snot”). And I told him the story about Carl, the housefly who plagued us while I was inpatient.
It’s good to have things back on track with Dr. A, even though he stared me down till I confessed that I still have ever-so-fleeting thoughts of death (which are banished fast when they do come). Now, if I can just get my life in order again, I’ll be golden. :-)
I saw my new primary care provider yesterday. My doctor of some 20 years retired this past summer, so an appointment was set up for me with the resident whom I will call Dr. Pleasant when I was released from the hospital. I wondered why I was following up with an internist after a psych hospitalization (I see Dr. Awesomesauce on Monday), but as I’m generally a compliant patient, I decided to keep the appointment.
It turned out to be a most satisfying experience. Dr. P spent a full hour with me, going over my entire medical history—when was the last time that happened?—and he listened respectfully to what I had to say. He may be all of 30, if that, but he is very thorough and seems to know what he’s doing. He’s a lot more interested in my diabetes than my former doctor was, and of course he wants me to diet and exercise; but he’s realistic about what I can do (or will do) with all my aches and pains and isn’t going to push me too hard. As a result, I’m going to cut back on the carbs at least a little, and make a good-faith effort to take off a few pounds.
Then we got down to basics about the bipolar. I wasn’t looking forward to this part of the discussion, seeing as how I live on the thin edge of dignity and it’s always hard to talk about my psych history with medical people who don’t know me. But it became obvious within a very short time that Dr. P is completely non-judgmental about mental illness, and he thinks it’s great that I finally have a definitive diagnosis so I can work on getting better within that framework. “Sometimes it takes a hospitalization and new eyes to look at the situation,” he said. “It’s tough to be in limbo and not know for sure what you’re dealing with.”
You can say that again. All I feel, now that the question of what “flavor” of bipolar I have is settled, is relief. I’m not thrilled, to be sure, but I can live with it. Besides, I had it long before someone slapped a label on it…..I just wasn’t fully accepting because the old diagnosis was so nebulous. It gave me wiggle room to deny I had the illness at all, and for me that can be very dangerous. You can’t give me wiggle room on such a serious issue.
I did the same thing with alcohol way back in the day, before I quit drinking—I figured that if I didn’t get hammered every time I drank, I didn’t have a problem. But then it got to the point where I WAS getting hammered all the time, and when I finally sought help, the good people at Alcoholics Anonymous broke through the last of my denial. I accepted the fact that I did, indeed, have an alcohol problem, and it happened much more quickly than accepting that I had bipolar disorder. The only thing that’s kept me from destroying myself completely is that dignity thing I was talking about earlier. I don’t want to be messy. I don’t want to be thought of as a coward. I don’t want people to know how much I hate myself sometimes. And I don’t want anyone to be angry with me.
But those are thoughts for another day. Today it’s cold and dry, but the sun is shining and my daughter has invited Will and me over for a barbecue. It’s time to enjoy life a little and appreciate its gifts.
Awhile back, I wrote a post about my frustration with what I considered to be a “wastebasket” diagnosis (bipolar not otherwise specified), wishing Dr. Awesomesauce would pick a number and settle the question for good. I was in bipolar limbo; I remember the Vocational Rehab counselor who asked if I was BP 1 or 2, and trying to explain what the hell NOS meant in the larger scheme of things. He was confused, and for that matter, so was I.
But now all that’s past history because I received my definitive diagnosis in the hospital. Funny how a depressive episode and not a manic one got me “upgraded”……if you can call it that. I totally skipped BP 2 and went straight to type 1.
I have mixed feelings about this. I’ve actually long suspected I had the more severe version of the disease because some of my manic episodes have been pretty wild. No, I’ve never walked down Main Street naked, but I did cause a lot of disruption on the job at times when I was working, and there have been a couple of instances when I was so out of control that I nearly had to be hospitalized. Still, I was able to continue my dalliance with denial, almost convincing myself that my case wasn’t really all that serious. And sometimes I’ve even talked myself into believing I wasn’t bipolar at all.
That’s over with now. If nothing else, this diagnosis establishes once and for all that I really do have a major mental illness and I can’t screw around with it anymore. It’s not something I can’t live with or learn how to handle better, but I have to give it a lot more respect than I used to.
If you’re not bipolar, you may be wondering what the difference is between bipolar 1 and 2. On the surface, it’s fairly simple: it’s the degree of mania one experiences. People with bipolar 2 have hypomania rather than full-blown mania—they are often more talkative and productive than usual, they tend to increase their activity and have grandiose ideas about what they can accomplish, and they can become hypersexual, which obviously can be a strain on relationships. On the other hand, they may be more irritable and angry, which is called dysphoric hypomania, and thus quite unpleasant to be around.
People with bipolar 1, on the other hand, have “classic” manic symptoms, many of which are exaggerated versions of the behaviors seen in hypomania and can be very dangerous. We can have hypomania too, either by itself or as a prelude to mania. Most of my own manic episodes have been preceded by a hypomanic state, which is the part of the disorder so many of us yearn to hang onto. I looooves me some hypomania and wish I could live the rest of my life in that condition; unfortunately, there’s no medication or therapy that allows us to keep the hypo without either going off the deep end into depression or sailing off on a manic high.
Not that it keeps us from trying. I myself have been known to drink a half-gallon of coffee and/or manipulate my medications to keep a budding hypomania going; trouble is, I usually don’t stop there, but keep zooming—straight into the danger zone. Only the thin edge of dignity has prevented me from taking actions that would embarrass me forever or put me in danger of incarceration. Otherwise, my manic state usually results in loud arguments in front of restaurants (in the pouring rain, no less), wild shopping sprees (I spent us into bankruptcy twice!), psychosis (gotta love seeing cats running under the linen carts in the ER), even threats to kill people (thank you, Wellbutrin).
Which is why I wasn’t sure if my manic episodes rise to the level of bipolar 1, but apparently the doctor who diagnosed me saw enough in Dr. Awesomesauce’s notes to label it as such. At any rate, it’s settled now, and it will never change because this is not the kind of illness that goes back to a lower level once the patient is better.
I would be lying if I said the label doesn’t hurt a little bit. No one grows up thinking they want to be bipolar 1 (or any other kind) when they get older. But it’s also a good thing because there is no more dancing around it, and God knows I needed to accept this as a permanent part of my life. And at long last, the confusion is over.
They weren’t in any hurry for me to leave.
I’d been inpatient for five days when my doctor and the treatment team asked me when I wanted to go home. I wasn’t quite ready, but I was eager to get out before the weekend. I wanted my husband, my pets, my freedom. And I really, really wanted my own bed because the one I was sleeping on jerked knots in my back.
So we settled on Friday, even though the team suggested that if I felt even a little freaked-out about going home, I was welcome to stay longer. What a contrast to regular hospitals, where they boot you out the door before you’re fully awake after a day surgery. But I was determined, because I felt safe and I didn’t want to become so comfortable in there that I wouldn’t be able to manage on the outside.
I continued to take advantage of groups and individual therapy, except the art classes because I’m about as far from artistic as one can get. I did join the drumming group though, and I played blackjack with some of the other patients on my last night in the facility. What fun that was—all of us were in there because we were or had been suicidal, and here we were laughing and having a good time. What a difference a week can make!
Then Friday dawned, and I performed a quick mental inventory to assess whether I was truly ready to go home. Yes, I was. The experience of being in the psych unit had been a good one, but I needed to resume my normal life, as stressful as it was. So when Dr. W met with Will and me, he agreed that I’d improved enough to leave. Then it was off to the nurses’ station to gather my belongings and get my discharge medications…..and then finally through those locked doors to the outside, where an impossibly blue sky and brilliant fall trees awaited me.
I never knew that fresh air could feel—or smell—so good. I marveled at the grass, which had never seemed so green, and the bright orange pumpkins that remained in front of a few houses. As we drove home I had to fight off the urge to stick my head out of the car window and take in the commingled aromas of burning wood and newly-fallen leaves. Everything was so beautiful that it nearly took my breath away. Who knew that a week in a mental hospital could make one appreciate life so much?
But I knew that week had made a real difference in mine. For one thing, I was alive, and I might not have been had I not checked myself in when I did. For another, I’d gotten over my fear of the place, and if/when something like this happens again, I’ll be less reluctant to go. And I’d learned that being around other mentally ill people had its benefits too—there was no judgment, because we were all going through a bad patch and we could relate to each other’s suffering. No one else can do that, no matter how much they love us or how hard they try to understand.
Thus endeth my story about my first (and hopefully only) hospitalization. Thanks for following along on my journey. :-)