DX: Bipolar I. Again.

So I had my three-month visit with Dr. Goodenough last week, and I continue to be amazed at how much ground we cover in 30 minutes. It’s supposed to be a med check, but we usually use up the entire half hour talking about all kinds of stuff: Family. Church. Death. Sex. Grief. Other matters of consequence. And yes, meds.

Thanks to some weight gain, he’s considering switching me from Zyprexa to Latuda. My liver function, lipid profile and kidney function are all outside the norm too and he’s concerned about it, which tells me he cares about being a doctor and not just a specialist. I appreciate that he looks out for me medically as well as psychiatrically; I’ve been with him just over two years now, and he continues to amaze me with his intellectual acuity and knowledge. I probably should give him a different name, because he’s more than good enough…I’ll have to think about that one.

While we were discussing antipsychotics, I voiced some concerns about them because I’m going to be 60 in about seven weeks, and medical providers often take older people off APs due to higher risk of strokes or even death. It was something I saw frequently in the nursing homes where I worked with almost universally poor results, as the behaviors and moods the drugs were meant to treat came back with a vengeance once they were cleared from the patients’ systems. I cherish my stability and while I don’t want to be on any more meds than absolutely necessary, I’m afraid of what may happen if in the future a doctor decides to decrease, or even discontinue, the APs.

He reassured me that this isn’t always the case. In fact, he called my remission “fragile” and would not even consider taking me off them even if I were old enough for this to be an issue. This surprised me; I thought I was rock solid, at least as much as someone with bipolar can be. Maybe after I get through next spring without a manic episode he’ll think it’s for real, but for now I guess I’ll have to live with the sword of Damocles hanging over my head.

Then we got into the subject of diagnosis. Dr. G has changed it several times over the past year, and most recently it was just “bipolar affective disorder”. No numbers, no specifiers. I thought maybe he’d changed his mind about my being bipolar 1; I still question it from time to time as the memory of my manic episodes has largely faded, and sometimes I think I must’ve overstated their severity. After all, I’ve never stripped off all my clothes and walked down the middle of the street, nor have I ever thought I was God (although there have been times when I believed I was on a mission from Him). We won’t talk about the episode where I was galumphing up and down the halls at work singing at the top of my voice, or the one where I was howling at the moon on Halloween night…

Dr. G almost laughed as he informed me that OF COURSE I have bipolar 1. In fact, he was so sure of it that he gave it a specifier and changed it in the computer and on my paperwork. He apologized for confusing me and reiterated his reasons for the diagnosis, number one being the fact that I have indeed experienced full-blown mania, as evidenced by repeated episodes of out-of-control behavior, delusions, hallucinations, and paranoia. (I keep forgetting about that last item—I’ve kept my curtains closed for days or weeks on end, believing my neighbors or the government was spying on me.) He’s only seen me hypomanic at worst, but the history I gave him at my intake appointment two years ago was enough for him to make the determination.

Now it’s been settled once and for all. I think. Knowing me, I’ll probably question the diagnosis again, especially when I’m particularly stable (or hypo) and it feels like bipolar doesn’t even exist. Haha!