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Bipolar, Wherefore Art Thou?

November 11, 2019

Having recently passed the anniversary of my hospitalization, I’ve had the opportunity to reflect on the course of my bipolar 1 disorder and stand in awe at the miracles wrought by hard work and a little medication. Well, OK, a lot of medication, but by this time I’m no longer counting.

It’s been five years since my last severe depression. It’s been even longer since my last big manic hurrah. For someone who looked (and felt) pretty bad off for a while, I’ve done quite well. Oh, I have the usual wintertime blues and the spring silly season, but that’s nothing compared with what I used to go through every year, and sometimes even between seasons. Despite meds and therapy, I struggled badly through the first few years of my diagnosis, and I almost gave up because if that was the way my life was going to go, why stick around?

Thank God I did. Life isn’t what I thought it would be at this stage, but it has its good times, and I enjoy them that much more because I know what it’s like to be so hopeless that the whole world loses color and becomes blurred around the edges. I also know how much damage mania can create when you have no filter between your brain and your mouth, and when you spend your family and yourself into bankruptcy, not once but twice. I look back on those days now and wonder how the hell I could have done so many impulsive and downright stupid things. In what universe is it OK to drop a thousand bucks in Walmart and have nothing to show for it but a bunch of junk? What was I thinking when I cranked up my car stereo full blast and flew down the freeway at 90 MPH, singing at the top of my lungs? And I certainly wasn’t thinking when I overshared with everyone at work the fact that I had a serious mental illness. Foolishly, I thought it made me seem more fascinating and mysterious.

Now THAT’S a hoot! This thing is not glamorous or romantic, it’s a giant pain in the ass and I hate it. But I can minimize its impact on my life by continuing as I have ever since I fully accepted my diagnosis and committed myself to staying compliant with my medication regimen. I didn’t have a hint of mania or hypomania this year, and with the exception of a little depression and anxiety (both situational) during the late summer and early fall, I’ve been completely stable. It’s as if none of the craziness ever happened, or it happened to someone else.

But of course it did happen to me, and I’m always going to be missing a chunk of my life because of symptoms that have interfered enough with my day-to-day existence that I’ve had to make permanent adjustments to accommodate my limitations. I had to give up my nursing license this year because I haven’t been able to practice in five and a half years, and there’s no going back. It was a good career while it lasted, and I met so many great people and got to do some pretty incredible things. But it’s over, and I’m not sure I’d try to resurrect it even if I woke up tomorrow completely free of bipolar and able to work. I’ve moved on from it. Besides, I’m getting to be an old lady and my back and knees would punish me severely if I even attempted it. Haha!

(Speaking of achy body parts, I think I’m nearly done with this walking cast/boot. I go back in to see my foot and ankle guy this week for another X-ray to confirm it is healing, which I think it is because I’m no longer in severe pain. It feels very delicate, like it could break again with little to no provocation; but I’ve been able to put my full weight on it on occasion and can even stand up in the shower without it hurting much.)

I’ve come a loooooong way since 2014. To have no bipolar symptoms at all is amazing and if it stays like this for the rest of my life, I will be one HAPPY woman. But of course, I can’t count on that because this is a cyclical illness, and eventually I’ll probably cycle out of this wonderful phase and into something less thrilling. Still, I’ve heard of people who experience long-term remission for years, even decades…why not me?

If It Ain’t Broke…

October 19, 2019

But it is broke. My ankle, I mean. The X-rays I had at the imaging center said it wasn’t fractured, but then I had a second set of X-rays done at the podiatrist’s office which clearly showed the break. Now I’m in this walking boot for at least the next five weeks and possibly longer, and with the way injuries to my lower extremities take forever to heal, I’m not particularly optimistic that my poor little bones will knit themselves together quickly. The pain is better, but it doesn’t take more than a few minutes of standing or walking for it to start throbbing, which makes things kind of interesting when I try to do normal things like grocery shopping and showering. The pain feels like someone is drilling straight through my ankle with a white-hot screwdriver; Aleve takes it down to a dull ache.

But get this: I can’t get prescription pain pills for it. I’m going around on a broken ankle without benefit of narcotics. I don’t necessarily want narcotics, but it bothers me greatly that I am being denied them because Klonopin is on my medication list. It doesn’t matter that I take them very infrequently, or that decent pain control would make me even less likely to take them for anxiety related to pain; as far as the medical establishment is concerned, I might as well be a flaming drug-seeker. And that really pisses me off!

I have heard many tales of people being blackballed from pain meds. What used to be considered the “sixth vital sign”—pain, as measured by the patient’s subjective description of it—is now largely ignored by medical professionals who used to actively treat it. Now most of them won’t prescribe anything stronger than over-the-counter Advil or Tylenol because the federal government will come down on them like stink on a bad smell if they do. Because SOME people abuse narcotics and die, ALL of us have to suffer…especially those of us who take the occasional benzodiazepine or mild central nervous system depressant (think Tramadol, or beer).

Maybe I’m just cranky because I’ve been limping around in pain for the past six weeks, but this is the first time I’ve ever been denied relief and it gives me a lot of sympathy for other patients in worse circumstances. In the past, I’ve actually turned down offers of pain meds; I hate the way they make me feel, and yes, I’m on a lot of other medications that make me sleepy; they also make me constipated and I have to be vigilant about bowel care or things can get ugly fast. But I’m not going to become an addict from judicious use of an opioid to get me through the worst of an injury. Hell, I feel like I should just go ahead and take the damned Klonopin if I’m going to be accused of it…at least I’d be able to sleep better and relieve the pain that way.

But that’s not how I operate. I don’t take any drug for pleasure or fun; I take meds to treat certain conditions. Of course, being part of several marginalized groups (women, poor, mentally ill etc.) doesn’t help my case any, because our complaints are often not taken seriously to begin with. My strength has always been my ability to advocate for myself thanks to a couple of decades in nursing, but even that isn’t enough to make a healthcare professional risk being scrutinized by the government. I don’t blame them for not wanting that; in fact, it’s been my experience in working with them that most doctors and nurse practitioners don’t refuse to prescribe narcotics because they are mean and like to watch patients suffer. They just don’t want to risk being sued or losing their medical licenses, and that is a reality in 21st century America.

I remember when I was a nurse in the late 1990s. Back then, we assessed patients routinely for pain and medicated them appropriately; we also taught them to call us before pain got bad, not wait till it was out of control. Now it’s almost the exact opposite, you have to be crying and shaking and practically peeing yourself before anyone will even consider giving you an opioid, and God forbid you have a medical condition that sends up red flags when a provider goes over your prescriptions. I’m sure the fact that I have bipolar disorder doesn’t encourage my healthcare professionals to give me drugs. So, there’s that. But damn, the ankle is broken, not merely sprained or contused, and that fucking HURTS.

Just a little whining on a wet and chilly October night. I’ll get over it. Thanks for listening.

Fall Back

October 6, 2019

It’s Saturday night and I’m in my customary spot on the sofa with my poor outraged left ankle encased in a walking boot, and surrounded by little dogs who seem content to be close but not ON me. I have Live PD on the television, fresh ice water on the end table, a Butterfingers bar, and much less pain than I was in 24 hours ago. It had gotten so bad that I could hardly bear weight on it anyway, and then I somehow stepped down on it wrong yesterday morning and almost went to ground. After calling my NP, who told me he wasn’t going to prescribe pain medication because I’m on Klonopin (like I take it every night, haha), I decided I’d had enough waiting around for this to get better on its own and went to the local urgent care center. I didn’t get pain meds there either, but I wasn’t looking for them. What I wanted was a good strong brace, and that’s what I got.

I also bought the large economy size bottle of Aleve, which I’d forgotten works a lot better for me than Advil and Tylenol, and started that this morning. Now I can walk a little without holding back screams or wondering if this is the time when I roll the ankle again and fall hard. The boot is a two-piece affair held together with lots of Velcro straps in a sassy black shade, and I think it weighs at least half as much as I do. I’m not sure I know how to put it all back together again when I take a shower and have to remove it, but like everything else, I guess I’ll figure it out.

In the meantime, autumn has definitely arrived. It’s been wet and blustery with occasional sunny days that are absolutely spectacular. The trees are changing to beautiful hues of red and yellow and orange; the nights are cool and make it necessary for me to snuggle under the electric blanket; the dogs are growing out their winter coats. (They are very thick. Makes me wonder what kind of winter we’re in for.) And I’m struck by how early it’s getting dark now…my least favorite thing about fall.

It’s this last that makes me feel like I’m backsliding. I’m not depressed—yet—but I can see it from here. We didn’t really have much of a summer, and I feel cheated; as you know, I live for summer all year round and we just didn’t get enough of it this year. It was as apt to be in the 60s and raining as it was to be warm and sunny. So now that my favorite season is gone and my second-favorite has taken over, I look at the leaves and wish I didn’t dread the upcoming winter months. The only things that get me through November, December and January are football, pumpkin spice everything, my birthday and hanging out around the pellet stove. (February, on the other hand, has NO redeeming qualities.)

Now, I try not to let the doom and gloom get me down. There are plenty of things to like about the cooler months; I just can’t think of many. But it’s very hard to avoid seasonal depression when I hate half the year!

I check my weather reports from all the places where family and friends live. It’s 80 in Pensacola, where my oldest daughter and her family are; it’s 81 in Dallas where we plan to move one day. Places where it’s winter for about five minutes in the middle of January. I bet I wouldn’t get depressed down there, at least not because of the weather. Then again, it’s the loss of light early in the evenings that really throws me for a loop, and that happens everywhere.

I’m not sure what exactly can be done about that. I should be using my HappyLight, even though it’s not dark in the mornings yet (well, by the time I poke my nose out of my room there’s plenty of light), but that only helps minimally. That leaves medicine, and I’m already taking a lot of stuff. My son happened upon my medication list today and said “Holy CRAP, Mom, you’re on a lot of meds!” And that was just the psych meds—he should see the rest of it. Four blood pressure meds, an inhaler, vitamin D, and aspirin. Not to mention all the OTC pain remedies!

Anyway, that’s what I’m up to these days. I hope this fall and winter won’t be too hard on me, because it’s a loooooooong time till spring. I know that if I start sliding downhill I’ve got Dr. Goodenough to help me sort things out, plus family and friends who can see it’s happening sooner than I can. This month marks five years from the last severe depression I had which landed me in the hospital, and I’m happy to say that I’ve never been anywhere near that bad since then. Even now when I could easily slip into a low, I know that my brain is trying to lie to me, and I’m much quicker to recognize that than I used to be.

It’s all good.

Etc., Etc., Etc.

September 22, 2019

A random collection of what’s been going on with me for the past couple of weeks:

  1. I managed to sprain my left ankle after Mass last Sunday. I slipped on wet bricks and it was either going to be that or a nasty fall, so in a split-second I decided the ankle had to be sacrificed. Now it’s a week later and I’m still limping around, living on Advil and liver-killing doses of Tylenol, and wishing the damn thing would stop hurting. It just wears me out, and I’m sure not gonna make it heal any faster by dragging my sorry carcass to the grocery store and standing/walking on it for half an hour. Big mistake—the next day I could barely walk on it.
  2. Saw Dr. Goodenough on Tuesday, and for the first time in our three years as doctor and patient, he didn’t have his shit together. He had the wrong patient’s chart pulled up on the computer and began asking me what dose of Prozac and Remeron I was taking. I don’t take either of them. He was, however, appropriately embarrassed and he apologized, and I promptly forgave him. Everybody has a bad day now and again, but I’m glad I’m such a stickler about knowing my meds and diagnoses inside and out. I guess that little adventure known as a nursing career taught me something.
  3. I am most definitely done with trying to change my medication regimen. I didn’t have even a moment of mania this spring or summer, and the longer I live with this illness of mine the more I realize that I really DON’T want to become manic again. That whole thing about hypomania? Sure, I’d love to have that kind of energy but I definitely don’t want to torpedo my credit rating, get involved in projects I never finish, drive like my hair is on fire and my ass is catching, or wake everybody up by noisily cleaning the kitchen at 3 in the morning. Life may have been a little more exciting back in the day, but I don’t want to change anything because the way I am when I’m not manic is better.
  4. Mild depression is lurking around the corner. I can feel it softly creeping in sometimes early in the morning, but it’s gone by the afternoon and I go about my business as usual. Besides, I’ve got my HappyLight, and as Dr. G says, we both have phones.
  5. Speaking of phones: I’ve actually been without one for the past three days and I am in acute withdrawal. For some reason my sweet iPhone Xs Max decided that I shouldn’t make any calls—although I could receive them—and the only solution was to get another phone. So while I’m waiting for the new/reconditioned one to come in, 100 times a day I’ll reach for my phone to text someone, check out Facebook or take a look at my stats here at bpnurse. My fingers literally itch to have it in my hands. I take it with me everywhere, and I mean everywhere, but for now I have to be content with carrying around my phone case and trying not to lose my mind.

So that’s how I’m doing. How about you?

Peace and Quiet

September 9, 2019

It has occurred to me over this short, mild summer that for the first time since I don’t know when, I haven’t had the slightest inclination toward becoming manic or even hypomanic. I’m calmer on the higher dose of antidepressant, and I have the Klonopin as backup. But I haven’t needed it except for a couple of nights ago, and that was only because I couldn’t shut my brain up long enough to go to sleep.

More importantly, there has been a subtle shift in the way I view all of the crap that’s happened to me in the past 7 1/2 years, and I don’t think it’s going back. You can’t un-know the known. I’ve reached the point in my bipolar life that I no longer see mania or hypomania as something to be sought after. I hate depression like nobody’s business, but mania truly is not my friend. It’s been long enough since my last big hurrah that I’ve gained some perspective and I remember how little control I had when I was full-blown manic. I did so many stupid and foolish things; spent money I didn’t have on things I didn’t need, endangered life and limb flying low on the interstate, and screwed myself out of jobs because I couldn’t keep myself stable for longer than a couple of months.

As a result, I’ve had many, many medication adjustments over the years which have brought me to this place of peace and acceptance. It amazes me to look back over the years and see how much has changed. How much being in control has changed me. I’m sure some of it is plain old-fashioned maturity, but I have to credit my treatment for at least part of it. I was somewhat of a case of arrested development before I got sick. I didn’t have enough insight at that time to know that, though. I just thought I was a little slow at this adulting business…if I thought about it at all.

Then there was the diagnosis, and all hell broke loose. Those of you who have been reading my blog for a long time know what I’ve been through with this illness; I invite newer readers to check out the archives for stories about my difficulties with reining it in. I still have very minor episodes of depression and maybe a little hypomania once in a while, but I haven’t been suicidal in five years and I haven’t alienated anyone by my outrageous conduct at the top of the mood scale.

It’s not perfect by any means, and sometimes the process slips a bit. I still tend to think people are mad at me when they don’t speak to me or when they make vague complaints about something that involves me; but I have just enough emotional IQ now to think about it and understand that not everything has to do with me, so I don’t take stuff personally like I used to. This has saved me countless times when Ben snaps at me or my other kids don’t call or text me as often as I wish they would. (Lately, however, I’ve been in frequent contact with all three of the others and we have had some great conversations. I love it!)

Hell, I’m not even tempted to mess with my meds anymore. I didn’t do it back in the spring when I usually lose my shit, and I’m not doing it now when it’s September and this is the OTHER time of year when I tend to be a little wacky. I know deep down that they are the only things keeping me from destroying myself, and obviously I don’t want that to happen. Other than recent (and ongoing) stresses, my life is pretty good, and who wants to screw that up?

The other significant thing that’s happened is my sister Louise has moved in with her daughter in Maine. She flew out early yesterday morning with her little dog, who was understandably upset about being confined to a carrier. It’s for the best; she will get more attention there than Ben or I were able to give. I will miss her, and it was an awful realization when I hugged her that it would probably be for the last time. Maine is about as far away from Oregon as you can get and still be in the continental U.S. I wish her well and hope she and my niece will be able to get along OK. I think they’ll do fine, my niece is a tough lady who can stand up to just about anyone. It’s a skill she’s developed over years of a hard life. She’ll need it, because one of Louise’s little personality quirks is to make a fuss over something—often something trivial, like being handed a dessert fork instead of a regular fork—and then outwit, outplay, and outlast her opponent. (Ben and I both know this from experience.)

Anyway, I hope life will be gentle as the summer fades and the leaves change colors. I’m thankful that the bipolar bear is hibernating. And I welcome the peace and quiet that not struggling with it brings.

Anxiety, Be Gone!

August 24, 2019

I saw Dr. Goodenough last Friday, and rather than the decrease in meds I’d been hoping for, we actually INCREASED one of them. But you know what, it’s OK; I’ve made up my mind that this is how it has to be, and every now and again the shit is going to hit the fan. It happens, and I’m no longer going to beat myself up for needing an adjustment.

I told him about the constant anxiety, how I was waking up every morning with dread and going through the day feeling like my nerves were about to snap like the strings on a violin. I also told him I wasn’t depressed, just worried and agitated, and I needed some relief even though it’s mostly situational. He agreed that Klonopin would be helpful and gave me a new prescription. Then he proposed something I thought would never happen: doubling my Celexa. This is my antidepressant, and doctors have been extremely resistant to raising my baby dose to a therapeutic one for fear of inducing mania. Dr. G doesn’t seem to think it will be a problem, in fact he told me it may be better for my anxiety in the long term than anything else. What he was mostly concerned about was how my state of mind was affecting my bipolar, which it really isn’t…I’m not depressed, and I’m certainly not manic. I’m just anxious!

I hope he’s right about the Celexa. I’m not worried about mania—going from 10 mg to 20 mg (the standard dose) isn’t likely to send me to the moon. In the meantime, I’m taking Klonopin every night until the Celexa kicks in, and I’ve noticed a considerable decrease in my feelings of impending doom. The stress is still there, and I’m not completely out of the woods yet, but I can see daylight from here. It’s nice to have my heart beat at a normal rate instead of pounding so hard it feels like it’s about to jump out of my chest. It’s good that the shortness of breath I’ve been having is gone. And I love it when I can go right to sleep at night without all the worries in my head converging on me at once. The Klonopin also has a nice half-life of some 15 hours, so when I take it at night I’m not waking up in a lather in the morning, and it lasts well into the day at which time my other coping mechanisms have taken over.

It’s also helped having my daughter Mindy visit us for the past three weeks. She’s on her way to a new job and a new life in Minnesota, and I swear we talked more in those three weeks than we have in the past 15 years. She is an amazing woman, and she reminds me so much of her Dad that it’s almost heartbreaking. Like him, she has a way of turning even negative experiences into positive ones, and she’s a pro at figuring stuff out when there’s no one else around to fix things. Her main problem is being unlucky in love, but ever the optimist, she’s still willing to try.

The other good thing that’s happened is that our puppy is recovering from his parvovirus infection. He’s still a little weak, but for a dog who was at death’s door just a few days ago, he looks fantastic. It’s like with people, you never know what you’ve got until you almost lose it. He belongs to Shelley, but he’s wiggled his way into all our hearts and we were sick with fear that we’d lose him. Now he’s eating and drinking and eliminating and being his cute little affectionate self, and life is good again.

So that’s all the news that’s fit to print, as the saying goes. And yes, I’m finally at peace with the idea that I MUST take this many medications to remain stable. This summer, I haven’t had the slightest bump up in my mood, and I haven’t been tempted to mess with my meds. I don’t even want to be hypo/manic anymore–there’s just too many ways it can go haywire, and who needs that drama? Not me!

Time Of The Season

August 14, 2019

Well, it’s happening—the change in the angle of the sun’s light that is so subtle that very few people notice it. I am one of those people. It’s not affecting my moods, I’m just more aware of the shift than most. The weather still gets hot, but it takes a little longer to reach the hot part of the day and it doesn’t stay quite as warm, quite as long as it did a couple of weeks ago.

We haven’t had much of a summer, anyway. It’s hit 90+ degrees on only eight days, and most of the time we’re in the 70s or low 80s. It’s pleasant enough, but there have been too many clouds for my taste. I live for summer every year, so I feel kind of deprived. Hopefully we’ll have a heat wave or two before fall arrives next month, but then, that’s only MY hope—the rest of the family likes it cooler.

Speaking of family, I’m having a great time visiting with my daughter, Mindy, who’s been staying with us for the past two weeks. She is figuring out her life in her inimitable manner, going right for what she wants with no muss, no fuss. She is a remarkable woman who’s been through the wars in Iraq and Afghanistan both as a soldier and as a civilian contractor, and only now am I learning of what she really had to deal with during her deployments. She had always emphasized to me that she was perfectly safe in her control tower on base; now I’m finding out how dangerous it really was over there. I’m so glad I didn’t know. But she’s also chock full of funny stories about her adventures, and I love her resourcefulness (ever try to drive away jackals with a BB gun? She has). It’s such a gift, to have a daughter like her. I will miss her desperately when she leaves next week to move to Minnesota, of all places. She’s found a job that pays well, bought a car, and even has a house picked out. So life is going her way again, and I’m so happy for her. She rocks!

Then there’s the issue that has caused a great deal of stress in the family, and it’s not going to end anytime soon. Thanks to the distraction posed by my daughter’s visit, the anxiety has been down to a dull roar, but every week something different happens and it just ratchets up my distress that much more. I’m sleeping OK but my slumber is filled with distressing dreams that make me almost as tired as if I’d done what I dreamt about. Most of the nocturnal festivities have to do with working in the hospital and the patient I didn’t know I had till the end of the shift, which is my default dream when I’m under pressure. I also dream about my kids being in trouble with the law, and recently I’ve experienced my first two nightmares about Will. In both, he told me he didn’t love me anymore and left me. I’ve never had those kinds of dreams in all the time since he’s been gone, but given everything that’s happening—plus the recent anniversary of his death—it’s easy to figure out where they came from.

Yes, this has been a strange summer, and it’s not over yet no matter what the weatherman says. Ben and Clint were supposed to be on a cruise right about now, and they had to cancel due to what’s going on. (I wish I could come right out and share, but this is something I can’t discuss until it’s resolved, and perhaps not even then if things don’t go our way.) We’re still scheduled to go in March; only time will tell if we can make that trip. I hope so, because that’s when I’m sick to death of winter and need some warmth and sunshine.

In the meantime, I continue to hang in there and try to navigate my way through this miasma of suck. (Forgive me for sounding pretentious, but I’ve long been fascinated with the word miasma and I finally got a chance to use it. Huzzah!) What else ya gonna do?