Category Archives: medicine

Doing something

In between meds means in between states.  I am tapering off the 100 mg topomax @ 50 mg and hoping to maintain that dose while getting the rash that developed @ 100 mg x 1 week to recede.  So far, it is receding, but slowly.  So is the initial mood lift and subsequent dip from going off the wellbutrin 100 mg cold turkey because of those pesky suicidal ideations.  Since I tapered back to 50 mg on the topomax, my anxiety dreams have slowed, and I feel about 40% less panicked/ nauseous/ enraged by situations at work, but I still am exhausted and prone to inner rage storms even if I’m less overtly weepy.

Monday, I started on 5 mg lexapro.  It takes up to 3 weeks to be effective, so we will see.  Today, though, I feel my “usual” hypomanic lift from starting an SSRI, which seems to indicate that the lexapro’s doing something.  If it’s not just a hypomanic “crash” from the topomax or the cessation of .5 mg doses of klonopin throughout the day to manage my panic and suicidality instead.  Either that, or the resurgence of spring sunlight this weekend, even with yesterday’s snow, and hence an up tick in my circadian rhythms.  Although I did sleep 10 hours last night.

Then again, that hypomanic productive mood I feel today, where my head feels stuffy, my chest and stomach feel hollow, and I can laugh at any joke as long as it’s mean might be the result of knowing that come Saturday, I have 3 weeks to figure it out and get some of the personal crap in my life out of the way so it looms less if/when I go back to work.

It will tease itself out, I hope.  If I do lots of things, surely something will work.

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Side effects may include (not as described)

Any drug is going to have side effects.  Any psychoactive drug, either when it stops being effective, or causes you to be in overdose (the “mild,” not-dead, not in the hospital yet kind of OD) often has side effects that mimic the symptoms you’re trying to treat.  Sleep disturbance, anxiety, paranoia, lethargy, apathy, catatonia, insomnia, suicidal ideation, you get the drift.  In something cyclical like bipolar, it’s hard to tell if it’s the meds that aren’t working, if it’s too much meds, if it’s the change in season (bipolars’ diurnal & circadian rhythms are really sensitive and prone to getting extremely messed up), or some external stressor that has set off a dip or upswing in mood– but it can be a slow creep, and sneaky, and even practiced, self-aware, general ly pretty in-control folks can find themselves in the midst on an onset before they realize they’re having an episode.

And then there are the physical side effects.  These may or may not be listed on the drug label– my own experience since 2007 is that some of the side effects are always going to be idiosyncratic to the patient, especially when dealing with psychoactive drugs, which doesn’t mean they still aren’t real to the patient, and that some aren’t listed because they’re not widely known yet, because a lot of bipolar drugs are off-label anti-convulsants, and so, obviously, bipolars’ reactions are going to be a little different from people with seizure disorders.  (This is why patient med wikis like crazymeds are so integral to feeling like you aren’t totally nuts when you experience symptoms that are listed nowhere official.)  I mentioned the sleep disturbance– so, multiply that by weeks or months, and then see how your joints and muscles ache because you’re exhausted.  See how your patience and moods fray, and your sense of humor disappears (and makes your mood swing even worse). Sometimes, there’s muscle stiffness, so painful you can’t turn your neck, and it brings tears to your eyes to touch your own skin to rub in some arnica cream or Tiger Balm or whatever other placebo-self-care balm you think might possibly help.  Some of the meds make you clench your teeth so that you wake every day with a headache or walk around with a permanent frown that turns people off because they think you hate everyone.  (You don’t.  Just your meds, the same ones that make it possible to get out of bed everyday and come to work to frown at everybody in sight.)  They dry out your mouth, or leach out salts so that all you do all day is drink water and crave a salt lick.  Sometimes, the meds dry out your skin, so that no lotion is thick enough and you have to go to the work bathroom three times a day to lather up just so you won’t claw your skin off.  (But it’s spring, and you’re hitting a middle age hormone change, it makes sense that your normal spring dry patch would just be worse this year, that’s what you tell yourself…)  You take ibuprofen to deal with the headaches, the jaw pain, the muscle stiffness, the aches of exhaustion, and suffer the bruising that comes with too much NSAIDs as a result.  Another side effect.  Not so bad, right?

And then you realize, maybe after the fourth time you’ve closed you’re office door because you’re leaking tears again, OH, I’m having a mood swing and I need to adjust my meds and maybe I’m also overdosing because– what’s this weird rash on my chest?  DO NOT IGNORE THE RASH ON YOUR CHEST, DO NOT IGNORE A RASH ANYWHERE, I REPEAT, especially if it’s raised & it itches, take a benadryl right away.  Cut your dosage, call your shrink, look up your meds to see if you need the ER, if your shrink does not call you back, call your primary care doctor, call your therapist– tell someone your meds do not work and you need to get off them and onto something else, pronto.  Keep calling until someone calls you back.

I try to not completely discontinue meds– withdrawal sucks cold turkey & it has dangers all of its own– but so does strong suicidal ideation, and sometimes complete cessation of meds = cessation of strong urges, plus sometimes there is not enough klonopin/other anti-anxiety med du jour (or sometimes, there’s just enough in exactly all the wrong ways) to make those wrong, ugly inner voices quiet down so you can hear something besides your mood swing.  A bridge medication is good, even if you still are going to feel, over all, pretty bad for a bit– because a bridge helps you cross the chasm, and if it makes you feel a little dopey, a little zoned out, a bit unable to spit the words out, a little less in touch with the finer feelings you’re going to have to deal with at some point– well, at least it gets you over the fiery pit part in the middle.  (That is a crappy metaphor.  Sorry.)

No one ever tells you this in the psychiatrist’s office.  I don’t know if it’s because they don’t take the meds so they don’t know (or because it’s unprofessional to admit they they feel your pain) or because they think it’s scare you to know that at some point, you’ll have to switch it all up, and that at a certain point you’ll have to start down a new road, your old bridges burning behind you– such that you’ll never start off in the first place.  I do know now, what I didn’t a while ago– the lessons learned smell like ash, but they still illuminate, even if it is just at the brink.  (Oh, crap, it’s a rash– that’s an illumination.)

Decisions, decisions (it’s only dinner)

I didn’t make supper tonight.

Is that a failing or a freedom?  I don’t really know.  It is a decision, though whether it’s a capital D Decision or a small decision just for the right thing I needed today, I’m not really sure.  I do know I started to assemble things out of the fridge, all knackered out, and then looked at the ingredients out on the board in the pantry and said to myself– no.  I don’t want to.

When I came in, my dad had been sitting there for at least a half hour, snacking on all the various food he didn’t have to cook or reheat that was there in the house– and I was just wrung out when I came in on automatic and started to housewife, you know, in the ways that we do.

I didn’t want to, though.  I’m not hungry, because I’m upping the dose of the particular meds that kill my appetite dead (anorexic anti-convulsants, woohoo!), and also because I had a late snack/drink at the store in accordance with the preset alarms I’ve got in my phone and which I obey whether or not I am hungry, on the hard lesson learned that your body needs fuel whether your stomach feels like it or not.  But– having had protein and some carbs and some veggies on three occasions today, not to mention too much caffeine and other fluids, the idea of doing it all again just because I have let my dad get into the habit of me doing the cooking made me kind of sick to my stomach, physically and mentally, too.

Instead, I said– sorry, I was really just tired, I didn’t know what to cook & didn’t feel like eating in any event, and that there were X & Y leftovers to heat in the fridge & I was going to bed.  Dad did not understand the not hungry thing, so I explained, for the fourth time in two weeks, about not being hungry with the increased dose of the meds and feeling grossed out by food– and then retired upstairs.

I supposes it’s a measure that the increase dosage is working that I didn’t have a temper tantrum of rage or start crying because he just can’t pay any attention to what’s going on outside his own head.  And I suppose it’s good, too, that I still feel pretty calm and chill about the fact that I said no, sorry, I’m not your wife or your nurse, feed yourself, and am not feeling horribly guilty or like a terrible mooch.  The fact is, I do buy a lot of the food, cook & clean, do the yard work & heavy lifting.  If it’s not money, it’s still work, and it’s value– and valuable.  I’m starting to know that.

There will be a time when my dad can’t “do” for himself at all anymore, including the cooking, and then I will have to take care of him whether I feel like it or not– but right now he can, whether or not I’ve fairly/unfairly stepped into the cook/caretaker role in an attempt to pick up some of the slack my not paying rent leaves.  He taught me how to cook, after all– if he’s too tired to do it, well, then we’re both in that boat.  Any stupid decisions he makes about salt intake or junk food or excess fat or calories are just that– stupid, small-d decisions, rather than life-impacting Decisions that are the product of someone who’s senile, demented, or some other process of aging or illness.

Maybe, for example, an Illness Decision could be: someone who’s manic-depressed and making bad life choices instead of self-caring ones because they’re not really lucid?  Then again, Bad Life Choices can be really good learning experiences,  even if it takes a while in the rearview to bring them into perspective.  I think skipping dinner, though, isn’t so big as that.

Ask me next week.

Crush

(Re-post from my fannish tumblr)

Up-front disclaimer— I don’t recommend just discontinuing your meds to anyone who’s bipolar and having escalating mood regulation problems.

That being said, I went off my wellbutrin (100 mg) last night, because I’ve been feeling more and more like crawling under a rock, quitting my job, and/or running out into traffic, plus everything, everything hurts. (Anyone who tells you depression is all in your head is a steaming sack of dog shit.)

I’ve been diagnosed bipolar since 2005.  I’ve blogged off and on about it as a way to get the thoughts out of my head and maybe because it’ll be helpful to someone else to know they’re not the only one feeling nuts and still getting on with their life.  It hasn’t been easy; I’ve had some real setbacks, including starting over in a new career path after I self-sabotaged my old one during a bad depressed phase, plus realizing I needed to end my marriage because my husband (who had his own problems) couldn’t deal with being supportive when I was being crazy.

But since 2009 I’ve been on a drug cocktail that has more or less worked well enough to give me good insight into escalating mood problems— not in a *ooh, lightbulb* kind of way, but at least in a *oh, I’ve been working myself into a lather and I’ve been crying a lot and I hate everyone and I’m really angry and I don’t want to go in to the job that I love and I just want to sleep* kind of way that takes me only a few weeks to see, rather than months.  Having a therapist who asks if it’s time to adjust my meds rather than tell me it’s all Freudian shit (fuck you, last therapist, for undermining the fact that I do have a neurotransmitter disorder as well as a fucked up family life, you can’t just turn off the biological disorder like that) helps, too.  Plus, there’s that whole blinding headache all the time thing, kind of a clue.

Accordingly, I’ve discontinued the wellbutrin, because the mixed states I’ve had before have always resolved when I’ve gone off the SSRI* for a few weeks & then either reintroduced it or switched out that med, while increasing by 25 mg. the anticonvulsant (topamax) I take and bringing more of the benzo-class drug that I take (klonopin, 1 mg nightly) with me for day time anxiety swings, .5 mg prn,2 mg. max. daily.

I feel better this morning already, with the crushing headache absent and the body aches mostly gone.  SSRIs* are controversial for bipolars and bipolar IIs (my particular diagnosis) because a little can maybe help but it builds up and then you get depressed— and me, I get depressed and angry and despairing and— hate everything, including myself.  But up until they don’t work, they do.*  It’s a catch 22.

We’ll see how the mood is affected tomorrow when I go into work and all those situational stressors reassert themselves.  I did leave a voice mail for my shrink (it’s the weekend) of what I was planning to do.  I did tell my dad, who I live with, how I was feeling and what I was doing, but that I was basically ok if he just gave me some real quiet time this weekend.

It’s a rollercoaster and a ferris wheel— because it’s both up and down, but also it’s a slow cycle around.   I’ve been here before, in this crushing, aching, self-hating place, and I have to take a step back and give myself perspective even as I employ all my coping skills.  I have to be my own best cheerleader and say— you’ve deployed your support system, you’ve let people know you might need time off, you’ve been proactive, you’re taking time to yourself, you’re balancing quiet time and coping mechanisms like reading fanfic and listening to music with normal adulting stuff like doing laundry and taxes.  I have to remind myself that yes, it’s up and down, yet again, but the relative volatility isn’t as much, and if I was a jerk to someone at work, I did apologize right away and tell them they weren’t at fault— and they accepted that apology and let me be human, which is also a credit to me because this time, this career change that was a little more voluntary, a little less self-destruct, I chose a workplace where, for all there is too much work, at least I am allowed to be human.

Maybe this time, out of the crush, there’ll be some wine to drink— not just me, feeling like pulp.

*I have been on two other SSRIs from 2009-present before switching to wellbutrin in 2011-ish, and my shrink has always called wellbutrin an SSRI.  The wise ladyofthelog has noted, however, that wellbutrin is actually a DNRI, which I did not know until today, and which may well explain why I’ve been on it more or less steadily with two or three two-week-breaks, maintaining a pretty good mood state at low dosages (100 mg combined with the rest of my cocktail) for the last three years, when most of my other SSRIs usually only work for a year & a half at most.  Thanks, verity!  ❤

Please let’s not talk about the weather

This is an all over the place kind of post.

I suppose, first off, my mom is okay as far as I know– she was discharged from the hospital after an overnight with some treatment, but I haven’t talked to her.  My brother’s in touch with her.  I don’t think I’m going to be, anytime soon.  I have been pushing her to get this problem dealt with for a really long time and she hasn’t, and I’m just furious– despite the fact that I know that she’s crazy, that she’s literally so nuts she can’t hear anything outside the stories she needs to write for herself in her own head– that she can’t trust or listen to me.  (Even if she lies and says that she does because she knows I am angry at her and that makes her uncomfortable because it doesn’t fit into the story she tells herself about us.)  I had a talk with my new awesome therapist about it and clearly, still lots of work to slog through, but right now when he asks me the question– what do I want from her?  The answer is nothing, because I won’t get the things that I want.  I won’t get an apology.  I won’t get someone respectful of boundaries or attentive to my interests and issues, much less aware that I am a distinct intellectual entity.  So, sadly, what I want from her is, precisely, nothing for as long as that can be maintained, because her refusal to trust, to listen, to acknowledge the adult competencies she herself thrust upon me by her infantilizing, victimizing behavior and her need to nevertheless whine to me because she somehow things that we’re friends or I’m her mother?  It’s too much to bear.  The only resolution is no.  I feel bad my brother gets to deal with her, but then again, I do get my dad, and he does infuriate my brother in a way I mostly ignore or poke right back on.  Even trade?

I will help with any legal or medical matters, either at hospitalization, institutionalization, or death, but I can’t bring myself at this point to bear more.  I can only turn off my furiousness at her when I have to put on my I WILL FIX EVERYTHING HAT, the one she forced me to wear as a child, and then I will high tail it out of there to get fucking drunk off my ass– one of those rare times.

I have been debating if my creeping anguish and apathy and everything everything everything has been SAD, too much work, too much stress from my dad, some institutional problems at work that need active rooting out and more support than I’ve had but some of which may change soon– not enough therapy, or all of those things.  It’s just been getting worse, though, and while there are lights in the darkness I am starting to dread going into work, getting snarly, putting off yucky projects, and feeling generally hateful of everyone and everything.  I talked to my personal boss (rather than my store boss) about it and that I wasn’t sure what I needed quite yet but that I was feeling messy and I might need a little time off– she was supportive and when I offered with my heart in my mouth that I felt like I generally knew what I was doing, she agreed– but it’s going to be weeks before the institutional stuff at work is fixed and I’m in no place to have the patience to explain myself without starting to cry or just be a horrible beast.  (Which I can’t be, because I am the one who’s supposed to be the source of counsel.)

I have been dealing with being crazy for a while now.  I suppose this is “easier,” in that I haven’t messed anything up yet, I asked a boss for help and she said “whatever you want,” and while my plans to leave early when completely to shit because of said institutional problems, a few more perceptive coworkers saw I was in a really bad mood/didn’t look right and slowed their roll long enough to ask if I was okay.  I even was honest with a few of then and said “No, but thanks for asking.”  But it doesn’t change the fact that I’m so depressed and feeling isolated and lonely that I feel incapable and in need of a goddamned parade and a hug from everyone in the store and I KNOW I am overreacting to stuff– and I am afraid if I take time off, I won’t come back.  I need this job, this one in particular, plus the money is good, because even if I am getting fed up with the store, I like the company and I have plans for regional and eventually global domination.  And I don’t want to start over again, much less be angry and sad all the time.

Almost as a one-off, my new therapist asked me if maybe my meds needed tweaking once we ran through the was I eating & more or less sleeping routine, and OF FUCKING COURSE.  Lots of carb cravings, increased appetite (when they work, my meds make me very unhungry and anorexic in the clinical “lack of appetite” sense), mixed anger and sadness, no sense of humor, no time for any small talk or bullshit (and rage at any waste of my time) apathy, procrastination, anxiety, increased sleeplessness & anxiety dreams– and I’m so used to my old therapist being all MEDS AREN’T THE ANSWER that I haven’t been thinking that way.  (Maybe I should report her to the board of licensing, bullshit billing crap to the side.)  It’s been 5 years on this regimen, wellbutrin plus an antiepilectic and klonopin– it stands to measure that the SSRI has ceased to be effective, in the way that they do for bipolars, and that I need to wean myself off the wellbutrin and try something else.  (Yay, rapid cycling mixed states, kept under moderate control?)

Soooooo… do I work during that time?  In a fit of wisdom, I signed up for short term disability at annual enrollment, and I am sure that my therapist would write me a note, and that I could wrangle my shrink into writing something as well, though I don’t see her as much except for refills.  (And I should call her this weekend to set up a check in appointment for sooner/this week.)  I am worried the place would burn to the ground in my absence, but at the same time one of my institutional problems is people both taking me for granted and not paying attention, so maybe it would serve the damned bastards right.  I am concerned, though, about stigma when I return, and yet– if I can’t take the time off to get my shit together at a place like my current employer, then there’s no hope for anyone, anywhere, ever.

It’ll be spring sooner or later.  I’m just worried it won’t be soon enough, and after 5 years on this regimen, I have lots of worries about starting new meds and seeing how they will work.

Change is good– it has been.  I fucking hate it anyway.

Subject

The almighty whir-clack-clang of the machine has to be heard to be believed.  It’s loud.  Hella loud.  Internet radio on headphones cannot compete, and Pandora’s idea of generic “alternative rock” is 90’s era Bush, Stone Temple Pilots and Red Hot Chili Peppers, stuff I consider elevator music by now.

Maybe I should have picked opera.

The air blowing through the tube, the weird positioning because of course it’s face down and your various parts have to go in various slots and it’s like the most uncomfortable massage table ever, and then– then you can’t move when the godsawful racket starts in– well.  Everyone’s MRI is different, I guess, but everyone is probably the same in that it’s disorienting as hell, trying not to think too much while you’re essentially alone in that tube, waiting for the tech to say it’s okay to shift that half-inch that’s going to relieve that itch in your neck, that crawl under your skin, that whirring dizziness that comes with the contrast injection or maybe just too much cool air over too-naked skin.

The fact that at least I got hospital pants to compensate for the flapping-in-the-MRI-machine-breeze bits of my johnny’s not really a comfort, and while the tech was a pro and it wasn’t that long, all in all, as some scans could be, nor nearly as painful (mammography is, and always shall be, horrid, despite all the blessings clear pictures can bring) it’s a weird feeling, off– to have to surrender, to wait, to listen to horrible rock that I “chose” but not really, to lie still against too many thoughts mundane, benign, and elsewise– to wait, until the results are all in and I can move, once again.

 

I stand confused (you dropped a bomb on me)

Ayelet Waldman (who I really haven’t liked every time she’s written a column for the Times, just my gut, I have felt like she’s often written herself so she comes off as selfish and there’s a projective worry I’ll deal with later…) wrote recently about her initial diagnosis as bipolar II and her experience with topamax and her later discovery that she wasn’t bipolar at all– “just” premenstrual dysmorphic.  I’d missed the article, but my therapist brought it up at yesterday’s session as a way to work back to a frequent topic– her perception of my overreliance on my organic disease versus more situational causes for my depression and my consequent feelings of powerlessness over my future, and the fact that Topamax hasn’t been effective for me in the long run even as it seemed to really work at the start.

I can concede the last point, even as I argued with her (again) about how I know and understand that there’s an intersection between genetic predisposition and my situational triggers and how I cope/choose to respond– but that sometimes I do better than others.

What Waldman says in the article, though, about the intense feelings of relief that the bipolar diagnosis gave her because it explained some of her more intense behaviors– her rages, her hypomanias, all of those things– those are things I’ve had too, even as it’s been true that no mood stabilizer has worked for me for more than a bit and unpacking the question– am I medication refractive?– or is it just that coming off one med and onto another works an equilibrium/placebo effect in me for a while before I hit another major depression, and I’m “simply” subject to major anxiety and depression, as she suggests?

I don’t know what to think.  I’m going to be working with a new psychiatrist starting next month because the one I’ve worked with since I was first diagnosed is changing to a different type of practice and won’t be able to continue to see me– and I’m certainly beyond the efficacy plateau on the Topamax at the 2-ish year mark (suicidal ideation will kind of make you see that light), just like the rest of the mood stabilizers, just as I’m feeling better now that I’m on SSRIs and reducing the mood stabilizer in my system– but there are things left to explain.

It makes me sick to my stomach to think I have to start from scratch in trying to understand the whys of my crazy again.  Shellshocked, even.