Med Check

This past week has been rough to say the least. The biggest problem underlying the whole out of control, mixed-mania, depressed train wreck was a simple mix up in my med dosages.

I used to have Archway monitor my meds for me, in that once per week a worker would stop by my house and help me fill my daily med planner. Yes, one of those big old lady ones with Braille and the whole bit. I have to admit, it does sound silly that a 30 something needed all that help, but then factor in the bipolar brain fog (read about that here) and the fact that I am on 12+ meds at any given time.

But I gave up that service a while ago. The reason was that I couldn’t just sit around the house all day until they showed up.  So I’m going it alone…and I got a little confused.

Instead of taking the maximum dose of Cymbalta for my fibromyalgia, which is 120mg, I was taking 240mg. My Neurontin went from 200mg a day to 600mg. And on top of all that, I was only taking my anxiety medication once per day.

Needless to say, I was fucked up. I also lost some of my sight, which has returned with straightening everything out. Now every time I see my shrink, I will get a print out and a double check on my meds.

I’ll try to write more on the fallout next week. Stay strong!

Colorcoding My Life

Next to my work computer, and hopefully soon at home as well, I have a veritable garden of Post-It Notes.

Each day has a color; for example, Sunday is yellow. I have listed all the regular tasks I should do at work on a Sunday…including the personal note to blog and pay bills. I am hoping that improving my memory for work duties–clearly visible for my boss and co-workers to see–will help me to actually keep this job. The only one I now have.

From July 2013 until I was fired on October 14th, working a second job at the Library was extremely stressful. I was forgetting all sorts of things, like taking meds, completing work tasks, etc. It was not until recently I’ve had some explanation as to why my memory is just so very bad.

I read the article “The Cognitive Connection” in Bipolar Magazine, a magazine I didn’t know existed.

“Psychiatrists and researchers are coming to appreciate that memory lapses and other neurocognitive problems—disorganization, groping for words, difficulty learning new information—can go hand in hand with the more obvious mood and behavioral symptoms that characterize bipolar.”

So maybe it is not a character flaw or something I can blame myself for, like some people have done about losing my second, higher paying job.

“Bipolar brain fog can complicate everything from succeeding in school to paying the bills.”

What a precise way to describe this memory meltdown: Bipolar Brain Fog! I was actually fired for attendance, but it all stems back to slipping off my meds and forgetting elements of my job.

I remember all the Post-It Notes and Day Planners and homework note books that got me through college. Time to dust off some of those tactics.

The article also mentions lapses in attention, which can cause lose of coordination and balance! Did I mention I fall a lot?

I highly recommend reading the excerpt of  the article. I’ve also subscribed to the magazine and am eagerly awaiting my first issue.

This past week went a lot smother with the Post-It Notes; at least I felt a lot more productive at work…a pay period of 79.75 hours.

The only trouble, and my Mood Score of only 57% shows this, is the raging anxiety, sleeplessness, and irritableness at home. I see my shrink on Tuesday, so I suspect an increase in my Buspar.

More on meds later…

They tried to make me go to Rehab…

…and I said, “Sure, OK.”

It takes me a while to work my way to the truth. Or at least a somewhat stable version of it.

I am in rehab, an all be it outpatient one, but rehab nonetheless. The few friends I am in any kind of contact with are dealing with this fact in very different ways. One wants to take me drinking. One traveled 4 hours by train to take naps with me. One comes to my house for dinner and brings pie.

But how to I deal with this? I should be writing lots of great poetry.

I’m not.

I am trying to remember to take my meds. I am trying to remember they are good for me, and that I should stay on them. All but the week’s supply is padlocked into a great big black box I have no access to. I also receive a phone call every evening to tell me to take my medicine and charge my cell phone. If this new protocol fails to keep me on meds (and prevent another fist fight and an ER visit for a broken hand – or at least severely contused hand), people I don’t know will come to my house twice a day and watch me take the pills. Then they will ask me to open my mouth and move my tongue around.

I am trying to remember to shower everyday and get dressed. I am trying to put my clean clothes away and pick all the clothes up off the floor of my new bedroom. Almost all of the socks I own are underneath my new bed.

I am trying to slowly chip away at the mountain of paperwork I have to fill out because the poorer you are, the more paperwork you have to fill out.

I have learned if I drink the smallest amount, I will laugh until I begin weeping followed by a spiral that will probably end in physical violence to others or myself.

I have learned I have not really slept well for the last 20 odd years, that Ambian is a precious commodity never to be squandered, and that sleeping meds will be my new best friend hopefully very soon.

I have learned to admit to my bitterness over having to leave school and that no one really seems to care as much as I think they should.

And of course, I have come to appreciate that the times I can spend in the company of other people who have experienced psych holds and The System are actually a relief. I can use a shorthand–no need to explain myself or explain why I am such a shadow of my former self.

And finally, I think about how much time must pass before I can no longer call myself a poet and what to do with a life that has no purpose.

I am a Wikipedia cut and paste

So, I went to see my counselor today and finished the last of the psych eval questions. There were over 700 questions altogether. I don’t even think that is the last of it, but I should have some results and possibly a clearer diagnosis soon.

The oddest part about taking these tests is that they stirred up a lot of stuff for me that I was not at all expecting. I had terrible nightmares after the first session, and had to skip testing the next day.

I have tried to track my moods still, and I think when I start hitting the single digits it is time for me to be a little concerned. I’ve tried to define exactly how I am feeling, since it is so confusing (and I’ve still been confused).

Enter Sarah from Seattle! She wrote about two different types of manic periods, which I’d not read about before. And as I was posting a comment to her blog, I realized I should re-post my response here. A little bit of self-plagiarism, if you will.

“I like the idea of defining two different types of manic episodes. I’ve not really heard about that elsewhere. I love how you can put something into words I’ve only begun to start noticing…

“I think this is what I was trying to explain to my counselor (rather unsuccessfully) that before I started taking Cymbalta my manic episodes where the racing, intense, 12 project, chest pounding kind. And that was good for me because I was working and managing projects and my life was a house ‘o fire. I could let grading slide for weeks and then barrel through a month’s worth of grading in a few days. I could put events or school packets together at the last-minute that looked well planed out, etc.

“But now, I have two OTHER kinds. 1) I am so wired I can’t sleep but also can’t be productive. While I used to be able to write whole poems during a manic cycle, I have trouble concentrating on any task. Everything is just a blur and I can’t focus. I can only sit around and think. And play video games.

“Then, recently, I have been getting these rather frantic periods of no sleep, buzzing thought, but my mood is subterranean. I guess that would be a mixed episode.”

I actually looked up the definition of a mixed episode because I was unsure. To my aid comes Wikipedia, which is actually a much nicer way to read about mental health issues than is WebMD (haven of hypochondriacs).

Here is the definition:

“In the context of mental disorder, a mixed state, also known as dysphoric mania, agitated depression, or a mixed episode, is a condition during which symptoms of mania and depression occur simultaneously, such as agitation, anxiety, fatigue, guilt, impulsiveness, irritability, morbid or suicidal ideation, panic, paranoia, pressured speech and rage. Typical examples include tearfulness during a manic episode or racing thoughts during a depressive episode. One may also feel incredibly frustrated or be prone to fits of rage in this state, since one may feel like a failure and at the same time have a flight of ideas. Mixed states are often the most dangerous period of mood disorders, during which susceptibility to substance abuse, panic disorder, commission of violence, suicide attempts, and other complications increase greatly.”

To be diagnosed as having a mixed state, symptoms are supposed to last a week, but then it says, “However, mixed episodes rarely conform to these qualifications; they may be described more practically as any combination of depressive and manic symptoms.“

I also learned that “some antidepressant drugs may trigger dysphoric mania in susceptible individuals.” So I am thinking since I have felt this way since stopping the Lamictal, it might be having some lingering effects.

So, what about treatment?

Good question, since I’m not really sure.

As I mentioned, I was prescribed two new medicines: Saphris (asenapine) and Cogentin (benztropine).

According to Wikipedia, “Treatment of mixed states is typically based upon administration of mood stabilizing medication, which may include anticonvulsants such as valproic acid; atypical antipsychotics such asolanzapine, aripiprazole, and ziprasidone; or first-generation antipsychotics such as haloperidol…Mood stabilizers work to reduce the manic symptoms associated with the mixed state, but they are not considered particularly effective for improving concurrent depressive symptoms.“

Saphris is an atypical antipsychotic, but it tastes SO BAD, I threw up the first time I tried to dissolve it under my tongue as directed. My doctor wrote the script for the black cherry flavor, but the pharmacist gave me the plain ones. Why would a company even think of marketing something that tastes so foul!?!

My counselor sent my shrink an email asking if it is alright if I just swallow them.

The Cogentin is to control the seizures and muscle pain I am still occasionally having and which the Saphris could make worse. I have resumed taking it. So I’m currently taking three meds.

I would say, as bad a depressed states are, a mixed one is worse because I can’t take refuge in bed. In fact, I’ve not slept in my bed in several days, just cat-napping on the couch in the A/C.

I’m still having trouble keeping up with simple things such as checking my voice messages or answering emails. And next week is the day camp I am supposed to be teaching! I need to work up my lesson plans ASAP!

So if any of you are waiting on an email, phone call, etc., please don’t take it personally. I will get back to you before the year is out, I promise!

The early bird

At around 4pm on Wed. the 20, I decided to take a nap (after being up for 20 hours again). I wasn’t particularly tired, but my body ached a bit.

I woke up at 4am on Thurs. the 21. Nuts.

At least on Wednesday, I did find the insurance forms. Now I just need to find paper to print them out. No deadline was listed though, so that is a good thing.

This getting (or more usually being up already) for the early morning is quite beautiful. I am generally not the type to leap out of bed in the morning, so I usually miss the special qualities of the light coming into the world. Something about the quality of the air, the hush, the calmness of the dark after the sharpness of it earlier in the night, makes me particularly inspired and restful.

A restfulness of mind, which is so very hard to come by for me these days.

I feel more centered, more connected. And this only happens during my manic cycles since I am usually sleeping the morning away in a depressed funk otherwise. Ironic, isn’t it?

It makes me wonder if my poetry also comes from this place of centeredness, of connectedness, of burning in the womb, of mania. The poems I usually like the most are those that have a sizzle in them. When I look back at them after the initial fire of creation, I usually am surprised I wrote them. There is a sureness of voice, a strength, that I only feel in myself when I am manic. I feel like I am then a truer version of myself. One who is stronger. That is the one who survived.

Which makes the down times that much worse. Because that person is not the survivor. That is the damaged victim. Those halves are always present, but like id and ego figures, they assert themselves more at the highs and lows respectively.

Maybe I write Id Poetry–I kinda like that.

So I guess, what I’m trying to say is that I may be crazy, but I’m enjoying myself right now. Of course, in 10 days, the rent is due and I have $10 left in my checking account…

But I am working through that aftermath plan with baby steps. Today = kittens’ shots. Friday = a friend driving me around to the Social Security office and Human Resources to start the disability process and file for energy assistance, respectively.

All those offices used to be in the same building along with child services and food stamps, centrally located downtown near the main bus stop. Now you have to go to three different places all over town in a virtually bus-free town.

You’re only a conspiracy nut if you’re wrong…

My hope is that temporary disability and unemployment together will be enough to cover July’s rent. I’ll worry about August later.

Namaste

So, that’s a bad thing. Right?

As close as I can figure, I was up for 20 hours “yesterday.” I went to my counseling appointment, made a list of all the things I need to do to start dealing with the “aftermath,” as I am calling it, of those lost 10 days, went to my parent’s house and pulled up my Double Delight rose, transplanted it into a pot on my porch along with some pink clematis, and generally felt like I was doing pretty good. I also got most of the trash out of the house.

Obviously, I am ramping up for a manic cycle (if not technically in one right now). But I am having a hard time thinking of that as a bad thing. I am actually relieved. I have lots of things to do, and I need some get up and go.

Granted, the get up and go also tends to wander off and get distracted (in the time it’s taken me to write the above two paragraphs I’ve also played a few Facebook games, said good morning to unsurprisingly grumpy trash collectors, retrieved my trash can, hung a hanging basket, chased the kittens around the porch, put more soil on the rose/clematis, and watered some of the garden). And the not being able to focus long enough to really eat is bad for my hypoglycemia but good on the budget.

I understand that predicting cycles can head off calamity; i.e., knowing when I am about to become suicidal is a good thing to head off, but is knowing a manic cycle is imminent a calamity waiting to happen? My answer: Depends.

Granted, during my last two manic cycles I spent a grand total of about $1,500, and though that was not the greatest, I can’t really be too hard on myself. I struggle a great deal when I am down, and the ups are rewarding in their way. Ok, that was classic justification, but what the hell? I had fun and didn’t get evicted after all.

What are the other pitfalls of mania? Unprotected sex is a continuing issue I’ve faced in the past, but given my geographical location (i.e., not a large population of lesbians or bi-sexual men), travel issues (no money for gas + dizzy spells), and the fact that I have worked REALLY hard to have some sense of taste when it comes to who I fuck, I don’t really see that as much of an issue.

I don’t think I ever could endanger the lives of my cats, no matter how bad I get. Bad driving? Sure. Going into the 10-day confusion zone, I hit two cars (no damage), but since the social anxiety is still pretty heavy, I don’t see myself going wild outside.

So I waste a few days playing video games and watching TV. Who cares? So I rearranging the furniture in my apartment and throw away a ton of trash. That’s a good thing, isn’t it? Even if it is some nicer stuff, or I break some shit, still not the end of the world. Or I might finish a short story or actually dive into that novel project I’ve been nursing. I would put that down as a positive, even though the chances of that happening have been practically zero since the Cymbalta (curse you, fibromyalgia!)

My days of delusional thinking about how I was going to change the world are fewer and farther between, and while I still get that sense of my life seeping out of my hands as I do something pointless and shallow, I am trying not to pay too much attention to it.

Looking back, I think I was actually mostly manic all through college. I would have really bad crashes, but with the flexible class schedule and very understanding supervisors at the library, I was able to get through fairly ok. The delusions started even before college, though the collegiate environment is a fertile ground for delusions of grandeur.

I remember feeling so very different as a child. I was the only one in my immediate family born outside of the month of October. Since I was the only child born in a hospital, I would fantasize about being switched at birth. Until I was in my teens! (I still secretly wish I was the confirmed result of an affair).

I remember meeting a distant cousin once when I was 10 or so, and she asked me if I wanted to study medicine (after I’d rattled off some fact I’d recently read). I told her no, but she replied, “Well, I know you are going to do something special. I can sense that about you.”

That off-handed and potentially insincere comment stuck with me, gentle puffing up my ego. By the time I hit college, I was utterly convinced I could not only accomplish but succeed at anything I “put my mind to.”

During my college career and even as recently as when I was working at the theatre, I tackled projects with a fever that intimidated the hell out of many people. I have a lot of cool things under my belt. But my days of working miracles are most certainly past. I don’t know if it is age, the fibro, or the Cymbalta (or their powers combined), but my magic wand is as limp as a, well, you get the idea.

I still have people tell me things that tend to inflate my Jesus complex from time to time, and my college roommate is my personal cheerleader to keep those delusions alive. But something about after college and my time living in New Orléans, and those delusions started to evaporate.

I was fired up again when I first started seriously studying poetry. But this time the fire didn’t last long. I still want to figure out how to not close the door on an MFA forever, but that is not my first concern in dealing with the aftermath.

Assignment number one today is calling the travel insurance and seeing if there is a chance in hell I can get my $900 for the airline ticket back.

Assignment number two is the write all my appointments in my appointment book and see if I’ve double booked myself.

And that is all I am scheduling, because I want to feel good about what I do accomplish.

In the time I spent revising this, I logged into Moodscope to chart my mood. It is interesting to note that on June 4, I tracked myself at  01% and that is when I wrote that I was not sure I’d found bottom. I definitely went down from there into the minus numbers.

Today’s score?

97% and the top of the mountain is still straight ahead!

Feeling awake…when I’m awake…

So yesterday was probably the first day in almost three weeks that I have felt more completely awake now that I have stopped taking the Lamictal. I was able to pay some bills that were close to or just past due. Yay! for keeping the internet on!

Today, I went to bed at 6:30am and woke at 4:30pm, so a reasonable amount of sleep but with the characteristics of wakefulness I get when I am ramping up for a manic or hypomanic phase.

According to my counselor and her interpretation of the Big Book of Problems (DSMIV), it is not possible to have both manic and hypomanic periods. Something about that just doesn’t sit right with me. Beside, how can anyone really know what my cycles are really like when I only talk about them or seek treatment AFTER I am already taking medication.

Cymbalta is prescribed for my fibromyalgia, but without any clinical degrees under my belt, I am convinced it interacts with my cycles. It could be the absence of the severe bone grinding pain I was in pre-Cymbalta, or it could be a “rare” side-effect like the fact that it makes me extremely irritable, or it could be just something about my strange anatomy (extra / lack of organs, blood abnormalities, etc.).

Today, I was able to shower, get dressed, and run up to my parent’s house to drill some holes in the bottom of my new large pots.

My plan this week is to get stones from the local quarry along with some more soil to plant the clematis and transplant my rose.

The kittens also get their second round to shots and deworming this week, and I have both counseling and psychiatrist appointments. I also have to loan a book out for the free presentation I bailed on later this month.

If I accomplish all of that, I will consider this a very successful week.

What about all that other stuff, you ask? To hell with it until either the letters are red or they come knocking on my door with handcuffs!!!

Define “normal”, please…

When I was little (between 4 and 10), I had  a theory that different eye colors effected the way people saw colors in the world around them. That people with blue eyes must see blue that much more vibrantly, and people with brown eyes must see everything as mostly muted.

However, since I always desperately wanted violet eyes (and still do…I’m always contemplating getting contacts and when my eyes deteriorate enough to justify the expense, I totally am going for it)…I therefore assumed I saw the colors blue and violet (or purple) differently than other people even though my eyes are honey brown.

Some of this also largely had to do with the frequent disagreements with my mother over whether certain items of my clothing where indeed blue or purple.

In point of fact, they would probably best be described as periwinkle and thus impossible to define definitively, but my theory made sense to me (like all of my various pet theories, of which I had/have many) and made me feel better when I lost those silly arguments with my mom.

But it raises a good point, I think, even after I learned about the color spectrum and light refraction. Our perception has a lot to do with how we “see” things. And everyone’s perception is different. We may have common perceptions about some things based on shared or enforced culture, but even with the big things–sexuality, morality, death–we each negotiate between our individual perceptions and what the status quo supposedly is.  More complexly, we also sometimes have to negotiate between our own perceptions, our internalized/enforced perceptions, our groups’ perceptions, and our culture at large. This is what is known as negotiation with hegemonic culture, a.k.a. postmodern queer studies, a.k.a. what I used to live and breathe in college.

I always was a theoryhead…even at 8 apparently.

So if perceptions are negotiated, arbitrary, changeable, fluid, and from a Buddhist POV, impermanent, there is no such thing as normal.

And if we start from that basis…there is no normal, only normativity, then how can anybody, any non-Self, set a standard?

Ok, maybe that is a little Looney Tunes. Too full of anarchy. And I tend to hate Anarchists.

Maybe it needs to be put a different way, more subtle, more beer drenched…

So maybe sleeping only 6 hours on average per night in the last week is perceptually normal for me? Maybe sleeping 16 hours on average per day the week before was perceptually normal for me then?

Um, probably not. But can you be abnormal yet also aware of abnormality? I mean you can have pneumonia and not realize you have it, but you can also surely have pneumonia and be totally aware of that…say when you are in the hospital coughing up a lung.

Can I be manic but also aware of the fact that I am manic? I obviously am manic…right? Maybe? Or am I just like my 4 year old self who never wanted to go to bed, afraid she’s miss something. Who would be so intent on playing with her little toy cars, she would pee herself and have to wear her 5-year-old friend’s male underwear home.

I don’t know.

All I do know is that I’m not sleepy.