Category Archives: Medication

Three Weeks

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And two days, for those of me keeping track.  That’s how long it’s been since I stopped my miracle med I was going to take for the rest of my life.

Since I wrote The Finish Line, things have improved quite a bit with my psychiatrist.  And I was cautiously optimistic about the three drugs we had decided upon to replace the one I had to stop.

Things started off well enough.  I was getting up mornings and doing yoga, then going over to the rec center and using the bag for an hour.  I was feeling motivated and determined to fight with everything against depression, because that had been creeping on for a long time even before the med issue.

After about a week or so, I noticed by the end of my day my head was in a complete fog, and I felt like I had been up for three days in a row, mentally (though I wasn’t requiring any extra sleep).  The only thing this could have been coming from was the medication I was prescribed for the immediate relief of my depression.  I held out until the middle of last week, when I realized that even when I doubled the dose, it would only help my depression for half-an-hour, max.  I then said enough.

Strike one.

The second, more long-term medication that was meant for my depression is one you have to start slowly and raise the dose of incrementally.  The reason is there is a small chance of a potentially deadly rash in reaction to it.  You may know the one to which I am referring, but I would lay down 20 to 1 you don’t know half the fun, detailed, descriptively vivid particulars about the two distinctive rashes you really need to watch out for, the ones that are actually serious.  My former psychiatrist believed education was key, and God bless the man for that.

I did very well on this drug before, no reaction, good response, took it for years.  Earlier this week I raised my dose on schedule, and the next day the tip of my tongue hurt a bit.  I figured I must have burned it, or perhaps I was dehydrated.  When I woke up Friday it was in so much pain that I couldn’t move it around my mouth, all I could do was take little sips of tepid water and hold them on it a bit before swallowing.  I knew I wasn’t dehydrated at that point.  I put in a call to my psychiatrist, and even though it looked completely normal, I had already decided I was taking no chances by the time he called back.  He found it odd, had never actually heard of anything like it, but was in agreement with me.

So I didn’t take any yesterday or today, and my tongue is improved enough for Fugdesicles.  My father got the sugar-free kind by mistake, so that’s a good 80 calories a day right there I’m living off of!

Strike two.

The third medication, which I insisted upon because I had no anti-manic. . .  Well, now I’m off the amphetamine all I’m doing is sleeping.  I increased the dose to treat what I rightly identified as prodromal mania last week.  So the last two nights I quartered the dose I had gotten up to.  Tonight I’ll go down to a half.  And maybe, by Monday — when I next see my psychiatrist — I’ll be able to stay awake for more than an hour-and-a-half at a go.

In which case we’ll call that one a foul tip.

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I added that ‘specially for you, Sailor.

Thank you so much to everyone who has shown me such love, support, understanding, caring, and kindness, and to all of you who continue to do so. It means more to me than I could ever find a way to put into words.

© Ruby Tuesday and I Was Just Thinking. . . 2013. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

The Finish Line

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Last week my life as I had blissfully known it, for the past year at least, came to an end.

I have been struggling very hard to write something to update everyone, and failing, and failing, and failing.

I wanted to explain more of the situation, but that’s not going to happen, so here are the bare bones.

I can no longer take Carbatrol, which has been my mainstay in mood stabilization.  Not ever again.

It's the Great Big Book of Everything, with everything inside. . ."

It’s the Great Big Book of Everything, with everything inside. . .

I have been through every drug and then some; when I stopped counting in 2010, there had been more than 70.  So I am at a point of patching together what I call the “least worst” solutions for my future.  I have a three-inch thick binder filled with my notes, my doctors’ notes, medication inserts, pharmacy info, articles from different websites, and I’m basically using that, along with a grip of reference books, to decide which drugs were the most effective and the least intolerable.

It’s only been five days, but things have really gone incredibly badly to start.  I don’t want to talk about it.

I’m actually very well-equipped for this, in one way, in an important way.  I have been through this fire, for five-and-a-half years I went through it, and I came out the other side alive.  I know what to expect, and I know that I can get through again.

The thing that is knocking at my infrastructure is that I honestly and truly believed that this was it for me, I had found my cocktail and that was what I would be taking until I drew my last breath.

Also, there is the added element that I’m giving serious thought to looking for a new psychiatrist.  I am undecided here, as I need to sit down and discuss some things with mine first.  Additionally, I went through this process a little more than a year ago, for the first time since I’d sought help in 2006.  I got my first psychiatrist on the second try, and I didn’t know how lucky I was.

When I went through my search last time, I had very few doctors recommended to me, because my then-psychiatrist and my primary just didn’t believe there were many equipped to handle my case.  And, in fact, of those few, all but two said that they didn’t think they could help, because they honestly didn’t know what could be done that hadn’t already been tried.  I appreciated that frankness.

Essentially, what that means is if I do need to find a new doctor (still a big if), there is more than likely only one whom I can go to locally.  And that’s if he is still around, and still taking new patients. I do have information I saved on several national options, but there are enormous practical and financial considerations there. So, we shall see.

My parents are being very supportive, in their way.  After Thursday’s appointment, I told them I am no longer going to discuss with them what medications I am taking, because the last thing I need to be thinking when trying to figure out how to make the best out of a bad thing is, ‘Mom and Dad are going to freak out about this one.’  That really should not be in my mind at all.  Mom took it surprisingly well, she understood completely; Dad, well he will learn to deal with it.  He just loves his baby daughter and worries about me so much.  They both do, after these past years of seeing me hysterical and blanked out and taking me thrice weekly for ECT and rushing me to the ED many times and sitting up nights watching me because they were worried I would stop breathing.  Those are memories a parent can never erase.

So that’s the gist of it.  That’s how my life changed completely over one Thursday in January.  I was one month and four days shy of a perfect year.  But I’m glad I didn’t know that time had an expiration date stamped on it, because if I had, I wouldn’t have loved it as carelessly and blissfully as I did.  I wouldn’t have assumed and made plans and, yes, taken things for granted.  Taking things for granted is not always the monster it’s made out to be, my loves.  And if I have to spend another six-and-a-half years, or the rest of my life, striving for eleven months more like these just past, I will say that it’s worth the trade.  The reward is worth the fight.  More than worth it.

 

The rest of the crew.

More of the crew.

I’ll get through and find something, but it’s probably going to be an endless road of different drugs and dosage adjustments and changing this for that.  I won’t say I’m delighted, but neither will I sit here and wonder and wail that I can’t deal with that prospect.  To me it has never been a question of “how long” or “an end” or “too much”, it just is and I keep going, because this is the life I am living, and that is the only choice I have.  To keep going, to plunge ahead, to try something else.

I will always keep myself afloat, even if it means clinging to the fin of a shark.

© Ruby Tuesday and I Was Just Thinking. . . 2013. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

It May Not Always Be An Easy Life, But It’s My Life

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And I just want to live while I’m alive.

I think it’s time to update everyone.  I’ve had a very eventful couple of weeks.  To the point where I haven’t told anyone not directly involved in said events anything about them, not really.  It’s taken some processing time.  Also, it’s painful for me to be still long enough to write anything.

So, the new year started off with a bang.  I went to see my infectious disease specialist on the second.  There was good news: I am no longer in the acute stage of mono, I am now in the convalescent stage.  Except that really is only good news on paper, because the convalescent stage can last up to six months.  And having had mono before, I know that it’s pretty much guaranteed to with me.

I felt so miserable (physically) that very day that I went to the urgent care directly as I had finished my appointment, and they pumped me full of two liters of fluid.  I didn’t have to pee once.  I tell you this, because as anyone in the medical field might recognize, it was indicative of my severe dehydration.

The next day I took my two younger sprites down to see the lights at the Denver City and County Building, as I was meant to do the day before, but couldn’t, being hooked up to an IV and all.  This may have been a mistake, as I was in no shape for it (there was much to see, so we got out and they ran around while I trailed behind and hollered for them not to get too far away), but we had a really nice time and I managed to save my meltdown(s) until I came home.

I haven’t melted down like that in a long time.  That night I was like Vesuvius.  Explosions and tears and anger and yelling and frustration. . .  Well it got very ugly.  I was emotionally and physically drained, and had made the mistake of actually looking long-term and realizing that July was when I was probably going to be back to about 85%.

See, that was (and still is) kind of a huge thing for me to deal with, because I pretty much spent three years in bed due to mental illness.  Except for appointments and very rare visits with friends, I lived my life curled up in my sheets.  I couldn’t wrap my head around being forced back into a state like that, even temporarily, and even when I was doing pretty damned good psychologically.

Well, I had a lovely friend, whom I actually reached out to — which is huge in itself — help me through that night.  And for that (among other things) I’ll always be grateful to her.

So I’m dealing with the mono recovery road, but I’m also dealing with sciatica.  I developed mild sciatica about a decade ago, in my left hip and leg, when The Artist formerly known as Babygirl (I can’t call her Babygirl anymore, I’m afraid, she’s 13 and way too grown up) had been riding on my hip for a couple of years.  It went away — I would get a tinge every now and again, but no big deal.

Well, starting last Fall, it came back, and it came hard.  A couple of the times I went to the urgent care for Dilaudid injections, the sciatica was my primary pain.

(Side note:  My primary care doctor and I — the one I was certain there was no hope of salvaging a relationship with — somehow hit the reset button during one of my urgent care visits.  A doctor at another location in the same network that my doctor works in essentially treated me as a crazy drug-seeker, which pissed my doctor off righteously, and I’m wondering if it maybe made him see the way I felt he was treating me [minus the drug-seeker part, he's never treated me badly from that standpoint].  Whatever it was, he and I are now on the best terms once again.  Just goes to show you, there is always hope when a person is a good person.)

It continued to build, and it continued to build, and after seven urgent care trips in two-and-a-half months, and a conversation on the phone with my doctor this past Thursday, I ended up spending Thursday night in the emergency room.  My doctor wanted me somewhere they could do a more thorough workup, instead of just treating the pain, and I was happy to defer to him.

It took two shots of Dilaudid (I don’t think the first one was more than one milligram, I think the second was about twice that), but finally, finally, and for the first time in months, I think, I was out of pain.  I knew that day that I was in a great deal of pain, and waiting in the ER to even get through triage was pretty ugly, but I don’t think I knew how bad the pain really was until I got out of it.

So I saw my primary in the urgent care on Friday, because his office said they couldn’t get me in until the beginning of February (he said other things when I saw him).  I have an MRI set for Monday morning to check for a slipped disk or spinal compression, I’ll be set up for physical therapy contingent on the results of that, I’m taking an oral steroid — if that helps there will be steroid injections to follow — muscle relaxers, and I’ve got my good friends ibuprofen and oxycodone keeping my pain minimal for now.

It took me some time to process all of this, and I’m probably not done — right now I’m just kind of high.  I keep hearing things from people like, “Wow, you just have one thing after another,” or, “It never stops for you, does it?”  And there is truth in those statements.

But, with the exception of The Night Of Vesuvius, I’m alright. Better than alright.  Even that night was just some dealing and processing I had to do to get to here.  My mental health is well intact, praise God, and everything else will fall into place as long as I have that.  After being without it for so many years, I feel like as long as I’ve got it — and all of the support my amazing friends and family show me — I am leading a charmed life.  It may sound cockeyed, but then so have I been cockeyed for pretty much all of my life.  ;)

You may not be hearing from me much, as I have instructions not to sit for long, and when I do rest, the only way that I’m comfortable for any length of time is if I lay down and stick two big pillows beneath my hips.  You try working on a laptop at that angle.

But I’ve been playing on Twitter; if you don’t already know me there, my handle is @BlushingScarlet.  That I can do from my phone, which is easier to stick on my stomach and type with.  I’m going to still do everything I can to be a good admin for A Canvas Of The Minds, which now has so many wonderful authors that they can easily run they site without me (which is good, I may not be writing much there for the present).*  I’m reading posts from my phone, and clicking the “Like” button is my version of “I was here, thank you for giving me something worthwhile to read”, and sometimes I will attempt a comment — though those can get a little too runaway for a phone and a girl like me.

My personal correspondence is going to be a little slower.  And by that I mean even slower than normal.  Same with comment responses.  But just know it isn’t because I’ve forgotten, okay?  I love you all so very much.

I’ll leave you with the pictures I took in the ER while high as a kite on Dilaudid, Prednisone, Valium, and at least one or two other things.  I honestly just remember there were multiple shots and I swallowed a cupful of pills, and those of you who know me well know that for me to have been that willing to put so much blind faith in any doctor, things were pretty bad.  But I had fun trying to take pictures amid the tangle of wires (blood pressure cuff on my left arm, pulse oximeter on my right pinky, oxygen hooked up to my nose, mp3 player headphones in my ears to help zen me out) in my little ER bed.  Thank God the nurse left the sides up, I probably would have fallen out.

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And also, I give you the immortal words of Jon Bon Jovi, from the song Its My Life: “My heart is like an open highway/Like Frankie said, ‘I did it My Way‘”

“Don’t bend, don’t break, baby, don’t back down. . .”

I won’t if you won’t.

Kisses,
Ruby

*Speaking of Canvas, we can now boast of two Freshly Pressed authors! In case you missed it, DeeDee was Pressed in December for her piece Coming Out Bipolar, Round 1, and just this past week Alice was Pressed for her piece Epic Quests and crap like that. Congratulations to them both; they write good shit, and more importantly, they’re good eggs. Now they just have to get something they’ve written for Canvas Pressed!

© Ruby Tuesday and I Was Just Thinking. . . 2013. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

How Far We Have Come

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I wrote the following in my gratitude journal today, after coming across the text snippet.  For those of you who don’t follow that blog, I’ll share it with you here.

I am grateful for the relatively minimal number of meds I now take with such maximal results.  An excerpt from something I wrote about two-and-a-half years ago:

By contrast, daily I now take four different medications (all to treat what ails me, none for management of side effects) daily.  I also take three supplements every day.  The first is a mega-dose of folic acid (4mg) to try prevent any damage to the baby I don’t intend to conceive.  That probably sounds a bit strange, reading the post I wrote about how women should be as responsible as possible in this area will explain it much better.  The second is CoQ10, on the advice of my primary.  It’s a non-essential, he just said something to me like “with all the stuff you’ve put in your body in the past few years, it’s not a bad idea”, and I decided he made a good point there.  And the third is to give me thick, pretty hair.  Seriously.  I think it works well, and it isn’t ridiculously expensive, so I take it.  But once again, non-essential.

Finally, I have three semi-somewhat-kind-of-regular PRNs (as needed).  And one of them is for migraines, not mood.

I do have a difficult time conceptualizing what things were like for me, for all of those years.  It’s also occurred to me as I was writing this, at the risk of sounding corny — don’t give up.  Look at how far I have come.  No, it wasn’t the most fun time in my life, but seriously, I am in such a happy, stable place that it is mind-boggling.

I got here.  You can get here, too.

© Ruby Tuesday and I Was Just Thinking. . . 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

The Ties That Bind Me

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As you read this, please remember that I take all medication under the supervision of a psychiatrist, and also that my drug metabolism is quite unusual, so I often take very high doses of medications that would be extremely unsafe for most people. Don’t ever, ever try this at home.

Two days before I was to embark on my latest trip back to Pittsburgh (Monday, the 15th), I felt myself stricken with anxiety almost immediately after waking up.  I took a Xanax, and I did pretty well running what were meant to be the last of my pre-travel errands.  I went to sleep that night calm: purchases made, laundry done, a whole day left to arrange things in my suitcase.

The following day I woke suddenly at 4:22 in the morning, despite the fact that I had gone to bed at about ten the night before, and my body likes much more than six hours of sleep, especially if I have ingested any benzos.

I couldn’t get back to sleep.  A little while later, I again recognized anxiety and took a Xanax. I went out for a chai, and drove around in the five a.m. darkness for a while, allowing the fresh air from the open windows to soothe me.

Within another hour came another Xanax.  I was wound up like a spring.  I realized I had one or two more errands to run after all, and down the hatch went Xanax number three.

It was at that point I realized I was in the grips of a panic attack so intense that the last one of its caliber had sent me to the Emergency Room for a night.

Sitting in the parking lot in front of the open-air mall I was about to patronize for some odds and ends, I talked on the phone to my shrink.  He could get me in for 15 minutes that afternoon, could I make it?

Could I?  I would have cleared my entire schedule!  As I hung up the phone, I realized what had woken me up in the early hours of the morning had been terror.  I just couldn’t figure out why.  I had general anxiety about the trip — I’m not a nervous flier or anything, these trips just bring with them a special brand of family stress.

Xanax number four was popped in the doctor’s waiting room.  If you want to count along, that’s eight milligrams of Xanax in as many hours.  And not only was I not asleep or in any way goofy, I was so wired that my psychiatrist, who had previously been against giving me any more benzos, was pretty nearly throwing them at me.  I got more clonazepam (Klonopin).  I got more diazepam (Valium).  I got permission — actually it was much more like encouragement — to take the diazepam on top of the mass amounts of alprazolam I had already ingested.  And for the first time in the relatively short ten months we have been seeing each other, I thought, ‘Thank God for this man.’

But even with all of that, do you know what I have spent most of this trip doing?  Arranging my belongings.  And rearranging them.  And taking things apart to reorganize.  It wasn’t until I repacked my carry-on for the eight zillionth time that the light bulb went off in my head.  Hello, OCD, haven’t seen you around for a while!  Haven’t missed you, either.

Now don’t get me wrong, I know it could be so much worse, because in the past it has been so much worse.  I’m soothing myself, while distracting my brain from all of the germs I can feel on every surface of this hotel.

I’m dealing.  I’m coping.  And while it certainly isn’t the most fun way to spend my trip, it’s a very interesting insight into the way my anxiety disorders are linked.

I’m just praying that nothing triggers my PTSD.  Which, given that it’s primarily linked to a fundamental betrayal of trust — and electroconvulsive therapy — I’m thinking it’s unlikely.

I’m praying it’s unlikely.

(Note:  This post was written Sunday, the 21st (four days ago) while I was traveling.  I’ll pre-date it accordingly, but just a heads up that this is not exactly the current state I am in.)


© Ruby Tuesday and I Was Just Thinking. . . 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. Any and all permissions set forth here are superseded, and when applicable revoked by this page’s Creative Commons Attribution-NoDerivs 3.0 Unported License.

The Addiction Thing

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Do you know, it’s been so long for me, I’m kind of having some difficulty figuring out how to start talking about what I dealt with when I was fighting my mental illness dragons?  I’m only about seven months out, and I don’t pretend that what I live with will not have to be accounted for and managed for the rest of my days.  There’s this enormous disconnect, though.  Because I know I’ve won.  I spent about six years solid in a terrible war, one I had given up hope of ever winning fully, toward the end.  And here I am now. . .  This life is so different from that one, it’s difficult for me to bring back the sense of it.

But it’s still there, in its strange, separate space.  I haven’t forgotten.  Maybe it’s my mind’s gift to itself that I don’t have the sense of those dragons tearing at me.  But that doesn’t mean I don’t know how they did.

And to think, this wasn’t even meant to be so terribly heavy as all that.  But even I don’t know what my fingers are going to say until they get down to it.

One thing I was always grateful for was the absence of what I would come to call “the addiction gene” in me.  I never smoked cigarettes. When I was young I played around with pot for maybe a year, but it never did anything for me, so I just stopped bothering, and I never got into anything “harder”.

I have taken Vicodin for my migraines for more than 16 years.  Pretty much always as prescribed, though I’m not going to say that in all those years I never doubled up a dose because I was in so much pain.

Alcohol was fun in my early 20s, but I never drank like most people I knew.  I was always the designated driver, and while occasionally I would get good and tight at home or at my sister’s, it was very much a rarity.  Recently I decided I needed to stop consuming any alcohol, because even just having a drink or two makes me severely maudlin for three or four days after.  I’m sad that I can’t have my strawberry margs anymore, but the havoc drink wrought in my mind – and to some degree, my life – it just isn’t worth the trade.

And last year, last year I was on Valium for my mania, because we had run out of ideas.  Valium is not meant to be a long-term, three-times-a-day solution to anything, because the incidence of addiction is so high.  My current psychiatrist doesn’t like to prescribe it at all; I had to fight for a dozen pills earlier in the summer when I was dealing with anxiety that nothing I’d tried would alleviate (it turned out to be from the premenstrual dysphoria, and those Valium I fought for helped very much indeed).  I’m actually getting ready to go to the mat with him over it again, but that’s a different story.  Coming down off of months on that particular drug was probably the most hellish substance withdrawal I ever dealt with in my life, but I did it and I did it twice over.  There was never any question in my mind that I could.

When the Let’s Talk About section on A Canvas Of The Minds was launched a year ago with the topic of Self-Medicating, our authors discussed things like self-injury, shoplifting, drugs, drinking, sex, eating disorders, and more.  The closest I came to having something to say on that subject was to discuss my shopping habits, the over-spending and credit card use that got me to the point of needing to file for bankruptcy.  And as it turns out, I’m not really sure that falls into the category of self-medication, especially not in the broader context of addiction.

Thing is, I know how incredibly lucky I am.  I’ve always known.  Addiction runs through both sides of my family.  Some have been spared, some have beaten it, some are managing it, and one beautiful soul died because of it.  My Uncle Jimmy, my dad’s baby brother, he died about ten years ago after struggling for years with addiction to, primarily, Vicodin.  Of all things.  The same crap I’ve been prescribed for migraines since my teens, and never had any issues with.  The hydrocodone wasn’t what got him, it was the acetaminophen that it’s typically cut with.  And when I say “cut”, I mean the way prescription Vicodin from your local pharmacy is prepared.  Most states won’t sell straight hydrocodone, you either get it in Vicodin or Vicoprofen (ibuprofen replacing acetaminophen in that).  So eventually, his liver couldn’t handle it.  He didn’t overdose in one sad event.  Over years, my dear sweet uncle was taken out by the likes of Tylenol.  And heavier and heavier this post gets.

But he is my guardian angel, that I know, though I only met him a very few times.  Maybe that’s why I’ve never had issues with addiction, which is so commonly concurrent with bipolar disorder.  I don’t know all the finer points, but I do know he’s been looking out for me for a long time.  Even when I was 11 and he was in his late 30s, we were kindred spirits.  Death sure as hell didn’t keep him from watching over and taking care of me.

Do you want to know, finally, what I set out to write this post about?  What has become my one addiction in life, one that I recognized this morning had actually become a problem for me?  I officially give you permission to laugh, because after all of that build-up, I kind of have to.

Chai tea lattes from Starbucks.  I know, right?

It started out as a drink I just really liked.  At some point I discovered that the combination of the heat, whatever blend of spices is in the chai syrup, plus the caffeine helped with my migraines.  Okay, that is to me still a legitimate reason for drinking them.  I also found that sitting and sipping these hot drinks was a comfort for me, a way to soothe anxiety (in spite of the caffeine), depression, mania, a whole host of symptoms and manifestations of the various things that made up my personal Alphabet Soup.  And that was fine, too; I could happily rationalize the hell out of that, anything that was so innocuous and helped quieten the dragons in my mind was (and is) okay by me.

And really, in the grand scheme of things, there isn’t anything terrible about me drinking chai.  Yes, right now where I am financially, it’s not such an easy habit to sustain. And yes, I have to be careful to watch my blood pressure when combining any amount of caffeine with the Carbatrol I take (or so says my doctor – more or less).  But what really got me this morning was, well, me.

I’d fallen asleep on the couch watching a movie.  I woke up this morning, and my first clear, conscious thought was, ‘What time is it?  Is Starbucks open?’  I proceeded to grab my tumbler, a five dollar bill, and my keys.  I was in my pajamas, which is no big deal, I go places in my pajamas frequently (especially Starbucks).  But my hair was sticking up funny on one side, I looked genuinely strung out, and for the first time since I’ve been well, I didn’t even attempt to make myself slightly less horrifying.  I just went for it.

And I thought, as I drove to get my “fix”, ‘Something ain’t right here, girly.’  The sunrise was gorgeous (oh wow, was it ever!), the temperature was just perfect, I had Simon and Garfunkel’s America playing, and things fell into place in my head and I realized the jig was up.

There’s nothing wrong with me enjoying my chai.  The baristas at my local Starbucks are lovely to start my day chatting to.  But right now, this shit owns me.  And yes, I know there are much worse things to be owned by.  And yes, I feel a taste of the absurd given all that I wrote leading up to this.  But what it comes down to is that nothing owns me, nothing ever has, nothing ever will, and I have to find a way to walk away from something that has become so much more than a “guilty pleasure”.  Everything in moderation, if I can manage the moderation.  If I can’t. . .  Bye-bye, sweet spices and milk and steamy goodness.  Not even for you will I let go of one tiny bit of my self-containment.

I don’t blame this tumbler.  It’s merely a pawn.


© Ruby Tuesday and I Was Just Thinking. . . 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

Premenstrual Dysphoria, Mood Disorder, And All The Joy That Comes Along With It

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It started during the first round of the NHL playoffs, I know that for certain.  Well, that’s the first time I noticed something, anyway.  I remember sitting in my family room, overwrought and having murderous thoughts about my father every time he would flip to another channel during period breaks.  It got me timing them on my phone, 17 minutes to the second, and after that he had better watch out.  I didn’t really think too much on it, after all, hockey is the closest thing I have to an organized religion, and I’ve been pretty intense through playoff seasons in the past.

Except a few days later, it progressed to me watching the games on the television in the basement.  I was very upset and reactive, and not just about hockey.  My father became the target for my anger, and my mother for my not-quite-hysterical crying jags.  I thought it was hypersensitivity and anxiety, and in many ways, it was.  Just not quite the ways that I thought.

Then my head started pounding with migraines.  I became exhausted.  I already knew my emotions were all kinds of erratic.  And I was spacey and generally unfocused.  I would stop in the middle of sentences and just stare off at nothing, losing thoughts – or even the ability to generate them – completely for a minute or so.  I knew by then things were not at all right.

The migraine tied it up into one neat little cluster of symptoms for me.  It was all related to my headaches, a seed my psychiatrist had planted with complete innocence at one of our early visits.  He had discussed my migraines, my mood, and done some very casual speculating about temporal lobe epilepsy.  I brushed it off entirely in the moment.  When I was having psychogenic nonepileptic seizures (PNES) from the post-traumatic stress disorder (PTSD) that manifested due to the electroconvulsive therapy (ECT), I was sent to see a neurologist specializing in seizure disorders, the Man, every doctor in the land knew of him and how good he was (and I had to wait six months for an appointment).  He cleared me absolutely of epilepsy, or any kind of pathological seizure disorder apart from the one induced by the trauma.  And yes, it was fun to stick all of those unpleasant acronyms into one sentence, thank you.

But with my bipolar disorder stabilized, there was this strange cluster of symptoms that I knew beyond a shadow of a doubt were not bipolar-related, and the migraine was seemingly the pivotal item upon which they all rested.  There had to be more to explain it.  Especially because shortly after the migraine episode passed, my symptoms remitted.  After a second episode when I was back home to visit my family in Pittsburgh, I began to poke into information on partial seizures, and even made an appointment with Dr. the Man.  But while, in theory, things were coming together, something about this explanation didn’t feel right to me.  I canceled the appointment and just kind of left things alone to simmer.

Then last month, a light bulb went off.  The light started in my uterus, but quickly made its way to my brain.  I was holed up in my room, I had been for days.  I wanted to smash someone or something, I was gobbling up Xanax and weeping, everything around me was irritating and stupid, I was exhausted and my head hurt. . .  And then I had a cramp.  Just a small one, but it pulled everything together in my mind.  I looked up the symptoms of premenstrual dysphoric disorder (PMDD), and voila!  My mom had it, too, which I knew somewhere in my brain.  They gave her a couple of medications to try back in the day, but apparently the cure was worse than what ailed her, and she just had to ride it out. Cooped up in a house all day.  With two small children.  Good Lord, that woman really is a saint.

So between me, my OB/GYN, and my psychiatrist (except mostly it was me), we’ve got it all set to where I up my mood stabilizers (Carbatrol and gabapentin) at a certain point in my cycle, and I’m a normal (well, my version of normal), mostly functioning human being again.  I’m still a little more anxious, irritable, and weepy, but I have been getting by pretty well on the balance. Especially since I started kickboxing again. Such joy, such release, endorphins, everything that is good.

So since things are going so well, let’s throw something into the mix to fuck things up.  It’s the way things work for me, I think I would be caught more off of my guard if things just went to plan.  And honestly, there is no bitterness in that statement.  I am completely used to it by now.

The IUD.  Oh God, the saga of the IUD!  Everything about it has been great, except the excruciating pain after insertion and the unholy cramping of my last period.  I don’t think I gave quite an exact idea of that, and even if I did, I’m going to again.  Keep in mind, ladies, that this is super-atypical.  There is usually increased cramping during your first couple of periods, but not, not, not anything like this.

Last period, I spent the majority of time basically bed-bound.  I had a heating pad cranked up to very high, I was taking Vicodin, alternating every three hours with mega-doses of ibuprofen, and I added in some old, expired muscle relaxers that belonged to my dad (he was happy to contribute what was left in the bottle as long as I shut up after I said the word “cramps” – and by the way, don’t be stupid and ever try this at home), and I had worked out a technique to keep myself immobile from the chest down by the end of the first day.  It was a simple thing, I moved, I wanted to die.  Pain really is a fantastic learning tool.

And still, and still, all of these measures only made my pain just bearable.  I swear to you that I am not playing up the intensity of this.  It started in my back, wrapped around my abdomen, and actually went shooting all the way down through every nerve in my left leg, out through my foot.  My OB/GYN said that it sounded as bad as labor pain to her.  I have no frame of reference, but I did feel totally legitimized and not like I was being a whiny bitch about things.  So that was nice.

And now I’m counting down to go time again.  I’ve got my shiny new bottles of (doctor prescribed) medication in my nightstand.  I’ve got my heating pad next to my bed.  I am all prepared.  Only I’m stressed as fuck about it, of course.  And ladies, you should know what stress can do.  It can delay your period!  Which for me means a longer time on an increased dose of mood stabilizers.  Which at this point is honestly making me a little dopey.  Time is passing oh-so-incredibly slowly, I’m walking around in a bit of a fog, and I just feel like there is something like a medication buildup clogging my brain.  But I can’t knock my doses down, because even now I’m still edgy.

Of course, there is somewhat of a light.  The good doctor and I agreed that we’ll (we’ll? what, is she going to go through the pain, too?) try two more cycles, and if the pain doesn’t get any better, the IUD comes out.  Which is a bridge I shall cross if and when I can see it in front of me.  Right now it’s a pretty long way off.

© Ruby Tuesday and I Was Just Thinking. . . 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

The Illusion And The Reality

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I really started this post out with the intention of addressing a handful of common misconceptions consumers have about psychiatric treatments.  There is a great deal of information “out there” that frustrates the hell out of me when I see and hear and read what people have been told about various psychoactive medications.  But ultimately, this post came down to just one medication, and just one idea, because it’s one that seemingly almost everyone believes, and it can really hinder your ability to become well if you suffer from bipolar disorder.

Now, I don’t really expect you to listen to me.  I wouldn’t have listened to me when I began treatment either.  But that was six years, over 50 medications, 16 shocks to my brain, and countless hours and forms of therapy ago.  And it’s time for me to stop feeling hurt and frustrated that everyone has to learn things their own way, and that all of this knowledge, all of the research and reading and questioning and talking to specialists I have done over the years; all of the critical thinking and arguing until I found solutions that gelled both with experiences and the literature seems only to be beneficial to one person: myself.

Don’t get me wrong, I’m delighted that I have reaped the rewards.  I am well.  For the first time in decades I can say, I can shout, without fear of contradiction or a nagging thought that it will all fall apart on me that I am healthy, and I am happy, and that all of the things I went through were worth it to get me here.

My frustration comes out because I want to fix everyone else, too.  And when I finally got tired of offering knowledge that was for all useful purposes disregarded (of course not in a hurtful or even deliberate way), I stopped offering any input at all.  Which is ridiculous, but it was a way I had found to cope.  A coward’s way.

As it turns out, I am not cut out to be a coward.  Nor to shut my mouth even if no one will listen.  It doesn’t suit.

How many of you are taking Lamictal (lamotrigine)?  I know a lot of you are, and a lot of you are taking it as a mood stabilizer.  I’m going to tell you something about it, something that absolutely baffles me more people don’t know, and that it would seem more doctors don’t know.  (Yes, I do know more that your psychiatrist.  About a great many things.  There, I’ve said it.)

This I have to address, because I recently witnessed two very painful situations with good friends, up close, that were directly a result of improper prescribing of, and reliance on, Lamictal.  One friend I know from blogging, and one I know “in real life”, but they both fell into the same trap.  And so much damage was done.  And I see so much more in my reading of blogs, maybe not always active damage like in these cases, but a passive damage (if I can even use that term, I’m all keyed up and can’t think of a better one).

Now let me set the record straight right now.  I am not Lamictal-bashing.  I took it for years, and I think that it is a wonderful medication, an absolute godsend, when prescribed correctly.

But do you know what Lamictal is not?  Lamictal is not a mood stabilizer.  Let the stoning begin.

Lamictal has had a very positive history for treating bipolar depression.  And, yes, it was classed (on some not-so-strong evidence) as a mood stabilizer in 2003 (I’m going by the FDA, as I live in the U.S.).  But my former psychiatrist expressed about as early as a month on in my treatment, I think in about 2006, that Lamictal has no efficacy at preventing mania or hypomania.  Considering that the Food and Drug Administration only approved it as a mood stabilizer some three years before my doctor was in on the joke – and he wasn’t the only one – I’m wondering why it is still so widely prescribed as one, now, in the year 2012.

And no, I am not taking one doctor’s word on this.  If you’ve only just found me, it’s okay, I forgive you, but for those of you who have known me for any length of time?  Shame on you for even thinking I would do that!  I literally have texts piled around me on the bed right now – texts, not layman’s guides to bipolar, which can, of course, be very, very valuable; I read enough of them, certainly – but books I had to hunt down and shell out for because they contain the source material, the studies themselves, and they all say the same thing in different words.  I’ll give it to you from my favorite, what I call “The Bipolar Bible”, Manic-Depressive Illness:  Bipolar Disorders and Recurrent Depression (Second Edition) by Frederick K. Goodwin and Kay Redfield Jamison.  It’s so pretty.

On the subject of lamotrigine, a tidy little summation of a great deal of information:

“Case reports and open studies have suggested some efficacy for this drug in treating mania, but this finding was not confirmed in controlled studies. . .  Other controlled studies in patients with mania/mixed states and hypomania found no significant difference between lamotrigine and placebo.”

The emphasis on hypomania is my own, because often, this medication is used as a “mood stabilizer” in Bipolar II.

Like I said, I am not trying to imply that Lamictal is not a worthwhile medication.  On the contrary, I feel it is an excellent medication, especially for bipolar depression, when combined with a legitimate, tried and true mood stabilizer.  Lithium, Depakote, carbamazepine/tegretol (for a few examples), even success can be seen when combining it with antipsychotics.

But so many people out there are prescribed it as their go to.  And in a few anecdotal cases, it may help.  Hell, I’m taking gabapentin, which failed the clinicals miserably as a mood stabilizer, but works for a handful of people, myself included - in conjunction with other medications.

So consumer beware.  It’s your body.  It’s your life.  They are your ups and potentially downs, and hypomania and mania can manifest in many less obvious and unpleasant ways: anxiousness, irritability, anger, etc.  I know that of which I speak.  I lived it (and still do, in moments).  Relying on Lamictal to be a mood stabilizer is a little like doing a high wire act with a net that isn’t really there.  You feel like you should be safe, you’ve been told that you are safe, but the reality is, there isn’t anything at all to break your fall.

© Ruby Tuesday and I Was Just Thinking. . . 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

Through Pain Comes Growth

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I’ve heard that, you know.  I remember it most specifically from an episode of The Nanny, of all sources.  But I have no idea what has come from my latest pain save meals of hydrocodone and promethazine, and a renewed terror of the Migraine Monster.

I’ve had severe headaches since I was quite young, so young, in fact, that my mother remembers them more vividly than I do.  What I remember is a diagnosis of common migraine (a migraine lacking aura – all the weird, usually visual changes that precede the pain by roughly 20-30 minutes in a complex migraine) more than half a lifetime ago.  There was one emergency room visit with CT scan (normal), injections and prescriptions of every drug developed for migraine ever (please don’t make me reiterate them all), prophylactic meds in failed attempts to prevent them, or at least lessen their frequency, about a half-dozen specialists who all confirmed that my brain wasn’t doing anything underlying to cause this pain, and from all of that we have arrived where we were more than a decade-and-a-half ago.

The only thing for the pain is Vicodin (unless someone wants to hospitalize me and give me a nice shot of Demerol in the butt, makes me throw up every time, but oh! how it obliterates that pain!), and thank God I have a doctor who trusts me and is willing to write me for it. And now I’m drinking promethazine for the nausea, because last November, for the first time in all of my life, the nausea progressed to actual vomiting. It was traumatic, having never happened before, so I now work to avoid it.

All of that being said, this time was entirely different.  Trying to even remember. . .

About two-and-a-half weeks ago, I started getting horribly irritable, reactive, anxious, emotional.  These were no mood symptoms, at the time I had no thought of what could be causing them.

Then, last Tuesday into Wednesday, the dam broke and there was pain.  Oh, was there ever pain.

But there were pain-free periods interspersed, and they were sometimes worse.  Because I experienced in them such confusion, the first night was nearly an emergency room visit because my blood pressure jumped and I felt as though I was dying.  The problem is that after my ER experience for a dystonic reaction, I realized that sometimes that little voice is there for a reason, and that it’s better to err on the side of a little hypochondriasis than to, well, die.

I basically lived through some psychosis that was entirely unrelated to mania or depression.  My mood has been completely stable throughout this.  Really stable.  Almost frighteningly stable, if that can be said.

So the pain alternately remits and returns through this past Monday, with less intensity each time.  But it wasn’t until late afternoon on Monday, when I finally passed out in the middle of a text conversation, and slept for nearly 24 hours that I felt like I was on the mend.  I always need to follow my migraines with a good, long sleep (I’m told this is not uncommon).

I still expect another few days of being “out of it”, convalescing, recovering.  My writing alone should indicate that my brain is not yet back to where I want it to be.  This is decidedly not my best effort, but I don’t know how really to share a migraine with you.  When it’s intense, there is no looking at any light, so I cannot type something up.  During the brief periods of remission, I have been able to type short emails, comment responses, etc., but no long trains of thought.

I guess I want to post this because my brain is still so addled.  It will give you some sense. It is not brilliant work, but it meets Ruby’s standards for valuable because it is honest work.

Incidentally, I have never in all of my days experienced a three-week-long migraine.  I have an inkling of what may have caused it, but if I’m right, well. . .  It’s going to be ugly for a while.

© Ruby Tuesday and I Was Just Thinking. . . 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

Deconstructing Ruby

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Something kind of interesting has happened since my last post, exactly one month ago.  I seem to have lost the habit of being able to write one of these.  But I guess the best way to do this is to just hurry up and do it, and trust that the things I need to fall back into place will do so.

That isn’t the only interesting thing that happened in my life.  December happened, Christmas and the New Year’s holiday and stress as well.  Slipping under and breaking the surface and treading water.  I’ve dealt with unrelenting migraines, relationship stress, seclusion and self-isolation, and a recently worsening essential tremor.  But I have also enjoyed unwavering love, support, and understanding from the people I need most.  I’ve had wonderful news (news that something akin to superstition will not yet let me post here, but hopefully soon), and thanks to an offhanded suggestion by my mother, I am delighted to announce that I am reading again!

(I am eating up books at a speed that has even astonished my mom, who knows how much I used to read.  I think the “slow processing speed” they tagged me with during my neuro-cognitive evaluation is a load of rubbish.)

Actually, I have written about a dozen posts in my head.  I just trashed each and every one.

Right now I am in sort of an odd place.  My mind is actually pretty peaceful, for the most part.  I am content to just let each day unfold on its own, to not force myself to do or think about or be anything except what I am.  I have been calm and relatively symptom-free, despite the fact that I am not currently taking any medications to manage my mood and anxiety disorders.

But. . .  Well, if I look at things from a different perspective, I seem to see that by all objective measures I am severely depressed.  I almost never leave my house.  It is just too colossal an effort for me to even drag my coat and shoes on over my pajamas and drive two minutes to get some coffee.  I barely eat.  Even simply heating something on the stove is too big a task.  I have cut myself off almost completely from all of my friends and family, except for my parents.  Aside from my newly rediscovered passion for reading, I don’t really have any interest in doing anything.

So why don’t I feel like I am depressed?  Oh well.  Small favors, right?  Or, actually, that would be a very large favor.

I hope that all of you have been keeping well.  My next big step is going to be to step back up to the green felt table and throw in my chips for some more medication roulette, it would seem.  All psychological and psychiatric issues set aside, these constant, debilitating migraines I have been dealing with are forcing me to go back to taking something regularly to control them.  And a lot of the medications used for migraine management are also used for mood management.

Moral of the story:  ”And so it goes.” ~ Kurt Vonnegut, Jr.

© Ruby Tuesday and I Was Just Thinking. . . 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.