Monthly Archives: April 2018

Don’t Miss Out On The Little Things In Life

Today is World Penguin Day. I love penguins. I love their little waddle walk, their permanent tuxedo attire, and just about everything else about them. I have seen them in zoos, warn them on my feet (fuzzy slipper socks with penguins embroidered on them), and watched all the penguin movies. But it was a story …

Pinch Me

Five days settled, which means I’ve ticked a few things off my Master List:

Furniture rearranged and boxes unloaded.  Check.

New bank account opened and changes reported to Social Security.  Check.

Internet connected and (HooHoo!) a Netflix subscription ordered.  Check.

Most important wall hangings up with the rest on hold.

I’m thinking more about fabric, fibers, flowing funk.  Must ponder this a bit.

Modest IKEA and summer clothing orders finalized.  Check.

Cats settling down and loving actual window sills that offer views of pregnant robins and mourning doves.

Today, I’m off to start applying for Medicaid, then browse a big antique mall for an idea that’s percolating.

I know its early days, but we all love it here.  We love the funky, older construction of the duplex, the friendly neighbors, the bend-over-backwards landlords, the wealth of shops and amenities, and the joy of family rediscovered.

So, pinch me.  I think I’ve come home.

(P.S.) My Etsy shop is open again (the link is in the sidebar at left).  Not that there’s anything new yet, but some folks wanted to know.  And there WILL be new stuff.  Soon.

The Good Guy

You are always a good person the day people find out you died. This phenomenon is pretty amazing actually. I suppose it stems from that old adage ‘don’t speak ill of the dead’, but it goes well beyond that. People love to talk about the good things when they hear that news, no matter what […]

Bipolar Disorder Psychopharmacology: Updated Guidelines

In March 2016, the British Association for Psychopharmacology published new bipolar disorder guidelines.

Summary by Flavio Guzman, MD below.

The complete publication is 59 pages long, so I extracted some key points that you may find useful:

• Lithium remains the most effective treatment preventing relapse and admission to hospital in bipolar I disorder (I)

• Lithium prevents relapse to mania and, less effectively, depression (I). The highest dose that produces minimal adverse reactions and effects should be employed.

• Concentrations below 0.6 mmol/L are potentially too low to be fully effective and adverse reactions and effects become important above 0.8 mmol/L.

• Lithium reduces the risk of suicide (I).

• Valproate as monotherapy has limited trial data, is somewhat less effective than lithium in the prevention of relapse.

• Valproate should not usually be considered for women of child-bearing potential (I).

• Carbamazepine as monotherapy is less effective than lithium, has little if any effect on relapse to depression and is liable to interfere with the metabolism of other drugs (I).

• Lamotrigine is effective against depression in long-term treatment (I) and should be considered where depression is the major burden of the illness (IV).

Running Away From Home

photo by Karen Cox

When I was a teenager, I lived in Ohio, and all I wanted to do was leave. The suburb I lived in was homogenous and boring. The surrounding area had little to interest me. I was miserable. When it came time to select a college, the first thing I ruled out was anything in the state of Ohio.

It did not occur to me then that the reason I was miserable was not the state of Ohio, but bipolar disorder. And of course I took that with me to college.

When I returned to Ohio and began living in a suburb very near the one I grew up in, my friends were astonished. “I thought you hated Ohio,” they said. “I never expected you’d come back here to live.”

What I had been seeking was a “geographical cure” for a problem I didn’t know I had. I thought could outdistance it, outrun it, make a new life for myself somewhere better.

Believe me, it’s not possible; unless you are trying to leave an abusive relationship, moving somewhere else will do nothing for your underlying problem. Probably not even then.

The next time I had a chance to take the geographical cure – to move to Pennsylvania – I turned it down. I had by that time built up a support system in Ohio of family, friends, and doctors, and I couldn’t bear the thought of leaving them and trying to build a new support system in an unfamiliar place. (Eventually, my husband-to-be moved from Pennsylvania to Ohio, where we’ve lived ever since.)

But there are still times when I think about running away from this life. Often, I wish the Mothership would arrive and take me away to some interesting planet or galaxy.

But sometimes, when life just seems to be too much for me, I think of simplifying my life by starting over somewhere. It would be like being in the Witness Protection Plan, I always imagine. I’d live in a small, unimposing town somewhere. I would have a bookstore (maybe used books). I would live in a small apartment over the shop with one or two cats.

But alas, that wouldn’t work. Aside from the difficulties of moving, which I loathe, I would find myself in another place where I had no support system – no doctor to prescribe meds, no therapist to continue my progress with (I hate breaking in new doctors), no family or friends or husband. (I usually picture myself on my own, except for the cats.)

And life would be just as difficult, if on a smaller scale. I would still have days when I couldn’t get out of bed and open the store; weeks when I couldn’t bring myself to shower, driving away customers; times when the loneliness would become overwhelming. I would still have trouble with finances, health, isolation, shopping, business, et endless cetera. At least I would have a lot of books to read.

I would still have bipolar disorder. I might be able to replace some of what I would have to give up; it wouldn’t be easy or freeing. But sometimes I still like to imagine that it would be.

If my husband dies before I do, I may find myself in some form of such a solitary life and have to adjust to it, though I would most likely remain in my comfortable suburb, where I know a few people and have some great friends, and a psychiatrist and a therapist. I doubt I would again attempt a geographical cure unless forced by circumstances to relocate.

But I wouldn’t enjoy it, just as I wouldn’t really if I ran away from home now. The bipolar would just come with me, hopping into my suitcase before I even packed my underwear.

Seeing the light in the darkness of depression

A lot of people struggle with something. Whether that’s having overly busy schedules, trying desperately hard to meet all of life’s demands and perhaps added challenges of dealing with life and a health condition. But what I’ve learned in trying to find a balance of all these things is that even in our most difficult times having hope can be the game changer.

In my role as a mental health advocate I often hear very challenging stories of people living with mental illness or their loved ones walking the journey with them. It’s not superficial conversations. These connections with other people are deeply personal. I feel grateful that I can be a person who can bear witness to the struggles of others, because even in those very trying stories having hope keeps people going.

Anyone who had ever been handed the card of depression knows how important finding something positive to hold onto gets one through the tough times. There’s a reason depression is the number one disability in the world. It causes the regular struggles in life to be much more difficult.

There’s an image I am using in my upcoming talk this week in Athens, Ohio. It shows an entirely dark room with a door open and a crack of light shining through. It reminded me of a day when I was sleeping 16 hours a day during a depressive episode. As I lay in bed I squinted my eyes when the sun slightly shined through the crack in the blind. A tear streamed down my face, as I held onto the hope that one day I would recover.

No matter your challenge, your struggle or the mountain your climbing, know that eventually if you keep striving toward the light-things will get better.

In my view hope is a life saver.

Curiouser and Curiouser

This spring just gets weirder. I am struggling mightily to stay on my medication and sleep schedules, I feel all racy and overstimulated inside, and NONE of it shows on the surface. Not even my family can tell how scrambled my brains are. In the past, I might have called this a mixed episode, though I can’t say I’m either manic or depressed. It’s not an episode at all. It’s just, well…weird.

Sleep is really hit-or-miss these days. I’ll sleep nine hours one night, and four the next. I dream all sorts of interesting dreams too. Last night I dreamt that Will and I were in Walmart and I was buying all kinds of plastic cups and plates in blues and greens, colors that remind me of the waters of the Caribbean. I was racing around the store grabbing whatever appealed to me, and he was smiling indulgently as if to say “that’s my wife, and I love her”. It was such a comforting dream, and one that was entirely realistic because I used to do that exact thing, especially in the spring and fall months. I was actually tempted to run to Wally World today and pick up plastic cups and plates in summer colors, until I remembered that my family has a little more class than that and we don’t  use plastic cups and plates. LOL.

As for meds…I’ve taken them religiously for six years, and then in March I got a wild hair up my butt and experimented with them ever-so-briefly. No Bueno. Now I’m taking them, but every day, twice a day, I open up those pill boxes and stare at the meds, resenting them, wishing with all my might that I didn’t need them, and then literally forcing them down. I don’t know why all of a sudden it’s such a big deal, but I suspect it’s because enough time has passed since my last major bipolar episode that I think maybe I don’t need all of them. Then I end up feeling guilty for not wanting to take my pills, because I have the privilege of access to good psychiatric care and medications and there are a lot of people in this country who don’t. It’s kind of like the starving-children-in-China argument for finishing your dinner. I’m blessed to have the chance to CHOOSE whether I want to be sane or not—even though going bonkers really isn’t an option because I like my family and friends.

Then there’s this other curious notion about going back to work. As a nurse. No, I know in my heart of hearts that I can’t do it and nobody, not even the federal government, believes I should have to, but I wish I could make real money again. I don’t miss the politics or the physical labor or being treated like a child, but I do miss taking care of people. I miss the opportunities to be creative in solving problems. I even miss working with women, although that definitely has its drawbacks. My RN license renewal is coming up in January, and I know I’m going to have to let it go because I’ve had zero practice hours in the past four years. (You have to have at least 900 in five years, and I don’t.) That just makes it so…final. Then I come back to reality and realize that the job would make me crazier than a shithouse rat—again—within a few months, and I’m way better off now even though I have a very diminished role in life.

So here I am, and for whatever reason, whether it’s spring and/or a touch of mild mania, I’m restless and fidgety and I want to shake things up. Now, I don’t have the slightest idea why, or what “shaking things up” looks like, but it’s been this way since I almost went off the rails a month ago. My job is to figure it out before something goes sideways. Maybe I should try writing for one of the online mental health journals, like The Mighty or Healthline or Psych Central. They’re always looking for contributors. Or maybe I should take up chair yoga and learn to meditate (if I could just get my brain to shut up for a few minutes!!). Who knows?

A Chronically Discontent Manic Depressive

 

I was diagnosed with Bipolar Disorder in late 1994 and I’ve had 22 some years to study and learn about this illness. I’ve learned a lot. I read books and magazines all the time and I search the internet. I’ve learned how to dance with this disorder pretty well, especially since last year when I was put on a new mix of medications. I’m doing much better. In fact I feel pretty stable for the first time since my diagnosis. It’s still hard, but at least I have a clue as to what’s possibly coming down the line towards me. My brain is different than it used to be and it’s taken some getting used to, but I’m getting there.

Last year I was also given the diagnoses of PTSD and Dysthymia. I’ve been studying about how these disorders affect me since then, and again I’ve learned a lot. But it’s still new, and I don’t know as much as I need to. I recently read a book called “The Half Empty Heart”, by Alan Downs, PhD. It’s all about Dysthymia, or what he calls Chronic Discontent, and man I can relate all too well to this description. It’s also called low grade depression because it’s always there and never really goes away. You’re in a low state of depression basically all the time. It cycles some but mostly it’s just there, underlying all your actions and thoughts. I read this book a few years ago and it intrigued me, but I didn’t have the diagnosis yet so I just thought about the subject and how it affected me. But since I’ve been diagnosed with it and know more I can see that it’s affected me my whole life. I’ve learned a lot more reading it this time.

One of the main things that people with Chronic discontent deal with is a tendency to emotionally and physically withdraw from stressful or difficult situations. It’s a hallmark of the syndrome in fact. And it’s one of the hardest symptoms to handle. There are exercises in the book that are intended to help you overcome this, but I haven’t gotten too far in that. But I have read enough to know that withdrawal has been a constant theme in my life, since I was a young child in fact, right up to today. When things get too hard for me, instead of trying to work it out I often tend to just disappear and run away from the hard stuff. I can’t tell you how many people and situations I’ve abandoned in my life. Dozens at the least. I’m not happy about this, in fact I’m totally ashamed of myself. That’s a big part of the symptomology too. Experiencing shame is the way we live our lives, based on perspectives we developed when we were very young. We just don’t feel like we’re OK as human beings deep inside of ourselves.

A shame based life is filled with regret and unfulfilled promise. We respond to life as tho we feel we aren’t as good as the people we interact with, and so we self-sabotage many of our relationships. We often are left with no one to call friends any more. That’s my situation. I’ve left so many people that there are just a few left. As I get older this is a big problem. And I don’t have a clue how to overcome it. It’s buried so deep in my pysche and I’m so terrified of changing it that it informs most of my decisions. It might as well be who I am. But it’s not. I still refuse to be defined by my diagnoses, but it’s hard not to be. I’ve always been ashamed of who I am, despite all the good things I’ve done in my life. It’s like they don’t matter and all I can see are my failures and abandonments. This has been true for as long as I can remember, even as a small child. In fact that’s where it started I’m sure.

I don’t mean to blame anyone for this, but it seems clear to me that this began in my childhood, and of course that means that my parents were at the root of the situation. I had wonderful parents and they loved me so much. They were happy to have me, but I was so sickly that they severely overprotected me and I grew up believing that I was too much an invalid to do too many things. This despite the fact that they also told me I could succeed at anything I tried, and I so often did. But the shame I developed over that time lives on today. Back then it was an undefined feeling that I was inferior to other people. I still feel that way. I know that both my parents suffered from low self esteem and I’m sure that it translated into my psyche at a young age. How could it not? Again I don’t blame them. They were just living their lives the best they could after all. But I never talked to them about this before they both died. Now I can’t ever deal with it with them and it’s up to me to overcome it alone. It hurts my heart because I love them so much and yet they left me with such a painful legacy.

The title of this book – the Half Empty Heart – is very powerful to me. It’s a hard thing to face but it’s the way it seems to be. We tend to look at life as a glass half empty instead of half full. And in that we fail to take care of our hearts. It’s very painful when the reckoning comes around and you see all that you’ve lost thru your lack of action, or actions you’ve taken to escape. It seems like every time I begin to have a good life and accomplish something, I sabotage it somehow and end up with nothing left. This is a common experience for people with chronic discontent. We stop ourselves before we’ve even given ourselves a chance to succeed. I’ve so often declined to even begin something because I was sure it was doomed to failure. It’s not that I lack courage. I just don’t have the faith in myself.

But here’s where the mix of diagnoses comes into play. Having Bipolar disorder means that you may cycle constantly and can be up or down depending on your current mood. When you’re “Up” you feel on top of the world and I think that because I’ve lived so much of my life in hypo/mania – the good stuff feelings – that it overcame a lot of my chronic discontent and allowed me to do more than I might have otherwise done. I couldn’t help but feel good about myself, even if it was based in mania and not reality, it still felt good and I believed it was real, so it was. In a strange way I feel lucky to have both of these illnesses together. I think that life would have been much worse for me if I’d just been chronically discontent, or just manic. I probably wouldn’t be here by now I suspect. I think that having those up times of bipolar mania allowed me to distance myself from the bad feelings and I had the courage to do all kinds of outrageous things that nurtured me and kept me happy despite the low grade depression I still felt deep inside. It was a strange mix, and it still is.

The other side of it is that the dysthymia often kept me from displaying florid manias to other people because I was too ashamed to “act out” and embarrass myself. I so often hid my horrible feelings of distress deep inside so that no one could tell that I was experiencing such difficult emotions. In some way I feel that this saved me a lot of heart ache because I never got “caught out” with my Bipolar until I was old enough to make better sense of it than I would have in my younger days. If I’d been diagnosed with it in my teens, as most people with BP are, I would never have accomplished half of what I did do. So the two diagnoses have worked in tandem to help form my life as it is now. Not great perhaps, but I’m not in a hospital (tho I have been) and I’m not dead (tho I’ve tried to be). But I haven’t been that successful in my life either. Depends on how you gauge it. I’ve done good things but I never made much money, and that’s how we judge success in our culture. So I feel like a failure even while I revel in my good works. It’s a weird way to live I guess but it’s what I know and have done. And I suspect there are others who have similar experiences.

I hope I don’t seem to be complaining about any of this. I assure you I’m not. I get it that I’m the one responsible for my actions and ways of being in the world. I’m not making excuses. I’m the one who bailed on my friends and communities in my chronic discontent, and I’m the one who was manic and did great things while I was too. I find it fascinating to try to embrace these two different illnesses. And I haven’t even touched on the PTSD. I could write a whole post just on that. All these diagnoses work together for me, sometimes in helpful ways, as I’ve described, sometimes in terrible ways too. I’m still working on the challenges of having these disorders and sometimes I think I’m even making progress. I hope I am anyway. Life is too hard for me too often, but it’s also so beautiful. I’m a lucky guy actually. I have a wonderful man who loves me to death and I have a home and good food to eat, and so much more. I even have good health, despite these disorders. So take all this as a discussion of how one can manage to live with these challenges and how I personally have dealt with them. At least it makes some sense to me…

If any of this resonates for you too – there is help. Go find it!

Steve

Yay! I Made It To Saturday!!

This week’s post is brought to your courtesy of Monster Energy drinks, the fuel that keeps me going during the week.  In fact, I am drinking an Ultra Violet Monster right now, just for the extra caffeine high.  I know these are basically chemical cocktails, but I DON’T CARE!!!  Monster is my Go Juice.

Needless to say, this job + commute is very tiring.  I have to do everything I can to keep up my energy.  I eat a very boring, high-protein lunch to try to energize me, and I don’t take the full hour of lunch because I start to get tired.  I have to keep moving to keep up my momentum.  I basically go and go and go and then I get home every night and crash.  Then I get up in the morning and do it all over again.  I have a little more than a month of this left and then I guess I’ll move in with Mom and Dad (GIANT SIGH) and my commute will be reduced by about twenty to twenty five minutes which is a big difference.

I don’t know how I’ll handle living with Mom and Dad, but I don’t feel like I can move closer to the job without knowing if this contract will be extended beyond July.  I’m liking the job a little more and I feel like I could do it for awhile.  The people are really nice and that goes a long way.  I don’t know what to do about my IT Security aspirations.  It seems like there’s a very small chance that the City of Longmont will help me get an internship or on-the-job training (I got funding for that through the local Workforce Center) because they have done nothing so far, but I’m going to keep pursuing it.  I think I need more experience in Security and this might be the way to go.  IF they’ll get off their asses and help me.

Yesterday was my Dad’s 85th birthday and it’s kind of a miracle that he’s made it to 85.  He’s been so close to death so many times but he just keeps coming back!  So today we are going to have a big celebration.  I got my Dad a birthday card that’s sure to make him cry, it’s so sappy.  He will love it.  No gift, because I’m saving my pennies.  He’ll understand.

I am practicing gratitude on the way to work every morning, and I can spend just about the entire 40 minute drive going through everything I’m grateful for.  That’s pretty good.  So I’d say my outlook on life is good.  Even though this job and commute is really hard on me, it’s also good for me.  My mood is steady and I come across as a totally normal person!!!  It beats the HELL out of not working.  My brain is happy being stimulated and busy and productive.  So, YAY!  Life is good.  I hope you’re all doing well, let me know how you are in the Comments.  You KNOW I love to hear from you!!!  Peach out and have a great weekend!!!

Ignition

So long, Iowa.

Thanks for giving us eleven years of sanctuary and for teaching me how to live bipolar.

Next stop: Muskogee, Oklahoma.