Showing posts with label hypomania. Show all posts
Showing posts with label hypomania. Show all posts

Tuesday, March 26, 2013

Running: Love or Mental Illness Recovery?

Today I'm going to talk a little about two things that hugely impact my life other than family. When I was diagnosed with bipolar disorder II back in 1997 I did all the reading that I could to learn about the disorder. Part of what I had learned was that exercise helps to lessen the effects of particularly the depression but could also help control the hypomania. Unfortunately, I was working full-time as a new RN, attending a bachelors degree in nursing completion program, went straight into graduate school full time for my masters degree, raising two kids who were 12 and 11 (older than I remembered them being now that I think about it), playing the taxi driving mom, attending all the school functions for the kids while the husband was spending a lot of time deployed to the desert.


There were times in the past 15+ years that I tried and even at times accomplished exercise goals mainly to lose weight that I had gained over the years of different psychotropic medications, many of which have weight gain as an adverse effect. For instance, the first time that I was on lithium I literally gained 40+ pounds in 2 months! Try to get that weight off when the medications makes it near impossible!

My biggest successes came in 2003 when I did the original PX90 program at home. I managed to lose about 20-30 pounds from the 160+ pounds that I was carrying. On a 5'3.5" frame that doesn't look too good., in fact the husband used to say I looked like the little round spaceman character on one of the old Saturday morning cartoons in that I was round with stubby little legs and arms sticking out. He wasn't trying to be mean, it was in fun but he was stating the truth. I had never been that heavy in my life. Even at 9 months pregnant I topped of at only 134 pounds!

From 1988 I was in nursing school for almost 10 years straight working on an associate in vocational nursing, then completing my second associate degree in registered nursing, directly into a Bachelor of Nursing completion program and finally a masters degree program. You can just imagine the weight I gained during that time studying all the time, not getting enough/any exercise...I finally reached a max weight of 172 pounds! Now, let me tell you, I was not a happy camper with the weight gain, but I also had no energy to do something about except for the off and exercise I mentioned in the previous paragraph. Actually, back in December 1991 through December 1992 I did spend the whole year in the gym working out a couple of hours a day in addition to working 12 hour shifts 5-6 days a week, raising the kids alone because the hubs was in Korea for a remote year long assignment and going to school full time. Studying and whatnot was done either at work or while the kids were at school after I got home from the gym. Needless to say, that was probably almost a year of hypomania and sleeping 2-3 hours during the day that got me through...I really don't know how I did it. I only remember a couple of minor depressions during that time but nothing major.

Anyway after years of no exercise, in 2011 I got tired of being sick, depressed and worn out. I knew my weight had a lot to do with it...not in the sense of a bad self-image, but just the stress of it all. I was just starting to come down from nearly 2 years straight of a major depression. The only stability I had between 2009 and 2011 was a period between August and December 2010 when another really nice hyomania occurred. I was so productive then! I felt like the old me...then I crashed again the following early spring. I eventually was let go of my teaching contract at the local university and applied for 100% VA disability benefits since my diagnosis was my 70% disability for the past 10 years or so since it originated/was misdiagnosed when I left the USAF in 1986.


That summer, in a fit of a mild hypomania, I got sick and tired of being sick and tired from the extra weight and the recent depression which I still was not totally over. In an effort to incorporate exercise into my mental health regimen and lose some weight, I joined the local Y. I started in some group exercise classes like boot camps, core classes, Hip Hop Hustle, Zumba and others. Zumba was my favorite and within 6 months I was a licensed instructor although I never actually taught. I lost about 20 pounds doing Zumba bringing me down into the 150-140 pound range, but I had a lot more to go with a goal weight of 125 pounds.

I also took up walking and eventually started doing run/walk intervals after joining the Leukemia & Lymphoma's Team in Training to run what what supposed to be a "bucket list" half marathon, the Inaugural TinkerBell Half Marathon (13.1 miles)  at Disneyland. Then it happened. I started having excruciating pain in my hips, primarily the left side which at time impeded my walking. I got that checked out and was told that I have a pelvic bone that has too much rotation and that it wouldn't fuse together until in my 50-60's. All the pivoting in Zumba had contributed to the issue causing my pelvis to lock down in un-natural positions. I spent nearly 10 weeks in physical therapy had to stop training for my race and cross training instead. I had fallen in love with ruuning...something strange considering that I avoided running at all costs for most of my life. Finally 2 weeks prior to my race I was released from PT and allowed to start training again. Thankfully the cross training kept my cardio up but I had to start almost from scratch to build up my mileage again...in two weeks. It wasn't easy but I finished my first half marathon in less than 3 hours which was my goal time.

Since then, I've sadly given up Zumba because my hips just can't handle all the pivoting and such. I've completed 23 official half marathons, 1 full marathon and several 5K or 10K fun runs/races. I can't imagine my life without running now. Even when I'm not training like I should be. I had another suicidal depressive episode from March 2012 through January 2013. After months of inactivity from the depression I began racing slowly (I'm not fast at all) and went to run a double (a half marathon on Saturday and Sunday of one weekend) in Nevada and Utah just because I needed a change even though I hadn't trained at all and the depression was causing some issues between the husband and I. I just needed some me time and that meant running. Those races were terrible but I was finally out and about some other runners and even saw a few running friends at the race in Nevada. Because I had performed so poorly, I took off the next month and a half and as the depression continued to resolve I ran another race in Kansas. Again it wasn't pretty but I finished. I've never failed to finish a race...ever...although I have DNS'd -Did Not Start- 8 or 9 races last year due to the severity of the depression.

  

This year, actually from mid-December 2012 until now I've been blessed with relative stability. I have felt better about my races although my times are still 20 minutes-1houf and 10 minutes off my previous half marathons. I just need to get out there and train (easier said than done most days). I even completed my first hiking marathon (26.2 miles) just a couple of weeks ago.

While running is not a "cure" for my bipolar disorder it definitely helps with the endorphins (the feel good chemical, a natural opioid formed by the body) to help lift/stabilize the moods. I still try to remember to take my medications which I'm not always successful at but if I find myself sitting on my rear for long periods of time...like this past winter I notice that my moods are much more inconsistent. Running and exercise definitely helps with mental illness; studies have proven that exercise in general can help those with mental illness feel better and recover faster from exacerbations. However, these actions in and of themselves cannot be considered a "cure."


For me, it's not only the mental health benefits of running/exercise but it's also a love of the sport and most of the people that I come across during my running adventures. This year I have 11 half marathons, 6 full marathons, at least 4 obstacle course races (Spartan Race, Tough Mudder as well as some smaller ones) and several small 5K and 10K races. Truthfully there's no telling where I'd be without my running. Possibly hospitalized again after another suicide attempt, dead or just turning into a female version of Jabba the Hutt just doing nothing.

So, yes I see running in both ways: a sport and as a form of mental health recovery.

If you have a mental health diagnosis what do you do to get those endorphins going? If you're simply a runner, why do you run?

Monday, March 25, 2013

Medication? Who me?

Lithium Capsules...truly a lifesaver for me.
Yeah, I'm still on my bipolar thought process roll. It doesn't usually last so long, but here we go again.

I am a terrible patient/former RN when it comes to my own medication compliance/adherence (adherence is the new "feel good" terminology since it doesn't make a accusation regarding the patient). I am one of those nurses who unfortunately lives by the "Do as I say, not as I do" motto. I've been on and off meds for my bipolar disorder since 1997. When I'm on the, most of the time I'm pretty stable or "normal" by some people's definition. Like I've said before I don't believe in "normal" anymore, I much more prefer "stable."

Anyway, there are times that I stop my meds on my own...and I mean abruptly stop them, something that should not be done with psychotropic meds...just because I'm feeling really good AKA in a hypomanic episode. I don't recommend stopping meds without talking to your psychiatrist, but if you do do so taper them down over a couple of weeks do not ever just suddenly stop them! Like I said I really recommend talking to your doc first...I'm a little dangerous because I have that extra knowledge that lay people don't typically have. During these episodes I really feel more like my old self than ever...except that I tend to overspend, have issues with lack of sleep or not sleeping at all, racing thoughts, etc. but I've never gone into a full blown manic episode that becomes possibly life threatening because there's a lot more risk taking involved. It's not uncommon for those with bipolar disorder to think that they feel good so they don't need their meds when the reverse is actually true. Mood stabilizers will help quell down the overly active/risk taking behaviors and in extreme cases an anti-psychotic may be needed in addition to the mood stabilizers to maintain the moods in check. Typically both these medications will be taken long term.

For depression of course antidepressants are prescribed. The problem is that antidepressants can actually trigger a  hypomania or mania. So it's not uncommon (or it shouldn't be) to only use antidepressants for short term...what I mean by that it 6-12 months. Please remember I was studying and two semesters shy (2 clinical courses and 2 theoretical courses from graduating as a prepared Pysch/Mental Health advance practice nurse or qualified to certify as a PMH-NP) of graduating so that's where a lot of my statements are built from...my educational background. After the prescribed use a trial off the antidepressant should be attempted and if all goes well the patient may be taken off the med...if it doesn't go well they stay on or maybe try a different one.


I digress, so on those occasions when I do stop my meds it can just be a few days simply because I forgot, or weeks & months (I've been off my meds for about a month and a half and just restarted taking them yesterday) simply because I feel "good" and I've even gone years off of them always crashing big time into a long lasting, severe and even suicidal depression. It's stupid. I was an RN for 22+ years, I taught psych/mental health nursing for 4 years and I've been diagnosed for 15+ years. You'd think I'd have my head all together and a grasp on this, but no.

So right now in Spring through the Summer this is when I can almost guarantee that I'll drop into a severe depression. I'm actually surprised that it hasn't happened considering how long I've been off my meds, but it's enough to scare me into starting them up again. To help with this I have a 7 day pill box to set up all my twice daily meds...OK, I have it somewhere but I can't find it but that's what I usually use to keep my meds straight. I've also downloaded an app called MyMedSchedule that has charts you can print out to track your meds and mobile apps for iPhone and Android that can be set up to send you email and SMS reminders to take your meds at whatever setting you determine. Once I got this set up correctly I started getting my reminders...now if only they could send reminders to Twitter/Facebook since I'm always on those and sometimes allow my phone and tablet to die and forget to recharge them.  However, the email can also be seen on your regular email account...as long as you check it regularly or have some sort of pop-up set up for the message when it comes in. Hopefully this will be something hat really helps with my med adherence.

Yes, this is in face my actual printable med schedule/checklist from MyMedSchedule
The printable medication schedule from MyMedSchedule
I've got one and a half days of medication on board and because I am familiar with the intricacies of these meds I know which ones that I can return to a full dose and those which I need to taper up to my normal does over several days. Depending on your meds never go straight back to the dose you were on unless you talk to you psychiatrist!! It can be dangerous to do so...and please don't decide that you're going to catch up on several days of medications all in one go. I know a lady who ended up and the mental health unit with me during my first psych hospitalization because she took  a week's plus of medications when she expected her husband to come back from a business trip!!

So to anyone out there who maybe having to deal with medication adherence issues whether it be psychotripic meds or regular medical medications take a look at MyMedSchedule. It may be of assistance. Good luck to us all!

UPDATE 3/25/13 at 11:55am;
I'm gonna try something a little different in addition to a hard copy checklist. If you look on the right hand sidebar you'll see a new page "Medication Accountability Checklist." this is the same info as on the checklist above but available online. Some people may wonder why I am so public about my meds, it's because I choose to do so. I'm not violating anyone else's HIPPA rights. I choose to try this and see how it goes. Let's see if I can remember to update it daily!

Sunday, March 24, 2013

Mood Confusion


I'm not sure what's going on mood-wise for me right now. Typically with my bipolar disorder, I'd be heading into a pretty dark place this time of year, but I'm feeling pretty good right now. Maybe a little too good. It's odd for me to have a hypomanic phase without a preceding depressive phase, but I'm noticing less sleep (typically 3 hours or less for most nights of the last 2+ weeks), a little more of the obsessive thinking happening and just a bit more energy than usual. Oh, and my typical lack of medication regimen adherence that's pretty common when I do start feeling a bit hypomanic.

Right now because I am feeling this way I"m going to start up my meds again tomorrow (someone please hold me to it) slowly tapering up the meds that I know I can't just jump back on at full dose. Hopefully I'll have my blood levels back where they need to be within 2 weeks. I'm telling you...a little too much knowledge can be dangerous (in reference to my psych nursing background). I'm also going to start myself on a 2 week course of Xanax at bedtime to try to get back into a regular sleep cycle. This sleeping for 2-3 hours, then napping 2-3 hours during the day isn't cutting it. I really need to get back on a day/night sleeping schedule.

I just hope that I'm not setting myself up for a self-fulfilling prophecy in that because I'm "missing" my depressive state that I trigger in some way that depression to come on sooner than later. Oh geez, did that make sense? It's late, I'm tired and I just took 1.5mg of Xanax to go to sleep to. Ugh.  Anyway, this is just not what I expected to be happening around this time...typically late Feb to mid-March I'll at least have a mild depression, but none so far. Again...I hope I'm not jinxing myself.

I dunno. Just a bit confused. Gonna give the meds about 20 minutes to kick in then it's bedtime and hopefully I won't wake up until close to 11am or noon. So, wish me luck in getting back into the medication and "normal" (whatever you feel is normal...I don't know what that is anymore) or at the least a "stable" frame of mind. G'nite!