Spring Mix(ed) Bipolar Episode

You'd think that after an exhilarating weekend racing a Spartan race with the Weeple Army that I'd be on a pretty good high or at least a good mood the week following, however that has not been the case. During that past week I've held in a lot of anger issues, been ill with a recurring cold/allergies/or whatever the hell it is, plus my mood/motivation has dropped to near nothing and I'm doing some unhealthy obsessing.

I'm not sure what's going on...is it just a mood swing or my annual spring depression setting in? All I know is that I'm just not happy with basically everything. It would be easy enough to blame everything on the bipolar but that's just not true, sure it's got a big influence in things but life is just biting the big one overall. Last week when I was feeling this way, but to a lesser extent, I was able to go get some exercise and get the endorphins to kick in beating back the poor mood/depression. This time around it's just hard to get out of bed, let alone go out for a run or even a walk. I have a 10K this afternoon and truthfully, I just may play drop out, get the shirt and man some drinks/fruit for our run/walk club. I just don't have the energy to deal with anything right now.

To top it off the old man's dad and step-mom called yesterday let us know that they'd be here early in the week. They're nice people and at least they did let us know they were coming whereas the old man thinks that his brother got no warning at all. I'm just not in the mood for visitors. All I feel like doing is sitting on my ass or sleeping. I'm still taking my meds, 3 weeks in a row now, but I just don't give a damn about anything.

This is especially not good since I have the Oklahoma City Half Marathon in 2 weeks with my longest run being 8 miles last week. I need to bump up to 10 miles at least before next weekend, luckily I graded down from the full marathon. Then there's the old man whose training has consisted of walking on the treadmill 3-5 miles at a time. I told him that I'd run the half with him (thus the downgrade) since it's his first road race but I don't know if I can go that slow. I'm by no means fast or anything, but I would like to finish around 3 hours give or take, at his pace he'll be lucky to finish before they sweep the course. Yeah, that's one of the things I'm angry about...

At least I have one thing that I'm looking forward to this weekend, the MTV Movie Awards with the Pitch Perfect cast reunion. I actually cleared off space on the DVR to record their 3 minute opening performance. I don't remember when the last time I watched the MTV Movie Awards but between the cast reunion (and my continued obsession with Skylar Astin...I mean really, what the hell is that all about?? He's freakin' 11 days older than my own son! Dude does have a voice that could met the polar ice caps though...) and Rebel Wilson hosting the show should be a hoot.

Other obsessions have cropped up again and have me thinking about racing in specific states just for the hell of it. Really, I seem to be the most content when I'm away from town whether it be with my racing friends or alone. Between the obsessions and the depressed moods most psychiatrists would say that I'm having a mixed episode which in fact is likely. Hell, if I actually drank, which I rarely do now, I'd love to get totally wasted and just pass out. Not to worry though, I'm not suicidal or having any suicidal thinking...I'm just fed up with everything.

Sorry for this downer of a post...it's just where I am now and this blog is a place that I can put everything into words. I do have an appointment with my psychiatrist in just over a week and the plan was/is to switch me over to Abilify in place of my Welbutrin, but considering I'll be running OKC within a few days I won't be making the switch until a little later...well actually probably a couple of weeks later because I have Military Spartan Sprint in Colorado the following weekend. Oh the joys of medication management and running. Later.

When the Depression Arrives

Well, it happened today...within minutes I was happy/content and then the depression arrived. I became irritable, went into a rage towards the husband (he deserved it) and have spent the afternoon after taking a nap crying. Not a full out boo hoo crying, but a steady stream of tears for no apparent reason. I warned my friends on Facebook and Twitter to expect me to possibly drop off the social networks at some point. I went off line last year for 6 months before slowly coming back on board.

The depression hits and my already low self-esteem plummets and I feel useless and like a waste of a human being. This is my life with bipolar disorder. When I was first diagnosed I could go years without a severe depression...sure, there were minor ones which were easily controlled, but as I get older the symptoms worsen, the depressions more severe and I have to enjoy the hypomanias when they do come.

I'm going to try to increase my activty level more, get more sunlight, I'll be starting back on my anti-depessant tonight (was off due to hypomania which can be triggered or worsened by anti-depressants) and will be following up with my psychiatrist and therapist on Thursday. It's bad when even my "feel good" movie...a movie I've watched over 200 times...Pitch Perfect doesn't even cheer me up. I usually still laugh at that movie even after seeing it so many times.

So, if I don't blog much or if you don't see me in Facebook or Twitter, I may just be lurking or I may not be logging on at all. But just in case, I want to wish you all well...especially those new friends who have discussed their own bipolar struggles with me

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!

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!

Reality bits

Yeah, the title is right it is supposed to say "bits" rather than "bites." I was just perusing my blog last night and this morning when I realized that a great deal of my latest posts have been about my running. I have to tell you, I don't picture this as a running blog but more of an eclectic mix of whatever comes to mind at the moment that I decide to write the post. With that being said let me meander through a few thoughts that are in my head at the moment.

Last night the little grand pup, Charley, unexpectedly came for a visit for about an hour. His mommy had driven the nearly 4 hours in snow to drop a friend off from the Albuquerque Sunport (Airport) and then turn around for the trip home. Really? She dropped Charley off with me while she and her roommate/SO (so confused about the relationship) went to have some dinner before heading back up to Albuquerque. Poor Charley didn't seem like his normally chipper self. He barely acknowledged me, no kisses whatsoever, wanted to spend most of his time alone out in the snow unless I put him up on the bed (he didn't even try to jump up by himself) and just seemed to be depressed. I was so sad and I worry about him. IMHO he needs to come home to grandma and live with the pack again. I actually cried for a little bit after he left to go back with his mommy. He'll be back to see us, if not stay with us, eventually. :(

A few days ago I had a sudden occurrence of some really negative thinking just out of the blue and totally unexpected. The whole episode lasted about 30 minutes and I didn't act on anything, but I know that something like that is one of the first signs that an impending depression will likely start within the month. It only makes sense...ever since I was diagnosed in 1997 I could set a watch to the deepest depressions that would occur every, and I do mean every, spring typically in late February or early to mid March. Nowadays my depressions hit anytime of year but only very rarely in the summer...it's all that extra sunlight and being able to be outside more. So, with this early indication of an impending crash of my mental health, I've added back a low dose of an antidepressant, Wellbutrin SR, at 100 mg daily to allow time for it to kick in before things get bad. I'll probably be back on this med, and maybe back up to my usual 150mg dose, for at least 6 months. Joy. Hopefully it'll only be the Wellbutrin and lithium that I'll need to be on. I really don't want to throw more meds into the mix since I'm running.

Lastly, have I mentioned how much I hate housework? That's what's staring me in the face at the moment so I guess I ought to stop blogging. So wish me luck! Have a great Monday!

100 Days Challenge: 

• Day 44
• 50 minute Aqua Zumba class

What I Ate Today:

• 1 bacon croissant-wich from Weinerschnitzel
• 1 hash brown patty
• 10 oz orange juice
• 20 oz G2
• 32 oz Pepsi
• 1 Bacon cheeseburger w/ grilled onions & mushrooms from Baby J's Grille
• ~3 cups overdone french fries

Lousy eating for running a half marathon tomorrow!! :(

The unfortunate genetics of bipolar disorder

Oh geez, it's been one of those nights. I'm dealing with my bipolar disorder quite well thanks to the running and getting back on my lithium, but one of the my main problems that I have to deal with the high risk of passing on the same genetic makeup to your children. Fortunately, my son has shown a very low tendency of having a mood disorder or other mental illness but my daughter on the other hand has had definite problems with mood disorders and substance abuse. In the past, even arguably minor problems have cost her significantly...relationships breaking up, the passing of a friend, basically things that most "normal" (and I do use that term lightly because what the hell is "normal" anymore?) people would recover from fairly quickly would send her over the deep end for weeks/months. Tonight I found out one of those life altering events has happened again.

I can tell by her Facebook posts that the mood is going downhill, but luckily she actually went to see a counselor at the college and has an appointment with a provider to get a prescription this week. Hopefully she tells the whole story about her mental health history...which I just don't see happening. But, she is an adult and needs to make her own mistakes...hopefully not a permanent one.

You see, I have a history of attempting suicide at least 6-7 times since I was diagnosed with bipolar disorder back in 1997 with the last time probably in the early 2000's. I've tried overdoses, planned out suicide by train, dreamed of driving off a deep ravine and so many other ways. I've been in the ICU for an overdose for 3 days and on the unit 4 more days. I've been in an inpatient psych unit twice for a week or more. My kids have found me after overdosing and had to take care of me while calling their dad to come home. I've been seriously screwed up in the past. I'm stable now...but the question is for how long? Had I known I had a mental illness before I had kids would I have even considered having them? Truthfully, I probably would not have taken the chance. Especially if I had the knowledge about mental illness that I have now. After being a psych patient for nearly 20 years and having taught/studied psych nursing for 6 years I know so much more now than I did when I first started having the kids.

Don't get me wrong, mental illness, in most cases, is totally survivable but there are always the few that don't make it. But had I known the trials and tribulations that I would go through there is no way I would have taken the chance for my kids to have to go through anything similar. Unfortunately, my knowledge and experience came too late. Now I have to sit and watch, crossing my fingers that my daughter will find a way to survive as I have. I'm here if she needs me, but she has to be willing to ask for help before it can be given. It's time to just take things one day at a time and watch for any major mis-steps that may occur.

100 Days Challenge:

• 1.69 mile walk in 26:02 minutes
• Hatha yoga class for 1:36:05 

What I Ate Today:

• 1 serving Cream of Wheat
• 3/4 cup non-fat, lactose free milk
• 12 oz non-fat, lactose free milk
• 2 Tbsp brown sugar
• 1 3/4 cup Skinny rosemary potato soup
• 40 oz G2
• 10 Swedish meatballs with gravy
• 3 cups cooked egg noodles
• 1/4 cup steamed carrots
• 2 oranges

Weight gain...oh my!

Well, I started back on my main medication (lithium) for bipolar disorder late last month. I had been checking my weight at least twice a week since then to monitor for weight gain...the very first time I was on lithium I gained 40 pounds in just over a month! Everything has been copacetic until this past weekend. I had been sitting at about 139 pounds for over 2 months and then I stepped on the scale Saturday morning to find that I had gained 6 pounds in just over a week!! I had seen my primary veterans care doctor a couple of weeks ago and had a 3 pound gain then, but had lost it by the beginning of last week. This current weight gain has just come up out of nowhere. When I look back to what my eating habits have been like in the past two weeks I'm pretty sure that it's not all the medication's fault although I do believe that it plays a part. I went on a Pepsi binge for almost 2 weeks having up to two 20 ounce Pepsis daily. Then there's the candy making (even though they were healthier renditions...aside from the toffee)...fudge, toffee and chocolate peanut clusters. I know it's the holiday season, but come on...I've gotta get a grip on things!! I was only 14 pounds from my goal weight and now I've gone and mucked it all up. So, I'm going to increase my activity level again (didn't help that I've been waylaid by injuries) and lose this holiday weight. Oh my...I feel like I'm starting from scratch again!

Medications, Patience & Sleep

Well, I've been back on my lithium for a week now. Can't say that I notice any difference, but at least I've got it back on board. I did miss one day but took it first thing in the morning as soon as I remembered. If I can manage to keep on them for another 2-3 weeks I'll go ahead and make a follow-up appointment with my psychiatrist (p-doc) to get labs drawn and figure out the next step in my medication regimen. Hopefully the small dose I'm on, combined with the weight loss will mean that I don't need to increase the dose again.

As far a patience goes I'm still waiting for the last $535 to be posted to my Team in Training account. All I want to see is that percentage bar maxed out to the 100% line...that way I know I've really reached that goal. *le sigh* Hopefully tomorrow...it would be nice to know for sure before the weekend comes.

Forgive the short post today, I'm just rambling. I've been awake since 6am Wednesday so right now I'm on hour 36 without sleep. Getting a bit cranky and my thinking is just a little cloudy. So with that, I bid you goodnight...I'm going to grab some dinner and then hit the hay!

NOTE: I wrote this Thursday night before I fell asleep. I just woke up this morning after about 10 hours of sleep feeling fully functional and back to normal...yay! :)

A bad choice repeated...again

Lithium carbonate capsules.
Lithium is effective in all phases of BPII..

OK, so...I was diagnosed with bipolar disorder, type II (BPII) in 1997 and since then I've been good and taken my cocktail of meds and at times I've been bad and not taken my meds. I've been okay without them and at other times I've crashed and burned big time. I'm supposed to be on quite a few meds: lithium (mood stabilizer), bupropion (antidepressant), quetiapine (antipsychotic) and lamotrigine (anticonvulsant/mood stabilizer) so without these meds I know that my brain chemistry (one of the major factors affecting mental health) has been out of whack.

Since I started exercising in late May I have to admit taking my meds has been a challenge. I was pretty good at the start and maintained my meds into June, but I got to feeling really good (not manicky, IMHO) and by the end of July was totally off of them. Anyway, I already know that fall, winter and spring are the worst times of year for me as far as mood swings...primarily extremely severe, major depressions...so I have tried on and off since July to get back on my meds with no luck. I've tried at least three times but the meds made me feel so low in energy that I stopped so that I could continue training for the half marathon.

With the recent change in my own ability to work and train, or lack thereof, plus the husband's recent layoff a few weeks ago has things have seemingly affected me a little more than I had realized. I was talking with my therapist today and for the first time in a long time became tearful. Not like me. I guess I'm beginning to feel the pressure but have always been real good at internalizing and hiding my feelings/moods. So, on the way out of his office we had to go past my psychiatrist's (p-doc) office. Today she was between patients and saw me start to walk past and my therapist asked her if she had 5 minutes to see me, which she did, so he ushered me into the office. Now, you have to understand that I have avoided my appointments with my p-doc since I wasn't taking my meds and feeling pretty much okay. However, with my failed attempts at starting back on the meds and the tearfulness today, I reluctantly 'fessed up to my poor choices and we decided to start from scratch again.

So...tonight I begin back on only my lithium at a lower dose since I've lost almost 20 pounds since I last saw her. Hopefully, the lithium will do the trick but I'll most likely have to start back on an antidepressant for awhile in the near future. One antidepressant that I don't think I'll ever take again is the quetiapine (Seroquel) since I think that had played a part in my vertigo attacks. That old adage that "Doctors make the worst patients" is true but it also applies to nurses...especially nurses that are too familiar with their own illness and make poor choices because of that knowledge. Oh wait, that's me! :-X

So, here's to new beginnings...yet again. Hopefully this time I'll stick with the meds instead of ignoring them again...

Mental Illness & "Two and a Half Men"

You know, I do enjoy watching Two and a Half Men but today's episode focused on Jon Cryer's character, Alan, having a bad dream while in the "stress clinic" or "looney bin" after being admitted to a mental health hospital after the death of Charlie Sheen's character. The use of the term "looney bin" grated at my nerves a bit. I am under no false pretense that the stigma associated with being an inpatient on a mental ward is not still prevalent in people's mind but I find such terminology distasteful. It's not only degrading to those, like myself, who have been a patient on psych wards but it's fueling the stigma associated with mental illness.

To further this negative view of mental illness, the failed suicide attempt by Alan I thought was a bit over the top. There must have been a different option than pushing the character to the point of attempting suicide, don't you think? I mean, really, times are rough for a lot of folk who are dealing with a lot of different issues and I just see this story line as being a bit morbid even though the attempt eventually failed. In the past 15 years that I've been diagnosed with bipolar disorder I have attempted suicide multiple times. Thankfully it's been several years since I have attempted although I always have a plan deep in my head that I can pull up and utilize. I don't keep it (or the other 3 or so plans) in mind for posterity, it's just that I've attempted that plan(s) in the past and they are ingrained in my mind's eye. So why "glamorize" suicide on a sitcom?

Maybe I'm just being a bit oversensitive or overzealous in my assessment of the episode, but people need to be reminded that mental illness is just like any other disease. The only difference is that it is based in the brain and involves chemical imbalances rather than elsewhere in the body. Come on you makers of sitcoms, television shows in general and movies...try to approach mental illness with a little tact! Rather than minimize the effects of mental illness try to approach the subject with at least a little information that would provide even a sliver of education regarding the fact that people with mental illness are just that...PEOPLE.  We are just like the "normal" people out there (really, is there such a thing as being "normal" any more?) and we have emotions/feelings just like everyone else, sometimes we just don't have the capability of coping with stressors or may not have found the right combination of meds if we're on them. Don't propagate the stigma!!

Medically speaking...

Dread...I hate feeling like this -

After a terrible 7.2 mile run on Sunday I'm at the point of dreading the pain that I've come to expect on my runs. I have an appointment next Tuesday for my first evaluation by physical therapy for hip and knee pain (iliotibial band syndrome or ITBS) that may be directly linked to a leg length discrepancy (LLS) that was noted last week on visual inspection. My left leg appears to be up to a ½" shorter than my right and may explain the cause of pain in my left hip. I'm hoping that they can figure out what's going on so that I can get back on track and get that great feeling of accomplishing a run. It's been a couple of weeks now since I've had a good run and I miss it. "Good," "run," "miss"...three words I never would have ever thought I'd use in the same sentence!

Haven't been spinning lately -

Not spinning as in cycling (although I haven't done that for months as well), but no issues with vertigo since the end of May when I had my last major episode. Tomorrow I have an MRI of the brain scheduled just to make sure I don't have an acoustic neuroma which may be a possible cause of the dizziness. I'm beginning to think that it may be related to the Seroquel that I was (and still should be) taking. If I never have another vertigo attack I'll be more than happy.

Bipolarity vs stability -

Well, as I mentioned I should be taking meds...a lot of meds...for my bipolar disorder. I actually stopped taking them shortly after I began running because I felt so good...not manicky but just good. I've tried to start them up again a few times, but they just made me feel so sluggish that I gave up. I've avoided going to my psychiatrist because what good would it do anyway? I'm not taking any meds so no labs to be done, I'm not having any mood swings (yet...although I know that I should be because fall, winter AND spring are the worst times of year for me), so why bother? Ahhh...yes, nurses do make the worst patients. At least I'm still seeing my therapist. I guess I'll have to try to start up again, but I'm really hesitant to because I don't want to affect my training...even though it's already being affected by the ITBS. Oh, the joys of being unwell. Whatever.

That is all.