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!

My Stand Against the Stigma of Mental Illness

A few weeks ago, I had officially added the Stand Up for Mental Health Campaign's header to my Twitter account and a link on my blog. I had already had the header up on Twitter for a couple of weeks prior to notifying HealthyPlace, the originator of the campaign, that I had done so. In that notification to HealthyPlace I included a brief outline of why I had added the header and of my background. I was asked if I would share my story either in a blog post that they could link to or in a story that theycould host on their page. I chose the former after reading this article about self-stigmatization which is something I haven't really done too much of...at least I think. I put myself out there for varying reasons...I've posted about my struggles in old blogs that I used to have or just venting on Facebook or Twitter, but it's just my nature and part of the career path that I chose...

I was diagnosed in 1997, about 2 months before I was supposed to graduate from my Masters degree program in nursing with a specialization as a Family Nurse Practitioner. Like many of us with bipolar disorder I had been an outstanding student throughout my whole life. Then all of a sudden, in late September I became increasingly depressed. Near suicidal at that point. I was doing preceptored clinicals, working on a thesis, working full time at an outpatient clinic and being a military wife/mom to two elementary aged kids. Luckily I had already been in treatment for unipolar depression for a year or two and was
seeing a therapist who also noted my mood swings and recommended an evaluation for bipolar.

Within a couple of weeks the official diagnosis of Bipolar 2 came in. My first action was to
read An Unquiet Mind by Kay Redfield Jamison. In this book, I found so much of me with a
lesser degree of symptoms as compared to Dr. Jamison. A lightbulb went off in my head and
that great "A-ha!" moment happened. Over the following years I would be able to retrace
my symptoms to my mid-teen years and so many questions about my previous behavior were
clarified. It was a year of finding out who I really was and the positive and negative
implications that my disorder had provided me with in my life.

I did manage to graduate with my master's degree that December with a lot of work and tears
and the dropping of my thesis course...thankfully it was optional. I went on to work as an
RN, never getting my license for my FNP because of the newness of the diagnosis and my own
fear of making wrong decisions if I was in a bad way. However, I did excel as an RN in different positions
but there always seemed to be a time that the stress just got to be too much and I ended up
resigning and taking several months off and even considering leaving nursing all together.

In 2004, after a 4 month or so hiatus from nursing, I began subbing at a clinical site for
the local nursing program. Teaching was something that I had wanted to do since I was in
licensed vocational nursing school so many years ago. I had found my niche. I came onto
the faculty full time the following Fall and the following year I volunteered to take over
the Psych/Mental Health component of the program for the upperclass students when the
previous instructor left.

This specific content was truly my niche. Teaching psych. I loved it. My interest in psych/mental health
had exploded with my diagnosis...my focus was primarily on bipolar and other mood disorders,
but I loved it all...the whole confusing lot of the DSM-IV-TR. While my goal was to teach
the students about the different diagnosis involved in mental health and their treatments
my personal goal was to help them learn to get over the stigma that the media and past
generations had built up about mental illness. I didn't want my students to be me when I was on my
psych/mental health clinical rotation in RN school...fearful and trying to avoid interacting whenever
possible.  I remember...my first question to the third semester classes was always, "Look around you...can you tell who might have a mental  illness?" Inevitably, they would all look around and appear a little blank as if to ask, "Why is she asking us this?" My next response would be to raise my hand and say, "I do!"

You see, I've never been shy about sharing my diagnosis. I've told employers almost from
the start even though I'm not required to by law. I've told co-workers not only for my own
good and patient safety but also so that they can be attuned to what's happening with me and call me out when things get a little stange (and they often did). Maybe it's only because I was in nursing but I'd
like to think that I'd be that open if I were working in a different field as well.

For me, personally, I felt that having the students know that I was battling what could be
a serious mental illness (I've attempted suicide at least 12 times in the past), that they
could see that it doesn't mean a mentally ill person could not be successful. I wanted them to
learn that they didn't need to fear mental illness. Granted, we're not all fully functional
but just the realization that a mentally ill person could look like me and be teaching a
class of 30-35 students about such a weighty subject could be an eye opener for some.

The students learned observations skills, communication skills and hopefully empathy from
not only classroom exercises and study, but also from observing me through  my good days
and my bad days. They learned to recognize when I had gone off my meds or when I was
becoming depressed or a little hypomanic. They were learning about mental illness in a
non-threatening way...OK, if you can just imagine nursing school being non-threatening.
But they were also learning to accept that I was a human being with a mental illness, no
different than any other human with a physical disorder. I just happen to have  an illness
that originates in my brain versus having diabetes which begins in the pancreas. They,
hopefully learned to understand that a mentally ill person is a human being...period...not
a monster or crazed individual to fear. Having this experience with me, I hope, prepared
them for our one week clinical at the state mental hospital where they had to
encounter more acute states of illness with a more open mind rather than fear; as well as for future encounters that they may have with the mentally ill.

Teaching gave me that opportunity to share not only my illness but to help, hopefully, break
the stigma of mental illness among the majority of my students. Granted, not everyone will
have made the connection, but I feel safe in saying that the vast majority did have their
eyes opened to the reality of mental illness while working with me. By the time I chose to finally
leave teaching in 2011 I was working on a second master's degree in Psych/Mental Health Nursing
and was within two semesters of graduating as a PMH NP as well as concurrently working
on a PhD in Nursing. Even though I have had to voluntarily remove myself from nursing due to a severe exacerbation of my symptoms between  2009 and 2011 I continue to do a guest lecture at the same nursing school each semester to try to help demystify mental illness and the stigma attached. That is the least I can do for now. At some point I'd love to start a support group through DBSA or NAMI but until I feel that I can be stable for a long period, or find a backup co-ordinator, that dream will have to stay
on the back burner for now. But no matter what, I'll continue to do what I can to help
break the stigma of mental illness and will hopefully one day be satisfied that I have done
everything I could to do so.

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!! :(

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.