Across and Inside my Universe

Unsafe

Well, I'm not safe.

Lability is uncomfortably high (I hope I'm using the term correctly).  My state of mind, my emotional perspective, keeps shifting so much that any decision I make, even fully believing and commiting to it, I can be doing just the opposite five minutes later (or half an hour, hour, etc.).  The place from which I am interacting with the world from, feels as though it's on a mess of shifting tides and currents.

Part of me thinks, well, isn't this just weakness of character, not being able to stick to anything or operate from a stable state of self or being or mind or whatever?  That word, stable, though, is part of the key.  The whole shifting currents thing, is another.  I'm NOT STABLE right now; I'd not call myself UNstable in a crazy, psychotic way, but  . .. well, basically what I've described above.

It is tempting to fall into the trap of thinking, hey, since I'm seeing this problem, and acknowledging it, doesn't that mean I'm functioning well enough to be or feel safe?  I've fallen into that trap before.  While identifying this stuff, prioritizing it, taking some actions with it, etc. are positive and functional, healthy things, the very nature of being so . . . well, volatile isn't quite the right word, I'm not going to lash out in an extreme way (although I guess suicide and other things actually are pretty extreme) at anyone else (hrm, I've been highly irritable and rather snappish, which I've been not pleased to have acted out as much as has been, the last few days; it has been uncharacteristically frequent and drop of the hat.)  I've been quite reactive and on a short fuse, not even necessarily being aware of having a short fuse, until I snap at my husband.

I've been irritable and snappish before, without the high lability; mixed states suck.  There is more here than just that, although mania and depression certainly make matters rather worse . . . 

I have therapy tomorrow, and I don't know if my psychologist will recommend the hospital.  We've already taken some familiar and not so familiar steps, around here.  Any excess medication my husband has hidden.  A step taken once before, for a time, that I've asked of him again, is to not leave me alone at home for three hour+ stretches.  Two hours feels like it'd be kind of rushed for anything extreme, but that may be because I'm particular.  I hate to scare him like this, but on the other hand it feels the responsible thing to do.

So, he may need to stay home from church on Sunday.  This would carry us to next Wednesday, when I'll be home alone for most of the rest of the week.  If I am still highly changeable/feel like my behavior could turn 180 in the blink of an eye/feel like my mania or mixed state or whatnot is pushing me to danger, then we'll have to probably hospitalize me or figure something else out.  I am REALLY hoping that I'm not like this, then.  It usually has only ever lasted a few days, 3 or 4 tops, but I had this a week to 10 days ago for 4 days or so, and now again and it's just rather scary.

I dunno, maybe I'm a wuss and not taking responsibility, when I say that I can't seem to be able to say that what I decide right now will be the place from whence I could reasonably still be operating an hour from now, etc.

The pull to reckless and harmful, serious things of a variety of types is strong, although I am currently fighting them.  Some things you can't come back from, and some you maybe  shouldn't (okay, definitely stuff to bring it up tomorrow in therapy.)

Edit:  This talk of lability, and danger, and unsafeness, and my assessments thereof, are based mainly on how my psychologist has assessed me most recently last week when discussing the same kinds of things, as well as in the past, the few other times that it has been this bad (all since early 2012, really).  Things I'm saying here are based on concerns he's discussed with me about my safety and stability and such when I'm in this/these states, having experiences as I've been this week and being all over the place, and stuff.  My safety has been a major issue and concern to him, in many of the ways I posted about here, and some things I haven't posted.

Edit:  Also, I do have upcoming appointments with my psychiatrist, later this month and then in August as well, since my urologist cleared me for going back on psych meds/back to the psychiatrist (I know one doesn't necessarily mean the other but he has pronounced my kidneys fine, after a CT and a cessation of the most distressing symptoms . . well, I may need to check one more thing with him, but he did clear me.)  Still, I may be contacting her sooner, by email I guess, if my psychologist thinks I need to go to the hospital.  Maybe her emergency nmber would be better, I don't know?  I' ve left a message on there before.

A Positive Demeanor

Okay, is it something I ate?

Is it in the chocolate milk I've been having lately?

What is IT?

Both my Bishop, in recent months, weeks, and days, and then today my psychiatrist, have both commented on a positive demeanor that I'm exhibiting?  They say it with things that indicate it's both different than they've seen me in the past, and a positive change as well . . .

Both of them seemed to see or feel it as something they couldn't quite put their finger on . . . They would look at me, upon first seeing me whenever, and remark on it, and look at me a bit quizzically or as if they were trying to bring something into focus.  They both were curious about it.

I'm not sure what to say when they (or if others chime in with this too when I see them) say and do this; was it my shampoo?

Actually, it may be just the fact that I've recently showered.  Embarrassing as it is to admit, when you are depressed you just don't do that much self-care.  So, whenever I'm showered, I feel good.  If we're going out (which is 85% of the time why I shower, and I'm kinda a hermit so . . . well this is where having a regular therapy appointment helps me be not an ugly stinky witch) then I get dressed in something other than my, just for around the house duds or pajamas.  This makes me feel good too.  At least, as good as someone my size can feel.

But really, is it just being showered and dressed for going out?  I know getting sunshine is part of it (since I can go many weeks in a row with just going out for therapy).  But would just sunshine, shower, and clothes do it?

I don't know.  I'm kinda confused by it.  Yeah, I could over-analyze, but if I knew WHY, then I could replicate it. 

When my psychiatrist inquired about it, I said, "I don't know; my church disciplined me and that was hard, but now I feel I'm moving forward and that is becoming my past, so maybe that's it?"  She seemed to think it could be, but she was curious about the discipline thing so I told her about it, with the harsh sentence and everything. 

What she went on about then, well, I'll post soon about my appointment, cause . . . I never expected anything like this appointment happening. 

Positive demeanor.  Multiple people noticing it and commenting on it.  My shrink doesn't even know me that well, in my opinion, so there must be something noticeable.

Wish I could bottle it, whatever it is!

The other day when the Bishop was outside, I go out and up the stairs to greet him, and then realize I'm in my short pajama bottoms (a few inches above the knee, I've never been through the Temple and so I don't wear garments, but it's still a modesty thing) and yank down on the legs.  He said I was fine, and then he looked at me in the face and mentioned the demeanor thing, and looked at me quizzically like, trying to figure something out.  So it's not the clothes.

I can tell you that the last time I saw him, I surely did not have a positive demeanor; going in front of four brethren of the Church, to have them sit in judgment over you, to talk about really embarrassing things to, does not lend itself to a positive demeanor, even if one of the men there (not the Bishop) tells you you should be happy to be there.  I thought, "What planet is he on?" and just kept quiet.  But that's rude, and I've been taught not to speak ill of the brethren.  Well, this isn't ill, it's just the facts.

Edited to add:  You know, maybe it's getting out of the house more often.  Or perhaps going out with just my husband at all, let alone often . . . My daughter has been at a Girl's Camp our church does, this week, and we've had alot of us time, which we need.  She's old enough now that we can go out for 2-3 hours and come home, but I always feel guilty about going out without her because since we don't go anywhere much, neither does she, and she's always eager to go for a drive, or go somewhere.  So this means my husband and I get pretty much no "us" time, which we sorely need, and is probably one reason our marriage deteriorated . . .

Balance is something I don't do well, or even poorly.  I'm awful at it.

Anyway, this week might explain the positive demeanor compliments this week; I'm not sure what the last couple months of this occasional comment by my Bishop might be related to.  Except there was something related to angels, which was really cool.

No, I'm not crazy, and no I'm not going to talk about it.

 

Bedroom Progress - Small Moves, Ellie

I started in this corner of the room. Floor only, as I'm doing a mostly garbage pass, although if something's on the floor we'll put it to donate, chuck, or find a home or temporary home for it until I can tackle everything on top of everything, which is pretty much taking up the space that needs to be homes for (organized) things. These pics are the same as the previous post, pre-cleaning, but they're a visual aid.

I cleaned just about up to the small child's chair you see in the corner of the room in this picture; a bit over a quarter of the room's circumference. That small chair, by the way, was made by my dad for my daughter when she was THREE. She's in Junior Highschool now.

That may not sound like much to some, especially since it was just the floor, but I was dripping sweat after 20 minutes, and had filled a kitchen-size garbage bag.

As well, I've been struggling with just doing dishes and laundry (not even folding) on a regular basis, let alone most other chores; that's kinda one reason the place has gotten to this point. Yes, doing things consistently, or at all, is a struggle when I'm depressed, anxious, trying to distract myself from mania (although mania does sometimes result in a burst of productivity, which I'm afraid may be the impetus behind this project). Most of the time though I'm fighting the things mania urges me to do that aren't good; that means there's not alot of me left over for ADL's (activities of daily life, as they say).

Regardless of the reason for doing this, I'm hoping blogging about it will A) help me stay somewhat organized about it, B) help my sense of efficacy and build upon it as I can look at the blog and see the progress I've made, C) help keep me motivated and carrying on with this even if the urge of productivity should desert me, and D) maybe keep alive some unreal notion that my non-existent blog readers might be sending me thoughts of support.

Yeah, that last one, not gonna happen. I need to do this for me, anyway, and I recognize that. Support doesn't hurt, though!

So . . . small moves.

I've been feeling overwhelmed over the last 24 hours, just looking at the whole room. As Adam Savage of Mythbusters would say (and that's how I hear it in my head), "There's your problem!" I have problems with looking too far into the future, looking at problems upon problems (it's turtles all the way down), as if I was looking at the humongous pile of food you need to eat over the next month or year, and feeling overwhelmed by it all.

We don't eat all that at once. It's made up of smaller meals, and those are further broken down into food groups, or various ingredients, or various steps of the recipe.

You can make your moves as small as you like; moving forward, even if it feels equivalent to maybe one frog hop, is the important thing. Just because it feels like a frog hop, doesn't mean it IS one.

The first day, I made a list (a HUGE one), took and posted the photos, and blogged about this. The next day, I took one of the categories of items I needed to research selling/trading, and started that process. (I'll be trading some old collectable gaming figures for a game I want, that takes up less than 1/4 of the space the figures did; a win/win, there. Boardgamegeek.com is great for exchanging, occasionally selling, old or new games and related items.) So, a small move.

I did not beat myself up inside about how little that seemed to accomplish in relation to the whole; the urge to do that came to me as it so easily does, but I countered those thoughts with, "No, it's not too little. You are no longer stuck and you are moving forward. FEEL how good that feels after being stagnant for so long!"

And I did. Feel good, that is. I transformed my negative thoughts and feelings not just into banishing the negative, but I created positive thoughts and feelings to replace them.

My mantra going forward will be, as you may guess, "Small moves, Sara. Small moves."

(P.S. Who wants to watch that movie now? Me . . .)

What a Not So Beautiful Mess . . .

To riff off of a Diamond Rio song title . . .

I'm being brave in posting this. I want to track my progress on organizing this, although the rest of the house is a mess too (mostly not as bad, but this is BAD, so that's not saying much).

This is the master bedroom in our apartment. Much of the mess is craft items, information, patterns, and publications. There's a big variety of crafts and materials: Beading/jewelry making (including chain maille jewelry), knitting, crochet, spinning, and weaving (that's a four-shaft table loom under a makeshift dustcover), Rubber stamping, scrapbooking, and a variety of paper crafts, with a variety of die-cutting stuff (including a Cricut, a . . . robotic die cutter, if you will, for those who aren't familiar with this stuff), and a big wooden rotating tower of ink pads, reinkers, ink pens, and other things.

I have fabric in various places in the room, handed down from my mom when she was clearing it all out; I have no sewing machine though except a tiny one designed for stitching in scrapbooks and on other paper crafting projects. The fabric has come in handy for a variety of my daughter's school projects, though. I've even saved jeans she's outgrown, and jeans of mine as well, for a variety of recycled/upcycled craft projects. It's a good thing I saved some of my jeans that I'd lost too much weight for, because I gained the weight back and needed them. Lol. I'm working on losing weight again, though.

I have a couple drawers of adhesives, from a Xyron laminator/magnet maker/adhesive applier, foam tape, masking tape, double sided tape, photo corners, glaze-type glues, rubber cement, tacky glues, post it note glue, glue for metals, and a whole host of other adhesives for different purposes, materials, etc.

The thing about all these crafts, is, the last two years mostly doesn't count for me not touching them much, due to a year and a half of surgical recovery; with all the pain knitting simple garter stitch was the most I could handle, and I've picked it up now and again. Also, the last two years my husband's been either out of work, or at two couple months long temporary jobs . . . with jewelry making, buying the findings like jump rings, crimps, clasps, bails, etc. can add up, and so as with some of the other crafts, running out of consumables has limited those.

Also, I suffer from a variety of mental illnesses, disorders, etc. You'd think an OCD person's bedroom would look neat, but then there's ADD, bipolar with lots of depression, etc. and everything's overwhelming. These issues also lead to a lack of desire to do anything, including favorite interests and hobbies. My therapist has recommended I not ditch everything, since once (or if, in my mind) my depression improves I'll regret having gotten rid of everything.

SO. With that in mind, I'm analysing how often I've used stuff, over the last 6 years or so, and factors affecting that, in order to help with what to ditch and what to keep. The last couple years it's been mostly knit, with a little crochet and a moderate amount of weaving. A little spinning, too. The couple years before that, there were sporadic bursts of rubber stamping (often related to mania, but not always), mixed with alot of knitting and the like. Also alot of beading/jewelry making during that period. The couple years before that, was when I started the jewelry stuff, as well as the knitting/crochet/tiny bit of spinning. Scattered Rubber Stamping as well, with a year of digital scrapbooking. It's been longer since physical scrapbooking, but that's mostly due to organizational issues (ie, I can't find my stuff) as well as some money factors (do you know how much the scrapbooking and stamping industries make? It's ridiculous. TOO many commercial products, I think a simpler, less expensive approach will suit me better.

Still, at some point when you're in an apartment, you can't just leave all that space being taken up by stuff you don't use . . . I need to figure out where to draw the lines. It's gonna be hard.

I can do it, though, one step at a time. I have a budget of $200-$250, from birthday and special occasion money I've saved up for awhile. That doesn't seem like much compared to all the stuff in there; some small portion of which needs to go in other rooms.

There's SO MUCH organizing info out there, though, that it's overwhelming. I'm starting with a blog or two, like http://iheartorganizing.blogspot.com/, which has some great ideas and showcases a variety of organizing products, ESPECIALLY in use, so I can get an idea of what may and may not work for me.

Wish me luck? And also, that I don't get so overwhelmed I just quit.

No judging my mess. I should have an apron that says that . . . lol.

Next post on this project will be the list of stuff that I've come up with that needs doing in there. Although, with the rest of the house being a mess too, I'm not sure what I'll do with the stuff that gets kept but goes in another room, before I've cleaned and organized the room it goes in so there's a place for it . . . . it's like a Mobius strip. Or MC Escher stairs.

The Cheapest Care Possible

I don't want to offend any nurses out there, especially the ones who can prescribe.

BUT, when you have as many co-morbid (proper term?) psychiatric conditions as I do, AND especially when you have as many chronic physical health conditions as I do, you really would feel most confident having a psychiatrist, an actual DOCTOR, prescribe your psych meds, since you have so many conditions and medications that can interact with each other.

Now, as I'll apparently be seeing an A.P.R.N, which is a psychiatric prescribing nurse? I'm sure that they have extra education for that, and plenty of experience since they are working for the county's behavioral health system, and see the most disabled and/or severe cases, since they only serve those with Medicaid/Medicare. Lots of people on disability with either of those insurances, so this would be where they go . . . the LCSW I saw for intake interview went out of her way to reassure me that the nurses see severe cases and are very capable (does this mean she thought I was a severe case, or just that knowing they treat severe cases all the time means they are competent to treat anyone?). I got the impression that seeing a nurse instead of a psychiatrist for meds is something alot of people aren't the happiest about.

Anyway, while I'm sure these nurses are capable in many cases, I just feel like I have so much going on both mentally and physically that I'd only be really comfortable knowing a doctor was seeing me; how can I know that these nurses know enough about all the physical health stuff besides the mental health stuff to be able to manage all the issues?

Then again, who WOULD be happy that they'd be seeing a nurse for what they've traditionally thought is a doctor's role . . . I think this is partly based on that, but still . . .

There is part of me that feels like, because this is a government-funded mental health care system, as well as government funded reimbursement for them, that this is why they use the lowest-level providers possible; I was told that they do have ONE psychiatrist, but I'm guessing he only gets sent the most complex or resistant of cases. I was told I'd be seeing a nurse.

I feel like, because I am dependent on government assistance for this, that I will be receiving a lower, cheaper (not necessesarily incompetent) level of care than I would if I had private insurance. I don't think you can argue that these nurses AREN'T less expensive than psychiatrists, which means they are cheaper (although I am not trying to imply that their care is valueless or without dedication, expertise, etc. - it costs less and is less educated than a doctor/psychiatrist, though, is all I'm saying). This makes me feel like I am a second-class citizen, but then, without regular insurance, I kinda feel that way anyway.

I'm sure if something like this was posted over at Shrink Rap, there'd be an outcry from prescribing nurses, and maybe even non-prescribing ones . . . the thing is, though, I feel that prescribing nurses should SUPPLEMENT what a doctor does, not REPLACE them, and it feels like in this case they are being used as replacements. THAT is what feels wrong to me, what feels like I am being given the least expensive care they can get away with.

I'm also annoyed at all the hoops and forms I have to jump through and deal with just to see a nurse . . . I'm sorry if that offends anyone, nurses are very valuable, but I do NOT, I definitely do NOT see them as the primary provider of the medical side of my mental health care. I do not think that is appropriate.

I'd prefer something like initially seeing a psychiatrist, or a psychiatrist with the prescribing nurse present (they'd never do that last, too expensive) for the first couple of appointments and then see the nurse the rest of the time, with maybe a twice yearly check by the psychiatrist; more often if moderate to high problems come up. THAT seems like it'd be more, well, working with both a doc and a prescribing nurse . . .

I guess this post is amounting to a big whine, that might affront a variety of nurses . . . but it's how I feel, and I don't think REPLACING psychiatrists with prescribing nurses is a good thing for mental health care. Supplementing, okay, I can work on getting used to that . . .

I'll have to get used to seeing just a nurse, I guess, but I will not be happy about it. And here I thought I'd come to a new, more open mind about my next shrink, about being more open-minded, more open to different personalities and learning whatever comes to be learned from them. Turns out, I don't get a shrink at all. I'm feeling like I, and other Medicare/Medicaid people, must not be worth it, in the eyes of the government and the people who vote in the people who fund or restrict how such places are staffed.

 

About My Psychiatrist/Patient Relationship

My last appointment was almost two weeks ago, with the psychiatrist.

She's decided to keep me on 150mg Lamictal, though I told her I wasn't sure how effective it was. She said I need to modify my behavior, implying that I'm expecting the medication to take care of the problem.

You know, I can understand that and that's fine, I work hard on modifying my behavior anyway even if it often seems to be futile and frustrating.

The thing is, when I came back to her last November after not seeing her since July, and told her about my mania and the most troubling behavioral symptoms of it, she was all, "OH! We need to get you on some medication right away so you don't ruin your life!"

So, I feel like she's being a bit of a hypocrite; actually, what she's telling me now with, "Oh, modify your behavior," it seems the exact opposite of what she told me last November!!!

Now, regardless of whether a behavior is influenced by or triggered by my mania, I believe a person should work as hard as they can to modify/change that behavior. BUT . . . when the mania is pushing you, urging you, sometimes overwhelming you . . . . that makes it so difficult it feels impossible at times to just manage it yourself.

Another thing: If I only engage in the behavior when I'm manic, whilst other times I have enough self-control to keep from engaging in the behavior, as well as at these other non-manic times I don't have any desire or wish to engage in the behavior, well that to me says there's a biological factor influenceing and/or triggering the behavior. Meaning in order for me to deal with this, medication would be more than helpful.

I am frustrated though that so many medications have not worked out for me, but I can remember how moderately well the Risperdal worked, as opposed to how moderately poorly the Lamictal is working at 150mg. When I was on 200mg Lamictal, it felt like it was closer to the effectiveness of the Risperdal, but I can't go that high on Lamictal. We had actually been shooting for 300mg even.

I'd say the Lamictal is taking about 24% to 30% off the edge of my mania, while the Risperdal was more like roughly 55% or so. This is academic however since I can't go back on Risperdal.

I am also rather afraid of Lithium, given its high side effect profile (not sure if I'm phrasing that right.)

I think besides Lithium and Zyprexa, the only other medication might be Seroquel, which we tried last year for depression and it didn't work well for that; I wonder how it would do for the mania, though. We stopped the Seroquel (it was 300-400mg, I forget) about two months before the mania hit big-time. I will NOT take Zyprexa, after the Depakote caused me to gain weight; I can't deal with the diabetes risk. I've heard that PCOS (polycystic ovarian syndrome) is a pre-diabetic condition anyway, but I have no idea.

As far as I know, we've run through almost all of the bipolar medication options. Then again, I don't know much lol.

I'm frustrated with my psychiatrist for acting like a hypocrite though. I do realize that 25% to 30% off my mania is better than nothing. I did not put it in terms of a percentage to her, however, I just came up with that as I was writing this post.

Another frustration is that I'd heard Lamictal and birth control pills can affect each other; I've heard that either one makes the other less effective, or that both make each other less effective.

So I asked her, and she said that, if anything, the Lamictal makes the birth control less effective (I had mostly heard it was the other way around.) So I had my husband ask the pharmacist when he went to pick up my pills, and he confirmed what my psychiatrist said.

This angers me, because neither the pharmacist nor the psychiatrist told me of this side effect with potentially huge consequences. Granted, I wasn't on the birth control pills when I started the Lamictal, but when I did start the birth control pills, I emailed the psychiatrist, as well as discussed them and the reasons for them as opposed to the permanent solution to birth control I am working on getting comfortable with. So during this whole discussion about my fertility and deciding to end it, and why I'm taking birth control pills instead of doing something else right now, she never mentioned this important side effect. And neither did the pharmacist, though I thought drug interactions were part of their main concern.

I know no one is perfect, though. It just could have huge consequences . . . . this is the first time I feel my psychiatrist has not been on the ball, really sharp mentally, extremely knowledgeable, about medications and the issues related to them. So she can't remember everything, all the time, I'm telling myself, trying to not expect perfectiong. Still, of all the side effects to forget, this one is a doozy.

I REALLY don't want to do something permanent to my body, ie, the uterine ablation or whatever it's called when they freeze the lining in there, until I'm comfortable with it, until I've come to terms with how I feel about ending my fertility (what little there might be with PCOS).

I'm also frustrated with my psychiatrist for not wanting to deal with my depression; we haven't tried anything for it since the Seroquel last year. Perhaps she wanted to get the mania under control, first, but it seems she's decided it's as under control as it's going to be . . . so why not address the depression?

I think there may be a couple of reasons for that. One, anti-depressants can set off mania, and we don't want to make that worse. Two, her practice has been getting busier and busier; it was six weeks between the last two appointments, and now it's two months until the next one. While I'm kinda happy not to see her as soon, on the other hand I wonder if she's getting too busy. Although it could be that since she feels I'm as good as I can be on the Lamictal, she wants it to float that way for awhile, and see in two months how I am . . .

I keep reading back and seeing I say, I think she may have these reasons, or she may feel this way, etc., and I wince, because shouldn't she and I be DISCUSSING these things? Then again I AM afraid of her, and we've discussed what I've thought of to discuss in recent appointments; it's been less of her forced "Let's talk about whatever comes out of your mouth first" contrived technique.

Do I think my fear of her may be part of the reason I "forget" important stuff to talk about? Perhaps. I'm certainly not gonna be near as critical of her in appointment as I am on this blog. There's a difference between being critical and asking genuine questions that may sound as if I'm questioning her reasons for what she's prescribing and why; I can see why I might be afraid to ask her such questions, but in a good doctor/patient relationship the doctor should feel or act threatened by a patient wondering about these things. Our relationship is not a good one, however, and after typing this post which is helping me think through these issues, I wonder how harmful to my health IS this doctor/patient relationship becoming, if I can't ask her the questions I feel are necessary for the best care . . . .