Across and Inside my Universe

When Your Doctors Don't Believe You

When your doctors don't believe you, you feel like you need to prove your problem/theory/what-have-you, if it is provable.

In my case, the Lamictal IS affecting my urinary system.

So the not brief but explained as briefly as possible history/experiences that I explained to all three doctors in September about these issues, WAS relevant, and I don't have to think of myself as a rambly, irrelevant person.

You see, I do ramble and/or am irrelevant at a variety of times to some degree or another.  BUT, I try to not do that at the doctor's office.

See, when I went and saw my GP a week after the Instacare guy prescribed oxybutynin, I did mention the bladder, urethra, and kidney discomfort/pain.  My GP said to keep taking it (because I'd laid out brieflly what happened after I stepped down off Lamictal, last year, unsupervised; it was what I consider to be likely a textbook case of how epically bad stopping a mood stabilizer on one's own can be.)

So, I kept taking the oxybutynin and the Lamictal. However, over the last three months the abdominal and sometimes side/back kidney pain had been becoming more frequent and too common.  The bleeding had gone away, the bladder was somewhat calmed down (although not like last March), but it still seemed to be over-producing as well as could only go about 4 hours, so it was still getting me up at night.  (Also becoming harder to sleep with the pain and discomfort).

The worries about it and the physical interference with good sleep are two factors in why I think the mania has been breaking out more the last few months.  The other factor would most often be stress from a juvenile court case in which I faced speaking in court, and other things (It's about the victim, not me, but since I'm not going to expose her on here, I'll risk sounding like it's all about me.)

These things all acted to marginalize the effectiveness of the 150mg Lamictal that I've been taking.

A week ago, it was getting so bad I wanted to go to my pyschiatrist, with proof, so I'd be believed.  Plus, I wanted it to stop.  So I cut my dose in half for a few days.

I did not expect such a quick or significant difference, figuring the urinary tract had been so abused for so long it'd need time to heal.  Within a DAY a significant amount of pain and discomfort was gone.

I knew that cutting the dose in half wasn't the wisest idea, so after a couple days I went back up, but only to 100mg.  I couldn't bring myself to take 150 and be that badly off, again.  The pain and discomfort went back up within a day of bumping back up, though not as bad as it was at 150mg.

Proof, anyone?

Now, I did consider that my judgment may not be the best right now, what with all the mania and stuff.  Also, the last time I took myself off Lamictal, the end results were . . . bad.

Still, this time it will be in partnership with my psychiatrist (as soon as I email her later tomorrow).  If she says to keep taking it, which I highly doubt, I'll do it until we meet and can figure something else out.  However, I hesitate to keep taking it for longer than needed to step down off it, because after so much abuse to my bladder and kidneys, what's the risk of permanent damage?

So, yes I took medical matters in my hands, but I didn't intend to do it for long, and as well the doctors didn't believe me before anyway.  Just because my psychiatrist said that this isn't a side effect of Lamictal, doesn't mean in my opinion that it can't EVER be; it's not a KNOWN side effect, perhaps.  Also, there are statistical outliers, people for whom their bodies' response to medications can or does fall way outside the reasonably or even rarely expected effects.

It's happened to me before, and now again.

I am regretful and a bit fearful that there is one less med between me and the mania; however, I'm on some Seroquel, which I wasn't last year, and I've handled twice as much as the current 150mg before, I think even over that to 400mg.  It was eventually stopped because at the time it was being used for depression, and didn't do much for that.  I can tell it's helping stabilize mood a bit, now, though.

Now, I actually don't think the doctors were wrong in what they considered and what that led them to recommend, AT THAT TIME (although they were still wrong, then, about the bladder/lamictal thing.)  There were several seemingly medically reasonable (to me) reasons to suggest going forward as the doctors had said with the Lamictal and the oxybutynin.  I'm glad I did things their way for long enough to know that not following orders wasn't what was going on.

My GP considered things with his knowledge, but also deferred to my psychiatrist as, I think, was proper to do given the risk of possible death if I stopped the mood stabilizer, since if I even THOUGHT I might start down the bad path from earlier this year again, I wouldn't be able to live with myself.  My psychiatrist, of the three doctors, gave me the best impression that she was weighing the pros and con of a medication that was possibly (though not likely as she did tell me Lamictal doesn't do that) harmful, against the pros and cons of stopping that medication.  She investigated anew with me how effective I felt the Lamictal was, and such, and I appreciated her doing that; it helped me feel that my experiences would all be a part of what she decided.  She said for me to keep taking the Lamictal, and I did, though reluctantly, because I'd been so tired of the bladder problems.

Knowing for sure, now, it IS relieving to know that something hopefuly fixable (after this long, has there been permanent damage?) is behind the kidneys/bladder.

I don't know that anyone necessarily cares about all this, but I don't know what audience I have in mind or think I have with this blog, so I'm all over the place with what I post and don't post.

I Want To Crawl Out of My Skin

I just read here, after I googled it, that other people have had something similar, on atypical antipsychotics.

This has happened to me noticeably twice now, within an hour or two of taking my nightly meds (Lamictal & Seroquel; I'm supposed to take Lamictal in the morning but I always forget.)

I start wriggling around almost frantically; the sensation of wanting to crawl out of your own skin is quite awful and difficult to describe.  You feel  a very strong urge to get out of your skin (and for me, the left leg is particularly worse than everywhere else.)  You HAVE to wriggle, writhe, and otherwise move, because not doing so feels unbearable.

This sensation is so much worse in my left leg, that you feel not exactly a loathing for it, but you quite dislike it as a result of the distress it is causing you.  This distress, this crawling out of your skin sensation/desire, makes you want to leave your containment within your skin behind, especially of the left leg for me.

Now, I don't LITERALLY want to get rid of my skin as that would be, um, inadvisable, dangerous, deadly, etc. not to mention horrifically painful, and at least a little bit insane, or psychotic.

However, I can't emphasize enough how horrid it feels to feel like your body is something distressing, or like some part of your body is, or whatever.  I mean, I know most every health problem is unpleasant, but what I'm talking about is feeling like your body or parts thereof are to a degree separate from your self, from the whole of you, and that they are something it feels like you would like to have some distance from, if only for a time.  I'm not explaining this well, I know I'm not too fond of my head when I have a migraine, but there's not even a slight sense of otherness or alienness, alienation from your own body or parts, that there is with this.

The people at the link above say that the feeling is because of the intense urge to move, but for me it feels the other way around; the crawling out of your skin desire is what's causing the urge, the compulsion, the body's DEMAND to move.  Although I can see that the demand to move also contributes to want to crawl out of your skin, and thus shake the distress off.  The distress feels like the confinement of your skin is exacerbating the distress, and the distress is exacerbating the feeling of being confined by your skin.

Thank heaven it goes away within the hours, but oh is this feeling horrible!

Second Psychiatrist Appointment of the Year

This was in June. 

Since I'm going to be seeing her again this next week, I'd better update the blog with this exceptionally positive step forward in our relationship.  Not perfect, but positive between her and I, to this degree, was unexpected.

I even brought up being afraid of her, and the last time I did THAT, she yelled at me.  Things went much better, this time.

She was running late, this appointment.  It was late in the day, and my appointment was for 5:20.  When she came out of her previous appointment (I assumed) right then, I prepared myself to get up and go in.  Instead, on her way back to the office, she called to a different patient, and as she passed me she apologized for being behind.  I indicated I understood and that it wasn't a problem, which she seemed to appreciate.

I could see that the next people to arrive, were startled/surprised to see that someone else (me) was called in, at the appointment time they thought was theirs.  I believe she apologized to them as well.

I like that she's conscientious of her patients like that.  It gave me the beginnings of a feeling inside that maybe today might be less confrontational in the past.  Just an inkling, really.

I forget what I first mentioned, which is a shame because she usually starts our discussion with something springing from that.  Ah, I remember, she commented on my positive demeanor as I settled myself on the soft green couch.  This startled me; she was the second person in three days to use those words to describe me.

She asked about it, and I said maybe it was from having dealt with formal church discipline and now it wasn't hanging over my head, I could move forward?  I'm not sure why I said that; it still hurts deeply, but with a bit of time I've come to see that actually it is better, now, moving forward with that behind me.

She went on with the discussion for a bit but her curiousity had been peaked and she had to return to the church discipline thing, ask about it, what it was, how it worked (briefly, very), why/what for, and such.  I had thought what for would be obvious, but I briefly, in about 40 seconds or so, described the situation, including that they were disciplining me for doing something for which my mania was a contributing factor.

She got indignant on my behalf, saying things like, "Mania is part of your illness; you enter an altered state of mind!"  She went into this for a minute or two, aghast that they would penalize me as harshly as they did, for something she feels was . . . well, that I wasn't in my right mind for, wasn't acting completely from who I'd choose to be were it not for the mania. 

For myself, I've always taken responsibility for myself and my actions as soon as I return to a state of mind where I can do so; however, I didn't frame it that way for my clergy, lest they think I was trying to not be responsible.  I was being responsible, but  . . . I framed it as, the mania was a contributing factor.

She went on to tell me that I should educate my Bishop and congregation about my illness and the way it works.  No one actually has ever outright said to me before that you go into an altered state of mind.  It would be nice if sometime someone would actually tell me more about it; yeah I can read on the internet, but I need a doctor to tell ME. 

My first shrink to my face thought I was borderline, not bipolar, and when I said that to my psychologist he pointed out that, well, he prescribed a mood stabilizer, and that'd be unethical if you're not bipolar . . . I never thought about it til now, that after that I just went into symptoms etc. with each new psychiatrist, and never asked for any education; no one had ever explained anything to me.  I got more explanation from the government-contracted shrink who evaluated me for disability than I did from anyone else, ever.

So, her advocating for me, showing that she cared that people had/were judging me for things that at the very least were influenced by mania, and that she was indignant that they wouldn't know or consider my illness to be much of a contributing/mitigating factor at all, well, this made me feel good, and more importantly, made me feel more connected to her as my doctor.  This strengthened a . . .turbulent therapeutic relationship.

As she made some notes and asked something to further our discussion on other stuff, I worked in my issues with her (some of them), such as that I was intimidated by her, scared of her, and that when she threw out advice to me as to stuff she thought I should be doing, stuff that I felt didn't fit my belief system (like the previous appointment's ridiculousness where she told me working on my marriage and family was selfish, I should look to serving others instead, I took this as her karmic point of view), that I felt like they were harsh, rigid orders and that she didn't understand or accept that I needed to take what I could from her advice, sort through it, despite any difficult feelings about her manner of presentation, and keep what worked for me and set aside what didn't.

She heard me out, and seemed a bit astonished that I didn't know that she wasn't ordering me at all; that she said what she did, and that it was my life and my decisions about what to follow and what not to.  That of course we're from different backgrounds, and that it's my life, I"m the one living it and not she, so who better than I to sift through what she advises and make my choices.

I was kind of stunned; I thought that if only we could have had this conersation 18 months ago!  I was so bouyed by her remarks I added some other things to the discussion of our relationship.

As far as meds, at our first appointment this year I had just gotten to 150,g Lamictal, with a mild non-sunburny rash.  In a different place than the last two times (and according to my hairdresser, there's an allergic-looking rash on my scalp, too).  I said the Lamictal was doing ok, though I needed more time to be sure.  I actually mentioned adding Seroquel; we'd tried it two years ago for depression, which it did not work for.  I didn't have any noticeable side effects except for being sleepy alot.

She said, "I thought we stopped that because of your PCOS?"  I was confused; what does Seroquel have to do with that, does it make it worse?  I ignored asking that and said, "No, we stopped it because it wasn't working for the depression; however, isn't it supposed to be a mood stabilizer, work on mania?  It didn't cause me side effects other than tiredness, so what do you think of trying it again?"

I went on to mention, a bit embarrassedly that I'd seen on someone else's blog that they were on these two meds.  Of course there's no guarantee they'd work well in combo for me.  Still, she seemed to want to know all of why I was asking, and so I told her. 

She was very open to it and, in fact, had prescribed the Seroquel at our first 2012 appointment in May.  At the June appointment, she asked if the meds were smoothing me out, making me serene.  They were definitely helping, and I told her, but I wasn't what I'd call serene.  In fact, I wondered if we needed to raise the Seroquel?  She held it at 150mg for now, and after some key things during our appointment had made her actively diagnose me w/ADD herself, instead of relying on other shrinks' diagnosis, we discussed Vyvanse.

I'll be trying it at what is it, 30-40mg?  Since the 70 I'd been on was seeming to be too much.  I'm just in a mess of getting the new dose approved by Medicaid, and dealing with her incompetent secretarial substitutes as her main secretary has been on two one-week vacations in 4 weeks.  UGH.  I may not have the prescription by this appointment!

Oh, one other BIG thing, is I will be going to a monthly group she holds there, for ADD adults.  No fee, at 7pm.  My appointment is at 6 or 6:30.  I'm nervous about this, but somewhat less so after clearing the air in our relationship.

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.

 

Don't Sweat the Small Stuff

After 40 minutes of walking around Wal-Mart, with half or more of that time spent looking at things in aisles without walking much, this is how I looked as soon as I came home.

Sweat was raining off of me if I tilted forward a little. But only my head and neck were sweating.

 

This has been the case ever since I started Effexor some years ago, and it hasn't stopped though the Effexor was halted in February of '09. Recently I read that excessive sweating can be a symptom of serotonin syndrome, but there's other symptoms as well; I don't think I have that because of one symptom. I did take Cymbalta throughout much of the rest of '09; then, in '10, I was tried on a few different antidepressants but none after the summer.

This symptom or whatever it is, is extremely embarrassing to me, and highly inconvenient; it's already hard enough for me to go to the store and walk around, with my knees/legs hurting, and often a limp, so my motivation to go out is already low, but this sweating causes me to not want to go out anywhere if much walking is needed.

I suppose I could wear one of those around the neck fans, into the store; we've got one, although it eats batteries . . . but I'm afraid people will think I'm wierd, especially if I do it in the winter. My therapist says, "Nobody's looking at you, they're not thinking about you." I think he may be right, partially, but the fan makes a noticeable though not loud noise, enough to catch someone's attention, so . . . and even with the fan, I sweat too much, but it helps slow the rain a little.

For years, I've thought of this as a small, permanent side effect of that medication. Now, I'm thinking maybe it's not so small, since it's interfering with my life. Granted, part of what's interfering with my life is my anxiety about this side effect . . .

I remember way back when, mentioning this side effect to my first psychiatrist; the thing is, this may have been while he was temporarily suspended, and so the substitute heard it. He may have gone over her notes before seeing me again but maybe it didn't jump out, if she wrote it down. I might have brought it up with him later but I really can't remember. Nothing much was made of it if I did, and I wish, if I did bring it up with him, that he had asked me more about it.

Maybe I feel that if he had he could have done something to make it go away, but if it's permanent now then maybe it was permanent as soon as the side effect first showed up . . . but that doesn't mean the psychiatrist shouldn't care about it, right? I'm just feeling really let down by those who one trusts to take the best medical care of them . . . it's just that this is a pretty big thing, for someone who tends to have hermit tendencies, this kind of clinches it . . . and that fills me with sorrow, though I don't know why.

So, for a long time, I didn't "sweat" what I thought was a small thing. Now, I no longer think it's a small thing. Maybe I'd be better off if I didn't care, because that would be one less thing to be depressed about; ie, being depressed about something you can't change probably isn't the best thing in the world.

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 . . . .

Maintain Lamictal @ 150mg

I went back to the doc and told her about what I did. At 150mg there was a faint rash but I'm not vain, so we continued it, although at one point it seems like she was going to try something else, then thought better of it.

As the last couple weeks have gone on the rash is more than faint, now, and itches occasionally, but it's not driving me nuts, so I'm fine with it. It's "livable" for me; for people who put on makeup everyday and care how they look, it might not be, but I don't wear low-cut tops anyway. Only when I wear my modest v-necks can you see it, and it's not obvious to most people.

The more important question at this point, is if the medication is effective to any degree and if so how much, and then is that enough? I'm having a hard time assessing this, so I'll just see how I do over time . . . . my next shrink appt. is 6 weeks from the last one; the secretary said that's how it's starting to be now and I am a little frustrated because that means I'll have to make an extra trip in to her office, an hour round trip, for my ADD medication once a month.

If she's too busy to see her patients as frequently as they need to be seen, she's got too many patients, imho . . . if this keeps up I may stop treatment entirely. I'm not going to make extra trips for longer than 5-6 months. Especially since I'm scared of her anyway, and now that I know most bipolar meds won't work for me I don't see the point of trying any more if this one doesn't pan out . . . . I may try another if she switches me but like I say, if she is seeing pt's every 6 weeks, and maybe it'll get worse to every 7-8 weeks who knows, if she can't manage her patient load, then that's that.

Yeah lots of fortune-telling and stuff in there. I wonder if she's going to lose other patients from being too busy to see them, requiring extra trips in for prescriptions for some of them . . .

On another note I'm feeling like I've put my foot in it again, but that's nothing new for me. STUPID. Labeling . . . ugh.

Lamictal?

Well, I DID email my psychiatrist about the stubborn rash on Lamictal; she told me since it seems like it's doing nothing for me, that it should be doing something at 200 and even 150mg, that we should lower the dose 50mg every two days until I'm off of it.

I responded to her by saying that the medication IS helping the mania, and that maybe we could try going down to 175mg since I still have some of the early 25mg pills as well as the current 100mg pills, and see if a week of that helped the rash go away.

She never replied to that email, so I went ahead and did that anyway. After a week, the rash was still there, so this last Tuesday I reduced it to 150mg, to see if a week of that will make it go away. I was beginning to doubt it would but now, late Friday night, it finally feels almost no sandpapery at all, I can still feel it a little but I think it's going away . . . hopefully by Tuesday I'll know for sure.

That's when my next appointment with her is, anyway.

I feel a little bit like I'm on my own, here, but since we'd already established that this rash is the benign one, it's not like I'm in any danger. I don't go out much so when it WAS on my neck and maybe face, it's not like I was out around people. It was mostly on the upper chest though.

I hope she's not mad at me for doing what I've done; I also hope the medication is effective ENOUGH at 150mg that it's worth staying on. Aside from the rash, I've seemingly had no other side effects, which is rare for me and these medications. It seems like I can never get up to the "full" dose of any of these meds without problems, but being partially effective is enough for me to fight the most troublesome aspects of mania, if it's effective ENOUGH. THAT is the real subjective point, though, and at the very heart of what should be done next . . . .

Stubborn rash

And all the itching! I can't seem to take the Benadryl consistently, but on the days I do, it doesn't get rid of the rash, even a couple days in a row of taking it consistently. It just makes it feel not sandpapery, at best. And stops the all-over not constant but there in the background itchiness.

So I've emailed the psychiatrist, telling her about it and that I've not bumped up from 200mg like I was supposed to Tuesday because I've had this rash over a week now and it's not going away. I was never told what to do in THIS situation, just if the benign rash happened to take benadryl for it.

Is this another medication down the tubes? I guess I'll wait and hear from her; I don't want a permanent rash on my chest, sometimes neck, and maybe face (I have extra redness on my face but where it fades I see some speckled splashes of rash, I think.) Besides, I can't afford to buy Benadryl three or four times a month. If long-term use of it was even a good idea, which I can't know.

Reassessing the Roles My Therapist Plays

I know I sort of recently said I'd get around to discussing the roles my therapist plays, at least that I think he does, but a week and a half ago I had a session during which a thing or two he did as well as didn't do, really bothered me, to the point that I woke up in the middle of the night that night and couldn't get back to sleep for hours due to thinking about it, trying to work through it, and trying to figure some things out.

It became clear to me when I woke up later after having fallen back asleep, that maybe I needed to reassess some of my attitudes towards therapy, some of the roles I think he plays or want him to play, and reassess my general orientation towards therapy. I kind of need a paradigm shift, about what I expect and want from therapy, and what I want it to do for me, and whether or not I've been expecting THERAPY to do for me what I should be doing for myself.

At the same time my thoughts get so distorted and tangled sometimes I KNOW I can't always sort them out myself; in fact fairly often I cannot and get stuck. But is helping me see the distortions in my thoughts, and helping me to work inside myself to come up with alternatives to those distortions, ALL my psychologist is there for?

Often, he also reveals observations about my behavior, sometimes connecting things from months or more ago to something I just brought up, and it's sometimes a "lightbulb" moment when he does this. Other times it feels like he is observing, without connecting with what I'm feeling or thinking, when he does this. And so I then feel like he is being, well, cold, almost, or so neutral that it feels like I'm not interacting with a person; like WE aren't interacting at all, but rather that he's just stating his observations without other therapeutic things going on, like empathy and such.

I suppose the nature of observing, and being observed, is that the observer, in order to adequately identify and point out what they are observing, has to hold themselves apart, in some ways, to keep anything emotional or biased from affecting the observation. I think it is that "apartness" that I sense when he's giving me observations that bothers me, a little bit.

He does, though, give empathy when he determines I need it; he gives understanding, he gives patience, and even kindness from time to time. He gives objectiveness (which sometimes promotes that sense of "apartness" in me) and he gives no judgements (most of the time; he's not perfect and when I think he's judged me, I say so and he'll most often explore it with me for a minute and, if he thinks that he did, indeed, judge me, he apologizes for it).

I should say that he strives for objectiveness and lack of judgement; these seem to me to be two of the hardest things to accomplish, especially after you've been working with someone for years and could have some caring about their welfare. He has said, on a couple of occasions, when questioned about it, that he DOES care about his patients; he has said that is an acceptable thing in his work, and a natural thing to happen. It's my opinion that the better therapists (I've only had one, though, so it's a guess) DO care about their patients, on a basic human level. I'd imagine that those who don't would come across as cold all the time.

Even knowing this, I still have times I struggle with feeling less "connected" in our therapeutic relationship. Is connectedness, a feeling of give and take, a feeling of working TOGETHER in therapy, necessary, positive, etc. for the therapeutic relationship? I would suggest that yes they are essential for a good working therapeutic relationship. This does not mean that the times I feel this "apartness" I've described indicate big problems in the therapeutic relationship; it just means that maybe I should note these things to him so he's aware that I feel these things when triggered by specific things during therapy. It does NOT mean that he'll necessarily change his behavior, but I believe it's important to communicate with your therapist if and when you feel like it is more difficult to connect with them, or any other things that trouble me about the relationship at any time.

This makes me wonder, am I after too idealized of a therapeutic relationship? I am thinking right now that I know I tend to idealize people who treat me positively, and so I wonder if this is another attitude about therapy that I need to examine and perhaps change. I do not know that I necessarily idealize the relationship for sure, but this blog post surely gives me THAT impression. I will think some more on it and even talk with my psychologist about it.

There have been occasions I've taken one of my blog posts into therapy, read it, and then discussed it with him, sometimes point by point, and sometimes at the end of the thing. I think this one would be good to bring to therapy this week.

I don't know why it still surprises me after all this years that writing or typing out my thoughts and feelings on a subject will sometimes lead me to new discoveries, unexpected realizations, and even a reassessment of my own behavior or thinking/attitudes on a subject.

A postscript on the Lamictal rash: Well, welts never showed up and it became even more sandpapery feeling, so I was right that it was not the "bad" one that leads to Stevens' Johnson syndrome; on the other hand, I've had it for a week now and taking Benadryl changes it only a little, though I admit most days I've taken it sporadically.

What I do not know is if I should bump up my dose to 250 mg tomorrow as scheduled; the rash appeared the morning after I bumped it to 200; I may be too fearful and cautious, but I will keep it at 200 until I hear back from my psychiatrist via email; I don't think it's urgent enough for a phone call, and it shouldn't hurt me to stay at 200 for a bit longer (I hope!). I guess I fear worse allergic reactions like anaphylactic shock if I bump it up higher, with the rash not responding much to Benadryl.