DBT Haiku

Tags

acceptance, therapy, DBT, mindfulness, willingness, practice

learning to accept

resistance slowly fading

I practice willingness

Bottle Me Now!

Tags

acceptance, birth control, cognitive behavioral therapy, diagnosis, dx, irritability, Lamictal, lamotrigine, meds, optimism, oral contraceptives, PMDD, seasons, therapy, Yaz

I sat down to write a post and drew a blank. The last couple of weeks have been relatively peaceful, stable, uneventful, and more or less productive. Nothing exciting to relate, and nothing much to complain about in the here and now.

This is one of several bucolic vistas on my commute. The lens flare is somehow just right.

The longer days and spring weather are a tonic; I just plain feel better when the sun comes out a little more often, when I’m not waking up in the dark, and when it’s warm enough to spend time outdoors (but not so warm that I have to retreat back indoors).

I said things in therapy today that felt amazing. Like, “I can’t do it all.” And then we both smiled (really big genuine smiles) because it has taken so long for me to say that, and not just say it, but also believe and accept it. After commenting that I seemed almost perky, Hippie Dude remarked,

I wish I could bottle you like this for when you’re just dragging.

I know exactly what he means. He asked if I was fixating on waiting for the other shoe to drop, as I usually do. I said, “What other shoe? I’m ignoring it. It’s not going away, but I don’t have to pay attention to it right now.” He seemed mighty pleased.

My moods have been fairly stable for the last month (a whole month!) aside from some irritability. The hormonal horrors have been muffled or muted or entirely absent. My system still needs a couple months to “settle in” but if this improvement sticks around, I’m going to declare it a miracle. I’m actually letting myself get my hopes up.

The Yaz seems to be stabilizing the hormonal layer of my mood issues, so we’re further reducing lamotrigine to 100mg. Three months ago I would have laughed and then cried (all day) if you’d said that I’d be titrating off Lamictal this spring. It’s terrifying, in a really complicated way, to let go of a drug that has served me well. But the idea of being free of it – well, that’s quite a carrot.

It’ll probably take the rest of the year to perfect my morning cocktail, but it suddenly seems possible. I can’t begin to express what an enormous relief that is. Seriously. It’s sort of mind-boggling.

At least for today, I’m feeling optimistic about getting my brain cooties under control. Not every detail has been accounted for as yet, and basically only time will tell, but it seems increasingly likely that the bipolar Dx could be rescinded. Although, ironically, one can argue that PMDD is a bipolar spectrum disorder – the affective symptoms sure can match – even though the cause is clearly hormonal. The DSM doesn’t rule that out, last I checked.

V58.69 and the Insidious Grain of Hope

Tags

acceptance, blood tests, endocrine, hormones, lab work, lorazepam, lumpy gonads, PCOS, phlebotomist, reproductive endocrinology, v58.69, vasovagal syncope

Yesterday brought another slew of blood tests – just what I wanted for Boxing Day! Ye olde V58.69 – long-term use of medications – is the prescription code for “any and all tests I want to run.”

Blood tests by br3w, CC-NC (remixed).

My last comprehensive panels were about a year ago, just after the bipolar diagnosis. Last time I had endocrine levels done was just the start of the “lumpy gonads” shebang (thanks to the Amazing Sara Lomas for that phrase!)

This time I had a whopping 17 tests:

• CBC diff (complete blood count with differential)
• CMP (complete metabolic panel)
• T3 T4 TSH (thyroid levels)
• Lipid panel (cholesterol levels)
• HgAiC (blood glucose)
• Dhea sulfate (endocrines – same for the next 5)
• Prolactin
• Progesterone
• Estrogens
• FeSH/LH
• Testosterone: free, total
• Folate (folic acid)
• Lamotrigine levels (minding the dosage)
• LFTs (hepatic function)
• 25 OHViTD (total Vitamin D)
• VB12 (Vitamin B-12)

A metabolic/lipids panel has to be a fasting draw, and they can’t split up the “prescription” for tests. My body hates fasting draws; my blood sugar is low, I’m uncaffeinated and cranky, and vasovagal syncope – fainting – is practically guaranteed.

Miraculously, however, I stumbled onto the best phlebotomist ever! She did the cleanest, quickest, most painless draw I’ve had in years. It sounds kinda sad, but I’m more excited to find an awesome phlebotomist than I would be to find a great stylist. And boy, could I use a good stylist…

Anyway, the Amazing Phlebotomist drew 3 large and 3 small vials – the most I’ve ever had done at one time – and I didn’t pass out! I think part of it was the Amazing Phlebotomist, and part was having taken Ativan beforehand. I’m much less likely to have a panic attack when my blood serum levels of lorazepam are just peaking.

Some of those 17 tests are standard ongoing monitoring, like verifying that my liver is still working alright and critical vitamin levels are OK. But the rest is taking a closer look at reproductive hormones.

Therein lies the Insidious Grain of Hope.

At a recent 4-month checkup on polycystic ovaries, there had been no improvement in the large cysts from hormonal birth control, so the GYN just had me go off it entirely. My PNP was puzzled about that – the pill had substantially improved cramps and acne (clearly suggesting hyperandrogenism associated with PCOS) so it would have made sense to try a different pill that might work better. Personally, I think the GYN doesn’t want to be bothered to dig any deeper. She probably thinks I’m just crazy.

The PNP, however, seems pretty convinced that PCOS may be one of the root issues. I can’t help but agree. What I can’t guess is whether it’s PCOS and bipolar, or just PCOS. After 7 months trying to get that question resolved, I’d guess “both” but who knows? The hormone levels from these tests will likely get me referred to a reproductive endocrinologist.

In the meantime, this is-it-isn’t-it thing is driving me up the wall. How can I accept and deal with these problems if even the doctor hasn’t fully bought into the diagnosis? At the same time, I just can’t ignore the possibility that it may be entirely hormonal (with a little neuroticism.) Although I’ve struggled with acceptance all along and this is just making it harder, it seems we’re keeping that insidious little grain of hope alive for awhile longer.

Coming Out Bipolar, Round 1

Tags

acceptance, ADD, anxiety, bipolar, coming out, disclosure, executive dysfunction, mental illness, work, workplace

Disclosing mental illness is complicated. So much depends on context that the only guides on how to go about disclosure are vague and full of mysterious caveats.

Well, I finally did it. I told my supervisor.

My stomach felt like this tortured bit of film, twisted and torqued due to my own clumsiness.

I had been thinking about it for awhile. Last month I hit a particularly bad patch for a week or so. My therapist actually asked if we should think about hospital admission or a leave of absence. He genuinely seemed to be at a loss for what to do with me and I couldn’t reason or decide for myself, so I’ve started working in earnest on a safety plan against future incapacitation.

But what if? I wouldn’t want a call from Mr. Chickadee saying that I’m in the psych ward to be the way that my supervisors found out about my mental illness. It would be better to get up the gumption to let them know sooner rather than later. I don’t want them to think I’m slacking when in reality, I’m unwell and I simply can’t work effectively.

I decided to tell my supervisor – let’s call him Mr. Flycatcher (he picked it, though he doesn’t know it) – just one day before our meeting. It’s the crazy person’s equivalent to coming out, and probably just about as stressful and stigma-laden. I decided I’d tell him the next day, without any real preparation, which would have just made me even more worked up about the whole thing.

The panic started hitting me on the commute Wednesday morning. Worse and worse. Although I felt sure that he would be understanding, I was freaked out. I could hardly work all morning and was grateful to have Ativan on hand before the 1 PM meeting.

We started with the usual pleasantries, he mentioned something about his daughter’s health. That provided a good segue; I said I need to discuss something that’s very hard for me to talk about – and held out my hands to show that they were shaking. He raised an eyebrow, leaned back, and listened.

I’d quickly scratched out a few things to mention, so I started by explaining that although he might not have noticed, my work can be uneven at times, and there’s a reason for it. He said no, he hadn’t noticed, but go ahead. So I launched into my points – starting with my diagnoses, and that I’m in comprehensive treatment and doing fairly well.

I explained that sometimes I’m unable to work at all and other times I’m hyperproductive, with unpredictable rapid cycles as well as seasonal cycles that predictably slow me down. The implications, I explained, include lots of insurance paperwork; 1-4 medical appointments every week; taking a lot of drugs – 5 at the time – and every time they get changed ( about 30 times in the last 2 years) it’s a kick to the brain. I said that I’m working really hard on wellness management, and minimizing stress is critical, but I never really know what to expect.

I started to explain executive dysfunction, and he cut me off – his son has it and really struggles with organization and planning. I was totally taken by surprise, because no one ever knows that. For me, it means that no matter how hard I try, I will always struggle with organization, prioritization, and breaking down tasks into achievable chunks. These were things I’d already told him were hard for me. Now I’ve said why.

Then I awkwardly went into my short list of what he can do to be supportive. Starting with, know that sometimes my performance is not entirely under my control but I’m doing the best I can. Plus things like understanding I may have to leave abruptly, being flexible with expectations, helping me keep the number of projects I’m juggling to a minimum, and assisting with prioritization of projects. That it’s unlikely but possible that my doctor or husband might call in sick for me. Finally, I told him it’s OK to ask me directly if I’m having problems, because asking how I’m doing is not the right question and will get a noncommittal socially acceptable response, no matter how I feel.

I’d exhausted my list of things to say. My face was flushed, hands were still shaking, and stomach was roiling furiously. But Mr. Flycatcher said all of the right things.

He said he completely understands ADD issues due to affected family members. He also said that the President of the Board for our organization is openly ADD and bipolar; apparently he’s had to miss board meetings because he was in hospital at the time. All of the Directors in the organization (which includes Mr. Flycatcher) therefore understand that having mental illnesses doesn’t mean a person can’t be highly intelligent and extremely successful professionally – both prerequisites for board membership.

Having mental illnesses doesn’t mean a person can’t be highly intelligent and extremely successful professionally.

That put me more at ease. Mr. Flycatcher said that he’d never have guessed, although now that I mention it, a lot of details retrospectively make sense (almost everyone says that.) I admitted that I work really hard to make sure people don’t suspect anything, but it’s very difficult and I’m constantly frustrated by ordinary tasks that are a struggle for me.

Then he smiled his kindly smile and said, thanks for telling me, I really appreciate the honesty, and I’ll do my best to be supportive. Only one question – why now? I kind of stumbled over myself, and he said, you feel like you haven’t been keeping up on your work? Yep, that’s it – October and November are hard, so I get behind and have to work even harder to catch up, even though I’m not quite fully functional yet.

And then we moved on to discuss my work progress and what to prioritize for the next week.

In January, I’ll tell my other supervisor when I go out to the Southwest for a workshop. He’s picking me up from the airport and we have around 90 minutes’ drive – plenty of time for discussion. I doubt I’ll be quite as nervous and awkward about it, but still plan on medicating to reduce the inevitable jitters.

After telling Mr. Flycatcher my big ugly secret, I felt so relieved. I hate hiding this from people I care about or work with closely. The experience made me think momentarily about being more open. Maybe putting my real nickname on this blog. Food for thought, but not action – at least not yet – feeling a little too self-conscious, paranoid, and anxious lately.

So I survived Round 1 of disclosure at work, but I know there are many more to come. I hope that as I slowly tell people who matter to me, they will see how much trust and vulnerability it signifies. For a perfectionist like me, it’s excruciating to reveal something so flawed behind the curtains.

Loving Someone with Bipolar Disorder

Tags

acceptance, bipolar, book review, diagnosis, family, love, relationships, treatment

Julie Fast and John Preston, Loving Someone with Bipolar Disorder.  Oakland: New Harbinger, 2004.

DeeDee was crazy when I met her. She knew it, and I knew it, even if no one really knew it. It was part of the attraction–a feature, not a bug. She was simply more interesting, more challenging, and more fun than other girls. Her mood swings made me work to keep up with what she was thinking and to know how to respond. Then we discovered why: she isn’t just crazy, she’s bipolar. I’d been doing well for years with her mood swings, but this was serious.

Treat bipolar first. This refrain echoes through Loving Someone, because unless the disorder is treated, there is eventually no one to love, only bipolar disorder where someone ought to be. Fortunately, this book is intended to provide a comprehensive, holistic program (in conjunction with medication) for doing just that.

The first step is to make note of all of the states the bipolar loved one exhibits: (hypo)mania, depression, anxiety, paranoia, hallucinations… then the various symptoms of each state, so both partners can identify when a bipolar attack is in progress. Next, compile a list of what works to address the symptoms, then begin examining the various triggers that set off an attack–so in future, noticing and treating a trigger might stave off further symptoms and escalation into a bipolar episode.

This is going to take a while. The authors provide examples to help get started, but also make clear that there are many lists to compile, discuss, and revise throughout the relationship. All of these are also part of the medical bipolar treatment process, so they should be familiar to someone who has already been diagnosed with the disorder, but Loving Someone is for the partner, who may not get this information from a doctor directly, or may even be exploring a potential problem before seeking diagnosis.

The rest of the book provides an example of one couple developing a treatment plan, then addresses other questions someone with a bipolar partner might have: the discussion about getting treatment, sex, work and money, and the “well” partner’s needs. It mostly seems like common sense to me, but it is a nice introduction to the disorder which makes the illness, and what maintaining a healthy relationship in spite of it requires, understandable for someone who is just starting to grapple with a partner’s disorder.

Deadlined

Tags

acceptance, ambition, anxiety, deadlines, hypomania, symptoms, travel, work

Blogging has been sidelined by deadlines lately. I’ve been working on wrapping up a year-long project (that shouldn’t have taken that long by any means) and writing up the initial results of a survey from last month. Once I get out from under those swords hanging over my head, I have to write two talks to give next week, and another one for the following week. Plus a 5-minute lightning update report for the day after that. And I’ll have to run a 3-day working session.

It’s a lot of pressure, heading into two solid weeks of travel. Writing talks too close to the presentation date is a regretfully common practice, and one that I occasionally fall victim to. At least I’ve outlined the first two talks…

Toward the end of last month, I started seeing some manic symptoms. As soon as I noticed the first few of them, I started paying a lot more attention to what was going on. It’s the same pattern I’ve seen before – can’t sleep for a few nights, which triggers inexplicable high energy, throws ambition into overdrive, and propagates the fervent belief that I can do ALL THE THINGS. RIGHT NOW. And for awhile, I can and do.

As I started noticing a few of those typical behaviors, this time I tried to harness that energy and drive to get the important stuff done. The work that was dragging behind for ages is nearly caught up, and all that writing that I just couldn’t even face comes so easily that I berate myself for procrastinating on it for so long. The reality is, however, that I probably couldn’t have made the words flow that readily at other times. I’m trying to accept that I will probably always have this “bursty” mood-dependent productivity cycle, but as long as I can keep things within a reasonable range, that’s OK.

So I’ve been plowing through the work day productively for most of the last couple of weeks. And then paying for it with that weird wakeful exhaustion where you know your body is tired but your brain is wired, wired, wired. Mr. Chickadee falls asleep on the couch, while I watch another episode. When my general mood and energy levels are a little high (but not Lucy In The Sky With Diamonds high) it just takes so much longer to get my mind to shut down enough for sleep that bedtime keeps getting pushed later and later despite an unchanging 6 AM alarm. It’s a catch-22.

Heading into 2 weeks of travel followed by another trip, I probably won’t be blogging a whole lot for the rest of this month. I’ll try to keep up a bit, and will probably stay hypomanic with the time zone shifts and overstimulation, but that’s pretty much the way it goes for me when I’m on the road. At least I’m avoiding the bar these days and heading outside instead. The mountains and deserts will be calling my name, and who am I to ignore their majesty?