I gotta be honest-- the possibility of psychotic episodes is one of my least favorite components of bipolar disorder. But I thought I should probably learn some stuff about it.
This information comes from NAMI
There seems to be a "prodromal" phase. Behaviors and stuff that people notice before an episode of psychosis. Here are some of those symptoms
Usually these are things that people who have had a psychotic episode look back on and say, "Oh, wow! Those things were all happening!" and not a great predictive tool.
The next phase is called the "acute" phase and is often noticed by family/friends
It is important to note that not all people with Bipolar Disorder have psychosis as a symptom. It is also more common in Bipolar I than in Bipolar II.
I think that I will appreciate the structure of an automatically updating to do list that has my daily stuff on there. These things that I have always really wanted someone to remind me to do or just do for me.
When I was looking through the accommodations that bosses could offer their employees with bipolar, many of them had to do with scheduling and staying on top of time stuff.
These are the ones that I remember. And I thought, "I can do that!"
So there. I feel somewhat ridiculous that I need to have a checklist for things that I feel I should just know and remember... but I don't know or remember. And email has been a persistent problem for me.
Today as a special reward, when I opened my email there was a message from the volunteer coordinator at NAMI (National Alliance on Mental Illness) and expect to be contacted some time in the next few weeks about how I might volunteer for them.
Grateful Crap: that feeling of calm knowing that I do not need to check my email until tomorrow
that's about it
After the experience of being swallowed by my email yesterday and in thrall to my calendar this morning, I have come up with a plan:
Todoist is my favorite organizing list app. It lets me have repeat events, which is key. Because I want to schedule things like: am meds, am email check, am look at calendar, blog, pm email check, pm look at calendar, pm meds. And I do not want to have to write those things every day.
I realize this seems excessively... excessive. But otherwise I will either
A) check and recheck and recheck for fear that something has changed
B) think that I have checked already and miss important things
So that is my plan. Daily check email twice, check calendar twice, take meds twice. Then hopefully communications will not be so super highly stressful. Ugh.
I think the lists will be a good thing and a limiting factor instead of an overwhelming factor. If I make sure to treat them that way.
Things I need to add monthly: contact with particular people... umm, other stuff that I forget.
Grateful Crap: asthma medication, although I really would like the hacking 3am cough to cease and desist. I have issued the order and am waiting for the other party to come up with a counter-proposal. Ugh.
did a bunch of organizy stuff
took meds (112+/- mg venlafaxine, 450mg bupropion, 200mg bupropion
will go to band rehearsal unless i am running a fever of 103. which I cannot anticipate will be the case.
I am trying (now that it no longer gives me heart palpitations 100% of the time) to keep up with my email without letting it take over. This afternoon I spent two hours checking my email every five minutes so I could instantly respond to anything in my inbox and keep said inbox empty. The fact that emails are collecting there now like falling leaves is quite disturbing to me. Because it means I will just have to go in later and deal with them.
Thing #1: I will only check email twice per day. Once in the morning and once at night.
But I don't always remember whether I've done things - especially routine things - so I installed five different to-do apps on my phone and tried entering things on each of them.
Thing #2: I will remember to delete the 4 to-do apps that do not work for me.
Grateful crap: Not sure. Feeling overstimulated and crowded by stuff. Ask me later.
Bipolar Checklist Stolen from Depression and Bipolar Support Alliance
_____ Trouble concentrating
_____Slept too much/Haven't been sleeping
_____Racing thoughts/going a mile a minute
_____Aches and pains
_____Difficult to concentrate or make decisions
_____Wanted to be alone
_____Thoughts of death or suicide
An idea from the days when you need to bring a note from your doctor in order to have an excused absence from school (or work): perhaps when I go visit the OFP for my next therapy session and/or when I next go see the behavioral psych nurse I should have people who are not me sign off on how I have been doing.
Because let's be honest: when your brain has been hijacked you are not a reliable reporter of the symptoms of my bipolar.
When I go to these places for my mental health I have to fill out a screener that asks me how often I have experienced certain symptoms in the past 2 weeks. And I am often guessing. Or wrong.
So what if I asked a few close people to help me fill out a chart. Not on what I am thinking (because that is all over the board for me-- isn't that part of this whole bipolar thing?) but my energy levels and how I am relating to people.
The Depression scale does not do any good for assessing how I am doing.
Grateful Crap: Coming off venlafaxine before the end of daylight savings time. Because if the time change throws me for a loop this year as Spouse says it does every other year... I don't need any extra help switching.
added supplements back into my pill minder: Omega-3, Magnesium, Multivitamin
tap danced in between other things (while waiting in line; while waiting for daughter to use the public restroom; while waiting for water to boil for tea...)
Will return to tap lessons tomorrow. Have not been since the beginning of January. Missing it.
Did all kinds of virtuous things involving meeting people and talking with them and getting things settled and it made me feel really darn good. Much less anxious than I've felt in some time. I realized that there had been kind of a spider-web thin layer of anxiety over everything I was doing and it just sort of blew away. Which was pretty cool.
Behavioral psych nurse practitioner
Who totally rocks. I had to catch her up on the whole diagnosis thing (bipolar) and her first words were, "Oh no, Effexor is a terrible medication for you, then!" I proceed to give her a heart attack recounting tales of my potentially disastrous but ultimately fine "mixed state" experience. I made her give me paperwork so that Spouse can talk to her about me if he is worried or has questions about my treatment (because when things are going wonky, he is much more likely to notice than I am). And she did several things I really liked.
I had some time in between my meeting with Behavioral Psych Nurse and the OFP. I planned to drop in on a friend, but when I didn't hear from her immediately I decided it was a sign that I should drop in on the Big Boss at work and blindside him with my bipolarism. So I did.
Conversation went really well. He was surprised, intrigued and supportive. Asked me good questions about what my treatment involved and what the ramifications were while they were trying to get my pharmaceutical cocktail correct. And was very sincere in his desire to help in any way I needed. THIS was when the big (but lightweight) layer of anxiety went away. Who knew that I had been so worried about telling or not telling my boss.
I made sure to let him know that I was not disclosing this information to get a pass. And that I didn't really need many accommodations beyond what I already have going with my supervisor. He thought it was very good that I was in open communication with her. Because it is.
I told him that when I am not doing well, one of the first things that happens is my becoming unhitched from time. That I can do the routine things... that I would never miss a day of teaching and other than the times I have missed for Depression, the bipolar has not interfered with my classroom stuff.
BUT I might think I just turned in a timecard when it really was three weeks ago. Or I might be convinced that I have a meeting in two days but it actually happened two days prior. And what would be helpful is if he notices that I am not responding to emails or starting to seem kinda flaky-- if he could follow up and ask me if things are okay. To assume that the pattern is not one of irresponsibility, but perhaps a clue that I need to tweak my treatment or change my coping behaviors in some way. And it would help me to know that in a non-judgy sort of way.
Crap. I knew I should have written this yesterday. I cannot remember what I talked to her about exactly. I went through the whole mixed state business and once she was resuscitated and breathing independently-- we talked about other stuff.
I do remember her complaining that by the time I got to her office I had clearly already figured things out. But I told her that without knowing I needed to talk to her I might be tempted not to figure some things out. It is another layer of accountability.
Also signed forms so she can share information that I am seeing her with behavioral psych nurse. And so that Spouse can talk to her.
Mentioned I wanted to figure out a schedule for stuff-- but there was not time in this particular session to go into that. Besides I want to get a rough draft going and maybe even try it out before I see her next in one month.
pretty much the whole fricken day
meds: 112mg venlafaxine, 450mg bupropion, 200mg lamotrigine
That's about it.
Grateful Crap: I refer you again to my awesome supportive coworkers and administrators. I am ridiculously lucky in this and do not take that for granted.
I got stuff in the works. I feel good about it. Writingly, I am doing a fairly decent job of staying with the blogging thing. I sent my trashy romance novel in draft form to Lulu.com so I can get a proof for my analog beta readers to page through. I am doing some curriculum-kind-of-thinking and that too is going well. Writing brain seems to be firing on all cylinders. Woot.
Planningly, I have meetings with my behavioral psych nurse practitioner (who I have not seen since pre-diagnosis when I unceremoniously-- and foolishly-- dumped her for my psychiatrist) AND the OFP.
From my behavioral psych nurse practitioner I will draft a lovely emergency plan regarding medication-related issues. So that if I have some kind of manic thing going on in the future I don't have to figure out what to do. I will already have a plan. Even if the plan is: stop what you are doing, sit down and call speed dial #2 on your phone. Then say, "ACK!' See, that would be a pretty easy plan to follow.
From the OFP I want to come up with some accommodations for dealing with my persistent denial of the existence of time. Okay, what I really want is a checklist of when I do things like check my email, look at my calendar, check my voicemail, call my friends, get in touch with my family, turn in my timecard... you know, things like that. I think they are among the things that if I schedule them I will do them. And if I stop thinking of scheduling as being scary and horrible and beyond me.
Realized one reason for not wanting to check email (that I may have mentioned before) is that I don't know what things will trigger me and I don't know if something in my inbox might be a powerful trigger. So sometimes it feels like I have an empty box that MIGHT have a rattlesnake in it... and I can choose whether to open it or not. Of course, that is not a very useful way to regard one's email inbox. Working on it.
More planniness: I am going to talk to the big boss regarding diagnosis. I'll let you know how that goes. I just think I will feel better if I disclose my bipolar self and talk about how it does and does not affect my work and crap. And with as open as I have been with friends, family and the whole wide world of the internet, it is not as if my bipolarism is a terribly well-kept secret. Which is deliberate. Not interested in living a secret life.
Also, I was thinking of my friend who mentioned some time ago that people could tell by looking at her when she was having a bad day-- her mobility was limited, she was confined to a wheelchair, there were obvious physical signs. But that people couldn't tell by looking at me that I was having a bad day.
And it made me think about bipolar disorder - characterized as a disability by the ADA - is a disability that it is (technically, maybe) possible to hide. But there are many that are not. Don't know where I am going with that thought. Maybe just that because I can (maybe, sort of, not really well) hide the bipolar crap doesn't mean that I should. Or something. It makes more sense in my head.
Crap. Forgot to take morning meds until just now. Be right back... Done.
Umm... rested with humidifier on and read how to avoid acute bronchitis
Will NOT MISS ANY BAND PRACTICES for upcoming concert
Grateful Crap: Have I mentioned how awesome my work environment is?
I am beginning to think it would be easier to write down the days that I am NOT sick rather than the days that I am. There seems to be some arguments between researchers on whether there is a link between infection and bipolar. But my theory is this: stress lowers resistance to disease and bipolar tends to flood the body with stress hormones. So it seems reasonable that there is some link.
I have another sinus infection that knocked me on my ass yesterday (slept from 4:30 - 8:30 and then was semi-functional until 11:00 pm). Today I am vertical, but I can tell my body is not terribly happy about this.
Moodwise, feeling pretty good.
I have a confession to make: I was hoping that being on mood stabilizers would magically fix my broken mood thermostat. That if I were on the correct dosage I would no longer be prone to mood swings and moods disengaged from my environment.
Apparently that gets to be the gift that keeps on giving.
In my mind I made up this fairytale that for the first little while-- getting the right meds, some sort of recovery period-- I needed to be very careful with my mood health and try to avoid stress and triggers. But that after a certain time, I would be indistinguishable from a non-bipolar person.
Bzzzt. Wrong answer. Try again.
I guess that is one of the things that makes ongoing talk therapy an important thing: establishing coping mechanisms and reminding myself that I will continue to need coping mechanisms and that I shouldn't freak out if I go off the rails every now and again.
Pardon my language.
This means that I really do need to get back on the physical activity bandwagon. This slid into nothingness during the winter break and never really got back on track.
But there will, of course, always be excuses. And it is not worth the risk.
took meds (112+/- mg venlafaxine, 450mg bupropion, 150mg lamotrigine)
Grateful Crap - 4yo: "Every day my love for you levels up!"
This morning I woke up all not-panicky. And I realized that is probably something to strive for. I could even think about stressful things and it didn't make me feel panicky. And I thought to myself, "Ah, so this is what my normal feels like."
Of course this is kind of ridiculous way to think-- as if people have one way of feeling when their moods aren't screwed up. But this morning was one way that I feel when I DON'T feel derailed by the runaway mood train.
This morning I had brunch with a friend and it was super nice. She made a suggestion (and it is a brilliant one) that I schedule my calls to friends. Because otherwise I forget and then a long time passes and then I feel like I can't call them because I have been a Bad Friend.* This means I will have to get better again at writing things on my calendar and then looking at my calendar.
Sometimes I feel like I need a PCA just to deal with all the time-related stuff. Or at least someone who can help me come up with a very strict regimen. Perhaps I will have the OFP help me work on that.
In Quaker meeting this morning I had a song on continuous repeat in my head. Then it became clear that I had a message. When I opened my mouth to sing, a completely different song came out. Which was cool, but a little bit freaky.
I was thinking a lot about how difficult it is when people who share a faith community split up... how too often one of the people is left out because it is too difficult to navigate being in the same space with the ex. And this seems like a big problem. Because when folks are going through a painful split, that is the time they most need support.
How can we support the whole family-- both partners and any children who are involved-- as they go through a really crappy transition time in their lives?
This is a real question. I have seen this happen many times in my own family and in my own faith community. And I know all there reasons why this happens. Life is messy and there are no good answers. But I think it is important to wrestle with this one. I am unwilling to leave people dangling when they need someplace to belong.
tap danced for 10 minutes (with daughter who was in snow boots and a bike helmet)
sorted out the beads from my venlafaxine for the next week
took my meds (112+mg of venlafaxine, 450mg bupropion, 150mg lamotrigine)
went to meeting
time with a friend
writing writing writing
Grateful Crap: People at my Quaker meeting. They rock.
*Note: one friend whose calls I have been ducking (for no malicious reasons... I have been ducking everyone's calls) got pneumonia and was hospitalized just so I would get in touch with her. Which I think is going a bit overboard. I'm just saying.
Quaker, teacher, parent,