Outpatient Therapy-Final Session

Yesterday was the last session of my group therapy program. I began this intensive program 21 October and we have met three hours/day on Mondays, Wednesdays and Fridays. Yesterday marked my 30th session.

Initially, I was very phobic to these sessions. Similar to my attitude when I was involuntarily committed , and knowing I was only obligated to attend for two weeks, my original intention was to skate through those six sessions with no effort on my part. I was still pissed off at the world for how I had been treated to date; I did not want to be in therapy and I certainly did not want to get better.

You just cannot imagine the amount of rage that pulsed through my veins—think Incredible Hulk. However, as the mandatory two weeks came to a close, something was triggered inside of me. Somehow, I came up with the idea that I no longer wanted to go on feeling the way that I did. That level of rage and profound depression was eating away at me and I simply had no more energy left. I voluntarily agreed to stay in the program having no idea that it would take this long.

There was a very detailed daily check-in sheet we each had to fill out. It was basically a way for the therapist to determine and track our progress. The dynamics of the group evolved over time with old patients being discharged and new ones being admitted during my stay. While the overall group was large (in my eyes), averaging around 18-20 folks, once everyone took the 10-15 minutes to fill out the check-in sheet, we always split into two smaller groups. The groups remained split while everyone reviewed their sheets, and we all came back together as one group after the break to start the second half.

I could handle the smaller group in which we each shared what was on our sheets. Based on our input, the therapist would probe further with each of us and ask penetrating questions. The sharing half had a tendency to be somewhat tedious at times. Every so often, there would be patients that liked to hear themselves talk. Repetition is the key word here. They would go on and on about one particular issue and even talk over the therapist as if they had no interest in listening to her feedback. I could see the frustration on the therapist’s face every once and a while. As a result, sometimes the first half of the session would take a long time.

After the break, when we all gathered back together, I had a major problem. I had a rough time being around large groups of people. The noise level would always increase and sometimes everyone would talk at once. That started freaking me out. Therefore, I retreated from the large table in the room (it was actually five conference room-sized tables arranged in a large square) and sat in the chair against the door right by the back emergency exit—it was as far as I could get from the group. The emergency exit was not wired to an alarm, and when it got to be too much for me, I’d walk out the door and take a breather. Being that it was the end of autumn as winter approached, the cool, brisk breezes usually refreshed me.

The second half of the session was psycho-education [I’m sure that Alfred Hitchcock could have had valuable input here :)]. This outpatient therapy program was based on dialectical behaviour therapy (DBT).  When I tried to commit suicide back in 2005, I went through a DBT program after I got out of the hospital. At that time, I thought that DBT was pure bullshit. It all centres on learning tools or coping skills to manage various stressors (depression, anger, rage, anxiety, etc). Being that I had been diagnosed with Bipolar I Disorder (BP) and Borderline Personality Disorder (BPD), everyone thought that this type of therapy would be one from which I would benefit. Back then, I thought all these coping skills were stupid. Sure, it might work for some, but I just could not imagine me taking the time to think through whatever emotion I was feeling at the time and remembering which tool would help me through that situation most effectively.

When I realised that this time around would be centred on DBT, I was quite cynical. However, after about four weeks into it, I discovered some tools that could actually serve me well (see this for a list of tools). Without a doubt, using these skills effectively requires constant practise. You cannot expect to utilise a skill and then have it at your fingertips until you practise it. Once practised, when you face an emotional obstacle, you can more readily adapt effectively.

I also realise that there is a lot of controversy around DBT. Some who have been through the training think that it is bunk as I did. I can say that I do not agree with the entire skill set. I learned what tools I knew I could use and left the others behind (there are some I still think are bullshit). All I can say is that it is up to each individual to determine what works in his or her best interests.

That being said, the first half of my last session was great. Our small group only consisted of seven patients and our small group never had the loud mouths (I am grateful that Mr. Noisy was in the other group!). I knew three of them; the rest were new patients. When I finished sharing my check-in sheet, I received wonderful feedback from the therapist. She basically said that I had done a 180˚ from the time I started the program and was extremely pleased to see the progress I had made. It had taken me all this time to see the huge steps I had made. Don’t get me wrong; I am far from being all fixed up. That is why I am going to continue with an individual therapist. BP and especially BPD can take quite some time to manage. While some professionals banter about the word recovery, I think the best I will be able to muster is to manage my BP and BPD to a tolerable level. Only time will tell.

The second half of my last session was surprisingly smooth. While Mr. Noisy was present and accounted for (as well as the other few loud mouths), the group discussion on the continuing module of assertiveness was quite ordered. It was quite appropriate that my last module would be on this topic. As I have mentioned previously, despite my butch bravado, I really could bolster this skill.

Saying goodbye was harder than I thought. All of the patients who had been around for a while (with the exception of one other patient, I had been there for the longest duration) took their time saying goodbye to me and wishing me luck for my future. As someone laughingly said, “Hope to see you at Wal-Mart should our paths ever cross again.”

Overall, I have to agree with the therapist. I have come a long way since I tried to commit suicide on 10 October. It has been a long road for me, some of it fought tooth and nail against any type of recovery. I know I still have a long way to go, but for now I will just accept the fact that I am in a better space than I was almost 12 weeks ago.©2009

Outpatient Therapy-Day 29 (28 December)

Because of the Christmas holidays, the majority of the folks did not attend on Monday. After that last fiasco the previous Wednesday, I was glad the whole group was not present. In fact, with the exception of two other people, everyone else was from the other small group. I was concerned because Mr. Noisy was there, but when it came time for him to share the information from his daily check-in sheet he took a direct approach and did not go on and on about everything for a change (as he usually does when both groups join back up for the second half of the session).

It was odd sharing among this group; only two other people really knew me. My check-in sheet was pretty much straight forward. This was the second-to-last one I would be filling out and what a comparison to the first one I filled out 11 weeks ago. So much had changed over all this time. I knew that this coming Wednesday was going to be my last day. The input I received from the therapist was very positive. She couldn’t be as insightful as our small group’s regular therapist (ours was out for the holidays), but she still remembered the state I was in when I first joined the group. I at least appreciated that. She saw the tremendous difference in my attitude, but mostly how much I had changed in the anger area.

The second half of the session was spent still going over assertiveness. Much like the anger management module, this was a long one as well. Being more assertive is something I need to get under my belt. Much like the self-esteem module, the two seem to go hand-in-hand. The group discussion was far more controlled than last Wednesday and Mr. Noisy was less dominating throughout the discussion. I didn’t really have much input that day; mostly I listened to what the therapist was saying.

There is one tool I have been taught that has served me well. It’s called Using Your ABCs. “A” is awareness: the acknowledgement that an event has occurred—it is what it is and no value judgement is placed. “B” is your belief of what that event is. “C” is the consequential emotion of that belief. A ≠ C, but B = C. The theory is if you can acknowledge what the event is and form a healthy belief about that event, the consequential emotion will be a healthier emotion rather than a destructive emotion. Here is an example. “A” = my family has refused to invite me to family holiday celebrations. “B” initially was that I felt unwanted. “C” resulted in an emotion of anger and hurt that escalated more than the situation warranted which cascaded over the rest of the day and then some. If you can change the “B” to equal a response more like “Well, they are the ones missing out on my joining them,” then “C’s” consequential emotion will be healthier along the lines of perhaps still being hurt and yes, somewhat angry (there are times when anger is a perfectly rational emotion), but the intensity of the emotion will be far more controlled and not spill over into everything else that will ultimately escalate (or for as long as you repeat the same thought process).

These tools are serving me well, but I acknowledge that it is up to me to practice them so they will be available for use when I need them. Going into this program, I initially thought these tools were just a bunch of bullshit, but over time, I learned that they merited some attention on my part and realised their value to my success. I will be discharging from this group therapy this Wednesday, After doing this non-stop three days a week @ 3 hours each day, I have found the experience to be quite beneficial. While I am looking forward to being finally discharged since joining this program 21 October, I imagine there may be some group therapy withdrawal I may have to go through initially. This program has become part and parcel of my life since being committed on 11 October as an inpatient.

I have a follow-up appt with my individual therapist in early January to segue into a continued therapy module rather than just quit. I still have unresolved issues to deal with, most notably the tremendous stress I am feeling about returning to work. Yes, I am going to feel somewhat disconnected when my group therapy sessions come to an end this Wednesday.©2009

My Christmas Day

I woke up at 0430 and just listened to the pouring rain. It was coming down hard. I thought of my basement and the sump pump. Sometimes, the pump just about breaks even. I went out on my front porch and saw all of the puddles forming in the dark. Then I noticed all this newspaper scattered on the front steps. I had forgotten to check my mailbox yesterday and realised it was the grocery coupon mailer. I stuck my hand outside the porch door and grabbed what was in the box and left the soggy paper on the steps thinking I’d retrieve it later when the rain stopped.

I rarely get personal mail delivered to my house as I have a PO box. However, I noticed a red envelope and quickly looked at it thinking it was a Christmas card. It was. I almost cried when I read it. It was such a beautiful card from my son. I was so happy that he remembered to send me a card. With everything that has happened in the last couple of months, the only energy I was able to muster was getting a card and a present for my son. I did not send out cards to anyone, but I did receive about ten cards which pleased me.

I rambled around the house for a while and then went out to the living room and cranked my stereo and just sat there and zoned out on the music (it would have been far much more pleasant if I could have rolled a joint). After a while, I decided to check my email and was pleased to see an email from a good friend of mine. He was inviting me to join him, his mother, stepfather and adorable two-year-old daughter for their Christmas dinner later that afternoon. What a special treat for me. I decide to call him and accept the invitation once it got to be a decent hour.

The morning just crept by. I was not in the mood to do any writing and felt a little aimless. It was too early to take my medicine and I did not feel like reading anything. So, I just sat on my couch and closed my eyes and listened to the music. I am so glad I live in a house rather than an apartment. I do have an upstairs neighbour that rents the small attic apartment above, but he was gone for the holidays and enjoyed turning up the stereo louder than usual (he’s hardly ever home, so that doesn’t really affect me)

1000 came around. I called my friend and told him how delighted I was to get his invitation, and I would love to join them later in the afternoon. It was still pouring outside and hoped the weather would clear up before I had to leave. Imagine, my family all celebrated holidays without me (their decision, not mine) and here I was able to join another family to partake in a Christmas dinner. I was really looking forward to this opportunity.

The afternoon finally rolled around and I started to get ready. The rain had finally stopped. When I got to his house, it was great to see everyone. This was the first time I had met his stepfather. My friend’s parents live out of town, but I’ve met his mom before as sometime she comes to town and she attends church with him. His stepfather was a great guy. I really enjoyed talking to him as my friend and his mom got dinner ready (I was instructed to relax!). I felt guilty just sitting there while they worked in the kitchen, but I really enjoyed getting to know his stepfather

While the food was great, what I enjoyed more than anything was sitting around the dinner table and sharing the meal with this family. We spent such a long time lingering over dinner and dessert (my friend actually baked the cherry pie—while I love to cook, baking has never been my thing). The conversation was warm and inviting; I was having a great time. When dessert was over, my plans were to help his mom clean up, but again I was kicked out of the kitchen. The rest of the evening we spent in the living room all sharing stories. What a close family they were. I envied my friend; I had not had this much fun sharing a meal in such a long time.

At 1930 I was bushed. I think the combination of a great meal coupled with the fact that I had been up for 15 hours did me in. This was the best Christmas I had enjoyed since my son visited me.©2009

Outpatient Therapy-Days 27 & 28 (December 21 & 23)

Monday was supposed to be my last day of group—the insurance company had only authorised sessions through then. I was not prepared for it to end. Despite my attitude at the beginning, I have gotten a lot out of this therapy and I think that I have made significant strides. I asked my therapist what process I had to go through for discharge and she told me she didn’t think I was ready, especially with the Christmas holidays coming up—she knew I would be alone as, once again, my family enjoyed their celebration with no nod to me. I am beginning to get used to the idea of spending the entire holiday season alone. My son came to visit me two years ago, but he lives out West and, for both of us, it can get rather expensive just to fly in either direction. So, the therapist told me to return on Wednesday as she was going to submit a request to see if the insurance would authorise additional days.

The second half was on self-esteem—something I am sorely lacking. Despite my butch bravado, I saw traits from the description of those who have poor self-esteem and I ranked right up there. That actually pissed me off a bit. Nevertheless, in reality, I do not always stand up for myself and usually take a back seat. I am not exactly a doormat, but I am not as assertive as I could be. It’s odd as at work I can take the lead with regard to directing projects (considering I have taken that blasted Six Sigma training), but when I am relating to others on a personal level it is more apparent.

As the session drew to a close, I wondered if today was going to be my last day. I gathered my stuff and flew out the door as I had another iron infusion directly after group.

I came back Wednesday morning and was pleased to find out that the insurance company had authorised three more sessions, including Wednesday, through December 30th. That would take me through the New Year’s weekend leading right up to when I was supposed to return to work. When our “small” group was sharing, I tried to process the difficulty and anxiety I was feeling about returning to my job. I fear that I do not remember how to do what I have painstakingly spent three months trying to learn. I try to stay in the moment as I still have another week to go, but I cannot help worrying about it. I feel stuck and do not know how to reinsert myself into the routine. I got a lot of good feedback from the therapist and others, but it did not necessarily quell my anxiety.

The second half of the session was on assertiveness—something that I am not very good at as I am more than likely to be either aggressive or passive aggressive. The entire group, as usual, gathered for this part and our entire group is getting way too large for me. It is enough that my little group, when we split for the first half, has too many people. I have discovered that there are a couple of noisy “talkers” in the other small group. As the therapist began her discussion on this topic, those talkers always had something to say about everything and would get into their own discussions if they disagreed with each other. The more they spoke, the louder they got and more people started getting into the action.

It was becoming too much for me. I wanted to listen to what the therapist had to say and ask my questions if any came up. After a while I thought, hell this is a topic on assertiveness, I think I will try it on for size. Rather than just jumping into the fray as everyone else had been doing, I raised my hand (OK, that does not exactly project an assertive position). The therapist piped up (she was pretty good about keeping the group on topic) and nodded to me. I waited for everyone to get quiet, looked around, and gave everyone eye contact. Then I explained that it was hard for me to be around large groups of people, especially when it got loud and everyone was interrupting each other. I told them that when they got carried away, I felt anxious and asked everyone if they could respect my position.

At first, everyone just stared back at me and then the therapist chimed in first. She said she was glad I spoke up and voiced my concerns and told me that it was an assertive position I took and was very appropriate (I thought to myself, “So there, hah!”). Then the noisiest of the bunch jumped in and said to the therapist, “Excuse me, but don’t you control our group?” She said it was a group discussion, but everyone had to be aware of each other. Then Mr. Noisy said, “Well, I’ll respect your position.” I looked at him and wanted to say, “What am I, chopped liver?” What I really wanted to say was, “Fuck you” but I did not (so OK, I was not completely assertive). For a while everyone seemed to settle down, but it did not take him long to go back to his diatribes and, once again, everything exploded. There were ten minutes left to go, so I just decided the statement I would make would be just to pack up my stuff and leave the room. I was not that quiet about it (here is where I was being passive aggressive), pushed back my chair and got up and walked out of the room. I though, “Well, we’ll have Friday off for Christmas, so that will give me a breather.” However, I was glad my insurance had authorised two more sessions.

Two more days until Christmas. To tell you the truth, this year it has almost snuck by me. I do not get out much so I have not been too exposed to the shopping traffic. Moreover, I definitely do not go to the mall. I have forgotten that it was going to be Christmas on Friday. For me, it will just be another day.©2009

Appt With My GP #5 (Friday 18 December PM)

I have been dreading this appointment all day. My hand is still sore from the IV on Wednesday and they cannot seem to pop either of my brachial veins or the antecubital ones in my arms—fairly decently sized veins. Luckily, for me, the guy from the lab was working today and he has always been successful in starting my IVs when the clinical specialist could not.

Before each infusion, the clinical specialist always draws blood once the IV has been started to measure my haemoglobin. My GP told her that if it was 12.5 or better to wait until this coming Monday to give my arms and hands a rest. Well, the level was 12.3, but they both let it slide until Monday anyway. As usual, I made the appointment to take place directly after group. I still dread going, but I can’t beat the price!©2009

Outpatient Therapy-Day 26 (Friday 18 December AM)

Today our regular group therapist was out. The person taking her place normally works as the inpatient intake therapist, so I was not sure how group would go. As I mentioned in a previous post, our little group was getting much bigger. When I looked around I noticed that we had three more new admits. I feet as if I no longer have a rapport with my group now that the original members have all been discharged. I have been here the longest—two months. Most people only stick around for four to six weeks.

I no longer feel that the group sharing part is meaningful to me since the other patients have no history of my background and what I have been through leading up to my time just before I joined the group. However, the second half of the session is still meaningful since we discuss the various tools to use to keep our emotions in a healthy balance.

Well, today was a little different. This therapist had a lot more to say for each person as each patient was sharing. I really liked his style. Looking back, I wish he had been the therapist all along. This is not to say that the regular therapist is not as competent—their styles are just different. I am still trying to process the increased depression I have experienced this past week as my financial situation looks so bleak. Most of the patients are on SS Disability full time. I do not see how they can afford it. When it got to my turn to share, one of the other patients suggested that I should file for bankruptcy. Aside from using the “should” word which imparts a value judgement, I cannot fathom filing for Chapter 7. I incurred this debt and I have an obligation to pay it off. He practically bragged about the fact that he filed two separate times. I just cannot imagine someone brushing off his or her obligations like that. Besides, I still have to get another car—how the hell I’m going to afford that one is still up in the air. My car is starting to make telltale noises, so I know it is not going to be around for much longer. I will never get financing if I file for bankruptcy. I have to be practical here. Because this therapist had a lot more to say with each patient, we spent the entire three hours going over our check-in sheets.

I cannot imagine not being apart from this group therapy. Despite the fact that I whined about it so much in the beginning, I have really benefitted from it. I found out yesterday that my medical insurance will only cover 27 sessions making this coming Monday my last day. Oh, yeah, I forgot to mention that the disability group that processes the claims did approve my extension through January 4th. I would like to be able to continue with this therapy for as long as I will be out of work.

Now that I have a fixed date to return to work on January 5th, I have to start planning for it. My FMLA runs out pretty much at the same time, so I no longer have any choice. I will be going back to work so I need to get that in my head and just deal with it. Oh how I wish I could afford to be on permanent disability. It is not as though I am being a gold brick about having to work. It is just that the job I have is very high profile and creates a tremendous amount of stress and long hours. It is going to be a rough transition after being out of work for two whole months. However, I am going to try not to stress out over that. Nevertheless, I cannot ignore it either.

Well, I have another appointment with my GP again today right after group to get another iron infusion. I sure hope that person from the lab is there as he has been far more successful at starting my IVs than the clinical specialist has been. You should see my poor arms and hands.©2009

Appt With Psychiatrist #10 (Thursday 17 December AM)

Today is going to be the last weekly session I will be attending. From this point forward, I will be seeing my psychiatrist every two weeks for a while, then once a month. I will miss the weekly visits, but he and I both agreed that I have made tremendous strides since I tried to commit suicide. It will also be much easier on my billfold as my insurance does not cover any of his fees (he is out-of-network and that deductible is $5500—it will be quite a stretch to incur that much of a balance any time soon).

He has decided to increase my Lexapro to 40mg/day. We have both been pleased with how effective it has been even though I am currently experiencing a setback in my depression (which is the reason increasing the dosage). It has been the only anti-depressant I have ever taken that has had such a marked difference in my depression without tripping a manic phase.

I learned something new today. I just happened to mention the strange reaction I experienced on Monday after my first iron infusion. He said it sounded like I experienced Cataplexy that would explain the sudden onset of fatigue along with the loss of muscle tone. It is frequently associated with narcolepsy and Provigil just happens to be one of the drugs that combat narcolepsy, which might explain why I did not have that reaction yesterday.

Overall, I am glad that I have made such progress thus far. I have received excellent therapy support from both my group and my psychiatrist. I think I am going to have therapy withdrawal once I go back to work. I have arranged to start seeing an individual therapist once I finish with group. I have already seen her two times and I think we have the chance to build a good rapport.

What was nice about today is that my appointment was at 0700 and I have nothing else scheduled for today. It will be nice to have some down time.©2009

Appt With My GP #4 (Wednesday 16 December PM)

The clinical trial continues. As soon as I left group I wish I had thought to call ahead of time to see if the office was still open. The weather report was calling for 70% chance of frozen precipitation mostly in the form of ice. When I left group, one of the parents told me that the county had already decided to close the schools at 1230.

As I was driving over to the office it was pouring, but there was no sleet mixed in with the water. Good sign. In most cases, when they predict snow or sleet, it hardly ever happens. I was a little concerned when I pulled into the parking lot as there only a couple of cars. Then I remembered that it was lunchtime. When I signed in, I did find out that the clinical specialist was waiting for me.

As she was prepping all of the materials for the IV, I asked her if she would mind if we just let the guy from the lab stick me instead since he got it on his first attempt on Monday (after she had already tried three times!). Therefore, we waited for him and, sure enough, he got a vein on his first attempt. However, as the specialist was adding the gizmos to the butterfly tubing she moved the needle and the IV infiltrated. I was not a happy camper, but we called the lab again and he was successful this time as well.

I like the fact that the iron can be pushed in only ten minutes. Sure beats the six hours I had to endure three years ago. Once the iron had been administered, I had to wait the customary 30 minutes to see if I was going to have a reaction. On Monday I didn’t have one in the office, but I did have that strange experience an hour after I got home. To be on the safe side I went ahead and took the Provigil just in case I started getting sleepy while I was driving home.

Well, it turned out that I did not have that strange reaction this time. Perhaps that reaction Monday afternoon was just a coincidence. However, I do not like the fact that I was overcome with fatigue and feeling so cold all at once. That has never happened to me before, and maybe it won’t again.©2009

Outpatient Therapy-Day 25 (Wednesday 16 December AM)

My group therapy session today did not go as well as I had hoped. I am feeling more depressed these last few days, since Saturday, but I did not realize how much until it was my turn to share. As I was going through my daily check-in sheet, when I got down to the section marked “current stressors,” I had written that I was facing huge financial burdens due to all the medical bills coming in and that I still had to find the extra money to support buying another car. As I was talking about this, the tears just started rolling down my face. I hate crying, especially in front of other people, but I could not keep up my façade. I was not even sure what the catalyst was of my recent downturn of my mental status, but as I was sharing this, it became apparent to me that my money issues must have been playing a good part of my increased depression. Of course, there was no real tool to deal with these emotions—anything I tried was fruitless. My bills were not going away and there was nothing I could do about it. The latter concept should have given me a clue as how to handle this situation—to accept it at face value and deal with it. But, how can you deal with knowing you have much more outgo that income?

Just to add to my worry and anxiety, today is the last day of my short-term disability. Both my group therapist and my psychiatrist have submitted extension requests, but when I called the third-party vendor that administers disability claims, I was told that the decision would be rendered tomorrow, my first day back to work. I am definitely not ready to face that stress. I left a voicemail for my manager indicating that, while tomorrow is supposed to be my first day back, I was unable to return and that the claim decision would be made tomorrow. I indicated that if the extension is denied, I would like to take my remaining vacation days through the end of the year (I had 14 days still coming to me, and while I was going to be using up 10 of those days, I would end up losing the other four as my company does not allow someone to carry over any vacation days). Then I sent him an email saying the same thing. If they do deny the extension and my manager does not go along with my vacation request I will risk losing my job according to the FMLA rules—I would no longer be protected by the federal guidelines imposed by FMLA. Why can’t the disability group make their decision by the end of today to give me a heads up as to what I should do about tomorrow in case I do not get a reply from my manager? My psychiatrist submitted his request along with the supporting documents on Monday, two days ago. They have previously decided with paperwork only submitted 24 hours ahead of time. Why did they need 72 hours this time?

I also have to go by my GP’s office right after group to get my third round of those iron infusions. I am not looking forward to that considering how many times they had to stick me Monday just to find a vein. I also had that weird reaction when I got home, but when I reported that to the clinical specialist yesterday, she looked up the reported side effects. While feeling tired was one, feeling that extremely tired along with the muscle fatigue and feeling bone-chilled made me think that something did not add up. I do not want to get the same reaction again this afternoon. I am worried in case these side effects start appearing while I am driving home. To be on the safe side, I put a tablet of Provigil in the pill container that I always carry with me. I just hope they can find a vein much easier today. I still have bruises from Monday’s attempts.©2009

Appt With My GP #3—Iron Infusions (Monday 14 December PM)

Good news…I found out last week that I have been accepted for the clinical trials for people that have iron deficient anaemia and can now qualify to receive my IV iron infusions for free, and they will pay me travelling expenses. The nice part is that all I have to drive to is my GP’s office. This past Monday I went for my first visit. The clinical specialist drew my blood to get a baseline haemoglobin level, and then she attempted to start the IV. Well, my veins are pretty much shot. She tried three times to find a vein, and then she finally called someone from the lab to see if he could start the IV. Boom, on his first shot he found one. It was a painful one in my wrist, but still the same, he got it started. When I had to have IV iron infusions three years ago, they gave me 25mg over a six-hour period. I had to have three at $1600 a pop. I can no longer afford to go back there.

One of the things they are testing me with is a new solution that will allow them to give me 200mg IV push over a ten-minute period—such an improvement. Once the iron was injected, the clinical specialist had to observe me for 30 minutes for any type of reaction such as anaphylaxis. I did not have a reaction so I went home and turned on my stereo and sat on the couch.

An hour later, I found myself nodding off. However, it was not a case of slowly getting sleepy and just closing my eyes. This hit me like a lead balloon. I almost could not move—all my muscles felt slack. Then I realised I was bone-chilling cold. Now, to save on money, I do keep the house rather cool in the winter, but I already had on thermal underwear, sweat pants, a sweatshirt and my thick terrycloth robe. I was freezing. I tried to get off the couch to snuggle under my covers and barely made it back to my bed. It took 20 minutes before I started to feel warm. As tired as I was, over the next two hours, it seemed that I just clock-watched. However, when I got out of bed (now much warmer) I had vivid freeze-frame images as if I had been dreaming. I was not as tired, so I went to my kitchen to make a pot of hot tea. What a strange experience.

The rest of the day was uneventful so I dismissed the entire episode. I am just glad that I can now get my much-needed iron infusions free. I wonder how many sessions I will have to have to raise my haemoglobin back to normal range (it was 9.0 before the iron and normal is generally around 14-16 for females). According to the protocol for this clinical trial, they can give me up to 1000mg over a two-week period, but stop at any point once my haemoglobin is within normal limits. I hope I do not have to have too many since they had such a hard time starting the IV. You should have seen my arms after this session—I had four nicely forming bruises where each attempt was made!©2009

Outpatient Therapy-Day 24 (Monday 14 December-AM)

I have been somewhat disappointed these last couple of days. I was doing so well last week. Since my short-term medical disability is only approved through December 16th, so I thought I would be ready for discharge from this group therapy program. The therapist recommended that I return today to wrap everything up, but after this weekend, I could tell that I was more depressed than last week. I do not know what the catalyst was, but I am glad I had the chance to return. My daily check-in sheet showed a marked decrease in my level to function since last week.

One thing that I am disappointed in is that there have been a lot of new admission over the last couple of sessions. I still cannot handle being around many people. When the entire group gathered this morning to fill in the daily sheet I sorta freaked out. I moved from my spot at the table to a chair against the wall in the far corner until everyone finished and the big group split. Unfortunately, that still left a lot of people in my own group. I miss the folks that were part of my original core group when I started, but with the exception of two other people, everyone is fairly new. I have no rapport with them. They do not know my history. When it comes to my turn to share what is on my daily check-in sheet, how can they determine my level of progress (or in this case, the steps I have taken backwards)?

Even though there were still a lot of people, once the group split, I assumed my seat at the table (I always sit in the same chair—the one closest to the back door leading outside if I have to escape for a short period of time). Luckily, the person already sitting there was part of the other group. The therapist asked who wanted to go first and I groaned because we go around the table and it was going to take forever to get to me. As much as I put forth when it is my turn to share, with all these new people I had no idea how long it would take them to get through their sheets. Some people have been known to go on and on about not much at all. Not that I am trivializing their plight, but to repeat the same scenario over and over again from one person can get to be a bit much.

Actually today, it was interesting to hear the new folks share. So many of them were in exactly the same mental space I was in when I first started. It gave me a new appreciation for the strides I have made even though I feel like I have taken a few steps backward these past few days. Then, finally, it got to be my turn. One of the things I processed was my interesting reaction to my first visit back to my church after a nine-week absence since I tried to commit suicide. Here I was anxiety-filled at facing all these people for fear of what they would all ask me about my absence. Sure, some of the folks knew the truth, but there were a bunch that did not. I can still remember how stricken I was standing outside at the front door for fear of what would happen once I went inside (see post below).

Once I described how lonely I ended up feeling after the service was over since no one approached me (I had to keep telling myself it was because they were respecting my privacy), the therapist thought it was quite oxymoronic.©2009

My Return to My Church

Today I am gong to try to go back to my church after nine weeks. I am feeling very anxious about this. The anxiety has been focused just upon opening that door after all this time. I plan to arrive after the service has started to avoid anyone ahead of time. I know people will notice when I come in and I am also anxious about what to do after the service. Do I leave early the same way I came in? With my cane, I am not walking as quickly as I could. What happens if someone comes out to the parking lot after I leave as I walk across the street back to my house? My exposure is greatest at this point. On the other hand, do I stay until after the service and just get it over with and let everyone welcome me back? I have 45 minutes before the service starts and I am trying to use my tools to quell this anxiety—stay in the moment and not try to project—take it 5 minutes at a time if I have to…

(later)… About five minutes before leaving the house, I decided to do some deep breathing exercise to calm me. That seemed to do the trick. I walked across the street and approached the front door having no idea what to expect. I opened the door and the service was late getting started, but everyone was sitting in their seats. When one individual noticed me, she said rather loudly, “Hi Alix,” and that was it. The service started and no one paid any attention to me. The message that the pastor preached was a good one for me to hear. It was all on how a mighty God we have. At the end of the service, I stayed for a few minutes and it was the dénouement. No one came up to me. I think I was a little bit disappointed, but I did not have to deal with anyone. Maybe everyone was just respecting my space. Therefore, I stood, put on my jacket and walked out the door feeling a little lonely. It is odd, while I had such anxiety about dealing with everyone, when everyone had the chance to say hi to me to welcome me back, no one did. Maybe next week will be different. But, I finally crossed that threshold.©2009

Outpatient Therapy, Day 23/Psychiatrist Appt #9

Today’s session went really well. My therapist said I had made such strides over the last seven weeks that she agreed that I could be discharged on the 18th. Today, in fact, we had some new people and some that have been in the group for a little while that had it rock bottom and the therapist used me as an example how things can really get better. I feel good about myself today—something that I did not foresee being able to say even a couple of weeks ago.

I have built up a small coterie of close friends that know me intimately—the ins and outs of my mental illness. This has become my support group, yet another thing I about which I did not even think about. I was isolating so much and vindictively pushing people away to purposely further isolate me. The ironic thing is that the majority of this small group is made up of people with whom I had gone to church. That is my next major hurdle—reinserting myself back into my church. I am feeling less anxious about it, but something is still holding me back. Perhaps it is because not everyone knows my complete story and I certainly do not want to share that with anyone who has not been along for the ride.

I still do not know what “normal” is, but I feel more content than I have for a long while. I have not had any suicide ideation for a while, but the main concern I have, feeling this good, is that I am not ramping up to swing into the manic dark side. I am carefully looking for signs, and my friends know what to look for, so they may see it before I do.

I am going to try to go grocery shopping by myself, cane aside, this weekend. I will see how I deal with being around a large group of people. This should be a good test for me. It has been the one hurdle I have not passed (aside from returning to church). I have gone shopping with a friend that lessened the anxiety, but it is time I try to do it for myself.

I also saw my psychiatrist this morning before group. He also seems pleased at my bipolar improvement. Now that I am getting about six hours of sleep these last two days he has agreed to start reducing my Zyprexa, yet one less pill to take. He is going to submit an extension of my disability (currently ending on the 16th) to return to work on Jan 4th for two weeks at half-time to gradually get accustomed again with full time beginning on the 18th. I hope they approve this extension, as I am simply not ready to return on the 17th. He is not sure if it will fly since I have made such improvement, but he is certainly going to try. He is going to send in the paperwork on Monday.

Well, folks, that’s my story for today and I am sticking by it!©2009

Outpatient Therapy, Day 22

Yesterday was the first day that I have driven anywhere outside of my own neighbourhood area for a couple of weeks, since I sideswiped the 18-wheeler on the interstate. I have not had one of those dissociative episodes when driving in a while, so I thought I would take a chance yesterday and drive myself. The weather was just awful. It was pouring and visibility was cut to almost 500 yards/457 metres. I left an hour early just in case and was quite anxious about driving on the interstate the whole way, but I got there OK.

Had the weather been fine, having arrived so early, I could have sat outside and smoked until group started, but I was relegated to sitting in our room for a while before some of the others started to file in. I had my daily check in sheet already filled out since I do it from home before I get there (gives me more time to think and try to remember the details).

After the huge group split we started out “sharing” routine. I volunteered to go first as I had to leave early since I had an early appt with my GP yesterday as well. I had a good report to share and even had a smile on my face that everyone made a big deal about. Afterwards, the therapist commented that I was showing marked improvements exponentially. I think it has a lot to do with my psychiatrist putting me on the Lexapro a couple of weeks ago. I asked the therapist if she could mark some time for me after one of our sessions as I want to talk with her about my discharge from the program. While I have made huge strides over the last eight weeks (it was eight weeks ago today that I tried to commit suicide), I knew it was getting to the point that I could no longer afford to be in this program. Yes, my insurance is helping, but 10% of this, that, and the other adds up with all of the appts I have been having. I feel that my seeing my individual therapist now, along with my psychiatrist should be enough to continue with my recovery. I do not necessarily want to leave the group, but I have to make some decisions financially.

I cannot believe it has been eight weeks since I tried to commit suicide. The whole memory seems like such a hazy nightmare to me. On the one hand, I want to forget about everything. Yet, I have to remember it all to keep where I am at now in proper perspective. I have made some huge strides since then and I cannot forget this. So much has changed for me. There are more evenings than not where I can be in my house all alone at night and be safe. I am not sure what “normal” is supposed to feel like, but I do know that I am not as profoundly depressed as I have been. It seems that my bipolar is slowly being reigned in. The positive aspect is that I haven’t swung onto the manic side since starting the Lexapro, a valid concern my psychiatrist has as giving anti-depressants to bipolar patients in a profound depression can kick off a manic episode since the anti-depressant can kick you over to the other side. I have been carefully watching for that. I am getting more sleep now than I have been, and my talking does not seem to be any more excitable than normal. When I am manic, that is the first sign I can spot. I will get on the phone with someone and not shut up the entire time and I talk fast and excitedly. So far, I do not see any evidence to that.

Could it be that my bipolar is finally coming into balance? I am almost afraid to think that one aloud. Once my bipolar is in check, then I can start looking at my borderline personality disorder issues that, for obvious reasons, have been put on the back burner. I can continue that work with my psychiatrist and individual therapist, although I am not sure how to begin that whole scenario. There are some deep-seated issues that I have to work out, and this is going to take some time.

Meanwhile I am socialising more. My friend A called me as she was leaving work last night to check in with me and I asked her if she wanted to stop by my house on her way home. She enthusiastically said yes and I thoroughly enjoyed having her visit for almost 90 minutes. It is so nice to have people with whom I can talk about every day things. This is one area that I have seen positive changes in me. I am not isolating nearly as much. Right now, all my socialising is one-on-one; I have not tried to be in a group of people yet outside of my group therapy sessions, so I am not sure how I am going to handle that. I am going to try to start attending the NAMI meetings (National Alliance on Mental Illness) that take place Monday evenings right around the corner from my house. It is going to be similar to group with a different twist. According to the facilitator I spoke with the other day, there are only about 10-12 people that attend regularly and I will not have to say anything if I do not want to. I imagine I will just sit quietly for the first couple of meetings until I can get the lay of the land.

I am still on full-time short-term FMLA disability, but that runs out January 18th. Right now I am approved through December 16th, but I am now going to have my psychiatrist (instead of the group therapist) put in for the remainder of the time to see if they will approve the extension. My psychiatrist does not think I am ready to return to work anyway, and he wants me to start back only working half-days. I’m thinking, with the deadline coming up (yes, I could always convert to long-term disability, but that’s only at 70% of my pay which I cannot afford) I could put a return to work start date for the 4th of January to work half-days until the 18th. I personally think I need more time than that, but I am financially constrained. To tell you the truth, what I dearly wish I could afford is to go on full time SS disability, but I cannot afford what they would pay out, and Medicaid will not kick in until you’ve been on disability for one full year. I cannot afford to be without insurance. Sure, I could get COBRA from my employer, but since I cannot already afford what disability would pay, there is no way I could also afford the COBRA coverage. Caught between a rock and a hard place.©2009

Doctors, Dentists, Insomnia, Oh My!

Well, it’s 0220. I’ve been up since 0030. So much for getting quality sleep tonight (or should I say this morning). One thing that has changed for me is this daily need I have now to take a mid-day three-hour nap which does me wonders. I’ll be sitting on my couch listening to music and just start nodding off, so I figure I might as well crawl into bed. The naps have had no measurable affect on my nighttime sleeping; I’m still getting the two-three hours. However, waking up at 0030 for the day makes for a long day!

I went to see the dentist yesterday for my six-month check up and they found a cavity at MY age. They told me most probably it is as a result of the long-term dry mouth I’ve been dealing with since going on the high blood pressure medicines. I loathe dental pain. After the check-up, the receptionist told me that they had a cancelation for 0830 this morning, so I took it. I can hardly wait. The shots of novocaine are giving me the chills as we speak, not to mention the sound of the drill.

Then at 1400 I get to meet with a clinical trial specialist at my GP’s office to see if I qualify for a study that may make me eligible to receive my iron IV infusions for free (otherwise, I cannot afford it). So many factors must come into play when determining who is eligible. I look at the fact that I am a smoker in addition to all the meds I am currently take. Any little detail could put me out of the running. I sure hope the novocaine has worn off before this meeting. The last thing I need to do is drool in front of this person!

What really amazes me about my sleep patterns is that when I awoke tonight after only three hours of sleep, I felt totally rested and ready to start the day. Maybe I should become a day trader in the Asian market.©2009

A Saturday Surprise

Well, yesterday could not have been more interesting. A person whom I know only slightly had been reading my blog (it seems my blog has been generating a lot of airtime recently). He emailed me to explain how sorry he had not sent me an earlier email in view of what had been happening in my life. Having only just read it I replied that it was no big deal since he had only just learned about it.

Then he suggested we get together as he wanted to give me the opportunity to talk about it. I figured, he had already read the blog, he already knew the good, the bad and the ugly. Even though I felt anxious about it, I agree to meet him at his house yesterday. To break the ice, I went to the local bakery and brought some bagels figuring we could be somewhat busy preparing our bagels, eating them and drinking coffee before jumping into the fray.

That said, our conversation started rather benignly. I laughingly said that he knew all about me, but I knew very little about him. Thus began his little history lesson. I found out we had a lot of common [with the exception that he hates North Carolina’s Tar Heel Blue basketball team :-)]

He had a lot to say about the scripture I had been quoting in my posts and my take on them. He also pointed out that the only reason we are in any church is to worship God, a point well taken.

We must have talked for about five hours and the time just flew by. He reiterated that he wanted to be my friend and to always feel to call whenever I might have the need to talk.

After I tried to commit suicide eight weeks ago, I started out bemoaning the fact that I had no friends, especially when I become subsequently suicidal. And suddenly, through a few people reading this blog, I realise that I have more true friends (not acquaintances) than I actually thought was possible.

I also think my medicines are finally beginning to work. Adding the Lexapro has really helped lessen the profound state of depression in which I have been. I feel I have a clearer head with which to think. While the racing thoughts are still present, they do not interfere to the same extent. Not to borrow trouble, but almost feeling normal (but not quite yet), I cannot help wondering if I am only just on this side of spiralling up into a manic phase. Until I was back on these meds, everything was black or white—I was either manic or profoundly depressed. I guess time will only tell on this one.©2009

Outpatient Therapy, Day 19 & My Early Christmas Present

Since I am not allowed to drive myself to group (at some point that will have to come to end and I cannot rely on the good wishes of friends who want to help; I just feel I am being intrusive.) I have to get over my fear of driving and side swiping an 18-wheeler did not add enough to my plate already! Therefore, on Friday I sat and waited for my “limousine.” K called saying she was on her way, so that should take about 20 minutes. Man, I hate winter. You bundle up like crazy for the early morning only to have to strip down by mid-afternoon when the temp gets up to 67˚F/19.45˚C. On those days when the sky is full of sun, I just sit in my comfy camp chair and put on my iPod and bask in the sun. I actually got a sunburn on my face last weekend!

I have made a template in Word to emulate the daily check-in sheet we must spend 15 minutes filling out. This way, the morning before I leave, I can just plug in the answers and be done with it. It buys me time to smoke a cigarette. I have even colour-coded my answers to indicate where my responses are.

I counted the number of pills I take every morning. There are 11: three for blood pressure, plus one for Selenium (those results finally came it and it was abnormally low) and one for the Thiamine. Moreover, I am back to giving myself my B12 injections once a month. That leaves me six daily for my bipolar disorder, not that they are working yet. That does not even count the five I take at night.

(later) There were a lot of fresh faces Friday morning, but I did well; I continued to sit at the table despite the full room. Then, after everyone finished filling out their daily check in sheet, we split back into our two smaller groups. However, out small little group was getting bigger. We did out “sharing” part and I was pleased that the therapist said I was showing marked improvement in certain areas. In the second session, where I usually resign myself to the corner away from the table, I decided to sit at the table and interact with my peers, clearly an improvement for me. We are still working on anger management issues which has been a good one for to listen to.

Well, high noon came and K was out there waiting for me. When we got home, she said she had some food she wanted to put in the fridge. Then, she put her hands on her hips and said, “Why don’t I help you clean up?” My dear friend spent three hours scouring my kitchen and cleaning my living room. In the pit of my depression, I just stopped caring for how the house looked and let it go to seed. I couldn’t believe the amount of work she did while she basically told me to go and sit down. What a caring gift that was to me. It was so nice to walk into a clean kitchen and sit in a clean living room.©2009 

Appt with Psychiatrist #8

We’re still doing psychotherapy for 50 minutes weekly with phone calls interspersed. He’s concerned over my profound depression. I made a half-hearted attempt to commit suicide Sunday night. I say half-hearted because I didn’t drink any alcohol which I know would seal the deal. I think halfway through, once I swallowed the pills, I realized I didn’t want to go through with it. My consequence: well, I did sleep for 4 hours, but felt very groggy. That morning tried to drive my self to group and got sideswiped by an 18-wheeler—my fault, I veered into his lane. Luckily, I self-corrected and stayed in my lane. Unfortunately, my car has the scars to prove it. Moreover, I fell asleep during the whole first session of group (no I didn’t snore, but no one woke me up either). At the break, I guess all of the noise woke me up, but my therapist wouldn’t let me drive home, so I called a friend to pick me up. I guess some of the drugs I had only taken a few hours earlier had not fully metabolized.

Well, back to my shrink, he has increased my Lexapro to 30mg. I found out that the normal dose is 10-20mg. I sure hope this helps me. I am on so many medications. Maybe once my Thiamine levels get within appropriate range things will start to change.©2009