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

The Perfect Borderline Dream

This morning at 1145, I was out on my porch enjoying the beautiful sunshine when I found myself nodding off. I thought, shit I am not getting much sleep at night; I might as well try taking a nap. I went back to my dark bedroom and snuggled under the covers just so certain that I would finally get some sleep. After about three hours I was still awake (but still feeling very sleepy), so I just stayed there all cosy (such a different experience than at night). Then I *woke up* at 1715 (yay for me, I got some sleep). Almost immediately, I recalled this vivid dream (I always have vivid dreams, I just never remember them upon awakening—they are just fleeting images), and began sobbing. The emotions flooding through me were painfully piercing.

Evidently, I was a mother to this cute, precocious girl of about 6 who was very obese, yet happy as lark to my suggestion that we go out to our swimming pool. My husband (egad, is that Freudian or what) was played by John Travolta (I kid you not) and had disappeared on us yet again (this dream came complete with this woman’s memories). He was employed as a hit man and received his orders in the mail. Well, this little girl ran out to get the mail and I heard her shrieking. When she put her hand in the mailbox, a shard of glass had practically shredded her wrist at the site where most people slice their wrist (yet again, how Freudian) and was bleeding profusely. Then she goes limp in my arms. Somewhere there was this a strange man (a neighbour perhaps responding to her shrieking outside??) was standing there and I yelled to call 911 while I tried to staunch the bleeding without removing the glass. I remember feeling that it was all my husband’s fault because of the line of work he was in. All of a sudden, the dream flash-forwards to the ER while I am in there waiting, so sure she wasn’t going to make it. My “husband” magically appears running into the ER demanding to know what I had done to his daughter

OK, so here is the BPD breakdown and my reaction to the dream: 1) I hate myself because I am a horrible mother. I let this adorable child get as obese, so therefore I am a failure; 2) my “husband” abandons us at our time of need—rejected and abandoned yet again; 3) again I’m a horrible mother because I had no idea that my child had gone running out to the mailbox situated on a street curb nearby traffic that could have killed her if she had walked out into the street; 4) based on my “husband’s” reaction upon arrival to the ER, everything is my fault—more guilt and shame.

Give me a fucking break. If I am going to enjoy some sleep and have dreams, can’t they at least be dreams of escape from my wretched life?©2009

Appt with Psychiatrist Week 4

The first thing we discussed was my weird reaction I had yesterday with Outpatient Therapy Day 9 (didn’t blog about it, as there was nothing new to report). When I woke up at 0200 I felt weak, my legs felt rubbery, and I was shaking all over. It was worse when I was standing, but even after sitting for a while, those effects returned when I’d stand again. At first, I thought my blood pressure was low, but it was normal. I was hoping it would pass by the time I had to drive for my group session, but it didn’t. I chose to drive anyway, but by the time I got to the location, it was worse. I couldn’t walk in a straight line and I stumbled a few times. I went right in and sat down and that helped a lot. The therapist thought it might be a reaction to my medication as I upped the Zyprexa to 40mg to aid my insomnia before going to sleep at midnight. I had my daily call to my psychiatrist later that day, so he dropped the Zyprexa back down to 20mg. This morning I did not have those same side effects.

Later, when I saw him, He had me go through a series of neurological exercises. The only one I didn’t do well on was the Romberg test where, while standing, you hold your hands out to your side, put your feet together and close your eyes. I couldn’t keep my balance. He is still wondering about my low B-12 values and a possibility that I may be low on Thiamine. I also see my regular doc this afternoon (God, I am so sick of having all these various appointments). We’ll be discussing the results of those lab tests I had drawn last week. I’m sure I’ll be told I have to go back to injecting myself with the B-12 shots monthly (cheaper to do it myself instead of paying for an office visit for the same thing). I wonder if you can test for Thiamine. If that’s low, I may be giving myself two shots for a while. My thighs will look like pincushions!

The only other change he made was to reduce my Geodon from 240mg at bedtime to 160mg.©2009

Outpatient Therapy, Day 8 and my Phone Check-in With My Psychiatrist

This group therapy is getting old. It’s the same thing everyday—too emotional for me, at least as far as some of the others in my small group. I know this sounds callous, but from the moment I sit down, I am just counting down those two hours of “sharing” before we have our break. Yesterday was no exception. There is one woman who, they decided a week or so ago, that she needed to be hospitalized again. It wasn’t an involuntary commitment—evidently she agreed to it. Well, her first day back into the outpatient program, all she did was cry while she was sharing but refused to go into any details. She said she was afraid they would put her back inside if she told the therapist what was really evoking this emotion. I have a handle on that one—I’m certainly not going to voice that I am intentionally suicidal (they gauge how “safe” you are as to how forward thinking you are regarding your actual plans to commit suicide). I can say that I was feeling suicidal the previous evening, but I have to show a coping skill I successfully used to avert that situation. I can say without a doubt that there are nights when I am suicidal and I go through the motions of preparing everything. If I were to say that I have the intent to follow through, that would land me right back inside the Big House. I don’t follow through, not yet, but at one point when will the intent be stronger than the want not to do it?

I can feel my depression getting worse even with my doc tweaking the cocktail. So far, nothing he has done has yielded any progress as far as my depression and insomnia go. I am living one day to the next with, at best, two hours of sleep. Oh, and get this, the results of my fasting blood work has come in. My psychiatrist always gets a copy from my regular doctor. He looked at the results while we were on our phone call check-in today (I’ve been on the phone everyday between my weekly appointments even over the weekends so he can adjust the meds, if needed, on the fly and spare me the expense of an office visit). Evidently, while my haemoglobin is 11 (low side of normal), my iron stores are pretty low. My ferritin level is only 5 (normal is 15-200 ng/mL for females). Ferritin is a protein that stores iron and releases it in a controlled fashion, in single cells and multi-celled animals. It is a buffer against iron deficiency and iron overload. The last time, approximately 6 years ago, my ferritin level was only 2. I tried taking vitamins high in iron, then iron pills to no avail. My body wasn’t absorbing the iron. I ended up having to take Infed (used to treat iron deficient anemia) administered IV. I had to have three separate infusions over a few weeks. That cost me one hell of a bundle. I can’t afford that now in view of all of my other medical bills recently incurred. In addition, ketones and protein are spilling into my urine. Ketones are produced in the body when fats, rather than glucose are used to produce energy, but my glucose is 94. Protein in the urine is a warning sign. It may indicate kidney damage or disease or it may be a transient elevation due to an infection, medication, vigorous exercise, or emotional or physical stress. Well, yeah, I am under a considerable amount of emotional stress. I don’t know the other results yet, but I see my regular doctor on the 12th. I am sick of doctors; I am sick of medical tests. I just want to be left alone.©2009

Another Lonely Evening Comes to Pass

I’m sure where to start with this entry. The house is quiet; I don’t even want to listen to music (pause) no, I changed my mind. Just opened my iTunes and am now listening to Frank Sinatra’s September of My Years. Hmmm, maybe the theme is a little too appropriate.

How do you explain to someone that you don’t want to get better? Yes, I’m about as mental as one can be. But, it is my comfort zone; it is what I know best. I know how to operate under this cover of darkness. Oh, sure, you must be thinking, why would someone choose to struggle with being suicidal so many nights a week? I do not know what normal is. I do not remember what being happy feels like. Was I ever happy—ever? Even when I was somewhat balanced while on my meds before I quit taking them, all I remember at best was being numb. At least when I am manic, I feel energetic; I feel as if I can do anything. Now, all I experience is the crushing defeat of morbid depression. Even after three weeks, the meds haven’t kicked in at all. My doctor keeps upping a dosage of one and waits a while, then he’ll add to the cocktail (he is rather conservative about how many types of changes he makes at one time). Either way, I don’t feel any different.

I am supposed to try to add yet another med tonight as a temporary measure to break my cycle of persistent insomnia. He wants me to take 10mg of Zyprexa an hour before I take the rest of my bedtime meds, and if I am not asleep in an hour, to take another 10mg. Then I have to do another phone call check-in with him again tomorrow (the addition of Zyprexa was the topic of our phone check-in today). He already knows how I feel about Zyprexa; it became a deal-breaker for me when I discovered what a weight gainer this drug was. Not trying to be recalcitrant, I argued with him since he already knew how I felt about this drug, but he said he only wanted me to try it for one week to see if it would break my insomnia and give sleep a chance. I agreed to take it temporarily. We’ll see what happens tonight. (Now Frank is singing “It Was a Very Good Year.” I wish I could say the same).

(later) I decided that I had to leave the house. The walls were closing in on me. I already know where that will take me. The weather is perfect outside. I decided to grab my atlas and don my new toys and go for a walk. I decided to go up to the corner Starbucks (yeah, I remembered to opt for decaffeinated). That meant I had to deal with people. I had no idea how many there would be. However, the evening was too nice not to go out. I was too exhausted to go for a power walk; there is no apparent rage seething within me at the moment—a welcome change. Just a short walk up to the corner to get some fresh air was perfect.

Starbucks just had two customers that were engrossed with each other, tucked away in the corner. I doubt they even noticed me. I got to the counter and looked up to the menu. There were so many choices. The cashier was waiting for me to place my order. I couldn’t make up my mind. I froze as she just stared at me and asked, “What I get for you?” a second time. Finally, I made my choice and just wanted to get out of there as fast as I could. Once I hit the door and the cool night breezes swept my face, I felt I could finally breathe. It was good to know I still had my bearings. I promptly left the parking lot and headed home.©2009

Outpatient Therapy, Day 7, the Gift Bag at My Door, & My Attempt at “Radical Acceptance”

I do not have much to say about today’s session. The therapist is concerned that I am not eating except a small snack to take with my Geodon. She is also concerned about my insomnia. I did not have much to share. Not much had changed from Wednesday, but I was able to report that I was not having any suicidal ideation Thursday night. Very depressed, yes, but I was able to leave it at that. She pointedly asked me if I could remain safe through the weekend and I could only tell her that I have demonstrated successfully one tool, and that was all I could promise her. I also told her that my psychiatrist has requested me to call him for a check-in call on Saturday and Sunday. She seemed rather pleased with that.

In actuality, my blogging has actually helped me with the ideation Thursday night. I spent a good deal of time writing, reading others’ blogs, and keeping up with my LGBTQ-oriented Facebook account (OK, a translation for you straight folks: Lesbian, Gay, Bisexual, Transgendered, Queer/Questioning), along with my Twitter feeds.

Something weird happened at break. One of the folks in my small group came up to me and wanted to know why I ignored her after trying to say hi two times. I had to honestly tell her that I really had not noticed her (remember me; I am all about blinders around other people). She started crying and I did not what the hell to do as she did this in front of everyone. Then everyone stared at me. Well, I am sorry that I must have hurt her feelings (I can recognize that from classic BPD symptoms), but I am not responsible for her feelings, only my own. I felt, with everyone staring at me, that I at least had to apologize. I really didn’t want to have to interact with her at all, but what was I to do? It is not as if I go around intentionally trying to hurt someone, or be rude or uncaring. I just simply want to be left alone. Soon enough, break was over so I went inside where both groups join and found my seat on the far wall. I also asked the therapist if I could crack open the emergency door right beside me in case I had to leave the room (I do not want to make a spectacle of getting up and walking by everyone to leave through the normal door). She said that was fine (no alarm attached to the door)

I came home and found this gift bag by my front door inside my porch. Curiously, I picked it up and brought it inside. The attached note said, “For your walks around the neighbourhood…a few things I thought would come in handy.” It was signed from the only church member (outside of my pastor and his wife) that I had been relatively honest with about some things. Evidently she has been reading my blog and noticed my entries concerning with my dissociative states while walking or driving. Inside the bag was some pretty neat stuff. It contained an atlas with very detailed set of maps of my city along with a street index finder. I found my house (conveniently already marked with an icon as there is a large city fire department up at the corner. Nevertheless, I am going to put an X right where my house is anyway because with a past dissociation, the fire department’s presence did not mean anything to me. I’ve even post-noted my relevant pages). It also marks subdivisions and schools—things I pass by on a regular basis. In addition, there was a device with a red blinking LED visible to one km with a range of 180˚. It came with a strap and three batteries. I can attach this to myself to make me visible when I take my late-night walks. There was also an LED pen light with a magnifier lens that only weighs 38g and has a metal clip attachment. The last thing in the bag thrilled me to no end—a new tool. This seven-in-one tool is only 12cm long. Get this—it contains an LED light, compass, thermometer, clock, safety whistle, safety mirror and a 2X magnifier. It comes with a lanyard I can wear around my neck. Now I can be all decked out in LED!

OK, time for an honest reality check here—my perception vs. my reality. This person does want to be close to me—not because of the gifts, but because of the intentions behind them. I wrote her a long email thanking her (I did not feel prepared enough to actually talk with her at that point). In the same email, I told her everything. I even attached two documents on bipolar and borderline personality disorders to help her understand the effects these have on me. She responded with such a kind email; it gave me some contact with another person who now knew me the way I wanted her to know me—no pretence about anything. She let me know that she clearly knew what my boundaries were and that she was not going to be in my face, but essentially would let me make any contact. Fearing that I would lapse into my normative state of isolation, I told her that it was OK to call me, but if I felt I was not capable to talk, she could leave me a vm. I was OK with that, so after reading the email, I actually felt better prepared to call her. I am trying so very hard to reach out, but I can only take baby steps. I fear rejection; I fear abandonment.

Now, onto my next hurdle—trying to use “radical acceptance.” The principles are 1) solve the problem, or, 2) change how you feel about the problem, or 3) stay miserable, or 4) accept the problem. It takes away the “judgements” and removes the “shoulds.”

The hurdle—all of the anger and resentment I have felt toward my pastor for placing the 911 call and coming by the house to show the police my text message. My perception? That he was disappointed with me, angry because I did not call first and ask for prayer before I got in that state, and that he would think less of me. Therefore, I took a very deep breath and wrote down everything I wanted to say before I called him so I could focus and concentrate on what I really wanted to say.

I called his house and thankfully, he answered. I am not really sure what I would have said if his wife had picked up instead…I wasn’t prepared for that scenario. I told him who I was not knowing if he would recognize my voice. Then I told him I had something to say and would he listen to me without interrupting me until I was done. I asked him if he would meet me because there were some things that I needed to say to him alone, that we could meet in a public venue of his choosing as long as I would not be seen as making a spectacle of myself if I got emotional, and it had to be a place where I could smoke (damn these city ordinances banning smoking to even include many outside venues). We settled on standing in the church parking lot (right across the street from me) for this Tuesday at 1630. When I finished what I said, he asked if he could say a few things. I hesitated momentarily—this wasn’t a planned two-way conversation. I wanted to say what I had to say, set the time and place and get off the phone, but I ended up saying OK. He helped fill in some more of the blanks. Evidently there were already three or four police cruisers and the EMS there across the street in the church parking lot before he arrived (I had been told earlier by one of the first responder cops that they parked there with no lights flashing on purpose so as not to alert me in case it was a situation of “suicide by cop”). The cops asked him who he was and he explained that he had placed the 911 call as a result of my text message. They asked to see the text message, but they would not let him cross the street to my house at any point. He told me that the only reason why he came over was that he was very concerned and worried about me. He said he had tried to call me after receiving the text message and I did not answer. Again, the problem with my perception vs. reality.

Am I ready for this conversation? I do not know. I have to find a way to let this anger and resentment go. While it is by no means my only trigger, I have obsessed over this a lot—primarily because I have always respected him. He is a WYSIWYG (what you see is what you get for you non-computer geeks) kind of guy—shoots straight from the hip with no guile. From the very beginning, he has accepted the fact that I am a lesbian and never has judged me. I owe him the same respect.

Well, I still have two days to process this. I am also going to discuss during my group therapy session on Monday. I also have my second appointment with my individual therapist on Monday afternoon as well. My question is am I sufficiently prepared to handle this type of conversation at this point so soon after everything has happened? I need to protect myself and not set myself up for failure. I am trying so hard to reach a point in my life where everything is in balance, but I have to put my needs first—a concept that never existed in my “I don’t give a damn” mode.©2009

Appt with Psychiatrist Week 3

My calendar said that we had our second appointment on the 29th, but I don’t remember that one. I can tell my meds have changed because I found his instruction sheet. He always writes everything out because he knows I may not remember. This visit was on 05 November.

My meds have changed again. Now my Geodon has changed from 240mg at bedtime to also include taking an 80mg dose in the morning along with a new drug called Provigil @ 200mg in the morning to help sharpen my focus and concentration. Its primary use is for the treatment of narcolepsy, shift work sleep disorder and excessive daytime sleepiness associated with obstructive sleep apnea. Other potentially effective, but similarly unapproved targets include the treatment of depression, schizophrenia, and disease-related fatigue. I guess my disease-related fatigue is the insomnia due to the depression

His primary concern is that I can keep myself safe. He has always been the only one with whom I’ve been able to be completely honest. I have been seeing him since June, 2000 when I was first diagnosed with BP (BPD didn’t become diagnosed until 2005 after my previous attempt at suicide). Aside from wanting to keep me safe, he is very concerned over my lack of sleep. He told me that I couldn’t expect to see measurable progress until I can overcome the insomnia. He’s also concerned about my weight loss. I’ve lost eight pounds since 28 October because I’m not eating. The only thing I eat is a small snack when I take my two doses of Geodon because it has to be absorbed with food.

Today he increased my Lamictal to 200mg QD. My short-term goals are 1) work on severe depression with medication changes as needed, 2) directly deal with my persistent suicide ideation as depression lessens and while my coping skills are still effective, 3) work on my rage issues as my depression lessens, and 4) work on my isolation as the depression lessens. He knows I am in the OP Therapy program Mon-Wed-Fri, so I am to call his office on Tuesdays and Thursdays and request a call back so he can check in with me. He also wants me to call his service on Saturdays and Sundays for the same purpose. He wants to keep me safe, and feels with this constant monitoring, if needed, he can make a med change on the fly. I couldn’t ask for a better psychiatrist. He gets me. And he said that once my bipolar balances out, he wants to work on my borderline personality disorder. He is more than just a psychiatrist. The time he spends with me and what we talk about is better than any individual therapist I’ve ever seen. I’m very grateful that the circumstances back in 2000 brought us together.©2009