Week in Review 30 January 2010

Not much to report this week. I had no therapist, psychiatrist or GP appointments for a change

Work: This full-time work week hit me like a ton of bricks. It is as if all my clients all knew I was back in the office all on the same day. I simply cannot keep up with the email, nor respond as quickly as I used to with some of my more high-profile clients. I still have emails unread dating back to this past Monday 25 January.

I had one major escalation that was a forefront priority for me that I had to stay on top of from the start. The problem was presented to me last Friday afternoon and it resulted in a client wanting a particular service on a product we offer. I let the client know that I understood the importance of a speedy reply to see if we could accommodate his request. No one on my team could give me a firm answer, so I was directed to Technical Operations.

Well, that group did not respond back as quickly as I hoped, but I dropped the ball by not keeping the client completely in the loop in just continuing to communicate that we were still looking into it, but so far, we had not heard back from Tech Ops. The client decided to escalate the issue above me that did not put me in the fairest of light (sometimes you learn your lessons best the hard way).

When all was said and done and Tech Ops told me that we could not accommodate the client’s request, my main concern was regarding who should be the one to tell him: someone from Tech Ops or me (I figured Tech Ops could explain better the technical details of why we could not provide the requested service).

After getting a few other emails from the account team who was also working with this issue, including my manager, and realized that no one had STILL not communicated anything to the client—now a week later—I decided to be proactive.

I called him and reiterated just how important this issue was for them; I told him I that I was remiss in not keeping the lines of communication more fluid in the intervening time, and offered my apologies for the duration of time it took for me to give him a final answer that we could not technically provide the requested service. He was very understanding. He said that he knew I was working hard behind the scenes. I still took responsibility for my lack of communication, and we parted amicably. He said he would contact me next week about some other information he would be requesting, more notably the specifics of the services offered by the products we were supporting for them.

This whole ordeal probably put a smear in my column in my manager’s eye, but I just have to chalk it up to an experience learned. I have always felt very strongly about providing excellent customer service to my clients; I do not know why I dropped the ball on this.

My other problem, which might have leant itself to the aforementioned issue, was the enormous amounts of email that kept streaming in. At the end of every day, there have been approximately 80-90 emails I still have not read, some stemming back, as I said, from Monday the 25th. I only have eight hours in a day (no overtime allowed) and can only process so much. I quickly scan throughout the day the subject headers to ferret out what might be higher priority items. I catch what I can, but I know there are clients who are still awaiting a response from me. In some cases, the questions I am being asked require me to run reports which take 24 hours to run, so that already puts me behind a day. Then I get emails where I simply do not know how to take care of the problem (my memory is still wreaking havoc). Thankfully I have a 12-member team who I can reach out to, but I fear they will get tired of my questions soon enough. What I fear is that they will not remember that I was only on this new job for two-and-a-half months before being out on a three-month medical leave. Essentially, I am still on my learning curve. There are parts of this job I just have not been exposed to yet which is resulting in me being slow on the uptake.

The bright side of this week was my performance review that my manager held with me on Tuesday. He said he was remarkably pleased at just how far I have come in gaining experience in the position and how fast I was learning everything. He pointed to my desire to provide superior customer service as one of my strengths, and the one thing I needed to develop was my sense of self-confidence in performing my job. If he only knew! I did discover that the company approved raises for everyone and I merited a 3.5% increase. Well, it is better than nothing! I also found out that the company has approved a performance bonus this year payable in early March. I am not sure what mine will be, but I will be happy to receive whatever I get. (business has been good, thankfully).

My Car: Well, ole Betsy (never her real name, just seemed fitting at the moment) has retired. I have been spending the last two weeks searching for another car. I want to stay with a Honda as mine lasted for 16 years with mega-mileage. I looked at several dealerships thinking I would examine their certified used cars that came with a warranty. In each case, all they had were Civics comparable to mine —somewhat new, but with massive mileage. Sure, affordable, but I would be right back where I was in a short time. The other choices were the high-end Accords that were not affordable. I had already examined a new 2010 Honda Fit Sport that, when we got down to negotiating, was a far cry lower than the Accords. At this point, why should I pay more money for a used Accord when I can have a brand new Fit for a few thousand less? Moreover, this one comes with a lifetime power train warranty (the very thing that went out on my old car that never had more that the standard bumper-to-bumper three years or 36,000 miles). I did negotiate a good deal and got rid of the sales person and dealt directly with the manager who ultimately had the final say so. We must have pushed the proverbially piece of paper back and forth about five times. Nuts and bolts, I will be getting the car at $3500 less MSRP plus some of the options I wanted. I have never been afraid to negotiate and walk out the door, and this particular dealership (the last of the three locally, two of which I had already walked out when they didn’t meet my price) started hedging when I said that I was prepared to drive 90 miles or so across the state line to get a better deal. Then they started singing my song. I will be picking up the car next Saturday.


General Info: Aside from the constant anxiety at work, my bipolar appears still to be in balance. In addition, my sleep patterns are almost back to normal. It has been such a long time since I have been able to say that. Currently, I am not depressed or manic. Is this what “normal” is supposed to feel like? I would not know; I have never been here before.

Next week I have my appointment with my therapist and psychiatrist. I did have quite an unexpected expense this week. I had to get my bipolar meds refilled. I already know that I have to stay on them, so I bit the bullet and called my insurance’s 90-day prescription by mail program. I had to fill my Geodon and Provigil (not generic) and my Lamictal. Because I still had $1150 of my $1200 deductible, one or some of those meds were going to have to be a full retail price. I almost fell off my chair when they quoted me the Geodon at roughly $1172 for a 90-day supply. So, that drug alone covered my deductible and I got the other two dugs with the insurance cap. Now, how many people can say that they’ve met their medical insurance deductible by the third week in January…LOL.©2009

Week in Review 23 January 2010

There are subjects that I have not caught you up on since returning to work full-time. I am going to use this week in review to address the various issues that actually encompass more than just this past week.

Iron Infusions: The study included receiving 1000mg of IV iron infusions. I received 200mg Mondays and Wednesdays for 5 days. Throughout the process, the clinical specialist drew blood to check my haemoglobin and ferritin levels. This study will go on for a year although no more iron infusions are to be given. All subsequent visits are geared towards monitoring my blood levels to see how I fare over the course of the year. On day 35, after the final infusion, my haemoglobin only rose to 12.1 (normal is around 12.3-16). However, my ferritin level (one of the key indicators in my case) rose from 5 before the study to 96. While I am pleased with the ferritin level, I still have borderline iron deficient anaemia. I am disappointed that my haemoglobin did not rise any higher. I am curious to see how the blood level results will be over the rest of the year. My savings grace is that I have not had to pay for any of this as being part of this clinical trial, and the added bonus is, once I have completed the yearlong study, I will be compensated for my travelling costs.

Vitamin and Mineral Deficiencies: If you recall, I began having symptoms of ataxia on 13 November 2009. It began with being unable to keep my balance then progressing to ocular involvement called nystagmus then to short-term memory loss. I failed certain neurological tests (most notable the Romberg test. The combination of all three symptoms indicated that I had Wernicke’s encephalopathy that does, in effect, eventually causes organic problems with my brain. If left untreated, the transient symptoms will become permanent. It was suspected that mine was caused by a vitamin B1-Thiamine deficiency. As a result, my GP decided to run a huge panel of vitamin and mineral blood work. The results showed that my B1 levels were undetectable as well as my Selenium levels (essential for the proper functioning of the immune system). I was ordered to start taking 100mg of B1 twice a day and 200mg of Selenium once a day. After six weeks, the repeat blood tests showed marked improvement and my balance had almost come full circle, although I still have some ocular involvement and short-term memory loss (my brain is healing slowly). Another level that was far below normal was vitamin D. Instead of taking an OTC version of vitamin D, my GP wrote a prescription that I am to take once a week for eight weeks, then once a month forever. This does not even include the fact that I have to give myself 1000mcg vitamin B12 shots monthly forever. My doctor essentially told me that I would be taking these vitamins and minerals forever, along with a multi-vitamin that I am supposed to start taking. Coupled with all of my bipolar medications and the ones for my continued high blood pressure, I am swallowing a horde of pills a day.

Individual Therapy: Now that I am no longer in group therapy, I have starting seeing an individual therapist. 20 January was actually my third visit with her following the intake assessment and one follow-up appointment a couple of months ago (my group therapy took precedence). This visit I determined that one of the first factors I had to deal with was my borderline personality disorder.  You’ll note further down in the link what the causes are—I meet all of them. In examining the causes, I decided to deal with my disruptive family history first. I have discussed at length in previous entries how I have been treated as a pariah at holiday gatherings these past seven or eight years always celebrated at my niece’s home. She patently exclaimed that I was not welcome the first time she hosted these events. I ended up attending, even though I had not received an individual invitation, as a result of my nephew’s insistence. He said, “Alix, family is family. You belong there.” When I showed up at the front door with my nephew, my niece clearly displayed her anger and let me know I was not welcome, but she could not refuse my entry because other people had already noticed me, so she was stuck. The entire time, even my mother showed her displeasure, I was uncomfortable. Always the queen of protocol, she said I should not have come because I did not receive an invitation. To this day, I have no idea why my niece hates me—my mother will not volunteer any information and my sister even told me not to confront her daughter. So much for my supportive family.

Getting back to my early years, I was sexually abused at age five. Upon my mother and older sister finding out, my mother shook my shoulders and told me I was never to ever speak of this to anyone. This was during a generation when it was not understood nor dealt with. I was made to feel as though it was my fault. The family dynamic changed forever after that. I felt abandoned by everyone because no one would help me with all of the shame and guilt I felt. Years later, those memories were buried during the haze of my years-long addiction to smack and coke (I used to shoot speedballs). I eventually cleaned up and have been clean for 23 years. However, during my detox period, all those memories came flooding back. I worked up the courage to confront my mother about the sexual abuse and at first, she denied it ever happened. Then, with further insistence, she simply said it was in the past and refused to discuss it with me ever.

A few years later, my parents had a huge celebration for their 50th wedding anniversary. I was living out of town, but my mother wanted my son and me to attend. I simply asked if that particular family member who abused me would be there and she replied yes. Then she told me that I was only welcome if I did not create a scene. I promised I would not (always being the dutiful little girl trying to find that ever so elusive but never found approval). However, I was very anxious about seeing this family member (whom I shall refer here as L). I had not seen L since the memories surfaced. I was not sure how I would react. When I saw him I felt a flood of emotions wash over me and I was not sure I would be able to control myself, but I remembered the promise I had made to my mother. He acted as if nothing had ever happened. I kept my limited contact to perfunctory responses and immediately found someone else with whom to interact.

The next two obligatory times I had to be around L was my father’s funeral and my nephew’s first wedding. I could not keep my distance as far as I wanted because these events were small family gatherings, but I was determined never to attend any events where he would be present with the exception of my mother’s eventual funeral.

Or so I thought. My sister called me this week and told me she wanted to do something special for my mother’s 90th birthday in September. She wanted everyone to be there. Not only will I have to deal with my niece (a favoured one as she has produced my mother’s only great grandchildren), but there is an outside chance that L will be there. My sister did mention that L had declined because he had already booked a hike in Italy and that was his priority. To tell you the truth, that pissed me off. Isn’t my mother’s 90th birthday, an occasion that will never come again, something that should take precedence above all else? Tell me that he did not know that the week he booked his hike was during my mother’s birthday and that it was her 90th. How callous can someone be? Of course I already had a very poor opinion of him (to say the very least), but this was the last straw. As oxymoronic as this sounds, I hope he changes his mind, if only for my mother’s sake.

So, getting back to my therapy session…I made it a special point to tell P that this celebration would be coming up in September, one that is creating enormous anxiety for me, even now. I need to process all that has happened since childhood. Since the event is not until September, this will give me quite a while to try to come to terms with everything. I wonder what the process will be concerning trying to deal with everything. I can only afford to see her every two weeks, so I hope we can accomplish a lot.

My Psychiatrist: I am now seeing him every three weeks—a far cry from weekly appointments along with daily phone check-ins. R seems pleased with the state of my bipolar disorder, and so am I. The cocktail he has me on (Lamictal 200mg 2/day, Geodon 80mg in the morning and 240mg at bedtime, Provigil 200mg 2x/day, Lexapro 40mg daily, Ativan 2mg 4x/day, and Ambien 20mg at bedtime) has been very productive. I am being cautious about the Lexapro since it is an anti-depressant. In bipolar patients, while these types of drugs can battle the profound depression I found myself in, I have to be aware if I progress to any mania since these drugs can produce this side effect. I am monitoring this very carefully. I do not want to mess with this cocktail as it is servicing a precious need of keeping everything in balance right now. However, R has discussed getting me down to a maintenance cocktail that would probably result in taking me off some of this medication. I do not think I am ready for this yet. It been too soon since I tried to commit suicide. While I have made great strides, I still feel as though, at times, I am teetering on the edge. Even though my next appointment is not until 04 February, I know I can call him at any time. He always calls me back and spends however much time I need without the cost of an office visit. I am very blessed to have such a wonderful psychiatrist.

My return to work: The days leading up to my first day back to work on 04 January was met with much trepidation. I was full of fear and anxiety as much as I tried to stay in the moment. As part of my medical disability status, R sent a letter to the group managing my FMLA program indicating that I should only work four-hour days the first week and six-hour days the second week. My manager was very supportive about that suggestion. I also asked my manager if I could adjust my schedule to work 0700-1530 opposed to 0800-1630 which he agreed to. This serves a two-fold purpose. First, it frees up the afternoon to make available opportunities to have my continued appointments without missing work. Second, I am finished working while the sun is still shining—something that is important to me. I used to hate waking up in the dark and finishing my day in the dark, especially during the Standard Time Zone in winter.

The first two weeks my manager wanted me to concentrate on taking some mandatory computer-based training that was indicated during my absence. Then he wanted me to cull through the 1000+ emails that had collected during the three months I had been away. Just as an aside, no one from work ever knew why I had been on medical leave. Nevertheless, I had to explain to my manager that one of the side effects of my “treatments” was a vitamin B1 deficiency which resulted in a transient short-term memory loss. He seemed to take that OK. But that factor gives me a lot of anxiety as I don’t remember how to do a lot of my job. I was only in this new job for two-and-a-half months before being gone for three. So, I am still on my learning curve. My team may not appreciate the fact that I still have to ask questions, especially on some things of which I had already displayed knowledge.

After the first two weeks, then all of my clients were informed that I was back to supporting their accounts. Just when I had cleaned up my email box, as of the 19th they started flooding in again, yet another source of anxiety. I made it clear that I was not capable of working any overtime, so I am always left with emails that I have not read by the end of the day only to snowball into the next day. Too many critical projects are all happening at the same time. Meanwhile, my day-to-day responsibilities go on.

I try to stay in the moment each day and that, along with relaxation techniques such as being mindful and deep breathing, are helping somewhat. I have to admit, my Ativan plays a roll here as well. My goal is to do the best I can for my clients during my eight-hour day, and when that is over, to simply walk away from the laptop and let my business line go to voicemail (I work from home). I am giving myself room to acknowledge that I am going to be slow on the uptake for a while, but I have to believe that, at some point, I will be back up to speed.

Overall, I am now in a much better space than three months ago. I am quite surprised at the insight I have discovered about myself along the way. I know I will never “recover” from my bipolar disorder and will be on my meds for the rest of my life. That is a sobering thought (and an expensive one—the Geodon alone costs about $1200 before my $1200 yearly deductible is met). It hurt to pay that much a week ago for my refill, but how many people can say that they have met their deductible during the second week of January! At least now, my coverage for everything is at 90%.

I know this was a long entry, but I had so much to review. It is my intention to do a week in review each Saturday since I am back to work full-time. I have to admit, after being on the computer all day at work, sometimes the last thing I want to do is to get back onto my own computer after work.©2009

Appt with Psychiatrist Week 5

On Tuesday, after posting this entry I called my group therapist out of politeness (yet another quirk—I can be completely suicidal and yet stop to be polite…go figure!) to let her know I would not be attending yesterday’s session. This was after canceling my psychiatrist’s appt for today and my appt with my GP tomorrow. In that state of mind, I did not want to be around anyone who was going to parse my emotions. When she asked me why I wouldn’t be attending, I simply replied that I couldn’t deal with being around anyone. Then I sorta lost it on the phone despite my keen attempts to be stable. I ended up telling her what had been going through my mind on Monday night when I was quite suicidal and how reading a comment yesterday morning on this post before calling her upset me so greatly. She asked if I could read to her the comment and then my response to that comment. She tried to remind me that this comment only represented one person’s opinion—an opinion that she was allowed to have, but one I did not have to agree with, nor let it have power over me. We talked on the phone for about an hour (unheard of with most in this community). I also told her that I had canceled the other two appts as well. She asked me if I was still feeling suicidal and I had to tell her that I did not know. Then she asked me if I could make a commitment to her to remain safe. If I didn’t tell her what she wanted to hear, I knew she would call 911 because she said as much. Not wanting to go there, I told her what she wanted to hear. Then she asked me if I would be able to call her before she left the office later that afternoon and I said I would.

When I get in this state, I always sabotage myself. That’s why I canceled the other two appts. I simply no longer cared about wanting to get better. However, after talking with her, I rescheduled both appts.

Well, the rescheduled appt with my psychiatrist gave me a valid reason for missing Wednesday’s group that I wanted to do in the first place. When I went in to see him yesterday morning, I could not make eye contact with him. His primary concern is that the meds cocktail he has me on is not working to get me out of this severe depression. He decided to finally add an antidepressant to the mix and gave me a sample of Lexapro. Not wanting to trigger a manic phase, he only wants me to take 5mg once a day. I also told him of my financial problems since I incurred all these medical bills. I also found out Monday afternoon that my 16-year-old Honda with 250,000+ miles on it was not long for this world (power train and transmission—the same quote I got from three different auto shops). I simply cannot afford to buy another car, and the cost to repair my car was going to be four to five times the blue book value of the car, an amount I couldn’t afford anyway. He told me not to worry about the cost of the Lexapro, as he would keep me in samples for the time that I felt I needed it. That doesn’t even touch the $175 I just had to shell out on my other bipolar 90-day scripts.

I also convinced him that my balance was much better and that I thought he and Wallace had just been alarmists. I said that because I don’t them to make such a big deal of my continued imbalance. I received some of the results from that blood work that Dr Wallace had ordered.  The Magnesium, Phosphorus and Zinc were all within normal limits (albeit on the low side). Now we are just waiting on the Selenium and the most important one of all, the B1 which, in part, may be causing my ataxia (we already know that my B12 is on the low side of normal, so I’m back to giving myself the shots again once I mail off Dr Wallace’s scripts—and I don’t even know if I have the money for all of those). I am sure my B1 should come back too low to account for the ataxia; I just don’t want to think that it may be because of an organic process in my cerebellum. If my B1 is too low, I wonder if they make an IM version I can use to shoot myself in my thigh, or if it only comes in IV form (we already know that I can’t absorb it orally because of my bypass surgery). Dr Wallace also wants me to schedule a time when I can get the Infed, the iron infusion by IV, but when I did that before, it was approximately $1600 a pop. The doc said I might be able to participate in a clinical trial currently being offered so I could receive the Infed for free, but I’ve yet to hear a reply on that one. If I can’t qualify, I won’t be able to raise my Ferritin levels, already abnormally low, even though my hemoglobin is only just slightly lower that normal in comparison.

So here I sit Thursday morning with nothing to do. I don’t know what I am going to do with my car. At some point very soon, it will die on me. I just hope I’m not on some interstate when it does. When it does crap out on me I will truly be up a creek.©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

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

A Pharmacological Dilemma

I feel as though I am stuck between a rock and a hard place. As you know, my psychiatrist added Zyprexa to my cocktail with the intent of trying to wean me off several of my bipolar meds with the hopes of me being successful with one maintenance drug (Lamictal). Lamictal had worked in the past before my bipolar reared its ugly head and I spiraled out of control. However, the Zyprexa has had a major impact on me in that I have gained 25 pounds in two months (it’s widely known that Zyprexa can be a real weight-gainer).

Zyprexa has really had a positive affect on me. I feel I’ve reached a very balanced state. However, at the cost of the weight gain I want to be weaned off that drug. So, my doctor has mentioned adding either Metformin or Phenteramine as a short-term solution to inhibit the weight gain. The Metformin acts on the insulin-producing hormone, while the latter addresses my increased appetite. I am inclined to go with the Phenteramine because it does address my major side-effect of increased appetite. I just feel I am trading off one drug for another. But I really hate the idea of coming off the Zyprexa since it has had such a wonderful impact on my emotional balance.

I don’t know what to do at this stage. I would welcome any feedback from someone who has walked in these shoes.

Insurance---What's the Point?

I am faced with quite a dilemma. There are medications that I have to take that are truly life-saving medications, primarily for my bipolar disorder. On previous postings I’ve indicated that I was fed up with the fact that none of the meds seemed to be working any more anyway, so what was the point in taking them any more, and that I had decided to wean myself off.

But, the more I thought about it, the angrier I got. I discovered that I owe my mail order pharmacy service their threshold at which they will cease dispensing all future prescriptions until the balance is paid up—an amount I simply do not have. Even if I thought there was a value to taking these meds, which I am not sure there is, I am hamstrung by system that is withholding vital medication, which could make or break me. I have approached the pharmacy program asking if I could set up a payment plan, which they flat out refused to consider. I have had my psychiatrist work with the drug manufacturers to see if any relief could be brought through those various channels—all of which came up empty handed.

To add insult to injury, my own psychiatrist, whom I have developed a history with for over a seven-year period, is not even in my network. Yes, I could find another shrink that would save me money, but I trust this doctor with my life and I am unwilling to start from scratch with an unknown entity, especially with where my life is concerned.

At what point is someone finally noticed that I am slipping through the cracks? If all that someone looks at is my bottom-line salary, I look great on paper, but in reality, I am one paycheck away from being homeless because of my debt load. My medical bills have overwhelmed me. Add this stress to the fact that my bipolar medication isn’t working up to par and I have a pretty good indication of where all this is headed and I don’t like what I see. This continued added stress is building to a point beyond which I can handle.

I am so tired of playing these games with all of these companies that don’t seem to give a damn what plight someone is. The customer service reps who answer the phones, as well as anyone else further up the flagpole, simply read their policy handbook to me by rote and I am left feeling as if no one gives a damn. I am not asking for any handouts. What I am asking for is a fair shake. Why is a payment plan too much of a stretch for someone to consider? Sure, they won’t get all of what is due with one payment, but it would show good faith on my part that I am trying to make good on my debt. My psychiatrist has even tried to work out something with the manufacturers of the medications that I am on, but once they heard what my annual salary was, they basically just hung up the phone.

The bottom line: even if I did decide to continue with my bipolar meds, it wouldn’t make a difference since I am no longer allowed any more refills on my prescriptions. And this doesn’t even begin to take into consideration the asthma medications I have to take. I am simply so tired of fighting this battle. I am so tired of not having any money to accomplish even the basic, most simple aspects of my life, like filling up my tank with gas. I’ve reached a point where I truly don’t give a damn about anything anymore because no one seems to give a damn about me or my situation—at least those who are in a position to make a difference.

Yes, I see the red flag glaring me in the face. This mind set is exactly what led up to my suicide attempt a year ago. Is that where I am headed now? If I tell my shrink, all he will do is put me back in the hospital to protect myself, which I cannot afford. It won’t relieve the situation that is already in place to have put me in this dilemma—only further compound it by putting me into further debt. There aren’t any other drugs out there that will make the difference; I’ve already tried them all. I certainly don’t care any more, so I ask the basic question, what is the point?©2007