Week in Review 20 February 2010

I apologise for the delay in posting my weekly reviews. I have been so busy at work that time has just flown by. So let me catch you up since my last entry of Week Ending 30 January 2010 (see post below).

Work: My job is slowly piecing itself together. My confidence has risen a little bit and I finally got ahead of my emails. For the past three weeks, I have ended the day with as many as 90-100 unread emails. By Wednesday of this week, I finally tackled them all and now I may only have 6-12 emails I have not gotten to. What an improvement.

I feel as though I am actually accomplishing tasks at work and being able to scratch off items on my to do list. I still have about 20 requests I have not handled—some more complex than others.

My circadian rhythm has settled now. I am going to bed around 1930-2000 each evening because I am awakening on my own around 0345. My job requirements changed while I was out on medical leave. Before, if I was in the middle of something crucial and it went past my eight-hour workday, being salaried but non-exempt, I would be paid overtime. I ended up working 10-hour days frequently, which very easily made me feel burned out. When I came back to work 04 January I was told no more OT would be approved which really lightened my burden. Oh, sure, that always left me with not enough time to get my daily job done, but I was freed from the expectation that I would work the OT if I had to. So, I clock in at 0700 and clock out promptly at 1530. Because I am getting up so early, it gives me a chance to drink my hot tea, eat breakfast and stay on my strict medicine schedule.

Now, here is the bad news. Now they have decided to make us salaried exempt meaning if I have to, I am expected to work additional hours without being paid for it. In my book, I think that is a punch in the gut. That is management trying to cut the bottom line while still expecting superior work effort. Not sure when it goes into effect, but this had the potential to increase my anxiety levels.

My Psychiatrist: I had my appointment back on 03 February. He seems pleased with my progression, but concerned that I am still battling the depression. Overall, since the mood swings have stabilised I can see some improvement. He did not make any changes to the cocktail and now I have graduated to only having to see him once a month for the time being. I am looking forward to reaching the point when I only have to see him once every three months.

We talked about my residual symptoms of incurring Wernicke’s Encephalopathy which is still lingering. I am still having problems with my eyes as I am still experiencing saccadic movement  which slows me down at work. It is very frustrating. Also, I still experience short-term memory loss which is equally as frustrating. I have to take copious notes during integrated phone/data conferences so I do not forget anything. I cannot tell you the number of tablets I go through just collecting facts and action items on my part. My psychiatrist believes that my brain will heal slowly over time.

Individual Therapist: My last appointment with P was 03 February 2010. It was a non-event because I told her I was going to have to switch to a different therapist. P’s last appointment of the day is 1300, right smack in the middle of my workday. I need someone who can meet with me at 1600 or later. She highly recommended one of her peers equally qualified, but when I tried to make an appointment with S for two weeks, she was booked. I now have to wait until 09 March—one month out. I will try her on for size in hopes that we can make a connection. It is going to be a bummer having to start from scratch even though she has P’s notes in my record. I just hope she takes the time to read it before our first appointment.

My Car: Well, I am now the owner of a 2010 Honda Fit Sport. I have had it since 06 January and have only put 78 miles on it! I just do not have any long rides to takes around the city. Almost everything I do is right in my own neighbourhood. There is a small part of me that is excited by the fact that I have a new car. However, what is first and foremost in my mind daily is wondering if I can really afford this car. I did well in negotiating it down from the MSRP, but a car payment is still a car payment. It still has that new car smell. Also, I have made the decision that I will not smoke in this car. Hasn’t been too difficult. I just make sure I do not bring my cigarettes with me.

I will try to be better at really trying to nail down a weekly review on time. It’s hard to remember the small, but important details two and three weeks out.©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

Three Months Since…

I cannot believe it has been three months since I was involuntarily committed  when I tried to commit suicide. It seems like a lifetime ago (no pun intended). So many of the details have just become a hazy dream.

I still do not remember any of the events that led up to being committed. I guess I never will. At least I have all of the medical records to give me an idea of what and how it transpired—what a rollercoaster ride these 90 days have been.

I can say right now that I am in a much better space than I was on 11 October. It has been several weeks now since I have had any suicide ideation. For a while there, after I was discharged, it was a nightly event. I have done a lot of hard work in my group therapy sessions that ended 30 December. And, it appears that my psychiatrist has come up with a sustainable cocktail that has stabilised my bipolar disorder.

Do I regret what I have gone through? Absolutely not. The end result has been incredible. I am stronger mentally than I can ever remember since being diagnosed in 2000. I had what I thought was a pretty good cocktail all those years having nothing to which to compare. What I did not have before was a strong handle on specific coping skills that made the difference this time. Oh, sure, when I tried to commit suicide in 2005, I was exposed to DBT, but never felt it was for me. Truth be told, I thought it was all a bunch of bullshit. And, I’m not saying that I am totally sold on DBT even now—some of the tools have worked well for me; others have been not so much. This time around, I made a concerted effort to learn these tools even, if at first, I resisted strongly.

Lessons learned? I am not sure I can even address that facet yet. I am still feeling my through this maze. OK, one lesson I did learn hard was to never go off my medication. However, when I made the choice to go off my meds in April of last year, it was because I had just found out I had been laid off and could not justify the enormous expense. Now that my insurance has rolled over to a new calendar year, I still have to meet my $1200 deductible for this year. That means I have to pay 100% of all my meds at retail price until the deductible is met. Even though I have a job now, I am pretty tight financially and I am not sure where I am going to come up with the money. But, if I have to, I will put it on my credit card even though it pains me to have to resort to that possibility. I simply do not have the option to go off my meds.

Another thing I think I have learned is the enormous help therapy has been. Now that I am back at work, I can no longer participate in my group therapy sessions (they were always held for three hours three times a week during the middle of the day). I have hooked up with an individual therapist now and saw her last week (I had already had my intake appointment some time ago and one follow-up, but I had to concentrate on my group therapy then). I am not sure how individual therapy will help me as the dynamic is going to be different from group. When I met with her last week, I actually told her I was not sure where to start. She asked me what issues I had that were most pressing to me. Not wanting to bite off more than I can chew, I told her that I wanted to focus on my stress now that I am back to work after being on short-term disability for 12 weeks.

Now that my BP has stabilised, I am going to have to start to deal with my borderline personality disorder and my anxiety disorder. Now, that is going to open up a whole big can of worms. I think that I am only going to put one foot in front of the other and take everything slowly. I have made some significant process and I do not want to find myself in a spot where I begin to regress. I value where I am today and that is what I am going to hold onto—the here and now. As someone once told me, yesterday was over last night and I have no control over tomorrow.©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

Individual Therapy #2

I met with my individual therapist yesterday right after group. My head is certainly having the time of its life! I didn’t think I would return after my first visit. However, this session went well. I’ve never done this before as far as dealing with a therapist one-on-one. Still not sure what to expect, but I liked the fact that I seem to get along with her fairly well. She’s upfront and direct—no bullshit. I’m not sure if I am going to chronicle these appointments as it appears that we are going to delve quite heavily into my personal life—more in detail than I want to publish. Suffice it to say that I think I can derive some benefit from this. At first I thought she was sold on DBT therapy (very similar to my group therapy sessions), but it appears not so much. I can’t take any more coping skills sessions than I am already exposed to through my group therapy. I like her (not so sure I can trust her yet; time will have to be the measuring stick on that one) and I feel I’ll be able to open up to her especially where my dysfunctional upbringing comes into play.

Oh, I did find out this morning that my medical disability has been extended through 30 November due to the paperwork my group therapist submitted. Evidently she doesn’t think I’m prepared to face going back to work tomorrow. I’m not being a deadbeat when I say this, but I don’t think I am ready yet to handle that additional stress right now.

Well, my plans for my midnight walks are quashed tonight. It has been raining like cats and dogs all day today. It’s absolutely miserably outside—chilly, dreary and wet.©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

Outpatient Therapy, Day 5

This morning was rather interesting. Did the usual sharing, but when I commented that I couldn’t remember anything from the time I left group last Friday (but that I remembered Saturday and Sunday) she asked me if I remembered calling her Friday afternoon. I drew a complete blank. She said I wanted to meet with her afterwards today to discuss my treatment plan. It was news to me (as she scribbled).
Well, we did discuss my treatment plan. I asked why, under master problem list, it listed merely “depression” and no indication of persistent suicide ideation. She explained that I had not been honest from the beginning about that on my daily check-in sheets, and only just started mentioning it. I tried to explain to her that the ideation isn’t just something I think about here and there, but that I struggle with this almost every evening. The only thing that has kept me alive has actually been using one of the coping skills. I am discovering that my house…my fucking house (or rather, being in it all alone), has become a trigger. I have to leave the house and I end up going for a walk—a long walk. My reasoning? It’s late at night, and walking releases so much of my energy. When I finally get home, I’m worn out—physically and emotionally—utterly spent.

She looked at me and told me that she thought I needed go back inside the Big House—that this outpatient treatment program, in her opinion, wasn’t going to be sufficient to keep me safe. I pleaded with her not to make that recommendation (i.e., have me committed again), that I had shown that I was successful in using my skills. I practically begged her to let me go as long as I made the commitment to her that I would use my skills when I was in that head space. I tried to stay calm, although my heart was banging so hard. However, she relented but there was this look in her eyes that scared the shit out of me. All I kept thinking to myself was to just deep breathe and stay calm. I didn’t want to trigger any action on her part.

When I got home later, I looked at my entries on the blog and, sure enough, there was my entry about Friday that I posted on Sunday morning. Evidently, I did remember at that moment actually coming home, but it doesn’t say anything else about the rest of the day. And today, the last thing I could remember was someone making a comment about the fact that I actually smiled for the first time just before we left group. My mind is so fucked up. I swear there are times when I don’t know what is real and what isn’t.©2009

Outpatient Therapy, Day 4: Treatment Plan and My Diatribe about Pot

Friday was an uneventful day again. I’m glad this program is only Mon-Wed-Fri from 0900-1200. Once the group split, I realized that there were a few less of us in my half. A couple of people, evidently, had finished the program. I wondered when I was scheduled to be finished. As usual, we went around the room “sharing” what was on our daily check off sheet. While I understand that this is the opportunity for the therapist to get a good view of the progress each of us is making from day-to-day, I have a hard time enduring what some of these mentals say. Some of them can just go on and on about nothing, or repeat themselves endlessly as if to really underscore the problem they are having with their “issues.” Yelling “I heard you the first time,” would accomplish nothing. Meanwhile, when it came around to me, I sorta just tonelessly droned through my list (nothing had changed from last Wednesday, except that I was still alive). I did underscore that I am having repeated states of dissociation and time loss. I swear, there are blocks of time where I can’t remember shit. Not that I go into another room and forget why I got up in the first place; I’ll forget an entire day and have no idea what happened (no, I am not drinking any alcohol and my meds have never affected me this way before). Or, I’ll be driving down the road and all of a sudden I have no idea where I am, how I got to that point, nor where I am going. Kinda spooky. Of course, she did some heavy scribbling here. Then I reported back to them how well I controlled myself when the cop came back to my house on Wednesday to answer my questions. Then, break time (I always arrange it so I am the last to report in).

The group as a whole has pretty much figured out to leave me alone while I smoke my cigarettes during the break. If there are too many of them around the covered picnic tables, if it’s not raining, I’ll just walk around the parking lot instead. When we came back in, I found out that the whole group would be together again for the second half, so I just grabbed my stuff off of the table and found my seat along the wall in the corner. A few people in the other half of the group looked at me, and I just stared back with this “What’s your problem?” look while I shrugged my shoulders and held up my hands. That usually works. In fact, I had to smile—one of the women in my half of the group saw me do that and looked at me and gave me a thumbs up sign. At least she gets it.

Then, the door opened and one of the other therapists called me out to her office. She wanted to go over my “Interdisciplinary Treatment Plan.” In other words, what they perceived to be my problem areas and their stated goals for me. Basically, this is how it breaks down:

ADMITTING DIAGNOSIS (DSM-IV):

AXIS I: 296.62 Bipolar Disorder, Mixed

AXIS II: Borderline Personality Disorder

AXIS III: HTN, Asthma, Arthritis, Headaches

AXIS IV: Financial, Social, Occupational

AXIS V (GAF): 50 (explained below)

MASTER PROBLEM LIST:

1. Depression
2. Intense anxiety
3. Work-related stress
4. Low self esteem
5. Impaired thoughts
6. Lack of social support
7. Grief (deferred to individual therapist)
8. Shame/Guilt (deferred to individual therapist)
9. Hypertension, knee pain, headaches (deferred to PCP)

GLOBAL ASSESSMENT OF FUNCTIONING SCALE (GAF): “41-50=Serious symptoms (e.g., suicide ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).” [Alix’s note: this description comes from a manual; it by no way implies that I shoplift…LOL]

LONG RANGE GOALS FOR TRATMENT (Discharge Criteria): Alix will exhibit skills adequate to maintain the gains made in therapy and establish adequate resources to function at a lower level of care.

PRESCRIBERD TREATMENT MODALITIES/SHORT-TERM GOALS:
Problem 1: Alix will verbalize and demonstrate 3 skills used to manage depressive symptoms, such as mood swings, feelings of hopelessness, isolation, low motivation, poor sleep, & the impaired ability to function. (Target date 11/27/09)
Problem 2: Alix will verbalize and demonstrate 3 self-nurturing skills used to reduce and help manage feelings of anxiety. (Target date 11/27/09)
Problem 3: Alix will verbalize and demonstrate 3 skills used to manage current work-related and financial stressors. (Target date 11/27/09)
Problem 4: Alix will verbalize and demonstrate 3 confidence-building skills used to experience an improved sense of self esteem. (Target date 11/27/09)
Problem 5: Alix will verbalize and demonstrate 3 skills used to improve memory and concentration, and decrease racing, irrational, and confused thoughts. (Target date 11/27/09)
Problem 6: Alix will verbalize and demonstrate 3 skills used to strengthen or build a support system in order to experience less isolation. (Target date 11/27/09)

Well, folks, there you have it: all my problems summed up in a neat tidy package! I’m supposed to figure out a shitload of “skills.” Hell, I don’t even know what most of them are. I sure hope that teaching them is going to be part of this program (since I’ve only been to a few, I really don’t know what to expect). I wonder if the target date means that is how long I am to remain in the program. I did find out that my current FMLA medical disability goes through 10 November. If the target date does indicate how long they perceive my need to continue in the program, does this mean they are going to re-file w/the disability group @ work and extend my FMLA? I know that, according to federal FMLA rules, I cannot lose my job. They don’t have to give me my exact job back, but they do have to provide minimally a similar job with the exact same pay scale. If my manager deems that the team can no longer proceed with my absence and brings in someone new to replace me, maybe my replacement position will be much less stressful and require less than 12-14 hour work days.

I’m not sure how I feel about returning to my current position. I love the interaction with my clients and being able to provide my services, but the overall demand of having approximately 150 high-end clients (major revenue-producing companies), coupled with the many ongoing projects in which I manage the majority of the work product (and so many of them all having approximately the same deadline dates) have become too much for me to handle. The mere hours I work have finally exhausted me. I have tried to manage my time as effectively as possible, but all it takes is one little phone call from a huge company to throw me all off track (not to mention the number of voicemails I have to address throughout the day). Meanwhile all those inbound emails continue to flood my account with more demands of my time and “invites” to numerous customer meetings. At the end of the day, when I physically can do no more, I look at what I didn’t finish and how many unread emails I still have that day only to realize that it will snowball into the next accompanied by a new day’s worth of meetings and unread emails. I have had too many people tell me that I can only do so much and to let the rest go; however, I am bound by Service Level Agreements as part of the contract signed with my clients. I am required to respond to their emails/voicemails within 24 hours (in some cases, within only one hour depending upon the problem). I also have to take into account that I work for a global company. While I sleep, Europe and Asia continue to send emails and voicemails. I am slowly realizing that, as much as I want to, I can’t be all things to all people. Moreover, this doesn’t even take into account the many hours of continuing in-house corporate training I must complete (e.g., Six Sigma). Vacation time? Sure, I have 17 days left. I’ve been too busy to take any of those up to now—too many projects always underway. (I actually took 09 amd 10 October as vacation days; however,the evening of the 10th is when the nightmare began).  It’s already the first of November. If I don’t use them, I will lose them (no carry over). Can you imagine how many emails are waiting for me right this very minute? How the hell am I going to be able to take off any vacation time between now and the end of the year? I just can’t do it any more, but with the way the job market is, I simply have no choice to not do it. With what I do, trying to find a comparable job elsewhere is a pipe dream—everyone is downsizing, even my own company.

When I got home from group around 1230, there was nothing to do. Yeah, my house could use some straightening up, a good dusting and vacuum job (at least the kitchen always sparkles). I can’t tell you the last time I actually made my bed. I just sit on my couch and listen to my music. Oh how I miss the old days when I could fire up a number, sit back and catch a buzz. When corporate HR policies everywhere instituted the mandatory compliance of random drug testing, all that went out the door. I never envisioned not being able to light up a joint again. I have a big problem with this whole scenario. Go after the tweakers and the hard ball coke and smack users, just leave us well-intentioned potheads the fuck alone. I never got high before or during work; it was simply my “martini” at the end of a long, hard day. Tell me who doesn’t have a beer when they get home from work (or goes out with the gang)? In addition, the drug test policy doesn’t even address the alcohol issue. I can’t tell you how many times, when I used to work in a corporate setting, I would be standing next to someone who smelled like a brewery first thing in the morning, or those that came back from lunch looking just a little too much bloodshot for my tastes. Why not address that pervasive problem. Their judgment is equally impaired. It’s just not fair.

Well, tomorrow is Monday, yet another group session. I have some questions about my treatment plan. At least I know I have something to do from 0900-1200.©2009

Yet Another Decision

Today is a day off for me. No appointments with anyone. Yesterday evening I made another decision, diametrically opposed to this one only made here.

I had nothing but time on my hands yesterday after my first encounter with my therapist. I spent much of the time playing catch-up in reading the many blogs that I follow and reading comments made to my posts, along with some personal emails I actually received from truly caring individuals. As the day progressed, I did feel the intensity of my rage lessen somewhat (certainly not from anything purposefully done on my part, I assure you)

I had already made the decision to come back and see the therapist for a second appointment—a commitment that I didn’t think I was capable of making, much less caring about. Early evening it occurred to me that if I am going to make an effort with this therapist, I should at least be responsible enough to go back on my meds (a value judgment?). I went back to my bedroom and lined up all the containers (three of which are for blood pressure since it seems I’m having an issue there as well and swallowed them all (I always feel I have to add the caveat: as prescribed LOL). With my history, making the statement “swallowing them all” takes on a whole other connotation!

Went back to my living room and spent the evening listening to some really fine jazz (John Klemmer, Stanley Clarke, Chick Corea, Miles Davis, Jean-Luc Ponty, Al DiMeola). As the evening rolled onward, I made a concerted effort to also start trying to structure the time I try to go to sleep (an ephemeral experience to say the least). Even though I felt far from tired, I took my bedtime meds, crawled into bed and tried to read a book. I am so frustrated with this last action. I opened up to where I had last read (just the previous day) and I had no memory of what this book is about (I’m only about 12-15% into the beginning). This repeated problem really pisses me off, because, if given the chance to be focused enough to read, at least concentrating on that action temporarily quells all my racing thoughts. *Sigh* I return to the first page and start over.

After a few minutes, I realized that I had made an error with one of my blood pressure medications, a mild diuretic (hydrochlorothiazide HCL, hereafter referred to HCTZ). This one, for obvious reasons, taken once a day, should only be consumed in the morning—certainly not just before going to bed. When I hopped up to hit the head, all of a sudden I did not feel so well. No, I wasn’t dizzy per se, but I felt as if I couldn’t catch my breath and also somewhat disoriented. It occurred to me that perhaps the blood pressure crisis I experienced while incarcerated was indeed situational after all. Was my blood pressure now too low? I walked around for a little bit and found myself having to sit down. Very weird feeling.

So, as potentially stupid as this action could result, I decided to drive up to the nearest CVS and use their BP machine. I had much difficulty driving; it required far more dedicated concentration and focus that what I am used to. When I walked into the store, the lights were too bright and there were too many people milling around. Without asking, I blindly walked to the rear by the pharmacy and found the machine.

Now, mind you, when I was first put on the initial does of medication, my BP had skyrocketed to 228/156. When I was released 11 days later, I immediately saw my primary care physician and my BP was still elevated (165/110). What was eerie in both measurements was the fact that my heart rate was only around 56. My PCP decided to alter the medication I was discharged with from the hospital. He effectively doubled the dose of one (clonidine HCL from 0.1mg to 0.2 mg, but dropped it from, 3x/day to 2x/day), increased to dose of another (lisinopril from 30mg to 40 mg 1x/day) and added the HCTZ at 25mg 1x/day).

I sat in front of the machine and it turned out that my BP had dropped to 137/61, HR 72. The diastolic measurement concerned me as I thought that was a bit too low which might have explained how I was feeling. I drove back home, still trying to catch my breath and thought about calling my PCP in the morning. Went back to bed, read a little and actually experienced the feeling of being sleepy (hooray for me). Perhaps adding the Geodon to my bipolar cocktail might have made the difference. I actually got about five (count ‘em FIVE!!!) hours of uninterrupted sleep. I cannot even remember the last time that happened.

When I woke up, I decided to get my BP measured again before calling my PCP. Weird. It was back up to 150/95 HR 61. (I decided to purchase a BP wrist monitor while at CVS this morning to save on having to drive each time. The first reading, while still at the store, calibrated closely to their BP machine, so I was at least on a level playing field) Knowing it was still slightly elevated, I decided not to call my PCP and took all my meds this morning as prescribed. It has now been one hour. My BP is 112/66 HR 71. Perhaps my BP meds are stronger than they need to be. I’m going to take the rest of the BP meds today and monitor this closely and then possibly call my PCP tomorrow and ask if I should perhaps reduce my dosages.

Speaking of tomorrow, I have my second appt with my shrink. As far as he knows from the phone call he received from my therapist yesterday, I have been off my meds since last my discharge. While I did fill the scripts the shrink gave me on my first visit with him post discharge, I never bothered to take any of them (still in the “I don’t give a damn” mode). I am sure his first response is going to be along the lines of “Why won’t you help me be a better doctor to you?” What can I say? I am now willing to take my meds, continue with this outpatient program for this week and next, and then pick up with my individual therapist the following week.

Is this progress? I don’t know. I still feel resistant. I’m still in my “don’t give a damn” mode. I still face abject loneliness, utter sense of no worth, absolute pain over all the consequences arising from my actions throughout my life, and above all, I have no reason why I should be forced to continue this existence from which I want to be finally relieved. Nevertheless, in reality, what do I have to lose except my life, upon which I still place no value?©2009

DBT Therapist, Appt #1

Well, I am finally caught up with keying in everything I had written in my journal since my “visit” to the ER. No more date stamping my titles! You know, my handwriting can really suck at times!

I agreed to this appointment as a condition of my release (in addition to the outpatient treatment program I am in, they wanted me to start seeing an individual therapist). Just so it would appear that I was being a “good little girl” I showed up.

While I was in the waiting room, filling out yet more “new patient” forms (hell, they already have a copy of my records from the hospital, why can’t they just read that?), I could feel my anger building. I didn’t want to be here. I had no expectations. And I sure as hell don’t trust the system not to lock me back up if I say how I really feel.

(For the first time since I started this blog, I am not so sure I feel safe even writing what I really do feel here. No one who knows me personally has the link to or the name of my blog, not that I can remember, anyway. At what point do I end up surrendering my 1st Amendment rights?)

I was actually somewhat surprised by this first visit. I wasn’t even sure we would “click.” I tried to get through to her that I did not care whether things “improved.” Of course she asked me if I was suicidal and I just laughed and asked her if she really expected me to answer that after everything that had happened (she started scribbling on her clipboard). She asked a few questions about my history and previous suicide attempts (more scribbling), but all-in-all, she got it that I was incredibly angry. She said my continued participation with her was strictly voluntary at this point.

Sure, I told her that I thought that my life sucks (did not expand on why at this point, but more scribbling anyway), that I had no clue as to how I thought she could help me, and that I thought DBT was for the birds (more scribbling). Then I simply asked her, “How can you even deal with me if I’m in a space where I don’t even WANT to use the tools—that I just don’t give a damn?” And she said that this would be a good place to start. At least she acknowledged where I was rather than determining that I was “unwilling “or “uncooperative.” She said that a return visit was clearly up to me. She didn’t try to preach about tools/coping skills or what I should be doing. She said that obviously I had to decide if I wanted to try to figure out why I was feeling the way I did well before I could do anything about it. It was the first reasonable thing I had heard anyone say to me to date.

I could tell that the time was almost up. She asked me if I felt suicidal, would I be willing to call the hospital, and I emphatically told her absolutely not (more scribbling). Then she handed me my sheet with which to check out, gave me her card, and told me if I wanted to come back to just call and make an appointment.

As I stood in line to sign out, I looked at what she checked off under “diagnosis.” She indicated bipolar (good catch) and anxiety disorder (yet a new label for me, oh goodie). However, conspicuously absent (despite the records from the hospital and the information I filled out on her “new patient” form) was borderline personality disorder. She was still in the hallway, so I called her back up and asked her about that. She said that she didn’t think it was appropriate. Well, I got tagged with that label back in 2005, and with everything I tried to learn about BPD, it seemed to be right up my alley. I told her that I thought it was amazing how no one wants to deal with that issue with me, not even my own psychiatrist and now her. She said that I was operating under an assumption that she didn’t think was accurate, but reached over and checked it off on my sheet and walked back down the hall. What’s up with that? Is BPD the dreaded mental illness that no one wants to discuss? All anyone ever wants to deal with is my bipolar.

When I went to pay (yay—only have a 10% co-pay and today’s, the most expensive appointment since it was an initial workup, was only $12), for some reason I did decide to make a return appointment. Don’t know why, or what I expect, but I thought I’d give it a shot. She has been the only person so far that seemed to be interested in the reasons why.

Meanwhile, she’s going to contact the outpatient therapy program @ the hospital to indicate that I did complete the follow-up appt (I went to see her today instead of the outpatient program), as well as contact my psychiatrist (he asked me to have her contact him for ongoing continuity of care). Since I admitted to her that I hadn’t bothered taking any of my meds since discharge, I guess that cat is out of the bag. I see my shrink Wednesday. I wonder what that visit will be like?

Why am I so resistant to taking my meds—even the blood pressure meds? Everything keeps coming back around to “I don’t care.”©2009