Upbeat

Well let’s try something a little more upbeat, shall we?

– Amy Adams, Miss Pettigrew Lives For A Day

Time for some good news, don’t you think? The last 2 week’s blogs have been a tad depressing. But then again, that’s what we’re dealing with; depression. And it is depressing!

But, time for some good news. Just as long as you don’t think that’s how it actually works in real life. Good news following bad in a nice little ratio. It doesn’t happen neatly like that. The depressing topics can go on for quite a while without relief!

Thanks to my amazing psychiatrist I actually am feeling quite a bit better this week. My meds have been upped again and within 3 days of increasing the dose I was coming up from the depths and feeling better, and my energy and mood have kept on coming up. Thank goodness!

My belief has been renewed that it is possible to get properly medicated and live a reasonably normal life. I stopped believing over the last little while, thinking I was living a doomed life. I have been reminded how closely the analogy of diabetes fits my disease. When a diabetic’s sugar levels go off, they feel awful but they go to the doctor and the doctor changes the level of medication. I just forgot that I need to go to the doctor and ask for more meds when I start sinking; I tend to think it’s on me to fix myself, as if I could! I’ve been reminded very clearly this time that when I’m struggling, it’s not just that I’m struggling, but that there’s something chemical going on in my brain that needs a doctor to sort out. I need to recognize it, and ask for help. That sounds obvious, but it’s not obvious to me, not when I’m sick. I just blame myself, feel like I’m not doing enough to be better, and I hibernate.  So I’m reminded it’s the level of chemicals in my brain that are dictating how I’m going, and when I need more, I need more and I need to ask for it. I’ll try to remember for next time…

I have faith again now, faith that things can be better, and will get better, and will be better. Something I lost lately.

But if I wasn’t feeling better, I was planning to write something “positive” anyway.

You know, so you wouldn’t worry. So you wouldn’t think it was all bleak and dark. To balance out the last two posts. To alleviate your concerns and to reassure you that everything is okay. Because that’s what we do, or at least that’s what I do. People who are emotionally and mentally unwell.

I want you to know when things aren’t going well because I believe in my friends and family knowing the truth. I want you to know, I really do. I think it’s good for a lot of people to know how these things work; so you understand, and maybe so it’ll help you help someone else.

Until all the condolences roll in and everyone is so worried. Until dear friends get scared, and fret about how I am going. Then I think about you, and how it’s affecting you and it makes me anxious, thinking of more questions and concerns, and I back peddle. So sometimes I tell you its all good so you can relax. And so I can relax, and I’m no longer fielding afraid questions from loved ones. My husband says this is insulting to people. To coddle them, and not let them in on the whole truth. To decide what they can handle and what they can’t. To give them the amount of truth that I believe won’t overload them, and by extension, me.

I’m sorry to do this! I don’t mean to take control of the information stream, or insult you, or lie. But it quickly becomes too much for me. Despite this, I don’t want you to change a thing. Please don’t stop feeling concern, or asking me about what’s going on. I’m just letting you in on my crazy brain!

But I think this is a very common thing in people with mental illness. I read a piece recently about “smiling depression” and so many times it IS easier to smile. I try not to be fake, but it’s still my fall back, the easier option.

It’s not about restricting your access to information about my illness and how I’m going. Like I said, I want you to know; at least theoretically. I have a limited capacity for emotion, including other people’s, when I’m not well. This is why sometimes I still say “fine”, “okay”, “not bad”, “good thanks” to skirt the question of how I’m going. Because when I’m really not well, just a simple “how are you?” is enough to bring me to tears, and have I mentioned how much I hate crying? Especially in front of anyone else! But I’m trying to be honest and open, so bear with me.

Sometimes I want you to think I’m okay, or not so bad so I can slink back to bed without attention.

It’s not that I don’t appreciate your concern.

I want to promote understanding of mental illness, but sometimes the kind concern and loving questions, while so touching, are a lot to deal with when I’m operating at low emotional capacity! When I’m better it’s a lot easier to process and when I’m well it’s easy, just the same as you or anyone, but of course the same thoughts and  questions don’t apply then.

But I am well this week. I’ve got energy, motivation, stamina. I feel good! Everything is easier. I’m doing more, and it’s draining me less, and not exhausting me just to move. My husband is happy, the house is in a little bit shape, things are just good. So none of this is fake. These are the real positives that I can see clearly with my eyes right now. Yay!

  • I’ve gotten out of bed every day this week, and sometimes before noon! Really!
  • I’ve talked to a potential employer via email and on the phone, and done an in-person job interview
  • I’ve done groceries, dropped off some clothes to be mended, washed and dried sheets, posted some clothes for refund, tidied up my side of the bedroom, even cooked dinner one night! Don’t get your hopes too high though, that’s about all I’ve done!
  • I’ve been to my GP for an appointment, to a doctor for an ultrasound, to a careers counsellor for help getting a job, and to KFC when I couldn’t figure out what to eat for lunch! That’s a lot of outings and socialising for me! On the days I went out, I went to bed when I got home, usually for an hour and a half…but I didn’t nap on the days that I didn’t go out, so that’s something
  • All this out and about meant I got some sunshine on 2 separate days. Actually on the skin sunshine!

So that’s me for this week. It’s not a lot from the viewpoint of my old life, but these days I take whatever I can take, and this is relatively awesome!

How about you? How are you? I’d love to hear from you.

 

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Saturday and Monday

I have been having some great days lately.

At my last visit with the psychiatrist he assured me that despite having poor energy and motivation, he felt I was 75-80% of the way to recovery.

He increased my lithium dose minutely and organised to have a blood level taken after 5 days at the new dose. That was Saturday morning. I see him this Thursday and I’m feeling so excited because for the first time in a long time I feel like I’m making real, sustainable, predictable, reliable progress.

I feel like I’m getting my life back!!

This is a big statement but it’s really, truly real.

I’m not all the way there but I’m so much better than I have been for a long time.

So Saturday I had the blood test. My long disused pharmacy knowledge is begging to be used so excuse the following jibber jabber.

Lithium is a tricky medication. For a lot of medication, you start at a certain dose, then increase by certain increments and the effect of the medication increases at the same rate as the dose to a set maximum dose.

For lithium and a few other medications, you start at a certain dose, then increase at ever smaller and smaller amounts because the removal of the drug from the body is limited and once the removal process is used up, more dose increases quickly lead to toxicity. For these medications there may not be a set maximum dose for all people as it depends on an individual person’s removal processes, or metabolism.

So a blood concentration or level is used to ensure that the medication is between under dose and overdose limits. These levels are determined during development of the medication for use or during clinical trials.

The blood test has to be taken at the right time so that the result is meaningful. In the case of lithium, the range we use to determine whether the drug is working but not toxic is established as a “trough” level. This means you take the blood test just before the next dose is due when most of the medication should have been removed by the body’s metabolism. If the body’s metabolism has been used up or “saturated” then the trough level will be higher than it should be and the patient is at risk of toxic side effects like blurred vision, unsteadiness, possible vomiting, diarrhoea etc. In fact the patient may already be experiencing these so the doctor will talk to the patient about side effects that they are experiencing plus look at the blood level result to get a clearer idea of what is going on.

The other part of taking a blood test is that it has to be timed correctly to when the dose was last increased. If the dose is increased today and we take a blood test today, the effect of that increase won’t be shown. If we look at the level and increase the dose based on that, we will have acted prematurely and risk the patient getting toxic side effects. So with each medication, there is a length of time between a dose change and when the level should be taken called the steady state. Consider it to be the time it takes for the higher dose to come to equilibrium or to spread out through the body so that it is present everywhere in the body to an equal degree.

For lithium, steady state is 5 days so the blood test must be taken at least 5 days after the last dose change.

Well that’s got that out of my system!

So to have the blood test at trough state, I have to be at the blood collection centre by 8.15am on Saturday. The reason for this is that I took my medications the night before at 8.15pm. Meaning I had to wake up at 7.30am! Good plan, very hard to follow through!! But I had the additional incentive that my hubby was going mountain bike riding and had promised to take me along so that I could go bird watching. I’d wanted to head out to King Lake for bird watching for a while so I was excited for that.

So I forced myself out of bed, through the shower and into the car without breakfast. I also had to have a fasting blood test. I packed my tablets and some food in with my fleece-lined coat and camera and off we went.

I won’t show a lot of my photos from Saturday at Smith’s Gully, just the new birds. But I wanted to say that we left home at 8am and returned at 4pm and I did okay!! This is so exciting for me! I didn’t tire out, I didn’t sit in the car and wait for the boys to get back, I didn’t feel exhausted, I didn’t feel like I couldn’t do what I wanted to do!

I did have a nap when we got home, then went out again for tea with my hubby. But I had walked and walked, I took photos for hours, it was pretty freezing cold, I didn’t have any lollies or chocolates or my other usual treats, I didn’t get grumpy or tired or feel worn out.

What a great day!!

The beautiful Queenstown Cemetery housing old-time gold rush prospecters

The beautiful Queenstown Cemetery housing old-time gold rush prospecters

Gorgeous yellow bulbs growing wild and free in the bush

Gorgeous yellow bulbs growing wild and free in the bush

I loved the beautiful gum bark, looks so much like a watercolour painting, and serendipitously shot an Eastern Rosella!

I loved the beautiful gum bark, looks so much like a watercolour painting, and serendipitously shot an Eastern Rosella! See top left corner

Mother and baby Eastern Grey Kangaroo across the paddock, as soon as I pointed my camera they all looked! So observant, gum trees, grass

Mother and baby Eastern Grey Kangaroo across the paddock, as soon as I pointed my camera they all looked! So observant

Large male Eastern Grey Kangaroo bounding across the paddock, grass, trees

Large male Eastern Grey Kangaroo bounding across the paddock

Beautiful country scene in Smith's Gully, lily pond under the gum trees, grass, reeds

Beautiful country scene in Smith’s Gully, lily pond under the gum trees

One of the many beautiful scenes of the winter sun showing through the gum trees

One of the many beautiful scenes of the winter sun showing through the gum trees

Group of Eastern Grey Kangaroos bounding across the green grass, gum tree

Group of Eastern Grey Kangaroos bounding across the green grass

A tiny litting bird that I've been trying to identify with a good photo for a while! I believe it is a Striated Thornbill; alternate opinions welcomed :)

A tiny flitting bird that I’ve been trying to identify with a good photo for a while! I believe it is a Striated Thornbill; alternate opinions welcomed 🙂

Striated Thornbill with a grub, the longest one sat still all day!!, tree branch

Striated Thornbill with a grub, the longest one sat still all day!!

Male Superb Fairy Wren in the bush, not new but always stunning!, grass, trees, bushes

Male Superb Fairy Wren in the bush, not new but always stunning!

A gorgeous Treecreeper that I have never seen before, I think its the White-Throated Treecreeper, tree branch, leaves

A gorgeous Treecreeper that I have never seen before, I think its the White-Throated Treecreeper

An accidentally amazing shot of a Grey Fantail in full flight!, tree, branch

An accidentally amazing shot of a Grey Fantail in full flight!

A day of rain, cloud, and the odd gorgeous blue sky :), dam, green grass, gum trees, clouds,

A day of rain, cloud, and the odd gorgeous blue sky 🙂

Mother and Joey Eastern Grey Kangaroo, so beautiful! green grass, eucalyptus

Mother and Joey Eastern Grey Kangaroo, so beautiful!

Beautifully delicate wattle sprig - looks like Spring!

Beautifully delicate wattle sprig – looks like Spring!

Sunshine, blue sky and everything is green, green, green, gum trees, shadows, green grass

Sunshine, blue sky and everything is green, green, green

Then Monday, after a slower Sunday. I’d organised to go for a walk with my Grandma at Blackburn Lakes. A couple of new birds, and so many kookaburras!!

A Noisy Miner is a very common sight but I just love this cute shot!, pink flowering gum tree

A Noisy Miner is a very common sight but I just love this cute shot!

I find these sky shots really fetching, I have taken a few lately but this one really draws me in, gum tree

I find these sky shots really fetching, I have taken a few lately but this one really draws me in

Australian Magpie, common but still awesome

Australian Magpie, common but still awesome

Juvenile Australian Magpie singing away, gum trees

Juvenile Australian Magpie singing away

A nesting mother Dove or Pidgeon sitting on its nest

A nesting mother Dove or Pidgeon sitting on its nest

Pair of Kookaburras sitting in a tree, gum tree, euclypt

Pair of Kookaburras sitting in a tree

Common Noisy Miner again, but how pretty are those wings? Sadly mis-timed! dead tree

Common Noisy Miner again, but how pretty are those wings? Sadly mis-timed!

Gorgeous pink native flower, not sure what but its so cute

Gorgeous pink native flower, not sure what but its so cute

Beautiful serene Blackburn Lake

Beautiful serene Blackburn Lake

Pretty Blue Iris flower probably sown by birds

Pretty Blue Iris flower probably sown by birds

Some kind of fungal growth on a tree

Some kind of fungal growth on a tree

Is this our state floral anthem? Its a type of native bell flower

Is this our state floral anthem? Its a type of native bell flower

A new bird to me, the Golden Whistler, a stunning bright yellow!, gum tree

A new bird to me, the Golden Whistler, a stunning bright yellow!

Pretty little Flame Robin showing off its bright colours

Pretty little Flame Robin showing off its bright colours