Canberra Day Fifteen

Strictly speaking not a Canberra day at all, but it’s all linked to Canberra so here we go.

Possibly one of the most exciting days of my life! I have been wanting to see whales in the wild probably since I was born, maybe a little after. Currently I subscribe to a tantalizing blog that sends me an alert from anywhere along the Great Ocean Road that a whale is sighted so that potentially I can go and see it. Of course I live in Melbourne and so the closest sighting has still been 2 hours away, the furthest one a ridiculous 4 or 5 hours. So in order to make this work for me, I set up a spreadsheet earlier in the year and put in all the sightings with where, when, what type of whale and how far off shore the sightings were so that I could pin my money on the most common places and take a driving holiday. That hasn’t really eventuated, but I still dream about it. Now that I’m living inland it’s quite of all moot, and even if I were in Melbourne and free to go on a 4 hour round trip for the sake of a possible sighting, I couldn’t because the Great Ocean Road is shut with landslides!

So, where is this all heading? Today we decided to go and check out Kiama and everything that is between Shoalhaven Heads and there. Lots of stunning lush scenery, beautiful hills, brilliant ocean views, just lovely to be enjoying it all, soaking it up. I’ve been to Kiama once only for half a day on band camp, but I remembered the blowhole so we headed there. It was a bit of a wash out due to flat seas, no wind etc but we heard people CASUALLY (how could they?!?) talking about taking photos of whales. I was like, where’s this? And it was a few hundred metres of shore happening right there and then!! Excitement plus; doesn’t even describe the happiness!! This is the best photo, they were a fair way off, but this shows what others thought was a mother and calf on her far side plus another whale in front flipping its tail!!! WHALES!!!!! I saw them! With my own eyes and through my 300mm zoom lens!! Oh of all the days I wished I’d spent those few thousand dollars on a 600mm lens…not really though, I have a great editing program that let’s me crop a lot of the photo away. I’ll put what my camera got as the header; what my eyes got was a lot less. Although I think when the header image gets cropped it does zoom in a bit.

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Well! What to say after that?! We enjoyed more driving once the rain set in after a sunny morning, the dramatic skies were a highlight and the scenery everywhere was just delightful. We drove a couple of roads that hubby hopes to climb another time; he needs to go home and get more gears!! It was seriously steep, we were wondering if we’d tip over backwards!! And we drove down in first gear and still sat at 30kmph! Fascinating. We saw some gorgeous sandstone cliffs, mountains, farming and horsey farms, little seaside villages and it was just a lovely day seeing new things and having new experiences!

Exams

I don’t know how many times I’ve had this dream, or something like it. It’s 5.30pm on Saturday afternoon. My final Year 12 exam starts in 3 hours and I’m absolutely not ready. Why an exam is scheduled for 8.30pm on a Saturday is never made very clear to me! I don’t have a cheat sheet ready, I haven’t studied all semester, I know nothing and I’m in a despairing panic. Or I’m in the last class of the term doing trial exams and unable to answer a single question. Or I’m studying at home and don’t even know where to start. Or I’m in a group study session and the others know everything and I’m absolutely lost, up the creek without a paddle! The subject of the exam is never one that you can cram overnight like biology or history; it’s always physics, maths, or chemistry where you have to understand the equations and be able to manipulate them in the exam to show your understanding. Or lack thereof in this case. There is no way that I can shove enough knowledge into my brain in time to pull it back out again in time for the exam. In other words, I’m doomed! Can you imagine the panic, stress, anxiety, despair, terror, the feeling of utter failure and of the future being bleak? In the middle of the night in my sleep it’s very real and very upsetting! Wishing I’d done better, afraid of the moment my teachers find out I’ve failed them, fearing my peers finding out I’m dumb and incompetent. Cheery stuff!

The thing is, I passed my Year 12 exams. I received my Victorian Certificate of Education in 2005. I did well in fact. I was in the top 10 of my year level, number 6 I think. I achieved 94.55 out of 99.99. This isn’t a brag. It’s an attempt to make my brain remember that actually I have finished this part of my life, and finished it well. I no longer need to fret, stress, despair, panic, etc about facing exams. I mean for goodness sake, it’s 11 years since Year 12! It’s 7 years since I finished my Bachelor of Pharmacy, a lot less academically brilliantly but still. Those years are done, finished; there’s nothing that can be done to change any of it. I can’t go back and do it again. And after all I did those exams and passed them. But these dreams, largely about Year 12 exams, persist! And it’s tiring to spend so much emotion in my sleep during the night on a situation that would never occur to me to think about during the day. But during the night, my brain can’t rationalise. It’s susceptible to the strangest things. And never more so than since I’ve been on antidepressants. Prior to starting antidepressants in mid 2013 I may have had this dream, but I can’t remember. I never dreamed that much and I remembered even less of what I did dream. I’d wake up and any dream would rapidly fade and become a vague thought, or just drift away. But then.

SSRIs, selective serotonin reuptake inhibitors, are the first class of antidepressant that you get to know if you experience your own battle with anxiety, or depression. They are the first line of treatment. Lexapro, Prozac and Zoloft are some brand names you may have heard of. I prefer the generic names because they never change: escitalopram, fluoxetine, sertraline plus paroxetine, citalopram and fluvoxamine. These medications can have a side effect of strange, or even frightening dreams or nightmares (NPS), otherwise described in some places as vivid dreams. Can, being the operative word. They don’t occur in all people, or all the time. I seem to go through phases then have a break for a while, then another series. I was amused at the beginning. I had these super realistic dreams of utter nonsense that were really quite entertaining. I just wished I could have hit the video button and recorded them; I’m sure my name would have gone down in history along with the famous movie directors. I could never write them down quick enough and in enough detail to really proper capture them; quite a shame. But then I started getting variations on this exam panic and it’s not anywhere near amusing; it’s very stressful and I wake up next morning entirely exhausted, as if I’ve hardly slept! It’s draining. And to what end? My psychiatrist doesn’t believe in finding the meaning in dreams, neither did my psychologist, nor does my GP. Rationally I know that dreams are just my subconscious processing data. But sometimes I’d just like a reason why I’m fighting with these emotions during the night. I mean I know why, in that it’s because of the medication. But why this kind of dream, why this stress about failing?

So. What to do about it? In my case, not a lot right now. I’m on an SSRI plus 3 mood stabilisers. Theoretically for bipolar patients, the antidepressant is no longer necessary once the mood stabilisers are in place. Theoretically. So in order to get rid of the dreams, and the sweating, my psychiatrist started slowly weaning my high dose of antidepressant. We got down to 375mg from 525mg, but when we went to 300mg, things started falling apart. It wasn’t worth it so we went back to the last dose that worked. We might try it again later, especially now that one of my mood stabilisers has been bumped up. But it’s a balancing act. Sometimes you have to accept some side effects for an otherwise good healthy life. That’s just reality.

In the meantime, my energy is going to trying to wake myself up out of these dreams and remind myself that although I did have some close calls with studying at the last minute during my university years, that’s long gone! It’s in the past and it needn’t bother me anymore. What’s weird is that it was my years at uni when I was less studious, but the dreams are always about high school. I guess that’s just proof that this is an irrational thing, and to just let it go as much as possible, let it pass, let it slide. Breathe in, 2, 3, 4, out, 2, 3, 4. Ahhh.

I’m back…

[Started on December 9th]

“I’m back, baby doll…”

-one of favourite quotes from How I Met Your Mother

I’m baa-ack. It’s been a month, apparently. It felt a lot longer! I only know this fact of it being a month since I was here from opening my blog today for the first time since … so it tells me … the 9th of November.

Wow.

And during that time I actually thought up zero topics, had zero inclination to write anything and was pretty much happy to climb into a hole and be a hermit for the rest of my natural life. But the light has broken through and here I am.

It’s been a very full month. I’m trying. A trip away to Werribee, days out of the house doing stuff, hanging out with girlfriends, some actual real live housework. There were, surprisingly, some pretty great times.

And then there were days when I wore my pajamas until 5pm and only left my bed to eat. But you know, looking for the upside!!

There was one amazing week where I thought I’d finally broken through the depression glass ceiling into what normal life could be like, and I loved it! So did my GP: ‘Imagine if this is how life could be from now on? That would be f*@%*^# awesome’. His words, not mine! Just to clarify. But yes, why yes, yes it would.

Sadly for me and anyone my life bumps up against, it was mania.

Oh mania, you heartbreaking devil you. You get us so excited and hopeful and relieved and let us sniff “normal” for 5 minutes, before depression overcomes us again and we all sink back into the swamp!

Normal, or a bit more overdone than normal; either way, it’s a nice change from blergh, uff and erk!

But it wasn’t devastating when mania went this time. Well not as devastating. This time. I’m getting more resilient gradually.

[Updated from here in later December but the computer wiped all my additions and made me so angry I gave up on it! Then I vowed to complete it on January 9th but when the date came around I was staying in a motel without WIFI…ahh the horrors of modern life! So here I am, Feb 9th…and finally I’m back! And saving my draft after every word!!]

Thankfully, bit by bit, episode by episode, high by low by high by low I am taking it less personally, getting less excited and less distraught when my brain chemistry flicks the switch and lands me somewhere I wasn’t prepared for.

So says my mouth, and my head. So I wish, so I hope. And maybe sometimes that’s the case, that I’m less wrung out over it. Maybe.

But actually now that I’m slipping down the slidey slope again I find myself not so okay with that. I don’t want to go down there again. I don’t want to be like that again. But it seems that I’m not being consulted in the matter of what goes on in my own head.

Ironic, isn’t it? My own head, taken hostage by chemicals. Chemicals that don’t even have brains or thinking power or motives – but they pack quite the punch! We’re doing all we can to oppose them but it’s turning out to be more of a war than just a battle.

I’ve been told over that I have tricky brain chemistry. At first I thought it was one of those placating remarks all doctors make to help ease you through the rough period between the diagnosis of depression and the onset of full medication effect, which can be up to 6 or 8 weeks at times in some people.

Although I guess I didn’t hear it said first until I was trying the 5th antidepressant; but I definitely needed to hear something at that point to convince me that I should still hold hope that this one would work! My doctor told me that every time an antidepressant didn’t work, we were one step closer to finding the one that would; we were one step closer to getting better; the depression was one step closer to showing us how it was working and what we could do to oppose it.

That’s a lot of talking for a chemical to do!

Time and experience have unfortunately proved the fact to be true. I have tricky brain chemistry. It’s difficult for the medications that we have available to match the chemicals that are lacking from, but should be in, my brain keeping me from becoming anxious, depressed, manic or a swinging monkey between all three moods!

I’d love to be one of those people who gets diagnosed with depression, gets prescribed whatever antidepressant their doctor has on their mind that week, tolerates it well and after a year or so with successful treatment and other supports, undertakes a careful withdrawal of their medication under supervision of their doctor and continues on with their life drug/medication free. Not trivialising their sufferings, just envious of their rapid and successful long term improvement and freedom from medications.

Of course that doesn’t happen in bipolar disorder; only in depression. Bipolar is not a condition that remits; it’s a life sentence. It’s not going anywhere, and it’s quite unlikely that I’ll ever be free from taking medicines.

But it’s the dream, isn’t it? To be medication free, drug free, not drug dependant; isn’t that the dream of any person tied to medication?

As a pharmacist I have to ask every person/patient I deal with if they take medications. Apparently this is the most annoying question that a person could possibly ever ask! Or maybe I’m just asking it wrong; that’s always a possibility.

When I was working, a distant memory just now, I’d get 50 people a day saying “I’m not the kind of person that takes medication”, “I’m not the type of person who takes tablets”, “I’m not some kind of druggie”! Or my personal pet favourite hate: “I don’t like taking pills”.

Really? Well who does like taking pills? And what exactly is the type of person that would take medications? I guess having to take medications to get by makes me more sensitive to these types of comments spoken from ignorant minds. It’s obvious that they’ve just never given the issue more than a seconds thought, or they’re basing it on inappropriate pill popping they’ve seen on TV.

But just a suggestion, if you ever come across me actually working as a pharmacist in the indeterminate future, please just answer no or pass me a printed list of all your meds with doses, thank you so kindly!

 Moving on.

Tricky chemistry, multiple antidepressants, additional diagnosis of bipolar on top of depression and anxiety.

The diagnosis of bipolar disorder, after the initial shock and rejection of the idea as stupid and crazy (oh the irony of calling it crazy!), was actually not that surprising, looking at it rationally. The failure of antidepressants to work or to work fully is actually an indicator of bipolar disorder, which I knew somewhere in my mind from when I studied mental illness as half of my post graduate studies. Another irony!

What if I’d had the clarity of thought to see it that way back when? To look inside my brain in a rational, systematic, logical manner. But that’s not how mental illness works. It takes a regular brain and clouds it with so much doubt, fear, hurt, pain, sadness, hopelessness etc that you just can’t see.

I’d go to my doctor and say, I was so bleak and black yesterday I nearly couldn’t stand it. And he’d say, how many Valium did you take?

Valium. Brand name of diazepam, used in my case as a sedative and anxiolytic, remover of anxiety and worry.

And every time he said it, it would be such a revelation to me: oohhhh! RIght! I should have taken a Valium! That would have made me feel better. Of course, how did I not think of that? I say every time because there were quite a few times he had to say that to me!! And I’m a pharmacist! Turns out being a good pharmacist doesn’t always extend to yourself! Luckily my husband is happy to jump in and now whenever I’m complaining of my mood he puts on his doctor voice and asks me, did you take a Valium??

I had this sanctioned stash of tablets capable of taking a stressed-to-the-eyeballs or suicidal girl and transforming her into a warm, fuzzy, calm girl ready to take a nice comfy little sleep to get her through the hours until her chemistry improved or she crawled into the doctor’s office, totally empty and out of ideas and ready for the next injection of hope, help and medication changes.

I had it. I still have it. 13 months later! I think I’m getting better at remembering how to render psychiatric first aid to myself when the complicated muddle of meds I’m on just isn’t cutting it, or the depression is just a bit too strong, or the mania is making my limbs dance a jig of agitiation. Or everything is just all too much and the circuit breaker has to be activated to prevent the whole place from burning down! Metaphorically, not literally.

 Because there are still those days. Bleak days. Blank days. Flittering days. Storm in a teacup days. Meltdown days. Frustrating days. Agitated days.

There are less of them. They come less often. They do less damage. They don’t get full control of me. But they do come. They’ll always come.

The key, as they always say, is management. So here we are, my and my team, managing. We’re managing. And that’s pretty great!

Thank you for taking the time to read my great big long shambles and hope to chat again soon x

Saturday Shoutout

I have hedged around this and hinted at in and mentioned it obliquely but it’s time for some straight speaking about an important part of my life.

My peeps.

Specifically, my psychologist, my psychiatrist and my GP.

My support crew.

Without them, I don’t know where I would be. Literally and figuratively. Would I be in a psychiatry ward in a hospital? Would I be in rehab? Would I be doing a lot worse than am I now? Would I be a vegetable in bed? They have stood by me, held me up, dealt with me, kick-started me, bucked me up and saved my life.

I don’t say this lightly.

They saved my life! They’re that important.

Everything I say here has what to me is an obvious unwritten addendum: as well as my husband. He is the most important person in my life and has been my most supportive friend through every hill and valley, through every new discovery and every boring pushing-on day, through every heartache and excitement. He is so critical in my life but there are times in life when you need to call in the experts!

And these times have been the last year!

My aim today is to give a shout out to my current team because I truly do owe my life to these people. There are other people who have also been hugely helpful to me and I acknowledge them mentally; they might get a write up another day.

Starting with my local doctor, my general practitioner or GP, Dr Richard Young.

I came to see him accidentally after a false start with the GP that I used to see back when I was at uni. She charged a fortune and didn’t give me any confidence that she knew what she was doing. In fact she said to me, I’ll ask my colleagues and check some textbooks; can you come back next week? Well no I couldn’t wait a week, I needed help now! I complained to a colleague at work that I didn’t know where to start looking for a good GP and that I wanted to find one close to work.and who didn’t cost me so much and she handed me a business card for this doctor. I rate this as the best recommendation I have ever had and am always so thankful to her for this!

I didn’t tell this colleague why I needed to see a doctor and yet she gave me a recommendation for a doctor with a special interest in mental health, and who sees many patients with depression and anxiety. That was lucky number one. Lucky number two was the location of the clinic, within a 5 minute walk from work! Could anything be more perfect? I could easily slip away from work in my lunch break, between discharges, after ward rounds etc for my 15 minute appointment. And lucky amazing number three is bulk billing for mental health patients! That is, no fee to pay for each visit! Thank you infinity for this amazing policy that has benefited me and my husband so much!

Richard is a young enough doctor to have passion for his job in spades, old enough to have experience and knowledge and confidence, and has bedside manner and compassion like you dream of in a doctor!

His knowledge of the health system is unsurpassed. I have attended many different GPs in my old clinic last year as well as here, and have never experienced such thorough care! I have cervical migraines; I get Medicare subsidised visits to a physiotherapist. I’m gaining weight on medication; I get some of those visits changed to see a dietician. I have deficiencies; I get treated. I have risk factors; I see the practice nurse to develop a care plan for how I will reduce my risk factors. I have depression/anxiety and need help managing my symptoms; I get ten Medicare subsidised visits to a psychologist, and when I use them all up, I get more! We need help managing the medications; I get Medicare subsidised visits to the psychiatrist. And most importantly, when I’m suicidal he doesn’t let me go home; he sends me straight to the hospital where I can be cared for and a new plan can be made for my treatment.

You get the picture: this doctor is amazing! There is nothing I have that he can’t fix me up with the appropriate health professional or service!

After 8 months of seeing Richard once a week every week I have no complaints! I have had to wait on occasion, I have had to be rushed through on occasion but I have proved abundantly that when I have acute and severe needs, I will be given as much time and attention as I need and be cared for exactly how I need. How I want not always; but always how I need. I think you do need to give credit where it is due and understand the limitations of the medical system and within those limits I have been wonderfully and carefully looked after!

I would absolutely recommend Richard to anyone!

It is due to Richard’s amazing insight and care that I was first given a referral to see a psychologist. Unfortunately the first lady I saw did not connect with me at all, and in fact I left worse than I arrived!! Crying going down the steps is not the right way to go. So Richard promptly organised for me to be assigned another psychologist and I have loved her since the first meeting!

Patty Sabbagh from the Nexus Psychology group is her name and place.

She has seen me through all kinds of scenarios. Happy, sad, suicidal, excited about life, demotivated, purposeful and everything in between are the ways that I have turned up at her door and she has adapted and given me real help and hope and a new way on from every problem! She has helped me to deal with all kinds of issues, she is so resourceful and like a good friend. Sometimes I have gone and its just been a good chat with an understanding fellow human that I needed, and she has been a listening ear, a shoulder to cry on and a clever therapist able to give me a better way to fight on. A mother, a friend, a support; all labels I could give her and more!

She listens and considers and recommends the best approach. Sometimes talking about it really does solve the problem, sometimes a new way of looking or thinking about an issue is needed, sometimes there is need for meditation, or mindfulness, or cognitive behavioural therapy. Whatever is needed, this talented psychologist and counselor has the remedy!

Anyone in trouble needing someone to help would be well advised to seek the help of Patty from Nexus Psychology or one of her colleagues.

Lastly my newest support crew member, and one who has changed my life. Another big statement but well deserved! My psychiatrist, Dr Ian Katz.

He entered later in the picture because I initially saw a psychiatrist as part of my outpatient follow up from being in the emergency department of the local hospital. He was the one who suggested cautiously that bipolar was indeed a possibility and who first started me on a mood stabiliser. However his role is to see patients in the short term then send them back to their GP to be managed. Which is what happened.

My GP and I went along with the plan for Seroquel and for a while we seemed to be winning. Then that started to fall apart and my GP gave me the referral for Dr Katz. He picked up the pieces, made a sensible picture out of it all and gave me a ‘wait and watch’ directive and asked me to come back in a few weeks. I returned with a history of the most manic-like state that had happened to me so far coupled with a long period of depression and the diagnosis of bipolar was complete. He prescribed lithium, one of the best things that has happened to me in a long time, and things have been improving ever since! He calls it “the game changer”; I call it a life changer!!

I have been so impressed with Dr Katz because of his huge capacity to listen, and hear all the information then process it in a logical and helpful manner. He will then set out a considered, clinically sound plan and make everything clear and easy for me, the patient. That takes a huge lot of knowledge, skill, patience, kindness and clinical experience to attain and I think there are very few other clinicians like him. In addition, his commitment to his work amazes me. I have had appointments at 6.45pm, 8pm and 9pm!! Thank you for that!

I have a very high respect for his opinion and his directions and am just so grateful to him for being the one to really turn my life around!

So there you have it. The three most important people in my life just now, besides my husband. Three people who have left a permanent impression on my mind, and my heart really. Conditions like bipolar absolutely need to have this three pronged approach, which in the past was not such a priority but I would not give up either one of these three for anything! Each has a separate but vital role, and each one contributes in a different way to my overall mental and physical health.

I don’t think I could step into any of their shoes, even assuming I had the appropriate training. They each have some strength of character to do what they do that is beyond my understanding but its so important to me that they continue to do what they do.

I don’t know when they take holidays, I don’t know how their families cope with their dedication to their jobs but I know that without them I wouldn’t know where to go or who to turn to and I am forever grateful to them, and everyone like them who works for us, the patients.