Canberra Day 69

[Saturday November 19th] A hot dry day with cool to warm morning for riding

I’ve had two early mornings in a row after late nights, like 5am wide awake after midnight bedtimes, so it’s time to be alert but not alarmed as needing less sleep can be the first sign of a “high” or manic episode coming on. It’s nice to have a little more energy though, get a bit more done, drag my feet less, enjoy life that bit more; hopefully it’s just a PMS thing, cos that can happen, or just an oddity. So at 8am, after going back to sleep for a bit, I decided hubby’s suggestion of a morning bike ride was actually a good one. Usually I’m not with it enough to get up until hubby is nearly or actually back home from his ride, so I don’t really get to thinking about what to do while he’s out. But seize the day! Let’s change that up. So off I go exploring, finding my way down to Lake Burley Griffin via some lovely back streets, then around the middle and wetlands loop and a bit of the hilly loop to get there. You never know what you might find in the backstreets; check out the awesome bird street art. I have to say I felt a bit disorientated riding around the lake! It was 8.30am, but what with the second sleep earlier and people’s activities I felt like it was at least lunchtime. I mean who picnics on the edge of the lake at 8.30am in the morning? Who races dragon boats and attends a full boating carnival at 8.30am in the morning? What’s with people, do they hate sleeping in on the weekend? I can understand the people bird watching maybe, because I dropped off at the Jerrabomberra wetlands for a quick peek at the bird hide where a group of elderly were yapping at the top of their voices!! Hello, its a bird hide! Silence is required at all times otherwise what bird in its right mind is going to come close so that we get great views? I asked them to be quiet, one lady paid attention. I asked again and one oldie told me I could come back later! I told him it wasn’t for my convenience, it was the rule of bird hides; they left not long after. It stuck in my craw though!! I also stopped off at the site where they built trenches for soldiers to train in; that was pretty fascinating. Anyway, it was just incredible to see the masses of walkers, joggers, dogs, cyclists all out and about so early. Then home to hang out with hubby. We were planning on going out together but I was fading after all that exercise and emotion, so off for a nap and hubby put his feet up on the couch to chill out for a while.

img_7766

If I could design my own wall, I don’t think I could have chosen better!

Our plan was to go to Sparrow hill in Kowen Park which is out off the Bungendore Road past Queanbeyan. It’s a dead end road that I think is a leftover from when they built the current road, and its beautiful with gorgeous green English trees mixed in with the eucalypts and otherwise sandy, rocky, dry bush. They’ve built 40 kilometres of mountain bike paths with linking trails and man alive, are they well used on the weekend compared to when I dropped by the other week! There was a single other car there that day and today I can easily count 20 without hesitating! As the afternoon wore on more and more cars with picnics and bikes and rugs and crates of stuff arrived…turns out there was a juniors 3 hour mountain bike enduro race so all the families were piling in for a nice night in the bush from 4 to 7pm. Meanwhile I wasn’t enjoying the 30 degree heat (yep I know its not that hot but I was dripping!) so I wasn’t budging far at all, and sticking to the shade (which gum trees aren’t really great for), and basically doing as little as possible while trying to watch for birds as much as possible. I didn’t get a great long list, but I was well entertained by a family of Rufous Whistlers that were chasing each other all around me, and challenging me to grab whatever photos I could as they fleetingly touched down then flitted off again to harass each other. Half at least of the satisfaction of bird photography is grabbing a decent photo despite the best efforts of the birds being flighty, the situation (directly over head into the blazing sun!), the weather (overcast, raining), and whatever else comes up (low battery, full memory card, dust on the lens, la di la di la)! Getting home and seeing that the photo turned out as well as I hoped is always a huge thrill! Anyway, an hour mountain bike (MTN) bike ride for hubby, an hour bird watching for me; everyone’s happy! Then a nice fresh dinner of Vietnamese, some groceries and home to chillax as the evening breeze comes drifting in the bedroom door and lounge room floor and makes for a gorgeous evening inside, as much as outside. Delish!

And to top it all off, I problem solved the reason my photo software wasn’t uploading almost by myself, not much hubby input. This is impressive because ever since I started dating hubby and he was studying software, I’ve pretty much left anything technology to him. I have learnt a few things too, but more or less anything out of my immediate knowledge goes to hubby. And he gives me the phrase made famous by the IT crowd: “Have you tried turning it off and on again?”. I’m trying to put my brain to learning a bit more, before the medications kill my memory retention altogether. Let’s see how I go. In typical style, I got my afternoon/evening burst of energy and got stuck into getting my blog up to date and managed to get 2 blogs written. I know I should be writing much less, but my memory being what it is, I’m trying to keep the details in so I can remember it later. I haven’t really been able to convey the sense of the day always, the mood, the weather, but hopefully remembering the things will bring back the feeling of the day. We’ll see.

Advertisements

Tales of a missed dose

[Written 16th June 2015]

This is a story of what happens when I miss a dose of medication.

What happens depends whether I miss a morning dose or an evening dose. As I write this I’m suffering from missing an evening dose so let’s go with that.

At night I take several tablets: quetiapine, lithium, valproate, rosuvastatin, pantoprazole. Mood stabiliser, mood stabiliser, mood stabiliser, anti-cholesterol, antacid. Yes, it takes that many stabilisers to keep me going!

In the morning I take thyroxine, venlafaxine, Levlen, valproate, lithium. Thyroid hormone replacement, antidepressant, contraceptive, mood stabiliser, mood stabiliser.

All done! Hopefully...I'll still count the tablets out every morning and night to double triple check

In terms of missing a dose, lithium and valproate aren’t the worst to miss as a patient because I’ll be taking some again soon. This is not an official pharmacist, GP or psychiatrist recommendation! Lithium and valproate should ALWAYS be taken twice a day, as close as possible to 12 hours apart for the best effect! And I repeat! This is because for lithium a healthy person’s kidneys clear it out of you in that time frame so to keep a steady level you should take it consistently. And for valproate it’s your liver. That’s why you should respect these two organs very highly! They are very important. But what I’m meaning is its not the worst in terms of the adverse effect of missing a dose. If I miss taking lithium at bedtime, I take it first thing the next morning which gets it back in my system before I physically notice that it even left. My overall level will be a bit lower for a few days which isn’t ideal, but it will work back up to speed soon enough. And I do have a level at least.

Whereas for medications that I take once a day, I’ll miss the effect for 24 hours. Which sucks. Plainly and simply!

boxes, bottles, tablets, capsules

Quetiapine is one of the once a day tablets. It is prescribed to me to prevent mood swings, reduce my anxiety and has the handy effect of giving me a good night’s sleep. It was doing this a bit too well for some months there and I was doped out all of the time, but my awesome psychiatrist recommended a change in the times I take it and we’re back up to speed. Yes!

So, do I get a mood swing if I miss one dose? No. Really not. The chemistry isn’t that reactive. In the same way that it takes weeks of first taking the medication to get the benefit, it takes longer than one day to mess up the whole thing. But I do have a rough day afterward, and a rough night too! It’s a bit like I’m sitting in my car going along nicely and I know where I am and where I’m going and how I am and suddenly another car rear ends me, or bumps into the side of my car at a right angle. Slowly of course, not fast. So my mood just takes a hit, a bump and suddenly I’ve jumped along or across and I find myself somewhere other than where I just was, a bit disorientated about how I got there and sort of catching up with what just happened and where am I now and how I am and are we still okay? That following day I may be in quite a different mood from the one before, either peppy and edgy and anxious and manic, or slow, and silent, and flat and a bit away with the fairies. But that doesn’t qualify as a mood swing, just a sudden small change that affects my day.

After missing a dose here and there I have now gotten the side effects of missing my nightly dose of quetiapine down in a pretty clear timeline. Yes, there are side effects from NOT taking your tablets, as much as taking them. Something to consider.

So here’s the quetiapine absence timeline.

strips, tablets, capsules

10 to 11pm: I can’t get to sleep.

This is a terrible thing. I need my sleep. Always have, and always will I guess, but especially since I’ve been sick. So does everyone, I realise. If I don’t get a good night’s sleep the next day is a struggle, emotionally. So I toss, and I turn, and I turn, and I toss. After an hour of this, if I’m alert enough, I’ll think to myself, self, why can’t I get to sleep? I usually go straight to sleep! Then I’ll look in my pill box, see my tablets, mentally or physically hit myself in the head, take them and all is good in the world. Just like that. If I’m not thinking too clearly, I might think to take a Valium and at least get some sleep. If I’m dull-witted, which is at least half of the time, I’ll eventually wrestle myself to sleep. It sounds funny to say, but I’ve become very good at putting myself to sleep. I nap most days from necessity, and there is a skill involved in going from activity to sleep in a short space of time. I guess shift workers eventually excel at this sort of thing. So I’m quite adept at getting myself in a comfortable position, getting the temperature right (cannot sleep well unless it is right!), darkening the room, doing a conscious relaxation of as many muscles as I can, and stilling my mind into sleep.

Say I managed that. Next time check?

3am. Yep, wide awake, fresh as a daisy, ready to go at 3am. I toss, and turn, and can’t get comfortable, and I’m restless and my poor husband is rocking and rolling every time I turn and I’m messing with his sheets, and he has to go to work tomorrow even if I don’t, so I try to lay still and physically can’t! Why am I awake, I’m usually asleep, what is happening, oh….ahhhh! Tablets! I forgot them! Duhh! I hate that moment! I try to do my utmost to prevent it, but it still happens and it does feel like a failure every time I somehow mess it up! So, should I take them now? The dilemma! It’s 7 out of 12 or 24 hours through the medication time period. So I can’t take all of them. Maybe just some of them. Can’t take quetiapine, I’ve missed the boat on that one otherwise I’ll sleep all day. And I’ll be taking lithium and valproate soon anyway, and can’t double dose. What about the rest? Which are nothing really, in the scheme of me being wide awake at 3am! Cholesterol and stomach medication. Sure I can take them, they should be taken regularly but it’s too late for my sleep. The next dilemma then: try to force myself to sleep again, or just get up, take my laptop to the spare room and do something else? Who knows? Depends what I’ve got on the next day really. I can never decide!

medication list

8am: I’ve finally given up the ghost on sleep so I’m up and peppy and full of life and only just partially anxious and ever so slightly manic and energetic and going to run the world! If I haven’t already taken one to sleep, now is the time for a Valium to wind back the jets on being super woman and achieving all my life goals in one sweet day! And talking my husband’s ear off and planning one hundred chores like a complete going through of the entire kitchen plus 3 loads of washing on a rainy day and lunch with girlfriends and all kinds of magical things. ‘Woah, says my husband, that’s too many things for today. No do that another day, you’ve got enough things for today. How about you sit down for a minute, what about some mindfulness? I think you should do some mindfulness…how about you go and do that now?’ At around about this point I have now blown my nose for literally the THIRTIETH time since waking for the final time. THIRTY. You just can’t blow you nose till it feels empty; there’s always residual. And it’s pretty much like a tap. The medical term is rhinorrhea, like diarrhea but your nose is melting and there is a constant liquid dripping, dripping, dripping!! Quetiapine dries you out like anything so you get dry mouth (and want to drink Coke all the time!), dry nose which leads to sores and blood noses, some degree of constipation which no one wants to know about and some urine retention. The last one isn’t noticeable on any other day, until the missed dose day and then I realise that yes I really have been holding back! TMI I know, but you wanted the whole story right?

But the nose thing really gets me! If I notice nothing else in the middle of the night, I do notice my nose dripping incessantly! It’s an instant giveaway! It’s different to regular waking up in the morning and blowing your nose. It’s more like hay fever without the sneezing but the medication to stop it cannot be taken til nighttime!!! Cue fierce under breath bursts of ‘idiot’!

And then it’s just getting through the day like usual, but bearing well in mind that you’re a bit high today, a bit edgy, a bit fiddly, a bit anxious, a bit overstrung so remembering to breath, relax, calm, easy, gently does it. And I should mention that the other things ease off too, just not in such an obvious diagnostic way. I have the right amount of saliva in my mouth (who knew that was a thing!) and going to the toilet is a breeze, like really easy, like maybe a bit too much and too many times! So happy thoughts!

medication box, tablets

Now the morning lot and venlafaxine. Anyone who is involved in the prescribing, dispensing, and before too long taking venlafaxine knows about the withdrawals. It’s described in the textbooks and it happens like the textbooks. Exactly like. I used to think this was pretty cool. I still do theoretically, but in practice I either love or hate that they’re so reliable and unavoidable. I love them if I notice it before I’ve left the house for a work day because I immediately fix the shortcoming. I hate them if I notice once I’m already on the way to the bus stop and I don’t have time to turn back, or I’m on the bus, on the train, on the tram, in the building. Then it sucks because I know what’s coming and I can’t do a thing about it! Unless I can get to my doctor for an emergency script but that means paying full price, and after all it’s nothing life threatening. Not bad enough to pay three times the normal price! And believe it or not borrowing stock from the shelves is not strongly encouraged by my employers nor is it in any way legal!

What the symptoms/adverse effects of missing venlafaxine are: electric shocks/tingling in your fingers, light headedness/feeling like my head is spinning/wondering if I’ll faint, nausea. Nothing fun. Nothing dangerous. They don’t make for a good day, and I have to wait til the next morning to fix it! More banging of palm to forehead and severe muttering to oneself!

So that the what. The why is a whole other adventure and I don’t have time today, but hang in there and soon we’ll have another chat and look at the other part of the problem. Chat soon!

On Wednesday I got excited…

[Author’s note: written two weeks ago]

The last three weeks have been a bit tedious, and boring, and uninteresting, and flat, and sleepy, and just hard to enjoy!

On the 19th May, after 5 days in the manic sphere having a fabulous super productive and energetic time, I collapsed! Literally collapsed into bed, fell into a coma (*exaggeration*) and hardly got up for week (*not an exaggeration*)! I left the house 3 times – Thursday, Friday and Sunday. A friend’s birthday lunch, a mother’s club that I nearly cancelled on, and the gospel meeting. I showered once. It was rough!

The last week of May was slightly better, I got out of bed every day and left the house a couple more times. I did next to nothing but I ate most meals and had a couple of laughs.

The first week of June I had a couple of ordinary days, an intermediate day that I thought might crossover into mania but didn’t (thank goodness!! Can’t take another huge mood swing!), and a couple days that felt like regular good days 🙂 I’ve had a bit more energy and for the first time in three weeks I actually feel like I could hit the gym! I’m even almost excited to go; to run, and jump, and lift weights, and be part of my fitness group again. This is great!

I mean I felt like it, I didn’t actually go; but I felt like it. So that counts, right?

So Wednesday. June 4th. Not a great day; an intermediate day. I left the house because I had an appointment with my psychologist/counsellor. Probably wouldn’t have left it otherwise. Got up late, showered – sad that this is noteworthy! I started well with a good breakfast, then had another good breakfast, then a couple of mandarins and it was starting down a slippery slope of sour straps and peanut butter that luckily got interrupted cos I had to leave for my appointment!

Getting out of the house makes a HUGE difference to how much I eat. This is something to always keep in mind. Having something productive or useful or purposeful to do in the day significantly reduces how much I eat. Mainly because I’m distracted from sitting and staring at food, and actively doing something else like driving or catching public transport or using my brain!

So off I go to the psychologist. Trying to think of something to talk about, and coming up with nothing! Nothing had happened in the week since I saw her last; no improvement, no gains. My brain is not getting exercised and can’t think of anything that we can work on. Luckily, she is a psychologist and counsellor and her job is to know these things.

So we got chatting about the week that had been, and things that had happened and how everything was going. Then about strategies to improve the days, to give me something purposeful to achieve, to help fill in the gaping hours. And it kick-started something in my brain. It jogged my memory again. It gave me flash backs of useful and interesting things that I had done, and plans I had had for other things that I hadn’t done yet, and which my mind hadn’t been able to access for the last few weeks.

It is amazing and fascinating that in down times I really can’t use my brain as well as in better times. There’s actually evidence to show that the pathways to creative and imaginative parts of the brain are diminished and much harder to get to when a person is in the midst of depression. The absolute opposite is the case with mania; the pathways are much easier to access and the creative brain is firing on all cylinders.

I started to get excited. I remembered my knitting, my drawing, my bird watching, my photography. I remembered how I’d been planning to join a choir, that there were pharmacy continuing education sessions I could go to during the day, that I had meant to go back to the zoo, to do a bush walk, have a bike ride, visit some gardens. It came to mind that I could call the pharmacy counselling number and have a chat to another pharmacist about where I’m up to and how I can proceed from here, that I could visit friends, finish my half-done quilt, sort some boxes from the shed, get involved in life again.

And I guess that’s why they pay psychologists the big bucks. This is why I definitely need my psychologist sessions. Just someone professional looking at how I’m going and offering a different perspective and some guidance on how to proceed.

I went into this session unable to think of anything to talk about, to discuss, and unable to see how I could be helped.

I came out of the session inspired with a long list of things that I could do if I wanted; interests re-remembered, hobbies re-energised and feeling more optimistic about the days ahead of me. I had things I could do, I had reason to get up in the morning, I had plans for spending the days. I had hopes and ideas and inspiration.

For that, I owe great thanks to my lovely psychologist. What would I do without her?