Slowing down

If you look carefully, and you shouldn’t feel the need to, you can see the signs of me slowing down. Mornings get harder (and they’re never really my strong suite, but I’ve impressed myself lately), I stop answering the phone (which is always my strong preference but sometimes I’m better at it), I stop doing anything much around the house (which isn’t saying much but still), I stay in bed longer and longer, getting up and going is harder, and I dive into my laptop and live there because its more predictable and controllable in there than in the outside world. I jump into a world that isn’t reality, where beautiful music and sitcom laughter falsely pep me up. But I take falsely pepped up over no pep most days.

This week I haven’t been doing so well. I know why, but I can’t seem to shift it and improve my mood. There’s just been this one thing that’s bugging me, and I haven’t been able to physically do anything about it to this point and its just biting and biting. That has worn me down as well as consuming my thoughts with less than impressive ideas about myself. It’s brought about a constant level of fight or flight instinct in me, and between palpitations and just feeling amped up it hasn’t been fun.

At work on Sunday a patient came in desperate for something to help him sleep. He really seemed quite beside himself, saying he can’t get to sleep til 2am, doesn’t sleep long, and then is bombed out all day and can’t get anything done for being tired. It seems like a pretty clear case for handing out a Pharmacist Only sleeping tablet, but this man is on an old school medication that interacts with EVERYTHING! He was well aware of this and told me about it before I could ask about other medications. So I did the proper thing and checked to make sure that I could offer him a safe option. Most of the medications we can sell are sedating antihistamines like Phenergan and Polaramine which you may well have heard of. But these interact with his medication so they’re out. There was only one option (other than referring him to his doctor whenever he could get in) so I set him up with that, explained it all to him, reassured him that it was fine, advised him to take a half dose to start with and we both went on our way happy.

Then I got a call from him saying he’d read the leaflet in the box (of course, he would be the one in twenty to do so!) and it said not to take it. I explained again that the reason not to take it with his medication was because of drowsiness not another side effect, and in his case we wanted the drowsiness. At this point I recommended he discuss it with his doctor before taking it if he didn’t feel confident, but he said I was the medicine expert so if I said it was okay, then he was okay with it. Flattering to hear, but a bit of a terrifying responsibility at the same time. But I was happy from what I read so all good. But that call back set off some doubt in myself, some insecurity that maybe I got it wrong and I just cannot get rid of the [insert adjective] questioning in my head!! I looked it up again, and again, and although it seems right, there’s just something!! Did I do the wrong thing? Should I have not given him anything and hoped he could see his specialist soon? Is my knowledge still not up to date enough? What if something happens?? That last one is a killer of peaceful thoughts! Is it likely? No. But…and that is pretty much the loop my brain is feeding me.

I’ve tried to breathe: in 2 3, out 2 3 4 5. I’ve tried distracting myself, thinking of something else like our holiday to Queensland sometime later this year: I now have put together the most thorough bird watching to-do list that you’ve ever seen, have an order pending for a Cairns specific bird book, and GPS coordinates for good locations! I tried eating: fail. Telling a colleague: they weren’t concerned but what does that mean? The responsibility doesn’t rest on their shoulders so…I was asked to work yesterday so I was going to look the patient up and give them a call to check everything is okay, but my shift got canned. So that phone call got pushed out til tomorrow. It’s been a long week!! I’m just stuck in quandry, in limbo waiting for the knife to fall, the bell to toll, the consequence to descend on me. ARGH!

So my mood has struggled. Monday I was in bed til lunchtime, or after lunchtime; sometime around 3pm possibly. I don’t think I did a single thing. Wake up, sleep, wake up and breakfast, sleep, wake up and snack, sleep, wake up and drive 2 minutes for KFC, sleep, dinner, sleep. Very interesting. I was bugged by this sleeping tablet business all day, but I didn’t realise how much it was sapping my energy, motivation, interest in anything else til later. But every time I woke up either overnight or during the day it was right there, clear as crystal in the front of my mind!

Yesterday I managed to get out because I had a voucher with a use-by date to redeem at the aquarium, and at Pancake Parlour; freebies are a good motivator. Breakfast/brunch near an open fire while sorting bird photos on my laptop was pretty fun!!

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Then on to the aquarium where I enjoyed walking around in a removed kind of way, apart from the lovely shallow rock pool with little rays and elephant sharks (which are so ugly!!) and little fishies; that was awesome. Then on to the behind the scene package where we got in a glass bottom boat and watched rays and sharks and fish swim just beneath us. That was pretty cool. But the breakthrough was feeding the rays. I’m not talking about the little ones, I mean the Smooth Stingray species that is 3 or 4 metres across. They come up to the side of the tank for feeding, and they aren’t meant to, but they flap flap flap their “wings” against the side and cause huge splashes!! So naughty, and so fun fun to watch and take photos of! That got me laughing out loud; I really enjoyed that. I was smiling for ages after that.

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Then I went down a couple of levels to the bottom of that tank so I could watch the big sharks and rays swimming around through the glass; another wonderful experience! That really did it for me, and it is SO important to have things that do it for you on not so great days. Last stop was the penguins, and a cute penguin onesie for a baby who I know will be coming later in the year. I was still wrecked by the end of the day, I was still dragging myself around the levels of the aquarium, I was still tired but I got some smiles and laughs in which makes it a win as far as I’m concerned. It didn’t take much to suck that out of me, but at least it was sucking from happy to regular, not from regular to down. That’s a good thing too.

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We had a chat last night, hubby and me. Something about me being in a rut, lost in my laptop, not really engaging with the world or him. And I recognised it then as a symptom, that I really was down a bit and struggling a bit and it was cause and effect happening right there in my easy chair. I was almost at a point to make an appointment with my GP for a pep talk and pick me up, but I’m still holding that card because I see my psychiatrist next Tuesday.

So what about today? There is purely one reason why today worked. Wheel Women had a ride on that I had RSVP’d too but wasn’t sure if the weather would turn out good enough. Last night hubby said: “go even if its raining because there’s only meant to be a small amount of rain, so if it’s raining its probably nearly done”. And it happened exactly like that. Even though it was POURING rain when I woke up, I got up, got dressed, got ready, checked in to make sure the ride was still going ahead, and drove over to Kensington. It rained the ENTIRE way over there, except the last 1 to 2km, and then it was the most spectacular morning you could possibly imagine. Blue skies, the Maribyrnong river was looking stunning in blue as it reflected the sky, the grass was green and it was good to be alive with friends enjoying the sunshine and the fresh morning. That alone does it for me, and I would have been so disappointed had I stayed home.

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Instead we had a lovely time chatting while we rode, chatting over coffee and chatting all the way home again!!! And then, because I wanted to check out some birds (so wishing I had my camera in these perfect conditions!!) and get some shots of the city that I couldn’t take while I was riding, I did the whole thing again!! Yep, 2 loops along the Maribyrong and I can’t think of a better way to spend the day! Right now, I’m happy. I have a low level of anxiety still going on but I think I might take a Valium to give me a bit of a break from that so I can enjoy this feeling of happiness and friendship and accomplishment. Every time I do that ride along the Maribyrnong I remember the first time when I thought it was the hardest thing in the world! Now I just spin along and enjoy it for the scenery, and don’t even notice the kilometres going by. It’s nice having landmarks to show how far you’ve come!! I always appreciate them.

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What else was good about today? I went back again to look at birds and I found some terrific ones!! A Hardhead duck so close I could touch it when they’re normally shy birds. A stunning male Superb Fairy Wren in full blue plumage on a fence post in the sun (oh camera, wherefore art thou camera??!!). A group of Little Black Cormorants fishing together. A pair of Red-rumped Parrots flying off JUST in front of my wheel! A Great Egret in slow, graceful flight. Beautiful, lovely day. Plus a new Wheel Women friend. And watching a recent Wheel Women member improving with every ride; I love that!! Let’s hold on to that happy!!

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Mania

[Written 20th October 2014, updated along the way, most recently 28th July 2015 ]

There’s a question that I’ve been trying to answer ever since I was first diagnosed with bipolar disorder and experienced the first obvious manic episode: how can I know when an episode of mania is coming on?

I have been working on answering this question for a while. Hence the start date for writing. It’s taken time, experience, reflection and I’m still not there yet. Here’s what I’ve got so far.

It’s not like people imagine. There’s no flash from the sky that strikes you down in the middle of your ordinary day changing you in an instant from deeply depressed to wildly happy.

There’s no sudden chemical reaction that causes an immediate switch from happy Harry to sad Sally. You won’t be mid conversation with me and I’ll sudden lash out with anger or anything dramatic like that. I promise. I also won’t suddenly slump into deep depression.

It’s much more subtle than that.

I have bipolar disorder type 2, or manic depression. As opposed to bipolar disorder type 1, or classic bipolar, which involves intense highs followed by agonizing lows.

In the six months or so before my diagnosis of bipolar, I would exist mostly in varying depths of depression with the odd dilly dally into sub-mania, or half strength, quarter strength mania. So sub-manic that I didn’t even know it was happening for the first few episodes! It was like a partial lessening of my depression, not very distinguishable from my usual depression. It certainly wasn’t the full mania thing; I didn’t get the happy, carefree, superhero mood to balance my sorrows. I actually noticed a worsening of my depression when the lighter mood ended rather than noticing a lightening of my depression. I felt that I was having cyclical worsening of my depression, whereas the mental health nurse in ED saw a recurring very weak mania.

Moods don’t change 50 times a day. I should know. When I was first provisionally (meaning this-is-what-we-think-it-is-but-we’ll-wait-to-see-before-we-commit-to-the-title) diagnosed with bipolar disorder I was in a phase called rapid cycling. As it kind of suggests, rapid cycling is where your mood cycles/changes rapidly! Pretty self explanatory.

What this meant for me literally was about once a week over three or four weeks I would descend into the big black pit from where I could see no possible exit other than stopping living in it. That’s what being suicidal is all about; utter hopelessness. It’s awful and very hard to bear.

But then I’d be a bit better again, and think, oh that wasn’t so bad. If it happens again I’ll definitely tell someone, but I’m okay now so it’s all good. Except that each time I went in it was worse! And worse, and worse until I was done with it! Luckily I had an appointment with my GP on the day I was done with it so that instead of being done, I went to hospital and you know the recovery story after that. Or if you don’t, it’s time to hit the archives!

So rapid cycling. Once a week, not once a day, 10 times a day or anything fantastical. That’s rapid cycling.

For the “regular” patient with bipolar 1…weird statement, I’m sure every one is different and there’s nothing regular about it!…mood changes might be more likely to occur every few months or even once or less per year. Maybe every few years once a person is medicated. But when they come, they can be a serious force to be reckoned with!

So my original question: how do you know when it’s coming?

I’m still not completely sure.

I’ve found that needing less sleep or unusually restless sleep, waking many times in the night and waking for good in the early morning hours is a sign of mania, which doesn’t rest, and wants to be on the move the whole time.

I usually have a couple of days of being more irritated/frustrated/annoyed about small things than usual. Ask my poor husband! I stub my toe and scream in full on rage at the pain and the stupidness of myself to do such a dumb, painful thing. I mess something up and totally lose it, raging at myself for my incompetence. I just can’t tolerate anything less than perfection in myself. I take a wrong turn in the car, get lost, run late and just burn up the road in furious outrage at my incapability to do anything right. I fumble my keys, my phone slips out of my fingers, 1 drop one of the 10 things I’m balancing in my arms while I walk blind down the stairs and write myself off as a useless, worthless human being! When actually I’m a regular human being possessed of a mood that makes me think I can do a lot more than I a) can or b) should.

At this point, the best way to end things and to not keep on getting worse and worse, is to go to bed and sleep. For however long it takes to wear off the mania.

It’s truly a strange disorder. In essence, this is what depression is, being upset and down on yourself, but this time instead of getting melancholy about being useless, I get mad, really mad! Not at you, don’t worry. The majority is forcefully muttering stupid, idiot, fool, dummy at myself under my breathe. The rest is taken out on my poor hubby, who tends to have a bad habit of laughing when I’m this mood and massively exaggerating the events of the day. Of course the more he laughs, the closer I get to bashing him with the rolling pin! Once the mood passes we laugh about it together, but at the time he makes me furious!!! Livid!!!

Then there is getting teary about silly things more than usual, although that can come with the depression cycle too. I’m naturally an easy crier, which goes against my attempt to be cool, calm and collected! I think I can see now that when these PMS-ish symptoms start, it’s time to take a breath and check what’s really going on. I say PMS-ish cause that’s how it kind of feels, although I maintain that I don’t get (much!) PMS…my husband prefers to not answer so who can tell?!?

Add some annoying heart palpitations which make me nervous about being anxious again and you have a pretty complete picture.

I suppose the more important question is, how do I know when I’m a bit manic? Easy! I have had some pretty perfect examples!

One day a while back, I woke up spontaneously at 5am without an alarm, feeling fully rested and completely ready to hit the floor running and get things moving! This from a famously unlover of mornings!
I had motivation, organisation, energy to boot and I’m full on into my job list!!! Check check check check check..what’s next???

All this despite being exhausted for the previous 4 days, not getting out of bed until 5pm one day a few days back and having a 4 hour “nap” two days before missing half of a family birthday! Whatever comes my way, today I’m all over it!
Before 8am I’d been for two laps around the park; most days I wouldn’t even be awake yet! And I never walk! I catch the bus/train/tram/friends car/taxi before I walk, except when Chester’s making an effort to get me out of the house and we do a slow stroll around the park…today I was striding! I was considering jogging! Today I’m on fire!

But I have to keep a careful check that I don’t get too cray-cray, too outgoing and chatty, too effervescent and bubble off the reservation! I don’t want to wander into the real manic territory of getting all spendy with the money I’m not earning, getting over confident with betting/gambling (not really a worry is my theory since I never do that anyway…), being over-enthusiastic/ambitious to the point of being a bit delusional or putting myself in dangerous situations that I think I can handle or just physically burning myself out being bouncy and happy and carefree and all over it!

The other classic manic thing is getting a bit over-affectionate…Chester won’t complain, as long as I keep it within the house!

And one perk: I’m so active, and busy PLUS I don’t get hungry as much and don’t wear out at all! So mania. Love it! Love it more when it stays more than a day or two but it’s usually pretty short lived. Love it the most when it isn’t followed by a big black lump of depression but that can be a common switch. In general, I’d prefer if I didn’t get depressed at all or manic at all. I love the energy of mania but it can also make me irritable, restless and impulsive and I start to get claustrophobic and nervous about all my typical old scary movie type phobias. And there’s nothing much I love about depression. So after an episode of sub-mania it’s back to the psychiatrist for a review and a new opinion of what to do next. I’m guessing there’s a lithium or valproate dose increase in the works…and that’s okay with me! Whatever it takes to get back to a comfortable holding pattern of “normal” moods. The aim is always for the lows to not be as low, and the highs not as high. Middle ground; that’s what we’re chasing. Here’s to it!

So, fortunately/unfortunately this has been the story of my bipolar. Fortunately I don’t get the massive mania with delusions, super hero thoughts and even hallucinations. Unfortunately my mood swings tend to be often, like weeks and months and they do throw me off balance each time. Despite what I’ve tried to learn about my mind and my body from my experience so far, and the fact that I know mood swings will come in spite of my meds, they still creep up and catch me unawares. And so far they do unfortunately seem to be getting bigger and more intense each time…but I won’t borrow trouble before it comes.

The last question is how can other people tell that I’m manic? My husband has some answers for that list! I may be a bit short with you, or seem a bit edgy and I will be less patient than usual. I’ll be more sociable than usual but it’ll be a bit fragile if things go wrong. I try to keep it together for everyone else but sometimes some sharp answers slip through my filter; I apologise in advance!