Dozy

Dear lovely readers, I am having the best time! I’m well, I’m happy, I’m productive, I’m energetic, not needing as much sleep or naps, I’m doing stuff, back on my bike, I’m out taking photos of birds, socialising, I’m having house guests, getting organised, spring cleaning of all things!! It’s remarkable and it’s thanks to my psychiatrist, thanks to the extra purple pill per day that I’m taking and thanks to my brain for accepting the intervention gracefully and allowing these happy days. I owe thanks to every lovely person who checks in on me when I’m unwell, so thank you so much; I’m glad I can write good news!

[Written a couple of weeks ago on One Of Those Days! I’ve been too busy living a happy life to write this week! YAY!]

Today I didn’t wake up, not altogether. I’m feeling a bit dazed, and a lot like there is a thick fog well settled well over my brain, and down over my neck, my shoulders and half way down my chest!

I’m struggling to open my eyes, and to keep them open, more to the point. They certainly aren’t fully opening. They just have an irresistible almost magnetic draw to close, and the sleep in the corners of my eyes clagging them together is adding to the problem. You know those moments, when people say they need matchsticks to prop open their eyelids? Except that’s usually at the end of the day, not the start of it. Bleary eyed, irritated and itchy, my eyes just aren’t ready for a new day. I realise this isn’t a first in the history of humans. Other people wake up like this too, it’s not just me. But this is after a full night’s sleep, a good rest. I should be rearing to go.

My whole body feels like its wrapped in a deliciously warm lovely blanket from which it would have to put up a great and tiring fight to escape. Well, I guess that’s not so metaphorical; I am still in bed, and I roll around enough in the night that it’s quite likely I’m twisted tight in the sheets by morning. My body is heavy and weighty and it just seems too hard to move it at all. And why would I want to put in that level of effort when I’m in such a nice situation? Oh yeah, to be the adult that I apparently am. But I can’t really think straight enough even to start planning what shape the day is going to take. What time do I need to get up again? And do I really need to get up, or can I cancel whatever I had planned? Assuming I can actually get this hefty body up out of bed. It’s like I’ve lost all muscle tone and I have to use my mind like a lifting machine to lift each dead weight limb, one at a time and they won’t cooperate! You know, one of those caterpillar diggers with the lifting clamp? Or one of the machines that nurses use, whichever environment is easier for you to visualize.

Drowsy, thick in the head, awful eyes, impossible body, can’t see where to start. And it’s my fault, my husband would remind me! Love you, baby; you really know how to phrase these statements. I am of course joking, he only says it nicely and when I know its the truth anyway.

But it’s true, it is my fault, in a manner of speaking. I took my tablets too late last night, and now I’m hung over. Basically.

I take my tablets by alarm, sort of. When you are prescribed a medicine that has to be taken twice a day, you should ideally take the 2 doses 12 hours apart. Says Miss Pharmacist, but what does Mrs Patient do? So, when will you take it?

It actually takes a bit of working out. Will you take your tablets at 7am and 7pm? 8am and 8pm? Really anything 12 hours apart works. Except there’s a complication because one of the tablets that you take at night with the second dose makes you drowsy and then comatose! It kicks in anywhere between 15 and 30 minutes usually. Sometimes it doesn’t really kick in for ages and I can stay up for an hour longer or more, but sometimes it kicks in fast and that’s it for the day. When I feel it starting to make my eyelids heavy and my insides warm and fuzzy, I head upstairs before I can’t stand straight anymore from dizziness and lack of balance! Please never try to see me at this time of night: the whole whites of my eyes go reddish and I scare myself looking in the mirror! It’s all gone by morning thankfully. In the past I’ve tried to push through the sedating effects but they won’t be argued with! I’ve crashed my way around my bedroom, lurching from wall to wall unbalanced and unable to see straight, and unfortunately having to go to the bathroom! There I sit, having done with the toilet, unsure if I can stand up and get back to my bed next door, feeling weak and heavy as a dead weight. Ask my husband, I think he’s had some interesting amusements in the early days of me using this drug! I’m talking about quetiapine, a mood stabiliser very well known for the drowsiness that it causes, among other things.

So, theoretically I could take my morning tablets at whatever time, then most of my evening tablets 12 hours later, then the sedating medication when I’m ready to go to bed…but that means having life interrupted 3 times a day instead of 2. It sounds trivial when I’m taking so many meds crucial to my health, but when I’m well I’d rather not spend all day taking tablets. So I want my meds in two convenient slots, but what times? If I’m working, this is especially critical. I want to take my meds before work, say 8am. But I don’t want to take my sedating tablets at 8pm and go to bed with the children. Plus its so early in the evening that I’m be sure to be awake bright and early at 4am or something inconvenient! So I tend to push out the night dose to 9pm, 10pm or later. If I’m busy, I just wait til I’m finished doing whatever I’m doing and I’m ready to go to bed and THEN I take them. I intend to get to the point where I’m NEARLY ready for bed, take my tablets and get a little sleepy while finishing off whatever, and go to bed nice and drowsy read to go off to a deep sleep. But I often forget and finish what I’m doing completely before taking my meds. The later I take them, the more likely it is that their effect will hang over into the morning. By much trial and error over 2 years, we’ve figured out that 9 to 9.30pm is the ideal time to take my meds at night, giving me possibly up to 10pm to do whatever in the evening and allowing me to wake up fresher. But unfortunately last night I took my sedating tablets at 11.30pm! Which messes up my system, although it is a fairly flexible system to be honest! When my night tablet alarm goes off I’m just as likely to snooze or ignore as I am my morning alarm. Some little rebellion in me about having to take meds. It never works out well for me. And so, here we are. Sedated, drowsy, heavy, tired; finding it hard to get going.

It’ll get better but slowly, across the course of the day, and it’s probably just going to be one of those days where I shouldn’t drive, need to find something riveting to do to keep me awake, or just succumb and stay in/go back to bed! I guess this is one of those days where not having a job works out for me. I might manage to get up and go to work on a day like this, but it’s questionable what quality of work I would produce, and it’s probably in most people’s best interest that I don’t go at all. So if I’m working, I need to be a lot stricter with myself in taking my meds on time. There’s a fascinating concept called presenteeism which I recently became aware of. You know, like absenteeism where you’re absent from work? Except this is when you are unwell, under stress or otherwise compromised in some way, but you turn up anyway and consequently put in a worse day of work than you might usually. A workplace was looking at how much presenteeism cost them as opposed to absenteeism, and whether it is really better sometimes for staff to just stay home. Doing so would theoretically reduce errors, complications, injuries that may arise from incomplete focus. I don’t know how they’ll measure any of it, but I’m watching on with great interest.

So yes I supposed you could say that being hung over and non functional is my fault. I get tempted to have late nights, to be like everyone else, carefree and not worrying about things like tablets. I know it’ll catch up with me the next day, but in the evening when it’s all going down it doesn’t seem as bad as it will be in the morning. So I push out the time a bit here and a bit there, a lot here, too much there! I do have to be careful that I don’t get myself into a different time zone, taking my tabs at 11pm and 11am or worse and really messing up my hours. While I’m off work I can be a rebel and mess up my sleep pattern and sleep in til lunchtime. Who cares, basically! But work is something that I want and need, and when it comes it’s back to taking tablets by the alarm. Like a good girl. For the best.

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Victory Part Two

[20th June 2015]

Where was I?

Ah yes, bicycle, perfect timing, much enjoyed.

So this week was going to be epic! Until it rained, and rained, and rained. And spoilt my plans! I had my diary set: Tuesday ride from Strathmore, new one for me so that should be fun, Thursday repeat of an earlier ride from Maribyrnong to Williamstown, but hopefully no head wind on the way back this time and so a more enjoyable return! Then there was a ride on Saturday, to follow up our skills session with Bridie O’Donnell, along Beach Road for a road ride. That was a tentative. I haven’t done a road ride in years, and never in a bunch, and not since uni days, and was I really up for it? Definitely a query! In the end I read the updated description and it was for riders above my level so I let that one slide.

Tuesday I was up and at ‘em! This being the most recent morning after the night before when I missed my tablets! So I was firing on all cylinders! Chatty, energetic, ready to kill it on the ride! Etc! But it was cancelled. It wasn’t actually raining but it had been pouring with rain at 3am when I woke up for the day on a short amount of quetiapine-absent restless, fractured sleep! Our leader had been out to check the course and it was wet and slippery. And honestly, I’m having such a good time, and haven’t crashed since my chest infection-induced stupor in week 3 and I’d like to keep it that way. Don’t need any discouragement! So it was cancelled, but there’s always coffee and cake,Whee girls!! So I traipsed across town anyway for a good old catchup! And a divine cookie sandwich!!! I haven’t come across these till now, other than a Maxibon, but these are two yummy flaky bikkies with, in my case, vanilla bean cream in the middle! Very indulgent and just the best! Pin Oak Crescent, Flemington, people, opposite Newmarket Station! Wolf and Hound if I remember correctly! Worth the drive.

biscuit, latte, cafe

A Butterbing cookie sandwich and coffee at Wolf and Hound – not my coffee obviously

So that was all good, no ride for understandable reasons, and nothing could bring me down that day in any case, so a great day to bear with not getting to do what you hoped! When I say nothing could bring me down, I mean being too scatter brained to bring my phone charger, and my phone going flat from running GPS directed maps just as I got to the edge of my comfort zone and needed directions! But bipolar brain is super human and says, oh well, just drive up Flemington Road; you’re looking for an address in Flemington, you might get lucky! Well now we’re in Moonee Ponds so let’s turn around (not easy to accomplish!) and find a 7/11, surely they sell Melways. No you don’t? But I see a copy there, maybe I can just look up an address? Use your phone, are you sure, really I can look it up? Thanks, you’re a lifesaver, actually look it’s just nearby, 2 turns from here! Perfect, and I’m right on time! Thank you manic bipolar brain, you got through that mishap easy as pie. Of course, it is your fault about the charger…but everything else was great!

Cue Thursday. Restarted quetiapine on Tuesday night. There’s still some in my system, but miss a dose and boy, does the next dose feel like the first one! That first dose gives you the full side effect gammit: drowsiness like I’ve been dosed up with morphine, absolutely stupid after half an hour of taking it, cannot form words or walk anymore! Dry eyes makes them fully red which is just perfect for looking like a slurring, incoherent, stumbling lunatic if you happen to need the loo bad enough to get your eyes open and magically force yourself out of bed! Nose, eyes, mouth as dry as the desert, can’t pee or poop as much and boy is it hard to wake up the next day! Even if you wake it takes all morning for the sedation to wear off. Often I’ve just given up and gone back to bed at 9am, 10am, 11am. So Wednesday was not much of anything! In fact I sat in the same spot for the majority of the day once I finally got up at 11am to get breakfast. Think I did a load of laundry. Watched some Agents of Shield. Played Words with Friends. Ate lunch at 4pm. Tried to get my brain around our Wednesday bible study chapter. Started to think about dinner, then waited for my hubby to come home and make it. Bit of a washout day. But I knew that was coming, so yeah.

games, friends

Love this game! My husband isn’t such a fan, reckons I let him win so he’ll keep playing with me…so he stopped playing with me! Always happy to play with new people. This is one of the few activities that helps me feel like my brain isn’t rapidly shrinking!!

Thursday. Plan: repeat ride to Williamstown, without the head wind on the way back, if it please the Weather Bureau! 28 kilometres, gorgeous scenery, good friends, what more could we ask for? The forecast was 13 or something, but I have my neck gator, my head scarf, my new arm warmers, gloves, and a vest and coat to layer over my jersey, so no worries, plus I’m always warm on the inside! Despite the hangover effect, when my alarm went off at 8am I jumped right out of bed! Miraculous! Truly miraculous. The joy of the ride, the pleasure of good company, the scenic delights awaiting; my brain is on full anticipation mode, waiting for the lovely things the day will bring, which will in turn deliver to me those much lauded blessings of endorphins, serotonin, dopamine, etc. It’s the dopamine that has the upper hand if you ask me. Once I finally got to that place of enjoying in my riding, my dopaminergic system started its reward seeking behavior that drives addiction. There, I said it, my brain is starting a powerful connection between riding and good things, and it wants more!

I’d organized to car pool with a friend from the course, the first time Little Miss Independent has let someone else take the wheel and do the driving. A big moment of letting go the control, and making friends! So nice to be trusted to go to someone’s house, meet their family, share an experience together. I’ve always considered myself a bit awkward socially, a bit challenged at making friends and as a little kid especially this was true. I’ve had my own friends, my school friends, and work friends. But I’ve always had my own space, where no one else goes. I’m finding it’s different with riding, because you really share common experiences so we have something together that binds us, and no external person can really share in it because they weren’t there. It’s fascinating to me, to see how this works, and to be a part of it! We share our insecurities, our weaknesses, our doubts in a way probably none of us would fully own out loud in any other situation, and probably not with our partners or other friends. Because in this course it’s okay to be scared, to not know, to be worried. It’s ALWAYS okay to be how you really are and what you really feel and no judgement is even thought of, because this is a place of learning and building up skills and encouragement and doing it together. That’s why we love it!

boardwalk, pond, rushes, bike

One from the archives. Back when I could still fit into my wardrobe, barely, March 2014. Remember I told you my hubby took me for a ride and it wasn’t the best? This is it! A brave smile!

—RIDE CANCELLED— As I’m walking out the door, socks, runners, leggings, jersey, neck warmer, ear warmer, gloves, vest, coat, lights, ready to go to my friend’s house to car pool, my phone beeps. I’ve got my bag with helmet, bike computer, bike mechanic kit etc on my shoulder, I’ve grabbed breakfast, filled up my drink bottle, got the car keys in my hand, bike in the car…cancelled! Cancelled! Ohhhhh. Deflated! But I’m ready to go! But that was the last organized ride for the week that was at my level! But I’m up, and if it was any other day I’d be asleep til 10am while restarting quetiapine, but I’m up! I’m up! Okay, so it’s wet and slippery, but I’m up!

This is no criticism of Wheel Women ride organization! They do an amazing job many times each week, and absolutely made the right call! No disagreement. But I was up! And I wouldn’t be if it weren’t for the anticipation of friends and bike riding. Which is obviously a powerful thing, more than I would have ever expected from myself! So what now? Honestly I was flummoxed, wind taken out of my sails, left without purpose! So I sat down at the kitchen table, stared blankly at the wall and tried to think of what to do! Called my husband cos I was all out of ideas! Couldn’t think what to do next! It really had hit me for six, even though I always knew it was weather dependent. But I was going to go out and tackle that ride anyway, and do better. And now I wasn’t going anywhere! Huh!

blue sky, silver gulls, court house

A stunning Williamstown day on another ride

That was a great lesson to me, to find how much I depended on going riding, and expected to go, and could go the extra mile to get to the rendezvous point on time and all organized, because I wanted to go! Here are some powerful abilities that I can harness and use!

So, what to do? Actually I had a pretty flat day, which is so interesting to me, and something I can work on for next time for whatever disappointment inevitably comes. How can I response differently, better, not let myself get so deflated? I was still in a pretty soggy condition when my hubby got home so he set me to think up rides that I could do the next day. It was a great idea, but I parked it on the shelf. Right now though, I’m inspired so I’m going to try to do that, write a to-do list of bike rides for the future so that I always have a backup plan.

Inspired. Me, right now. Why? Its two days on from Thursday, and today I went and did that ride that was planned and cancelled with my husband, and it was great! The weather was cold but sunny, the scenery is always spectacular on that route and we had fun! Then we went and checked out the cyclocross race nearby and I got my fix of bikes and I’m feeling fine! Better than, in fact. It’s 10.48pm and I’m still tap tapping these ideas that were floating in my head while riding. Turns out riding really gives your head space to process ideas!

cars, blue sky, silver gull

Silver gull parade!! These ‘rats of the sea’ are standing guard waiting for the woman to finish her meal and hopefully leave some chips so they can all swoop in and grab the scraps

And that’s not the end of the victory parade.

The following Tuesday our ride was cancelled before the actual day. But I woke up that morning to a text from one of the lovely girls in our group asking if anyone wanted to do a replacement ride. What a genius, and what a great idea, and perfect for feeling like we haven’t missed out. Yes I did want to do a ride, so we met up really close to home and did an 18km ride together. It was a bit tougher than a lot of our other rides with a few challenging hills but we looked out for each other and I felt so satisfied by the time we got back. We had a nice coffee and cake at a cute new café, and I just loved it! Being independent, and able to tackle a decent ride on our own, and feeling like we’re capable and equipped; satisfaction! And it feels like a victory! I still want to do as many organized rides as I can, but what a feeling to be able to run our own ride if it falls through! Yay!!

So on Thursday, when the ride was ‘only’ 13km, we improvised and went the long way back to the cars together to draw the ride out to 24km. Imagine that! After such a slow, difficult start, I now feel a bit cheated if we don’t do 20km! I mention ‘only’ because the leaders would sometime say this to us, it’s only 6km, its only 13km etc. And I would think to myself, only, ONLY?? What are you talking about, only! I’m not at the only stage, every peddle stroke hurts. It was fascinating on Thursday because we rode the first ride we ever did to the bike store, which I thought would never end as I wheezed and sweating and burned my way along the ‘only’ 6km. And this time we got there in 10 minutes, before my legs had even warmed up, and suddenly we were there and I couldn’t believe how it didn’t hurt, or require much effort and we passed it like it was a kilometre from the car park!! That’s progress, and it’s so exciting!!

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!

Pregnancy

What could I do, I had to like it! It just made me think of myself, in a kind of funny.kind of truthful way!, gorilla, grass

What could I do, I had to like it! It just made me think of myself, in a kind of funny.kind of truthful way!

This popped up in my Facebook feed the other day from Brindabella and I actually laughed out loud! The expression ‘lol’ is so overused online that it has lost all meaning, but this is one situation where it was actually appropriate.

I laughed because over a few months I gradually increased in weight  until suddenly one day I looked in the mirror and realised I looked like this! Not a fun realisation! I mentioned it to my hubby and he agreed that he’d thought for a while now that I looked pregnant! Always helpful but he was kind about it. But its the truth so what can you do.

I should clarify here that I’m not pregnant; the weight is due to indulgence, medication side effects and the symptoms of mental illness. Just to be clear.

But anyway, somehow being that shape and seeing this gorilla translates to funny in my brain…not sure why, but I guess it’s amusing to see yourself mirrored in another species, and to see a big round belly, flabby arms and a double chin on a cute-ish animal looking equally unhappy about the situation!

The weird thing is, I know I’m overweight to the point of exploding over the obese line. But somehow my brain hasn’t caught up. Maybe because it happened so fast and unexpectedly, maybe because I’m in denial a bit…not sure why. I kind of knew already that my brain was lagging behind, but it became most apparent when I was in Thailand recently. Sitting on the boat in just my bathers, swimming in the pool, jumping off the boat into the water carefree and happy in front of everyone else, walking around at lunchtime feeling completely comfortable with my body the whole time. Which was a really nice feeling instead of hating it and wanting it to be different.

Until…I looked back and saw the photos! My big round tummy, double chin, fat cheeks and eyes deep in puffy sockets…ergh! Then I was not happy! Then I was not comfortable with my figure! Photos are kind of the cold hard truth that shoot you down out of your dreamy sky and bring you down with a big hard bang to reality!

I can kind of understand the idea behind body dysmorphic disorder now. I don’t have it and I’m not suggesting I do…but the brain is powerful and can really twist reality sometimes. To be one way, and consider yourself to be another way is…well in this case it’s kind to me to a point, but I guess when it comes to addiction or something like that it is very unhelpful, because you think you’re okay when really you are not. It can be unhelpful to me too I suppose, because when I’m looking at a block of chocolate I think it’ll be okay instead of considering my obesity and how chocolate is really not okay!

Here’s the other thing. When I was first really unwell, the psychologist and the doctor and all the self help websites told me to do nice things to and for myself to help me feel just a bit better. Have a bath, eat your favourite food, watch your favourite show, go to your favourite place either physically or shut your eyes and imagine you are there. So chocolate, a hot chocolate, a bowl of yoghurt…whatever you love, was okay to eat anytime and all the time to help get you through the difficult days.

Except there was no limit put on that habit…so I just kept going and going. A limit would have been good, but realistically I was unwell for months while we tried fluoxetine, venlafaxine, sertraline, sertraline plus mirtazepine, sertraline plus quetiapine, desvenlafaxine plus quetiapine, reboxetine plus quetiapine and full circle to venlafaxine plus quetiapine and finally venlafaxine plus quetiapine plus lithium, the best yet! All of those antidepressants working a bit or not much, until finally the correct diagnosis of bipolar and the life-changing prescription of lithium.

And still the end date for self indulgence hasn’t been set.

I’m better; I’m not back to where I’d like to be. I have more energy; but still need my daily naps. I have more resilience; but some days I just need something external to make me feel better. I’m trying to cut down on my treats and snacks; but it’s hard!

And here’s my shortlist of how fatness that looks like pregnancy is different to pregnancy:

1) In pregnancy, you know what to expect and you prepare your body. You moisturise and Bio-oil your belly to prevent stretch marks. In fatness, stretch marks pop up out of the blue completely unexpected and you have no warning to prepare for that.

2) In pregnancy you get the baby most times, not always. In fatness you just have the rumours, the questions, the look without the baby at the end. To be honest, I haven’t decided whether I think this is a bad thing or a good thing….I’ll get back to you.

3) In pregnancy you deliver the baby and the belly size reduces a bit, then gradually reduces slowly back to somewhere near where you started. In fatness, these is no initial tummy reduction; you just start from wherever you are and gradually reduce it hopefully also to somewhere near where you started. So actually, the two conditions can be pretty similar in this regard.

Well that’s about all I have to say about fatness and pregnancy at this point in time.

I started and stopped the gym, I did a few food coaching sessions, I returned to pilates for a bit, I go on and off calorie restriction, we’re trying to do daily walks, I’m trying to get back on my bike on the trainer in the shed, I’m trying to walk past my favourite snacks.

It’s a work in progress; I’ll get there one day. And for now, my attempt is to be kind to myself and remember why I came to be where I am, and whenever I can, to do bits and pieces to help me along the way to getting where I want to go.

Tired

Tired. Being tired. Feeling tired.

This is still the hardest thing of all for me to deal with. Especially so because I can’t really see that much of an end to it coming up with any haste.

Being or feeling tired, is pretty much the physical equal of being or feeling depressed, mentally. In fact I think they are different ends of the same condition. I’m sure that every depressed person feels tired; I’m not sure if every tired person, who is tired from some other cause that is ongoing and continuous, feels depressed but I’m guessing the percentage that do feel depressed is pretty high.

Most of the stereotypes are exactly the same.

You know, all the old favourites: “you don’t look tired”, “you don’t seem tired”, “I bet if you pushed yourself you would find that you’re not that tired”, “if you just tried a bit harder I’m sure you’d be fine”, “exercise is good for people when they’re feeling tired”, “if you were really tired you’d be sleeping instead of just laying around”, “are you eating properly because if you were I’m sure you’d find you weren’t so tired”, “are you sure you’re not just being lazy”, “are you sure you wouldn’t feel better if you did something for the day instead of sitting/lying there”, “are you sure quitting is good for you? If you pushed yourself I think you could keep going”, “everyone gets tired, you just have to push through it”.

Yawn! Surely it can't be time to get up! bed

Yawn! Surely it can’t be time to get up!

Really?! So let me get this straight. It’s not bad enough that I’m suffering with tiredness, but now you get to judge me for the affliction which I would never have wished for, and condemn me for however I somehow manage my way through it. Hmmm. Yep that sounds reasonable.

Rant over; that’s not what this is about. But I will make a side point here before we move one. Every single time that you want to ask someone a question that subtly suggests they are being useless and not helping themselves, think about this.

If that person had cancer and was suffering from whatever-it-is, in this case let’s say tiredness since that’s the topic, would you still ask the question? Would you still hint that they could do better and be better?

If that fails, try, and I mean REALLY try, to empathise with the subject, in this case, let’s say me. How about, as a mental exrcise, you imagine you were me? You may be a friend who knows a little about me, family who knows a bit more about me, or a stranger unmet that knows only what’s written here…but try. And if you can’t imagine it, or have insufficient information to really get into my shoes, then maybe it would be appropriate for you to consider that you also have no right to comment.

And please don’t take this as a rudeness or a get-out-of-here sentence! It’s meant only as a demonstration because I’m certain that most people commenting on health and mental health these days are not the people who have an inside and intimate view of the various conditions that exist.

So; being tired.

Here is the 50 million dollar question: is it physical or mental?

Here is the 25 million dollar: does it matter?

And here’s the question that I want answered that I’m not sure there is even an answer to: what the ……. am I supposed to do about it??? Fill in the blank yourself.

I have no idea what to do about it. No clue.

Everyone else has a lot of ideas.

Who has the answer that is best for me?

So here’s my systematic approach.

Why am I tired?

First cab off the ranks: I have depression, bipolar depression that comes with lack of motivation, lack of energy, lack of stamina, lack of feeling. So there’s that.

Second idea: medications including quetiapine (Seroquel) which literally puts me to sleep at night and possible hangs over a bit the next day; lithium which is known to slow you down a bit, so there’s a bit more.

Third thing: I have underactive thyroid which was caused by lithium and we’re still working on getting the thyroxine (Oroxine) dose right. I started on half a tablet, now I’m on a full tablet of the lowest strength and we’re waiting the 6 weeks before we can take a blood test to check if we need to bump it up again. Also I’ve had iron deficiency anaemia over the last year and while my iron levels are finally okay, my iron stores are still low so I’m still getting that sorted out with iron tablets and I’m also enrolled in a clinical trial to help with iron levels. None of that helps.

Fourth: the weight gain thing. The last time I ran around and got excited about jumping up and down, I was 30kg lighter! Thirty kilograms. It should surprise no one that a person carrying a bag of 30kg moves slower than they used to! It’s logical maths.

So actually, when I see it all written out on paper in detail…I realise maybe I could be giving myself a break.

Hmm. That’s actually quite a lot of reasons to be going slow…maybe I need to go back to psychology basics and re-frame my life these days. Maybe what is desperately needed here is some of that self compassion that I blab about but forget to apply, and a new perspective.

The perspective that says, Danika, whatever you can get done today is excellent. Congratulate yourself for getting up out of bed, for having breakfast, for getting out of the house, for getting through a shift of work, for whatever activity you do.

Forget about wondering why you can’t this and that, why you used to be able to do this and can’t now, why it’s hard to get through what you want to get through.

Try being excited and satisfied and happy about whatever you can get done. Give yourself a break. Don’t just say it, give it! It’s not a theory, it needs to be a practice. Give yourself a break!

And remember that you have hope of improving in the future: the plan to eventually wean you off sleepy quetiapine, your intention to slow weight slowly but steadily, your commitment to your medication that should correct your thyroid function and anaemia.

RIght now, it doesn’t matter what the tiredness is; could be anything off the list. Just take each day as it comes, and try not to have excessive expectations of yourself in your current state. You aren’t last year, you aren’t later this year; you’re right now, so just handle what you can handle, and leave the rest to another day.

And seriously: take your own advice! Don’t just right these easy lines for someone else’s benefit; read them and believe them and check in on them again each day. Every day. I don’t want you getting into a state about this tiredness thing anymore; give yourself a break!

Last night I had a dream…

Anxiety, depression, antidepressants.

Condition, condition, treatment.

Cause of dreams, cause of nightmares, cause of crazy, surreal, nonsensical, weird-as concoctions of ideas and sequence.

Either way, not a great night’s sleep!! And a poor night’s sleep leads to waking up tired and already sick of the day, and that’s no way to feel better about life!

In December last year I got started on a second and more sedating antidepressant to help with my anxiety, and depression. I was initially scared of being on two antidepressants simultaneously. The pharmacist in me was screaming “serotonin sydrome, serotonin syndrome!” [see author’s note]. But then I took it, as directed, at 9pm at night. Within in half an hour a warm fuzzy feeling was spreading all over me and I was feeling sleepy. So I went to bed. I fell asleep straight away, no tossing and turning and trying to force myself to sleep. No fretting, anxiety, stress, fears for tomorrow. Just pure sleep. Bliss!

I fell asleep, and stayed asleep. All night! In fact I couldn’t get up the next day! The doctor had warned me about this so I had started the medication on Christmas Day. I dragged myself out of bed about 9.30am, tried to keep my eyes open over breakfast and finally gave up after a shower and went back to bed about 11am. I slept solidly for two hours and woke up feeling a bit better, but still sleepy – luckily it was a small family lunch for Christmas so it didn’t matter too much. The next day was better, the next even better and within four or five days I could wake up bright and early as soon as my alarm went off and head off to work. And I was getting a full night’s sleep every night!! I was no longer waking up feeling like someone had “punched me in the face” as my doctor describes it, pretty accurately!

Oh mirtazepine! I still have a soft place in my heart for this wonder drug that put me to sleep, kept me asleep and then allowed me to wake up and get on with my life.

I’ve changed medications a lot since then. I had to get rid of mirtazepine because the doctors wanted to start quetiapine instead, an antipsychotic/mood stabiliser to stop me swinging from one end of  the spectrum to the other. It is also sedating. It does a pretty good job with my sleep: it certainly puts to sleep, and keeps me asleep, but I’m having this annoying phenomenon of waking up every morning at 4am or 5am bright as a button!

And to all the helpful people who say “just get up” – thank you for your advice but I respectfully decline!! What kind of time to get up is 4am?? What am I meant to do at that hour of the day? How am I meant to occupy myself all day? It’s hard enough as it is! So I go to the toilet and get back in bed and start the fight with myself to get back to sleep. Unfortunately by the time I succeed it is time for my hubby to get up and a much more reasonable hour of the day to be awake, and I’m conked out! Completely out to it! So my actual getting up time is more like 8am, 8.30am, 9am, 9.30am. Which doesn’t work well with a plan to go back to work eventually on a 8am to 5pm shift…but hey, I really shouldn’t be getting ahead of myself!

I asked my psychiatrist about this early waking thing. At first I thought it was just going to be a temporary thing, but it’s going on and on. He doesn’t want to increase the quetiapine dose anymore; I’m already fat and have cholesterol problems which are in part due to this medication and neither of us want to worsen that! Besides I’ve been started on lithium since which he hopes will be my main medication and the idea is to eventually reduce and possibly cut out altogether my antidepressant and mood stabiliser. His opinion on the matter is that depression is the cause. Early waking can be a typical sign of depression in his view. Bummer!! I was hoping it was something medication-induced that was more easily fixed than depression! Ah well, at least I got most of a good night’s sleep. Mostly.

There’s still the odd crazy antidepressant dream. I’ve heard about other people on antidepressants having strange out of context or deranged dreams, so I guess it’s something that can be part and parcel of treatment. I’ve had a lot more in the past but since being on a mood stabiliser they’ve been a lot rarer.

However I had one last night that got me thinking about this again.

Here’s the reality as background. My sister is a chemistry and nutrition teacher and mostly we get on well. We had a phone conversation last week that was really nice, we had a good chat about different things and only stopped because we had to go out for a date.

Now here’s the dream. I get invited to go to a private girls school to give a lesson on nutrition but I can choose exactly what I want to give the talk on. I choose to talk about waist circumference and it’s link to heart disease. I go to give the talk but I get lost and I’m running late so I have to call ahead and tell them I’m going to be late; not impressive for a guest lecturer! I finally get to the classroom and there are 5 girls; a bit surprising for a guest lecture but okay. Somewhere in the dream the classroom becomes a car and the number of girls drops to two!! Anyway when we get to the car part my sister (the nutrition teacher) turns up and begins heckling me about my facts, saying that they are not evidence-based, the greatest insult in modern medicine! I respond but suddenly I can’t find the evidence that I had before and can’t fight back against the allegations. It turns into a bit of a shame fest for me as a lecturer and then I start getting criticised for my lecturing style, my notes and my slides and it descends into a big higgle-di-piggle-di and I wake up!! Ridiculous!!

Questions: I have no idea on what authority I’m giving this talk, why me? I don’t really have to guess why waist circumference; it’s clearly because mine is well over the line and I need to do something about it other than eating chocolate! Why am I running late – I don’t actually do that much anymore; I’ve really turned over a new leaf. How did we get into the car and why? Why a private school; I went to public schools and have no idea what private schools are like. Why is my sister even there, she lives in a different state? Why are my facts being questioned, especially by my sister who would absolutely support them in real life?

There is no reasoning why with these dreams, they just have to be brushed off as we go on with life. Sometimes they are harder to brush off but I’m sure that looking for meaning in them isn’t very productive. If you beg to differ, and can find a meaning, I’m listening.

So sleep, dreams, life. All wrapped up together and getting the perfect balance is an art. It’s not perfect now, but it’s a long way better than it used to be so I’d like not to fight it but to be glad for what I’ve got and make the most of it!

[Author’s note on serotonin syndrome: when prescribed a high dose of a medicine that increases serotonin like SSRI and SNRI antidepressants, or when prescribed a combination of two medications that increase serotonin there is potential for a patient to develop serotonin toxicity or serotonin syndrome. I have been prescribed both at different times and have never experienced any problems; that is not to say it doesn’t happen, but it is not common. If you believe you have been prescribed one of these you should discuss serotonin syndrome with your doctor/psychiatrist. I am not an authority on the matter and won’t be giving a list of symptoms to look out for. ]