Sunday Summary

Dear friends,

It has been a busy week! For me, I mean; probably not what you would call a busy week. I didn’t work at all, I didn’t get many chores done, and the most I did daily was get out of the house for an hour or two. That’s busy, for me.

I’m so happy that it worked out to be that way!

When I finished work three and a half weeks ago I was worried that the naturally “depressed state I was in about finishing work, together with my ongoing lethargy and tiredness, would result in me becoming a bed bound vegetable again.

Well again isn’t fair; I’ve never ever not gotten up at one point or another during the day. But with no definite reason to get up in the morning, my lack of motivation to get up unless there’s someone waiting on me, and the general listlessness of having no set purpose, I thought that there was a fair chance of me lounging around all day.

And it turned out to be that way for a few days. With nothing planned, with accumulated tiredness from keeping up with my shifts at work for six weeks when they consumed about the last ounce of my energy, and no reason why not to get up, I had some pretty massive sleep ins.

Until I missed my tablets one Sunday night! This happened in spite of the careful routine that I have built into my days after I had previous missed doses to prevent the same thing from happening again. Obviously there’s still a loop hole somewhere that I haven’t found but I’m working on it.

My routine is to weekly make up a medicine box with all the medications that I need to take both in the morning and at night. My pharmacist brain cross-checks the directions on the bottles and boxes with the number of tablets I put into each slot and then double check that I haven’t missed anything by comparing what I’ve packed with my complete list of medicines printed on the bottom of the box. My triple check is when I take each group of tablets and I count again to make sure I have it right.

I set this medicine box right next to my bed on my bedside table so that I should see it when I get up and when I go to bed; this should give me a visual prompt to take my tablets. But I don’t trust this system so I have set a morning and evening medication alarm in my phone. This can only be snoozed three times so I also have a medicines app that generates a reminder at 7am and 9pm for me to take my tablets. This can be snoozed to infinity I think, but the fact that I missed a dose makes me wonder if it actually does have a limit to being snoozed. I’m looking into this.

So the missed dose. You wouldn’t think it would make that much difference; it’s only one dose right? But it does make a difference, at least for me at this point while we’re still fine tuning the medications. Most times when I miss my tablets I end up getting upset over some little thing or teary for not much reason or get in a fight with my hubby! Poor hubby, he has to bear the brunt of everything! I think this reaction has been when I’ve missed my morning dose, which means I miss my antidepressant and my morning lithium dose.

This time I missed my evening dose. That means my evening lithium and my other sedating mood stabiliser. I’ve only ever done this once before. It’s never fun, because it means there’s nothing putting me to sleep! This time was terrible! I’m sure I had a maximum of 4 hours sleep but who knows. When you’re tossing and turning and can’t sleep and want to sleep, time loses all meaning! Poor hubby again, every time I tossed or turned he turned! But I physically couldn’t bear the sensation of lying still! It was awful! I just had to move and move and move and move!! I woke at 5am and tried to exist as quietly as possible til hubby was ready to get up. Then, so out of my recent character that it was laughable, I jumped out of bed fresh as a daisy at just after 7am and left the house before hubby! I was in my runners and leggings and I was off!

Compared to my recent sluggish, only-move-if-I-have-to, and even then moving snail’s pace, I was striding off to the park like I haven’t since I don’t know when, and paced out two laps! It was ridiculous to me even as I was doing it! But it was a fabulous feeling! I could move as fast as I physically wanted to for a change, instead of how fast I physically could through mud bearing heavy weights!!

Incredible! And so friends, this is mania. Or a sub form of it. You won’t see me like it often, unfortunately or fortunately, but you’ll know it when you see it. I’ll be smiling at all and sundry, grinning, laughing, putting out a decent amount of physical effort, having a great day! I’ll be chatting flat out, possibly jumping topics or getting distracted. I’ll be super effective and get many tasks done. I’ll be physically active and able to do a lot more activity than usual.

It’s a feeling that is addictive actually, I never want it to end…to start with! By the end of the day I was pretty sick of it actually because I could hardly sit still or rest, and was just feeling irritable, agitated and like I couldn’t possible tolerate having another night like that. By then the frustration tears were pretty close to the surface, but let me tell you I achieved a great days work! All three loads of washing done, some of it off the line and folded! The kitchen was sparkling clean; I’d cleaned the grout and the stubborn grease on the splash back. Lots of jobs attended to, a family visit where I chatted away like a…like a crazy person! Chat chat chat chat chat chat chat!

But I was glad to put it away. Not glad to go back to lethargy and anergy (absence of energy), but after all it’s a balance. You can’t have everything, so you have to decide on the most important things. Which is not being a whirling dervish, but a calm reasonable person not prone to snap decisions and excess!

My short point at the end of that long explanation was that it broke my bed rest habit and got me out into the sunshine, and the outside world. I watched the ducks paddle, saw the swallows come out to swoop and feed, found a magpie nest without getting swooped and in fact saw the magpie partner watching from on high at a distance. And remembered that I liked the outside and wanted to be out there, not inside all day.

Add to this a pep talk from my psychiatrist AND my GP in the same week about just getting outside, no agenda, no pressure, no panic about how I was feeling, just enjoyment…and the message was clear! Just enjoy it.

So I have enjoyed it! What a glorious week it has been!

Monday started slowly, but a late afternoon trip to Blackburn Lake Sanctuary yielded a fabulous hour of the new Musk Lorikeets ( see earlier post) plus an added hour of delightful favourites. Then a sleepover with our great friends and delightful bubba!

I just love love love this gorgeous Galah eating wattle photo!

I just love love love this gorgeous Galah eating wattle photo!

This is the cutest Noisy Miner sequence I've ever had - mother catches moth, baby screams for it, baby gets moth, mother leaves :) eucalypt

This is the cutest Noisy Miner sequence I’ve ever had – mother catches moth, baby screams for it, baby gets moth, mother leaves 🙂

Tuesday didn’t work out how I had thought it would, but a picnic on the banks of the Yarra river in delightful Warburton with several girlfriends and their cute kids is a pretty fine day if you ask me! In addition I got to see two lots of adorable ducklings and a fun Kookaburra.

Cute cute cute! Discovering the innocent joys of crawling up and down stairs, green grass

Cute cute cute! Discovering the innocent joys of crawling up and down stairs

More cute! Fluffy Wood Duck ducklings huddling on a rock in the Yarra River at Warburton

More cute! Fluffy Wood Duck ducklings huddling on a rock in the Yarra River at Warburton

Wednesday morning was a return to Blackburn Lake Sanctuary, the top end this time for some variety of bushland and birds. What a day it ended up with a Kookabura flinging a metre long snake around and many cute tiny birds that were hard to capture.

The fabulous post and rail fence that completely encircles my favourite Blackburn Lake Sanctuary

The fabulous post and rail fence that completely encircles my favourite Blackburn Lake Sanctuary

I spotted this Laughing Kookaburra and stopped for photos, didn't realise it was in the process of killing a snake!

I spotted this Laughing Kookaburra and stopped for photos, didn’t realise it was in the process of killing a snake!

I just love being in the Sanctuary - so pretty and lovely

I just love being in the Sanctuary – so pretty and lovely

Thursday, oh Thursday! This was a bucket list day with a girlfriend and it was amazing! Glorious day, two brand new birds that I’d never seen before, loads of flowers, a couple of moths and some damsel flies! Some amazing scenery, the awesome Kuranga native nursery, Birdsland reserve and a flash trip through the Dandenongs (see previous post).

Friday was appointment day and catch up with my old work mates day and getting my favourite bacon and egg sandwich and eating it in the gorgeous Fawkner Park. A picnic above Yarra Boulevard with my fabulous hubby and some new photo ops over the city as the sun set…wow! Can you beat that for a way to see out the work week?

The great outline of Melbourne city backlit by a cloud sunset, blue sky,

The great outline of Melbourne city backlit by a cloud sunset

The brilliant sunshine, the silhouette of a pretty tree and Melbourne - I love you

The brilliant sunshine, the silhouette of a pretty tree and Melbourne – I love you

Saturday was another girlfriend catch up and was great fun finding plover babies and getting swooped relentlessly by their parents! Then we went on a Loch Ness Monster hunt all around the Blackburn Lake and still aren’t sure exactly what was doing so much flashing and splashing and swimming…tbc, duln duln duulllln! We got a fabulous shot of a Spotted Pardalote by the path and had a great lunch at Gourmet Girl – what an awesome catch up! Over tea cooked by sensational hubby we heard and saw two Striated Thornbills in our minimal garden! I think they’re building a nest! Excitement!!

Mummy Masked Lapwing with tiny weeny baby - these must be very new because the plovers have been docile until this week; now they are savage!

Mummy Masked Lapwing with tiny weeny baby – these must be very new because the plovers have been docile until this week; now they are savage!

Not a clear shot but the beautiful front of a Spotted Pardalote

Not a clear shot but the beautiful front of a Spotted Pardalote

Sunday is rest day and I’m glad for that, but boy I am so glad for every bit of excitement and interest that has sprinkled my week and made it actually fun! And thanks to all my wonderful people who are there every day giving me a hand along, and making my life more amazing!

Funny side story. After looking back at the week in the detail above, it made me remember all the good things and I mentioned to hubby that I’d had an amazing week. His response was fascinating: “Really? Maybe the last couple of days have been okay but I thought you had a bad week.”

To which I, in the mood of putting all the good bits together and seeing them in clear focus and forgetting the rest, replied: “Really? But I’ve done all these amazing things.” So we had a chat and here’s another perspective moment – what’s in focus is really clear and the rest in lost in fog.

My hubby was remembering coming home to me still lost in my afternoon nap, to me not able to get my thoughts together enough for our weeknight Bible study, to him making dinner from scratch every single night of the week, to me as a blob instead of an enthusiastic lover, to me struggling to get enthusiastic about any physical activity; basically to him carrying the load of the relationship, the housework, being the bread winner and the carer for this weighty gal.

So yes, if you look at all the cool bits it was a great week. If you look at all the failures it would bring you to tears. If you see all that hubby did to get us both through the week, you like me would have overwhelming admiration for this great fella without whom I don’t know what awful state I would be in!

So my motivation for this new week is trying to even out the load for my good man, and continuing to have great days!

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Saturday and Monday

I have been having some great days lately.

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

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

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

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

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

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

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

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

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

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

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

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

Well that’s got that out of my system!

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

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

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

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

What a great day!!

The beautiful Queenstown Cemetery housing old-time gold rush prospecters

The beautiful Queenstown Cemetery housing old-time gold rush prospecters

Gorgeous yellow bulbs growing wild and free in the bush

Gorgeous yellow bulbs growing wild and free in the bush

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

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

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

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

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

Large male Eastern Grey Kangaroo bounding across the paddock

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

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

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

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

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

Group of Eastern Grey Kangaroos bounding across the green grass

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

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

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

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

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

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

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

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

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

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

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

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

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

Mother and Joey Eastern Grey Kangaroo, so beautiful!

Beautifully delicate wattle sprig - looks like Spring!

Beautifully delicate wattle sprig – looks like Spring!

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

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

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

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

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

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

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

Australian Magpie, common but still awesome

Australian Magpie, common but still awesome

Juvenile Australian Magpie singing away, gum trees

Juvenile Australian Magpie singing away

A nesting mother Dove or Pidgeon sitting on its nest

A nesting mother Dove or Pidgeon sitting on its nest

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

Pair of Kookaburras sitting in a tree

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

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

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

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

Beautiful serene Blackburn Lake

Beautiful serene Blackburn Lake

Pretty Blue Iris flower probably sown by birds

Pretty Blue Iris flower probably sown by birds

Some kind of fungal growth on a tree

Some kind of fungal growth on a tree

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

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

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

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

Pretty little Flame Robin showing off its bright colours

Pretty little Flame Robin showing off its bright colours