Revolt

*WARNING (and spoiler alert): contains self-induced vomiting*

12th April, 2017

From one drama to the next! Honestly! Did I learn nothing from yesterday? The whole phone thing? Nothing about being careful and deliberate in my actions?

See, I have this system. Yeah right! A system is useless unless you stick to the system. Which I mostly do, but mostly isn’t really enough when there’s a system involved. You stick to the system, or you don’t.

This system involves my medications. I’ve probably been over this but I have a nice purple medicine box with 4 rows. One row for my morning tablets, one empty row, one row of 3 valproate tablets for each night still in their original foil because they go smooshy when exposed to air, and the final row for the rest of my night tablets. The valproate for the evening doesn’t fit with the other tablets, hence its own row, but the morning single valproate tablet fits it, hence the empty row. I have carefully marked the morning tablets, and the night tablets so that I can’t get confused. Plus there’s the fact that I unwrap one valproate tablet in the morning and three valproate tablets in the evening. The morning row has red and pink capsules of venlafaxine and 3 little white tablets; the evening row has a dark red iron tablet, a little pink cholesterol reducing tablet, and three chunky quetiapine tablets, apart from the lithium that is in both morning and evening. They are different, the morning and the night tablets; clearly distinguishable. They are not the same. If you take the time to notice, which I periodically don’t! Theoretically, I check all the tablets lying in my palm, to make sure every one is present and accounted for before swallowing them down. I have a list written on the back of the box telling me exactly what should and shouldn’t be there, for reference. But I’ve been on this same combination of tablets for well over 6 months now, and I’m very careful when I pack the box, supposed to be anyway, so sometimes I just pop the tablets and scull them down, get it over with!

Like yesterday. Before I knew what I was doing I had opened 3 valproate tablets, shaken out the dark red and pink tablets, noticed subconsciously the big chunky tablets, and sculled the lot! Even though it should have been obvious that I was taking the wrong tablets: wrong compartment, wrong colours, wrong amount. It took about 20 seconds to get that same shot through the gut as I had yesterday when I realised that I’d lost my phone. I knew then, consciously, that I’d really stuffed this one up!! It has happened before, once I think, but seriously! What was I thinking? And here’s the thing, I wasn’t. I was on auto pilot, distracted and that’s how it all blows up in your face. What’s the big deal? Those 3 valproate tablets, plus the 3 quetiapine tablets, they’s the big deal. They are basically my sleeping tablets, and here I’ve taken them 10 o’clock in the morning! They aren’t actually prescribed for sleeping, they are mood stabilisers but this is their major side effect. Any other day I’d just resign myself to going back to bed and sleeping them off, but not today.

Because there’s something else that I haven’t told you. I’ve got a job!!

I was going to save the excitement for my official start date on 29th April, however this happened, and on the first day that I’m going in to do the official orientation and get all of my paperwork sorted! I have a 4 hour shift starting in an hour and I’ve just taken my sleeping pills by accident/carelessness!! You can see the problem here. First impressions and all that, I don’t want to call in sick for my very first shift; I’m determined to be there and on time and get this job off to a good start. I don’t want to have to go home sick part way through the shift because I can’t keep my eyes open. I definitely don’t want anyone to think I’m under the influence, or unfit for work! That would be extremely unfortunate! Not just for this job, but for my career; the pharmacy board frowns heavily on pharmacists using any substance while on duty, oddly enough. So, what to do? I think you can see where we’re going now.

The ONLY way to try to prevent the sleepy pills doing what sleepy pills do is to get them out of my stomach before they are released from my stomach to my intestines, and absorbed into my bloodstream, making their insidious way to my poor brain. The only way to get them out of my stomach is to induce vomiting!! Honestly, I cannot think of a more revolting, horrifying task to have on ones hands than this. I don’t think I have ever made myself vomit before. I recognise now how compelling a disease bulimia is to convince you that this is a way to live. To me it is extremely repugnant. But what are my options here? It took a lot of psyching myself up for it, and a couple of false starts, don’t ask me how, but we got going. Here’s the killer: I ended up throwing up my entire breakfast which I’d had an hour and a half ago, yet there wasn’t a sign of the tablets and orange juice from 10 minutes ago. Here is the cleverness of your stomach. It knows that its job is to break down food into smaller pieces so that your intestines can do their job. But there’s nothing to break down in fluids, so your stomach lets them right past. In that 10 minute period, my stomach had already released all the fluid/orange juice, and the tablets with it, and they were gone. That whole disgusting, humiliating, distressing episode, for nothing!!

What next? Well, its time to go to work. Fingers crossed that I can handle this and get through what I need to get through.

Here’s the odd things about my sleepy pills. When I first started taking them I would be dead to the world within 30 minutes, or less. Honestly, I would take them and immediately get upstairs to bed because within 10 minutes all of the muscles in my legs would be jelly and I couldn’t step up a stair if I was being chased by an axe wielding madman! My arms would be equally useless. A couple of times I got into bed and then needed to go to the toilet. I would bounce off the wall, my bed, the dresser, my bed, the wardrobe, the bedroom door, the bathroom door and back again! I’m sure it looked completely hilarious from my husband’s point of view but I couldn’t even see straight, let alone have control of my legs. My eyes would go evil vampire red because of how much the medicine dried them out. Basically I was gone for the night. And I got the best sleep! I was drugged out really. And of course as my dose went up the effect continued.

But over time, as the dose has steadied out, I’ve become more tolerant. I don’t get that drugged out feeling now, and I can stay up sometimes for a couple of hours after taking my night tablets. On occasion it does make me drowsy enough to start blinking heavily, struggling a bit to keep my eyes open, but if I really want to I can keep them open; it doesn’t overpower me like it did before. It still helps to give me a good nights sleep, and without it I sleep pretty lightly and spasmodically. As I experienced last night, because after taking my night dose in the morning, I had to take my morning dose of valproate at night to keep the balance, and one tablet isn’t enough to sedate me; plus I had no quetiapine in my system.

So, I took the wrong dose, and didn’t manage to catch it before it got into my system. And now I have to go to work. Well this should be fun! Here’s hoping I can fight the effects for more than a couple of hours.

Okay, next strategy: a large Coke, no ice from Maccas. Hopefully the caffeine will do something!! I drove all the way to work (I was questioning whether that was a great plan, but I felt fine at this stage) feeling okay, until the last 5 minutes when that warm, fuzzy, about to go to bed for the night feeling settled in. I got a little lightheaded on standing, slightly dizzy if I turned my head quickly, and just plain drowsy. My eyes wanted to shut and go to sleep, my thoughts got a bit thicker, I was trying not to speak slower. I hope to goodness I managed to pull off looking as enthusiastic and committed as I wanted to. But there was a big challenge waiting for me. Most of the 4 hour shift involved sitting at a bench reading policies and procedures and signing off on them, and doing orientation quizzes on the computer!! I mean, seriously! Of all the days in the world, I really needed a stimulating day today, and I got reading of less than riveting material!! I think I pulled it off, I mean I got it all done, but I have no way of knowing whether I was doing it way slower than usual, a bit slower than usual, or how many micro sleeps I had sitting there at that bench! Luckily the chair was very uncomfortable so that keep a bit of an edge on my alertness, and after 2 hours when my supervisor went for lunch, I went out and got an iced coffee with plenty of sugar! I think that did help a bit to keep me going for another couple of hours! Plus the fresh air was good.

Yikes!! What a day! But I did survive, somehow, by some miracle, and I’m going back on Tuesday after the Easter break. To be continued.

Did I come home and go straight to bed? Yep, you betcha! A couple of hours sleep did wonders. Usually I can go straight back to sleep at night after an afternoon sleep because of my night tablets so I did struggle a bit getting to, and staying asleep without them. But I didn’t struggle catastrophically. I think I actually had a pretty good night’s sleep in the end, although I was awake from 5am on the dot this morning, Thursday 13th April.

I can’t double up once I’ve taken the tablets, even if they were the wrong tablets. So what’s the plan to get back on track from here? Most of my tablets can only be take once in 24 hours meaning I can’t take night tablets again today. So I’ll take my morning ones tonight, then my morning ones in the morning (the morning doses are smaller so it won’t be such a big deal taking them back to back) and my night ones tomorrow night; then I’ll be back on track. Until then I’m sniffing my head off because of the longer gap in between doses of quetiapine, from morning one day to evening the next. It usually dries me out so sniffing is unusual and annoying! Apart from that, and the obvious drowsiness there shouldn’t be any consequences from stuffing this up, luckily. When you take the same medication all the time, a one off dose mix up doesn’t tend to affect your overall medication levels enough for issues to arise.

And here it is 7am and I’ve written this blog and I’m ready for breakfast, bright and early. I could possibly be very productive without those night tablets, but it wouldn’t be worth it for my mood. Ah the catch 22’s in mental health treatment! 

So, have I learnt my lesson in being more careful? I’d like to hope so, but I find the lesson only lasts as long as my memory of it, and that’s a whole other story!

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!