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!!
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!!