Opioid Dependence and Mental Illness

Pile of pills

I’m not an addict. I’m not! I’m mentally ill. I have Bipolar Disorder. I also suffer from chronic pain in my lower back.

My primary care doctor (PC… PCD? Uhh… let’s go with MD) had been prescribing me oxycodone for the server and persistent (chronic) pain that I’ve had for years. After being active and doing something super strenuous like gardening for 15 minutes I think I’m dying. I’m exaggerating of course, but when I work as hard as Atlas does while holding up the world my eyes leak, I whimper and sit down. Sometimes I end up laying on the floor. The floor is such a very bad idea. If I straighten my legs my whimpering becomes desperate and I realize I’m crying. If I forget myself and straighten my legs I’m done. I can’t move. The pain paralyzes me.

I’m NOT an addict.

When I can think again, I try to find my phone. If I can’t find it right away I feel the panic rising and it triggers thoughts and emotions I thought I’d had under control.

This last time I thought I was managing my mania and depression (mixed state, rapid cycling) pretty well. I haven’t bought piles and piles of books on ducks or Oprah or how to be an astronaut. Honestly, I really haven’t. But please, don’t ask me what I’m thinking about. Also, I’ve been able to get out of bed AND wake-up in the morning and even go for walks. My depression skips through the dandelions with the mania comingling into a mixed state, which is always confusing.

I’m not an addict.

After many months of giving me a legal way to get my the Oxycodone I take for pain legally, and for free. The label on the bottle says I’m to take the little unassuming pills three times a day. They are 20 mg. Currently, I’ve convinced the assistant fellow at the pain clinic to reduce my Oxycodone to 20 mg twice a day.

I’m not an addict.

I’m mentally ill. I have Bipolar Disorder, ADHD, chronic pain, and other stuff.

I was referred to a pain chronic clinic… ah… chronic pain clinic, where my Oxycodone prescription was reissued. A five-minute verbal probe, that’s what it took for the doctor to determine whether or not I needed the narcotic. We didn’t talk about Bipolar Disorder or any potential interactions the Oxycodone might have with drugs that are meant to manage my wild emotions or tame my fantastic panic attacks. I’m not certain she has any record of my current medications. She asked questions, and I quickly tailored my answers to fit what I thought she was waiting to hear. She made a few notes on a paper as small as her palm. I wondered if she was actually making notes that she could refer to later. She thought for a few seconds and then wrote the prescription. I sighed in relief.

I’m not an addict.

A while later, like over a year or maybe two, I’m still taking the narcotic. The clinic has new owners and staff. They no longer asked me questions. Sometimes they required a urine test. Then, they stopped asking me anything at all. We spent my appointment chatting. I started asking if we could please try to figure out what was causing the pain and try to deal with it by correcting the problem. I wanted the pain to stop.

They didn’t listen. They wrote the prescription without hesitation.

I’m telling you, I’m not an addict.

My mental health drug dispenser began paying attention after I updated her about my drugs and included Oxycodone in the list. She stopped talking about whether or not my meds were working to stabilize my moods and started talking about “Black box” warnings.

She had my attention. I started to panic.

At the time I had over five medical people prescribing medications. They didn’t know what the other office prescribed me. They relied on me to tell them the truth. I didn’t have to tell anyone I was taking Oxycodone. That got me thinking.

I’m not an addict.

Later…

I’m still asking the medical folks to figure out the cause of my chronic lower back pain. I’m still not getting results. I’m getting way too much Oxycodone every bloody month.

Because I can, I’ve been researching my of collages of illnesses, disorders, and psychological malfunctions.

Ah ha! Black box warning. Do NOT take anti-anxiety medication (benzine’s) – death may result.

Oxycodone 20 mg

I recently saw Dr. T, my very superior knee surgeon. He saw the condition of my spine when he was looking at the x-rays of my hips. He was making certain that my persistent knee pain, post second replacement, wasn’t being caused by anything running amock in my hips. He was eliminating any possible cause of my knee pain before he even considering using surgery to further correct the inept effort Dr. B made the initial knee replacement. Dr. B successfully replaced my knee, but that’s where the project ended.

It sucked. My leg from the knee down, well, it kind of turned the wrong way.

Dr. T corrected the first replacement. He tried to minimize the damage his surgery could do while trying not to blow up my entire joint… okay, the joint that was already gone.

Dr. T showed me the x-rays he’d just had taken and explained where and why he left Dr. B’s “efforts,” while replacing the replacement. A month ago we tried a shot to relieve the pain and keep from having to have surgery again.

Nope. I’ve had no relief from the pain. In fact, my brain was overjoyed and thought that my knee was doing awesome. Holy cow! I should NOT have knelt down like that! Looks like surgery is probably what our next conversation will be about. I’ll need to be on pain medication again…. I intend to be off Oxycodine ASAP. I would really like to have some kind of painkiller to take after surgery – assuming I have it. Always be prepared! Sigh…

I’m not an addict.

After my constant complaining about my back pain that happens every time, I do regular human type activities involving the lower back. I’ve finally had x-rays of my back taken. Holy heck. Next stop is at a spine doctor.

The online personal information provided by my medical organization includes this: Opioid Dependence.

My chronic pain clinic instructs me to continue taking the Oxycodone. I haven’t been able to identify any specific relief from the pain in a long time. I have never felt any “fun” results from taking it. It has never made me feel sleepy.

I have found that taking Oxycodone at bedtime with the medication I take for Restless Legs Syndrome (RLS) helps me to get to sleep and not wake up in agony caused by the RLS.

Am I an addict?

“Taking opioids over a long period of time produces dependence, such that when people stop taking the drug, they have physical and psychological symptoms of withdrawal (such as muscle cramping, diarrhea, and anxiety). Dependence is not the same thing as addiction; although everyone who takes opioids for an extended period will become dependent, only a small percentage also experience the compulsive, continuing need for the drug that characterizes addiction.”*

I’m mentally ill. In my opinion taking any medication, especially one that alters my brain chemistry (opioids do this), should be thought about and discussed with other medical personnel who are also responsible for my continued living – and to live my best life.

Am I an addict?

No.

I have Opioid Dependence.

Dependence. I can live with that, but look, let’s get rid of that too. Okay?

{I have Bipolar Disorder. I’m a little manic now. I’m using it to write and post while I can. So, for now, I will post often because tomorrow, I may be depressed and unable to say what’s on my mind. I may not have anything on my mind.}

* https://ghr.nlm.nih.gov/condition/opioid-addiction

What My Med Provider Means to Me

burning-ice-cubes-640x402
I’ve complained about my med providers and their apparent inability to comprehend the word ANXIETY for over a year now. You could assume that I don’t like med providers… that I don’t trust them, that I think they’re stupid. Well, umm, yes, that’s basically how I’ve been feeling. I’ve been living a nightmare that has been driving me downward toward my old companions: anger and rage. It makes me feel like they’re getting out of prison and are moving into the house next to mine. I’ve been really scared that I was about to lose control of my emotions again, and eventually, my mind. It has happened before.

I last week I spoke with my counselor (Lee) before my visit with my med provider (Susan) this week. He thought the Ritalin obviously wasn’t working and that my ADHD was out of control. I allowed myself to interact with him the way I do at home with Jessica. My inability to control things like how fast, how much, and how many topics I covered while speaking certainly indicated that this was true.

<OMG! Alexa is playing music from the 1950’s for me. I LOVE THIS MUSIC!>

I was stunned. ADHD? If he was right, this could change everything about the way I approached my brain. I was told I had ADHD just a few years ago and had never taken the time to learn anything about it. Wow, that wasn’t like me at all. I love research! Following rabbit holes is my favorite pastime!

Anyway, I assumed Susan would look at my chart to see what notes Lee would have put in it before she saw me. Doing that would give her knowledge she should have used to help her understand where I was at and she would have seen what Lee was concerned about. It was an assumption I shouldn’t have made. Apparently, things don’t actually work that way.

Every time I see Susan 12 times a year. Yikes! So many times. One of the first things she asks me is if I feel like… if I FEEL like the Ritalin {1} is helping me focus? Focus? What does that mean? How can I tell it’s working? I can pay attention in class. Is that what she means? My attention is crap at home. I can’t ever do just one thing at a time. I have to leave the commercials in when I watch from the DVR (DISH) so that I can read or research stuff online that they just talked about. Is it working? I suppose so? I always replied that I guessed it did. I guess that was silly of me. I would say that because I had no idea what else to say. If I was a little boy, I could probably mean that I’d slow down and stop bouncing off the walls and maybe stay in my seat. But as an adult… I had no idea what that looked like. If I said the wrong thing, she might mess with my meds and right then, they were treating me okay. I wasn’t raging at anyone that day and I didn’t feel depressed.

After I mentioned what Lee and I had talked about and that he was very concerned she took a minute to read his notes. Suddenly she made a whole new treatment plan. I had been on Lithium when I was first diagnosed with Bipolar Disorder (BD). The first book I read on it was: “An Unquiet Mind: A Memoir of Moods and Madness” by Kay Redfield Jamison. I was deeply touched. I felt like I understood what she was talking about, like we were kindred spirits, linked through the ether by BD. Jamison was very sick when she was diagnosed.

Let me attempt to generally get right to the point for once. Jamison was placed on Lithium to treat her BD and it worked. So, that’s what I asked to be given. My personal doctor (MD), was the one who initially treated me. He said that Lithium has been around for many years and there is a lot of evidence that it works.

The Lithium worked.

Susan felt that since the Ritalin was obviously not helping me focus. I guess that made her rethink her strategy. She finally agreed that my brain was hopping along on two of four legs. She told me that does think I have ADHD she now believes that I’m far more manic, which was making me act like that bouncy ball they teach kids to sing songs with. Do you know what I mean? It might be too old for some of you. They wanted to teach kids songs so a character on a film or on TV would get you to sing along as it had a bouncing ball hop around on the lyrics so we could see the lyrics while we sang. It was great fun! than anything else. Sure I talk incessantly to Jessica, but my brain was exploding with ideas. It was time to help me continue to be creative, but to control my mania so that I could be productive.

The plan: no more Clonazepam, no more Ritalin. Start Lithium.
*The reason I went off Lithium was that my PC (Primary Care) had been highlighting the dangers of being on Lithium more than he was the benefits of it. It was because of these side effects, that I requested I be put on something else that didn’t have the same drawbacks. Lithium toxicity can occur even at a low dose. While on Lithium, the user has to be closely monitored so that the dose can be adjusted as needed. The symptoms of Lithium toxicity are numerous and I already have several of them for other random reasons. This website lists the long lists of side effects. In addition to these potential problems the user (remember this is me) has to carefully watch their intake of salt, caffeine, and alcohol. And get this… some of the other medications that may interfere with Lithium and increase the risk of toxicity are ibuprofen (Motrin, Advil) and naproxen (Aleve). Oh, and I can’t leave out this one: acetaminophen (Tylenol). So… yeah. I had a lot of scary reasons to ask to be taken off the drug that was helping me but was also kind of terrifying too. 

Susan believes that this change in medications should make my extreme moods in control much better.

Excuse me? As long as I’ve been seeing the professionals in this clinic, I’ve never had anyone decide to try Lithium again. All this time… lost. Years of feeling my little grey cells melting, running out of my ears. But then again, Lithium toxicity…

I want to be a writer when I grow up. I once heard that writers go through life with their head cocked a bit to the side. I showed Susan a piece of paper that was covered with writing on both sides. It was filled with websites, blogs, and email addresses that I’d created. She studied it for a while. I asked her if I was stupid and delusional to think that I could do all these things and believe that they were not just good ideas, they were great ideas. They were creative ideas. Is my mind actually existing in a consistent state of delusions of grandeur?

Delusions of grandeur. I’ve always been afraid that people would remember that part of the list of symptoms for BD and dismiss me as a kook. Am I brilliant? Or am I bonkers and deluded? I’ve always believed my ideas were great. Yeah. Delusions of grandeur?

She said no. It wasn’t that. Yes, my thoughts are crazy fast, but I am very creative and smart.

Me – creative and smart. OMG!

Of course, now I respect her. She believes in me. She agrees with me that I’m smart and creative. No one has really said that to me. No one has said, “Robin, you’re not delusional. You’re smart. You’re creative. You have good ideas… cleaver… innovative. Don’t worry about being crazy. We just need to slow you down so you can get things done.

Since then, I’ve discovered additional information that indicates that one aspect of BD is the tendency to be super goal oriented. Yep, that’s me. Why haven’t I’ve seen that before?

Watch out! Corner coming!

What are the good things about having BD? I’ll have to think on that for a while.

Go ahead, get mad when the medical professionals don’t seem to be listening. Pester them until they hear you. Then, you listen to them. Work together. Hope that things will finally start to workout. Now that Susan and I are communicating, now that she hears me, we have a new plan. Maybe my mind won’t keep leaving the scene without me.

Yes, it really has done that. We’ve called professional trackers to find it a few times now. It-is-very-embarrassing when your mind is so exposed, so naked.

New plan. New hope.

Bring it! I’m ready.

I’m more than ready –

{1 – Concerta and Ritalin are stimulant medications used to treat attention deficit hyperactivity disorder (ADHD). They’re both different brand-name versions of the same drug, called methylphenidate hydrochloride.  https://www.healthline.com/health/adhd/concerta-ritalin}

Bipolar – Days Racing Up, Down, Up, Sideways Right, then Left… It Never seems to End.

There will always be days that start well.
After they go along for a while…
Then the ground begins to frighten me.

train_crash_for_blog_imagedddddd(It says, “Somedays, This is how we feel…..””

I find that this is very true. At least it is true for me.

Is it ever true for you?

Today started out slow and exhausted. I was up almost all night with restless legs. It eventually became so horrible… that I cried in frustration and pain. I think I slept an hour. I was so tired. my goodnesss. Sleeping right nwooo dddkkk,,,,,,,,,,,,,

<I keep falling asleep. Sorry if this all comes out weird and confused… well.. that’s what you get. LOL. Pardon my language but this is crap””””””’>

There were other good things that happened throughout the day, but this was the best I think. I had a business meeting at a resturant! Isn’t that awesome!? I’m publishing a second edition of a book that I published 27 years ago. I’m so proud of how I wrote it, and the amazing artwork. But, it is time to update it and publish it in different editions and to update it as well.

I’m very excited because my meeting was an amazing. The woman I met with completely understood what I wanted to do and she caught the project and my passion for it really fast.

Then I got home, and stepped on the kitten, again. Sigh….

I’ve had enough of my day. So, I’m going to sleep. I usually do a lot of my work at night. I’m too tired.

I wanted to give you a look at this train photograph and share with you that I feel like I’m on fire and out of control.

Control. That’s hard to achieve when I’m being full on manic, have my ADHD surfing around everything I can possibly think of and somehow finding more, ever more, to add to the intense way I zoom. And finally, there is my always and every seemingly anxiety.

Anxiety – ADHD – Bipolar MANIA. Oh exploding stars that’s enough! Insomenia from restless legs. Oh I keep falling asleep and my fingers press the keys on my laptop and the strangest things get typed up.

I’m going to sleep now. aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaazzzzzzzzzzzzzzzzzzzzzz. Oh rere… ug. Whee are my fingers supposed too bee on the deyboard? I think I’m sleeep. Yes. dd

Nite my friends,

Robin

Pressured Speech – Bipolar Symptom

Descriptions of Bipolar Disorder are pretty standard across books and websites. The symptoms seem easy for anyone to understand. Unfortunately, they are not. I will be looking at each of the significant symptoms and will show what they look like on a real person. It is essential to understand them. To give you an example, what does it mean when I say that one of my most persistent symptoms is “pressured speech.” “Pressured speech,” this is not something I’d ever heard before.

I’m not a walking list of the common symptoms of Bipolar Disorder. Since a large part of mania seems to consist of going excessively fast I’m going to start right off with it. Get ready – The following information is critical to understand precisely what Bipolar Disorder is so that you can live life to the fullest. Ignorance of my condition left me without defenses and practically begs for things to go wrong. Now that I understand more about the disorder, I generally deal with it more successfully. Well, some of the time. Other times, it seems to slap me upside the head before I ever see it coming. Despite the seemingly inevitable setback, I feel like I have a fighting chance. For once, I even feel hope.

Mania – Pressured Speech

Bipolar Disorder is a mental illness where a person’s moods swing wildly from severe depression to reckless mania. Pressured speech is one loud symptom of Bipolar Disorder. I’ve repeatedly been told that I do it, but no one ever stopped to explain what it means. I had to research on my own to figure out what “pressured speech” means.

Knowledge – For me, a key to coping with any illness has always been understanding what’s wrong with me and how I can fight it. I hate seeing the same look on people’s faces when I realize that I’m my speech seems pressured. It freaks them out. It freaks me out too. It makes me realize that I’m talking crazy talk again and again and again.

“Pressured speech” is my “crazy talk.” Everyone deals with the disorder differently. Labeling pressured speech as my crazy talk is a way that I like to think I’m stuffing thoughts of being crazy into a specific behavior. When I can resist doing pressured speech I feel less crazy. I suppose that’s weird, but it seems to help me cope with it.

Some illnesses can be detected by looking at x-rays or surgically investigating a problem area. No medical test can be used to determine if I have Bipolar Disorder. I was required to meet with a medical person that I knew nothing about so that she could decide if I was eligible for disability status. She asked me some questions, and then we were done. I was labeled as disabled and given medical care. Since it only seemed to take mere minutes to determine that I have Bipolar Disorder, I wondered if I had acted excessively crazy. I tried to answer her questions honestly and without spending time trying to use wording that would influence her decision.

Whenever a person assesses me (which they regularly do to determine if I’m still eligible for mental health care), I hope that they are well versed in identifying the signs of the illness and are confident in determining if I have it or not. The first behavioral clue that screams that I have Bipolar Disorder appears to be my speech. I talk all the time. And fast. My kids tell me to stop and take a breath. Talking. I have so much to say. Okay, that isn’t a mental illness. It’s irritating, but it isn’t a mental illness. However, pressured speech can be evidence of it. Pressured speech is something that I do all the time. Even when I’m depressed, I still manage to have pressured speech. So what the heck is it?

Pressured speech is different for every person. Just about all the lists of symptoms of Bipolar Disorder will have it on them. Let me explain what it looks like in me.

People may wonder if I have Bipolar Disorder when they hear me speak too fast and sound like there is some crisis that I feel compelled to tell others about it. I can sound erratic and talk without stopping or even noticing that someone else might want to speak. I am not easy to interrupt. Often what I say is irrelevant or strange, and the person I’m talking at doesn’t know what I’m talking about. When I have pressured speech, I may not stop talking when I usually would. I act like what I’m saying is urgent and essential and it doesn’t matter whether or not the person trying to listen can follow me or not.

I seem to speak like I’m leaning into a wind, a mighty wind, and I’m bent over trying to stay standing. You could say that I am pushing a car up a hill that never ends. The pressure I apply to keep the car moving is just like the way I talk like I am pushing forward faster and harder all the time.

My speech is pressed out of me with an urgency that doesn’t even come close to the situation. It is as though I’m waving a flag in a frenzy announcing to the world that I have delusions of grandeur. What I say is of great importance even though it is often fragmented and random. I speak with urgency thinking that what have to say is so important that I have to be listened to right this very second and I have to tell everything to you all at once. All at once may mean that I’m going to talk at you for as long as I can unless someone stops me. Occasionally I can stop myself, but that’s usually when I see the listeners face and it registers with me that they seem to think that they’re being faced with listening to a crazy person.

I bet you didn’t know that pressured speech was such a  complicated symptom. That’s cool. It’s also a written example of me with pressured speech. <Deep breath, sigh>

Sometimes, when I’m finally taking a little break, I realize that I’m getting tired. Pressured speech can be hard work. Listeners should try to be more understanding. Don’t you think so?  <Heh>

<This is unedited and is a demonstration of pressured speech as I experience it. It may be different for another person, and it is different for me each time that I do it, which is a lot, all day long. It is meant to illustrate what people mean when they use the term “pressured speech” when talking about Bipolar Disorder.>

Bipolar Parent

Greetings friends, how are you doing in these wee hours of Friday morning?

Me? I’ve been both better and worse. Thursday had hours I enjoyed… then it crashed and burned as only the day of a parent can do.

When my three kids were young I had impressed even my ex-mother-in-law (let’s call her Kathy) with how well behaved and just good all around people my children were. Now, we are being stalked by rough and naked emotions that have always existed (that would be me, Bipolar parent) but are now beyond my own mind and have grabbed hold of my youngest.

I thought I was a good person growing up. I felt as though I were a likable person, yet I didn’t have many friends. I was lonely much of the time and kept my own company out on our small ranch with my horse, dogs, cats, chickens, pigs, cows and the occasional ducks.

I was a shit.

Seriously. I was a short, freckled shit. Today my mother and I can look years back and point to much of my careening and completely out of control behavior and emotions and say, “That, that right there!” And recognize it as full on Bipolar Disorder presenting before I even had my drivers license.

In short – I was angry all the time and blamed everyone one else for everything. My depression and anger were crushing me and the only name I could give it was – sin. I was a practicing Christian and all those “evil” emotions were clearly not of God… but that’s a topic for another time.

My youngest and his regular doctor decided that he does not have the highly genetic Bipolar brain that I’m still learning to embrace. Anxiety. Depression. Mania. Mood swings. Irrational behavior. That’s Scott, my “I’m a psych major. I already know how to deal with anger and anxiety.”

Scott is transitioning from my second daughter, Sydney, to my second son, Scott. (Incidentally my father’s name was Scott.) Scott is undergoing hormone treatment. He wasn’t always easy to talk to about things that he felt “attacked” him. Now he’s so much more difficult.

I despair.

He turns 21 this Saturday. He’s angry and bitter and is working so hard to make people not like him that I just want to sit down and breathe like I’m having a baby all the time. He and his wife are both psychology majors who it seems aren’t studying behavior.

Odd.

Scott sounds just like I did. If transitioning changes him into the sex his mind believes him to be, then I will continue to try to learn and gain deeper understanding. However, he’s a grown man (he says) and I expect him to at least respect me.

§ On Father’s Day Scott thanked me for being both his mom and his dad growing up. §

What I will not do is accept from him the same behavior at 21 that I had at 14. He has tools around him to teach him about what’s running loose in his little grey cells. Me – religion, animals, and hypnosis.

The weight of his relentless ill-will and violent anger crushed me at dinner. It was like fighting with my dad, but I was the reasoning one (yeah, no. My dad wasn’t good at being rational when angry either.)

Top the whole bloody mess off with a leaking red cherry on it and you have a self-entitled disrespecting second son.

I’m not having it anymore.

Being a parent with Bipolar is terrifying literally every second of that child’s life for me. With Scott acting like the individual (did I mention pressured speech?) that he clearly isn’t I have no clue how to even begin to help him to stop yelling into my face that I should shut up because I’m not listening.

Huh?

Parenting the twenty-something kid today is a massive challenge for this Bipolar mom. I have been charged with the crime of trying to build good family memories. I have felt despair and anger towards Scott. These are not the memories I want to build. We’re going to work this out, but I realize that I will very possibly react like I have Bipolar Disorder while we do it.

I can do this. I can figure out my part in healing our relationship. Be loving and kind… and forgiving.

However, Scott is a grown man and if he does not have Bipolar Disorder or some other explanation for his behavior, then he’d better watch out. I corralled the three of them through their teens by myself and while not properly medicated for my illness.

Respect me as your mom.

Respect my illness.

Respect yourself and get help if we just can’t talk it out.

I really wanted to go old school, like back to when I was a kid, and wash his mouth out with some nasty bar of soap like Dial or Lava and spank him with a wooden spoon. Two if the first one breaks.

Sigh….. parenting never ends, not really. My mom is still my mom. Who else would she be?

Scott, baby? YOU! It’s time for YOU to shut up and listen.