What My Med Provider Means to Me

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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}

Frankenstein – Bipolar & ADHD

Frankenstein-tumblr_ovgh5egVdd1wzx3t8o1_1280 I’m aware, that when given the chance, I will, without question, talk until the air has been sucked out of the general area and everyone has passed out. So normal.

Anxiety – After I graduated, and a few weeks had passed I could tell I was under stress from that. My anxiety has gone down. It did get better, for a while. I got to the point where I didn’t quite feel like my brain has been stuffed full of raging bees. Awesome!

ADHD – I was under the assumption that I was taking Ritalin to help me focus my attention so I could do well in my classes. I was always confused when my med provider asked me if I felt the Ritalin she was prescribing was helping me to focus better. I always said, and continue to say, “Um… I guess so.” I’m manic! What does she want me to say? I work very hard when I meet with her to sit, shut up, and answer her questions honestly. She terrifies me. What if I answer wrong and she changes my meds again? I’ll say something than think, “Crap! Why did I say that?” I always say that I guess it was working well. I suppose. Now I think that I was wrong.

More ADHD – I accepted the diagnosis of having ADHD because it was about not being able to focus on one thing at a time and I knew I couldn’t do that. But, being Bipolar was always the main objective of both my counseling sessions and appointment with the med woman.

Bipolar 1 – I assumed that my Bipolar was worse (or more dangerous to me) than ADHD could be. Wasn’t it?

You know how a doctor will sometimes leave a small tube that goes through an incision so that the area can drain and heal properly?

Yeah, I don’t know where I was going with that—

Switch – I have some ideas that I think are pretty good. I’ve done one or two or three big projects that have come out great. The other 45 ideas that are going around in my mind appeared to be stuck in orbit. I remember the video I watched on YouTube yesterday about ADHD and I was shocked. Frankenstein!

FRANKENSTEIN – I’ve come to think of Bipolar/ADHD as a Frankenstein type of symbiotic relationship. I can’t imagine why my diagnoses has always focused upon Bipolar Disorder. In counseling I talk faster and faster and cover an impressive variety of topics.

Pressured Speech (Bipolar) – Thought very little about ADHD or how to deal successfully with it. I’ve been taking medication for it for three years. In that time no one has talked to me taught me to handle it. Why not?

FRANKENSTEIN – Why hasn’t anyone explained how the two disorders interact, and how the medications for each may also affect each other. (“Do you think that the Ritalin is making your mania worse?”)

I have been primarily a mixed state, high functioning, Bipolar type 1 for years now. I always thought that my constant mental zooming about was just my amazingly stunning mania. (While I mostly talk about my being manic lately, let me just say that depression has played a big part in my mental health too.)

My daughter went with me to my last counseling appointment. We talked about my inability to stick with one thing and see it through to completion and how it was impacting her. Basically, I’m driving her bonkers. These are some of the things that I do: TALK CONSTANTLY NO MATTER WHAT WE ARE DOING, change topics as fast as I talk, pick up a pile of laundry in the living room to put it away, stopping to talk to our beta fish (Victor and Batman) and feed them a few dried wormy things and set down the laundry, forget that I had a mission with the laundry, see that the dog/cats water bowls are empty and fill them, read 1.75 pages in a book. What was I doing? Let the dog out to do her business. Hours later I discover the laundry next to the fish… you get the idea.

My new counselor, my daughter and I decided that I need to focus on being able to focus. Yes, my Bipolar mania hops it up like jet fuel in a race car, but with knowledge and tools to help me with my ADHD and settle on one thing, even for an hour, I might just begin to get a handle on my anxiety/stress and even mania.

Maybe. This is stressing me out. Bothering my daughter this bad is building an anxiety that is part of everyday life. Sigh…

Who knew that pressured speech and mania aren’t the same thing as ADHD? I really don’t understand what the hell is going on. I feel like my brain has been sewn together with blue and green colored twine and slip knots.

One final thing: It has taken me three days and four hours to type this. Just kidding. Two days. Honestly, I have no idea. I need a time-out.

Bipolar – I Think You Should Take Fewer Pills

I’m going to notify my counselor that I must be rid of my med provider as soon as it can be arranged. I’ve told Arthur, my counselor, that I don’t feel that Jamie (med provider) is working in my best interest. My next appointment with her she started right off by confronting me about what I’d told Arthur. I confessed thit it was true.

It got me no where.

She says that I’m on too many pills and she doesn’t want to add anymore. Apparently, this is her rational for not giving me medication that might actually have helped me.

I’ve been practically begging for something for my anxiety that only get’ s increasingly more consuming with each passing day

This whole school year has been like a nightmare.

She doesn’t want to give me more pills? Bull!! It is not her choice to decide whether what other doctors prescribe me for illnesses she knows even less about than I do.

She has repeatedly used this as an excuse not to give me something that could prevented me from my brake down. I have high cholesterol, my thyroid is out of whack, I have chronic horrible lower back pain, I have FM, RA, OA, a facial tick (probably stress related), PTSD, and have recently been diagnosed with IBS-d. It’s a crap load of stuff, but they have all been dealt with by someone more intelligent than she is.

I’ve asked each and every visit for something to help with the burning anxiety. She refuses. She gives me fewer chill pills.

Does she think I like taking a handful of pills twice a day? Moron.

I’ve finally had a breakdown. I blame her. In December I confessed I’d been having thoughts of harming myself. I’d hidden that for years, but at that point it was too much, and I confessed it.

She did nothing.

If I can’t trust my med provider to guard my mental wellbeing, than who will? There aren’t many options here.

I’ve started to shake, Twitter, and twitch again. I’m graduating today. My anxiety that mixes like a charm with my mania and depression making my constant mixed state even more confusing and painful. It’s too much to handle anymore.

I’m firing her. She truly doesn’t have my best interests in mind. I don’t need one of my medical professionals contributing to my madness. That’s just sick.

Bipolar – Med Provider Day

I’m unstoppable.

I’ve been trying to sleep, but it eludes me like a chicken running for its life.

I’m going to see my med provider at 10 in the morning today. I hope she listens this time. If she doesn’t I’ll be requesting someone else and informing them of why I’m choosing to under go all the stress that comes with a decision like that. I’ve had enough.

I’m going to confront her with the facts. I’ve been keeping a list of my symptoms since I saw her 30 days ago. It has grown quite long. It looks even worse than before I was being medicated.

I’m unstoppable.

My pain management guy and I had to ween me off one of the long acting pain killers I’ve been taking for a couple of years because of supply issues. I went from 100 mg twice a day to 50 mg over night because there wasn’t anymore to be found anywhere. No one knew it was going to happen so there was no helping it. It didn’t feel so great. Then we kind of gradually weened me off the rest. Now my pain level is constantly higher. Also, the torn fascia in my foot still isn’t healed. It’s painful. I got special shoes for it today. But as the compassionate woman said while I walked around and around testing shoes, my foot was going to feel soar and tired. It still is. It wasn’t fun.

All this has added to my overall stress level, as you can imagine. Withdrawal is never a good time, nor is added pain.

I’m unstoppable.

I will be thankful if my counselor, Arthur, can make it to my appointment. He said he’d try. He feels it is important for her to understand my mental state from his side of the equation. He’s been with me two previous visits.

It hasn’t helped.

I’m still choosing to be unstoppable.

I may stumble, and I may fall over and over, but this damn illness is not going to continue to run my life. I’m very ill. I’m too exhausted not to fight anymore. I feel like my life has been a waste.

I’ve had enough.

I’m unstoppable.

Help me. Or, stay out of my way.

I refuse to stop!

I’m Bipolar 1-How Much Further Must I Go?

I’m dang angry. I’ve worked my agitated ass off for three years, stumbling under the nightmares of depression and raging as anxiety unleashed tries to undo all that I’ve endured. So close. One more quarter and I’ll graduate from UWT. One more quarter and I’ll have to get a job and support myself.

Listen to me dear Reader, if you have a medical professional who won’t listen to you or thinks your complaint is in your head (duh) or is in some way not treating you with the dignity and respect that your insurance dollars demand of them… stand up and say something! You do not always need to be nice. Trust me on this one.

I learned long ago to hide much of my mental crappiness that was going on in my skull. I was super high functioning. I had kids to raise. I can play the “I’m fine, I’m a great” parent game.

But you know what? Turns out that didn’t help the “me” of today. The “me” of today STILL needs something for anxiety. Go ahead moron. Yes, you Jamie, you have ignored my pleas for something to do for me what all the hundreds of hours of counseling have been unable to do… relieve my over the top anxiety.

I’ve asked this woman for something for anxiety since the first time I saw her. You know what she did? She started lowering my Clonazapam (spelling). Every time I’ve seen her, she reduces it. “It is just one less pill. You’ll be okay.” [bitch]

I went home with 10 pills for 30 days.

She increased my Ritalin dosage and made it extended length. I didn’t ask for that. What? You want me to calm down so we can finish our 20 minutes on time? Have you dosed me so that I’ll be a good woman and let you get done with me?

Well guess what? The shits hitting this fan.

Can any of you relate? Have you felt unheard and improperly treated? Guess what? You are NOT ALONE. Not by a screaming momma long shot.

I have IBSd. I had to talk to my counselor from home. Since I was in my own I felt FREE to explain again about my anxiety and graduation and jobs and money and acting out in class because I simply cannot contain the mountain of anxiety spilling … over into my phone call.

For an hour I yelled about Jamie to my poor counselor. I accused her of having her own agenda and it didn’t include my mental health. I’m done. She either treats my anxiety when I see her next week or –

Or I will hand deliver a letter I’ve been writing about our times together to the facility director. I’m done.

I’ve worked my hardest, trying to keep hold of myself while my wild mood swings tried to prevent me from my goal – getting a college degree at 55.

This, this Jamie, she can’t seem to hear, see, understand, empathize or give a rats ass whether I self-destruct because my anxiety has paralyzed me again. I sit on the sofa and I cry because I’m terrified I’ll fail. So I don’t start. Then the panick sets in as I realize I can’t write the paper.

In the name of the oath that we have been lead to believe that those in the medical profession must swear to, treat me for my illness.

I cannot imagine going through the graduation ceremony in the Tacoma Dome with my freaking anxiety not treated.

I cannot imagine the day after graduation when I need to be looking for a job, but because Jamie didn’t treat my well documented illness I am instead sitting in the back yard vegetable garden pretending to being weeding. The problem with this scenario is that I have arthritis, and if I have sat in the garden without anyone home to help me up… I’m not going to getup. It would mean that I’d given up. It would mean that I’d be punishing myself for continuing to be the Bipolar failure that I’ve always been. (How I feel.)

And Jamie? Still with me? You could have prevented me from losing all the ground I’d worked so damn hard all these years to reach. And why? For what? From here it just seems you’re stupid. Some medical “professionals” are stupid you know. I’ve even taken my counselor with me on two occasions to verify what I tell her.

I’m done.

I’m saying Hell No! That’s enough of this irresponsible crap. You expect those of us with mental health issues to behave? Then treat us right. Hear us when we call for help. If we bring backup pay special attention. I’m trying to get my son to go with me. He’s a psychology major.

To all of you struggling to work with your own Jamie’s, you stand fast. Do not let them push you around. They’re there to serve your medical needs. Document what you talk about and when. Keep a clear record so if you need a new med provider you can state your case and prove that they aren’t listening.

One reminder though. If you’re really messed up you may not be thinking straight. No worries. You just take a family member or someone who you can trust with you.

You’re not alone.

Oh, and if you happen to be a Jamie, what’s your damn excuse?

Boob… oops, Bob!

This is my buddy, Bailey. She has figured out how to get the rest of the treat out of the Kong toy.

I started a post a few days ago. Then I left it, thinking the draft would autosave. Turns out it didn’t. Also turns out, it’s telling me now that it isn’t saving my draft. Maybe I should write this in Word… Good idea.

I’ve been busy. Too busy I think. My anxiety is still dancing with rage, but I’ve been able to let some of the excessive pressure off by telling every medical person I saw this week (four different people) about the trouble I’m having with my med provider and her unwillingness to treat my anxiety. Apparently, I’m hiding it really well. You know, not having the right mix of meds for my Bipolar sucks. Sometimes it feels like the woman isn’t trying to get it right. So frustrating!

Maybe I should start shouting at her. Is that anxiety? Or I could put a paper bag over my head. Is that anxiety? Hiding from the world? Actually, I’d have to purchase a paper bag from the grocery store because in my city they’ve  banned plastic bags. They make you bring your own bags or buy theirs. The paper ones are the cheapest. I’m always forgetting my bags so I just toss everything back into the basket then load it all into my bags when I get to the car. Nuts, right? I see lots of other people doing it too. So silly.)

I’m writing a literary analysis paper on a book about an Artificial Intelligent spaceship named Bob. Bob. That’s such a great name and so fun to say. Try it… “Bob, Bob, Booob.” Not “Boob,” “Bob!”

Have a good day everyone.

Robin

Insidious Black Box

I apologize for the length of this post. Please consider reading the entire post. It’s very important. Your life could depend upon it. (Robin)

Emotionmasks insane faces

I take two medications that I considered to have a Black Box warning. They both depress breathing. Together they can stop my breathing altogether… There are other dangers.

I have chronic pain with Bipolar Disorder and Generalized Anxiety. I am prescribed both Oxycodone and Clonazepam by two different providers. They both know that I take both medications.

I see a pain management specialist for my pain. I have for some time now. To be treated there, I have had to sign a contract that governs my behavior with regards to taking pain medications, I have to take a pee test every time I go in and they count my pills every time as well.

My med provider handles my Clonazepam prescription for anxiety. I suffer from extreme anxiety. Sometimes I feel like my brain is going to explode. Recently, this woman, who is the 4th or 5th provider I’ve had since I started going to this clinic, told me that I’m more likely to kill myself because of anxiety rather than depression. I was always told that a depressed person was more likely to commit suicide when they started to feel better. When they started feeling better, they finally would have the energy to follow through with their suicidal inclinations. Apparently, there is more to it than that.

My counselor and every med provider I’ve had is intimately aware of my massive anxiety and my inability to get it under control. We’ve tried all the counseling type of solutions including Cognitive Behavioral Therapy (talk therapy), mindfulness and other techniques. I’ve not had success with any of them.

My med provider is content for me to only take Lamotrigine, which is primarily to treat my Bipolar Disorder depression symptoms, and not to take anything other than Clonazepam for anxiety. From talking to her, it appears that this is primarily to treat the depressive symptoms that I experience. I have not been able to get any of the med providers who have treated me to give me anything for anxiety other than Clonazepam.

She, my med provider, told me at our second meeting, that people with anxiety are more likely to commit suicide than people with depression. Since I suffer primarily from anxiety, you would think someone would have warned me of this. I understand now why I feel so self-destructive while I’m exploding with anxiety.

She has told me that her goal is to get me off the Clonazepam completely. Now that I’m taking my runaway anxiety and the real chance I will kill myself because of it more seriously, I’m also taking the mix of these two medications seriously. I always have, but my frantic response to my anxiety has created a situation where I’m so afraid of what might happen if I stop taking the drug for anxiety.

I’ve always felt like I’m most insane when my anxiety is at its peak.

I understand that long-term opioid use for chronic pain is not the most effective way to treat it. I’ve wanted to find a different solution for a long time. My pain management provider doesn’t offer other alternatives than pain medications.

I normally don’t want to die. I’ve always had urges that are normally short in duration towards it, but I haven’t had times when I sit there with my bottle of Oxycodone ready to take it all. But, I could.

I’ve never told any of my mental health caregivers that I have suicidal thoughts. I know that my community does not have good facilities to treat acute mental health emergencies. I don’t want to become one of those people who is shuffled into a hospital emergency room with a guard sitting outside my little room. That’s what they do. I have first-hand knowledge of this.

So what’s the answer? Do I chance dying in my sleep? Or do I chance ending my life while I’m awake? Both are real dangers.

I’ve decided to deal with my feelings of self-destruction now. With the danger of the two medications and my new understanding the relationship between anxiety and suicide, I have promised my family that I will talk to my counselor on Wednesday when I see him. I will admit that I think about suicide. That’s a huge step for me.

I’m afraid. Admitting how I’ve been feeling for years is like admitting that I can’t control the one area of dealing with my mental health that I always felt I could say I didn’t have a problem with. I’ll finally be admitting I have no control over my depression or my anxiety in relationship to staying alive.

As I say, I don’t want to die. When my anxiety runs away I cannot always control myself. I can become violent and destructive. I break down and cannot function. I become paralyzed yet also hysterical.

Yesterday I talked to my mother and all three of my kids and admitted the truth to them. My youngest who is a psych major at the same university that I attend (so is her partner) said she had been wondering if that was a problem for me. They all agree that they would rather I call them than I call a suicide line. I’ll talk to my therapist about that.

I have tried to learn to practice mindfulness several times in the past. I never fully committed to it. Mindfulness was just part of the learning experience in one of my classes I just finished. It’s time for me to review the materials I have about it, I have lots. I need to try to learn how to harness it’s potential in earnest this time. My life depends upon it.

I have a particular fear: I’m terrified of my anxiety. I know what it does to me. I sometimes feel the insidious devil of insanity creeping through my mind trying to take over, and it literally shreds my mind.

If you have any Black Box warnings for medication yourself, please take it seriously. Now that I am self-aware of my true situation I’m ready to find a way to deal with my symptoms.

 

My main medications:

Chronic Pain – Oxycodone / Nucynta

Anxiety / PTSD – Clonazepam / Benzodiazepines

Bipolar Disorder / Depression – Lamotrigine

 

Oxycodone – Warnings

“To make sure this medicine is safe for you, tell your doctor if you have:

  • a history of drug abuse, alcohol addiction, or mental illness
  • if you use a sedative like Valium (diazepam, alprazolam, lorazepam, Ativan, Klonopin, Restoril, Tranxene, Versed, Xanax, and others)”

https://www.drugs.com/oxycodone.html

Clonazepam – Warnings

Risks from Concomitant Use with Opioids
Use of benzodiazepines, including Clonazepam, and opioids may result in profound sedation, respiratory depression, coma, and death. Because of these risks, reserve concomitant prescribing of benzodiazepines and opioids for use in patients for whom alternative treatment options are inadequate.

Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone. If a decision is made to prescribe Clonazepam concomitantly with opioids, prescribe the lowest effective dosages and minimum durations of concomitant use, and follow patients closely for signs and symptoms of respiratory depression and sedation.
(The above Warning is taken from: https://www.drugs.com/pro/clonazepam.html)
Concomitant: (synonyms: attendant, accompanying, associated, related, connected)

Lamotrigine – Warnings

To make sure lamotrigine is safe for you, tell your doctor if you have:

  • A history of depression or suicidal thoughts or actions
  • Some people have thoughts about suicide while taking this medicine. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

https://www.drugs.com/mtm/lamotrigine.html

Nucynta – Side Effects for Health Care Professionals

Psychiatric – Common (1% to 10%): Insomnia, confusion, abnormal dreams, anxiety, depression, irritability, nervousness, drug withdrawal syndrome, restlessness, sleep disorder, hallucination, depressed mood.
https://www.drugs.com/sfx/nucynta-side-effects.html

 

Benzodiazepines

Benzodiazepines may be used in the treatment of anxiety, panic disorder, seizures, or sleep disorders.
https://www.drugs.com/drug-class/benzodiazepines.html

 

Bipolar – Tick Crisis!

tics7089581_sThe last month has been a horror. I’ve developed my facial tick again and nothing we’ve done has slowed its march to make it so bad that I can’t have a conversation. In my classes at University I’m usually very outgoing and participate in class a lot. With this disability, and yes, that’s how I think of it, I can’t talk and participate with the others. It just kills me to just sit there. Sometimes I choose something short to say and I raise my hand and try to say it. My courage is met with stuttering, ticking and humiliation.

On the 10th I went to the ER because it was so bad that I couldn’t be understood when I talked. My eldest thankfully happened to have time to take me in. It was good because she had to translate for me at times. The doctors took me off my last added medication and prescribed me to take Lorazepam. The problem with that is I can’t take the Lorazepam if I plan on functioning. I have classes five days a week and two of those days are in the morning and in the afternoon so I couldn’t just come home and take it. So, it didn’t work. The ER wanted me to see my MD within 3 days of my visit to the ER. I tried, but my MD said that the ER always said that and that it wasn’t necessary. I disagreed. I was still ticking at a 7 out of 10 in intensity. It was a nightmare.

I finally got in to see him. He was of no help. He rudely informed me that it was probably permanent and was caused, he felt, by my Latuda, which I’ve been successfully taking for some time now. He also told me he wasn’t going to prescribe me anything new because he didn’t want me to go to the ER again for it because it would get him black listed at the hospital. I don’t know if he meant that there was a real black list, but he acted as though there was.

I asked to see a neurologist. After some maneuvering he agreed and picked a random one out of the directory and sent the referral through. I don’t think he thought that a neurologist would be of any help. Then he prescribed one of the medications I’d already tried for the tick. The problem with that is I’ve lost track of which medication caused which reaction or positive outcome.

I got ahold of the neurologist on my own and they could tell I was in crisis and tried to get me in earlier than the July dates that were for new patients right now. The helpful lady called me back the next day and sadly told me that they refer ticks to the mental health people and would I like their number? I told her I had it already. She was nice.

I had an appointment with my counselor this morning. Unfortunately, I locked myself out of my house and out of my car. I texted my eldest daughter and begged for help. She left class early and came to my rescue. I did happen to have some homework with me so I spent my time waiting for her doing that.

When I got back inside I called my counselor and got through! I asked her if we could do the appointment on the phone. She was great and agreed. My tick was at about a 5 for most of the visit although sometimes it got worse. She listened to what I’ve just recounted to you of my last few days and weeks and said I need to talk to my med provider ASAP. She put me on hold and went looking for her. Amazingly she found her and she was free so we stopped our conversation short and I waited for Sara, my med provider, to call me momentarily.

The call from Sara came right away. I went over all the stuff again and through asking questions about what new prescriptions I’ve started taking in the last month. I started a medication for restless legs (which worked!) and Lyrica. She has me discontinuing the Lyrica (which is funny because we’ve been fighting with my insurance for months to get it approved) and the last med that my MD had me start taking for the tick. Then she did some research and found out that indeed Lyrica can cause the tick and so can Latuda, which I’ve been taking for some time. Now were stopping the Latuda. I’ve just gone from 120mg to 80mg tonight. Last time we tried to lower my Latuda was during the Christmas holiday and it didn’t go well. Instead of being well medicated and under control, I began to have violent emotions and lashing out at my loving family. It didn’t feel great. But here we are, trying it again. I’m going to have to watch myself.

So now were taking action. I feel better about it. I see Sara on the 11th I think. We’ll reevaluate my condition at that time. She’s not happy with the way this has been handled. The ER should have referred me to my med provider, not my MD.  My MD couldn’t give a shit. I’m looking for a new one. Around here it’s really hard to find new ones. New patient appointments have waiting lists going out months. It’s frustrating.

I’m a communicator. It’s what I do. I am fully involved in all my classes. I can’t do that right now. It drives me crazy. Sometimes I raise my hand thinking I’m going to say something brief. Unfortunately, it turns into a long ordeal as I stutter and tick my way through what I want to say. Sometimes the friend I sit with tries to finish talking for me. It’s embarrassing. I know there’s nothing to be embarrass about. It isn’t my fault I can’t control my mouth. Thankfully I can control the content of what I want to say.

I’ve been using my situation to really make sure that what I want to say will really be helpful or ask a really good question.

My kids have been good about it. They laugh at me when it gets really bad. I’m glad. I can’t take it too seriously (though god knows it is). They help me keep my chin up. And, thankfully, they translate for me. Seriously. Even when I’m just talking to them they have to finish my sentences for me (when I’m at a 7 or higher). I’m thankful for my kids, my mom and my brother for their patience in waiting for me to struggle through a conversation.

So, maybe the next few days will be better. I’m not going to class tomorrow. I’m going to work on calming down. I need the time to rebound and relax. I have a ton of homework to do so I’m going to give myself the time to do it. Lowering my stress can only help my situation.

If you find yourself in a similar situation remember that freaking out doesn’t help. Well, doesn’t help much. Sometimes you get like I did and can’t talk at all and they take you seriously. But, in general, it’s best to persevere and keep bugging people, doing research, calling anyone you can think of till you find the right person to talk to. Now, I hope it works.

Tonight, as with the last two nights, I’m up late with back problems. It’s like all the nerves in my lower back are firing at the same time. I can only describe it as sever lower back pain. I take Oxycodone for that. You’d think that would help my tick and the stress associated with it. Nope. Nada. Zilch.

Sighing…. This tick seems like such a waste of time. I was thinking of getting a summer job, but that will never happen with this tick.

I’ll let you know what happens next. I’m afraid of myself. I’m afraid my Bipolar is going to come raging back like it was in the past and torment me. Hopefully I can use the tools I’ve learned since my last crash to keep me from going into crisis but you know, if it’s going to come, it’s going to come. I can’t stop it. But I can combat it.

So here we go, on my first day with my Lyrica gone and my Latuda going down. I have to admit, I’m more than a little scared. What if I flip out? What happens if the tick becomes permanent? What if? What if? What if? What if I get better?

My back is feeling better now. I’ve sat on ice and now the heating pad. Time to try to go to sleep again. Good night my friends. May you be able to speak your mind wisely and with confidence.

Bipolar – Danger Signs

solar-flare-1Now that I’m taking 120mg of Latuda again I can consider the signs I was having that I was going into a crisis. I believe it’s important for me, for everyone, to know what happens before we reach a full-blown disaster so we can take precautions and get help early. That said, I recognize that it is often difficult if not impossible to tell when we’re slipping. It’s like standing on a beach when the tide is out. You’re talking to a friend or looking at the beautiful water or a sunset. You’re not paying any attention to your feet, which is unfortunate, because your feet have been slowly sinking into the sand. Now, when you try to move, your feet stick and you fall on your face because you didn’t realize what had been happening while you weren’t paying attention.

The biggest sign that I’m crashing is that I lose my temper violently and in an instant. Most of my life I have been consumed with anger and ill temper. It has kept me from getting to know my family. My father, who is gone now, was as bad tempered and mean with me as I was with him. We reacted to each other like lighter fluid on a bonfire. I believe that he also suffered from Bipolar Disorder.

In addition to a catastrophically hellish temper I was angry all the time. I don’t mean mad. I mean angry like I wanted to hurt someone. My adrenaline was (and is) on all the time. To this day my muscles are hard as rock, cocked as if to lunge into flight or fight. Even after a massage my musculature remains as solid as steel. I never relax.

Over the years I’ve taken medications that cause my face, my jaw in particular, to violently jerk and I can’t talk. I look like I’ve got a massive tick in my face and I sound like I’m hiccupping. Now, when I’m stressed, the tick comes back. As a matter of fact, I’ve been having it happen daily now even during Christmas vacation when I don’t have the pressures of school work. It really frustrates me. It’s so remarkable that people stop talking and stare at my face. It stops conversation dead.

So this time, when my temper soared uncontrollably and I saw my family react to my words as though they’d been slapped, I realized I was in trouble. I thought I was just feeling my temper returning. I felt like I was keeping it under control. I didn’t realize others noticed it until we were celebrating Christmas Day at my brother’s house and I was talking to my daughter and her fiancée when suddenly Sydney stopped short and looked at me as though I’d just stabbed her. I shut my mouth fast. I knew I was in trouble. I had to stop myself from talking the rest of the day unless I was paying attention to what I was saying and how I was saying it.

My med provider and I had a backup plan in place incase reducing my Latuda to 80mg didn’t work. I was to return to the 120mg dosage immediately. So that’s what I did. I couldn’t wait until I was able to get back in to see her in three more weeks. I’m feeling much less volatile now.

I know it is rarely as easy a fix as returning to a medication that I already know works for me. It’s never that easy. This time was an exception for which I am grateful.

We, you and I, impact those around us. Our behavior doesn’t happen in a vacuum. We have a responsibility to control our behavior for our own health and for our family and friends. It’s funny that I say we need to control ourselves because that’s exactly what I’ve never been able to do. Not till I got well medicated.

The take away – be vigilant for signs of crashing. Then take action swiftly.

Bipolar – Hidden Emotions

After months of not really feeling anything accept sever anxiety, my emotions are waking up again. I’m hoping that all the months of counseling have prepared me for my feelings, my moods.

I took a poetry class this last quarter. I had a difficult time writing the poetry because my emotions were packed away in a closet inside my brain. I wrote very clinically, very much cerebral and didn’t feel inspired or moved at all.

I’m enrolled in the disability program at the college and one of the things I get is time and a half for exams. Of course there aren’t exams in poetry, but the first quarter that I had this professor with I’d gone in and went over my disability papers with her and explained about how this was my first year back to college and I that was having a hard time. I took a chance and told her about my having Bipolar. I haven’t really thought it was necessary to tell my other professors what my disability is, but I felt like I was connecting with this professor and I also felt like I would be able to come and her and talk if I needed to.

I talked to her about how my BP was affecting my writing and she suggested I read “Touched with Fire” by Kay Redfield Jamison to see how many artistic people have mental illness (especially Bipolar Disorder). Funny thing was, I have read it. I’ve spent so much time in it that the pages have come off the spine of the book and nearly every page has notes and things underlined in it. It is in such bad shape that I purchased another copy so I could read it again. This is one of those books I bought in paper back and not as an eBook. If I have a book I want to markup I always get it in print. It’s just easier for me to make notes and find things in.

The first thing I encountered in Jamison’s book was a through recounting of all the symptoms having to do with Bipolar Disorder. Having been only anxious and not having mood swings for a few months per se, I was shocked as I remembered all the emotions that are currently hiding behind my medications.

I’m glad that I read what the symptoms are again because of the fact that we’ve lowered my Latuda and I need to be on the watch for symptoms to return. I have to admit, I’m worried now. I forgot how bad it has been for me. I rate on the top of the Bipolar Disorder Type 1, but I’m also high functioning so I’ve been able to hide it from most people. At least I think I have. Who really knows what others think of us when we’re in the midst of an active outburst of violent emotions.

So here I go, with an intentionally lowered mood stabilizer, and me waiting to see if any of my old enemies come sauntering out of the closet. I must remember not to hold my breath.