Mood chart/Bipolar

After probably 4 years, this morning I figured out how to hook up my printer to my laptop. Fucking genius.

A couple of months ago my therapist – D – asked me if I thought I could be bipolar. Me? Bipolar? Why the fuck are you asking me?

So, like any good medical professional err… mental, I set out to do some research, examine the diagnostic criteria for bipolar, look at my history, and, of course, self-diagnose.

Bipolar disorder is a brain disorder characterized by unusual shifts in mood, energy, activity levels, and day to day functioning. Symptoms flow or fluctuate along a continuum between mania, hypomania, cyclothymia, and depression +/- psychosis.

Depression:
Since my illness began I have always believed that my only symptoms have been depressive in nature. No doubts, no questions. I usually had/have every or almost every symptom listed for depression. When asked if I had ever been manic the answer was, until very recently, always no. But on closer inspection, I find a few familiar descriptions of mood and behavior.

Mania/Hypomania:
Impaired memory, restlessness, increased energy, distractibility, decreased sleep but not necessarily a decreased need for sleep, music loops running constantly in my head, rapid, “bouncing” thoughts, lots of ideas and plans, impulsivity, substance use and feeling like I can do anything I set my mind to.

Cyclothymia:
I don’t know.

What I want to know is how do I tell the difference between hypomania/cyclothymia and being normal? Being normally content, active and productive? When does it slip into pathology?

Psychosis:
Call it what you like but Wolf is real, he talks to me and has caused bad things to happen. I’ve seen him.

So…I think I could be convinced that I am bipolar. Apparently, many people with bipolar disorder who never have a “true manic episode” are misdiagnosed with major depressive disorder. If I am, then I believe I am a rapid cycler. Last week I experienced 3 days of unfamiliar energy, I made long lists of things I wanted to research, check out, do. I shared unsolicited “wisdom” with random and familiar people. I could do 3 things at once. Then on the 4th day I crashed. Back into my familiar sad existence.

This morning I printed out a daily mood chart. I am going to try and fill it out daily for a month, maybe longer. It should force me to look more closely at my life and moods and maybe i’ll learn something new.

Last week my therapist mentioned mania and bipolar in the same sentence – about me. Maybe the little bastard is right.

Doc.

Visiting with family

My therapists’ parting words this week were – “Have as good a week as you can.” Translation – You’re fucked up. You know it and I know it.

I just got back from 4 days visiting with my mom and step-father. He’s 85 with dementia and she’s 76 with a newly discovered lung mass, probably cancer. He relies almost totally on her and she’s recovering from a repeat total hip replacement. My mom has been steadily losing weight over the last year or two, claiming she’s “just not hungry.” I calculated her BMI at 16.2 with being underweight at 18.5 or less. She looks like a walking skeleton. I’m feeling very guilty because I could see it happening but I deferred to her right to choose and manage her own life without me butting in. Now she’s facing possible major thoracic surgery +/- follow up chemo. and she has no reserves, nothing.

When I mentioned her body condition to my therapist, he questioned whether she is/has been depressed. I think I can remember not too long ago that she did express some depressive feelings. So, now, i’m feeling even more guilty because I of all people should have recognized it and suggested she considered talking to someone about her feelings. So, today I wrote a letter to her GP requesting he refer her to a registered dietician for an explicit meal and treatment plan. I also suggested a behavioral consult to address any underlying depression and a possible eating disorder. I also told him that I was concerned that her weight loss had not been addressed more aggressively until now. I feel a little less guilty but, she will kill me if she finds out (I think). I bet her GP rats me out. She certainly has good reasons to be depressed and has a lot of shit coming her way.

My brother was also there from W.Va. He is, to be honest – “difficult.” To be blunt, he is a self-righteous, know-it-all, control freak. God, I hope he never reads this. I love him dearly but right now my head is not in a good place to deal with him and my mom. He never shuts up and at one point I had to stab him with a fork to get him to shut up and fuck off.

She had a reasonable honey-do list which my brother and I worked on together. But by day two I could feel my mood slipping and despite a generous supply of good pot, I knew that if I didn’t escape soon that I would start screaming. There are likely bad times ahead and I need to find a way to get and keep it together for them.

Doc.

C.M.I.C.

I decided recently that I would treat myself to a usually forbidden goody for my birthday. So, once I woke up sufficiently today I took the typically dreaded steps to get dressed, drive to the store, and engage people. I had one thing on my list – Chunky Monkey ice cream (CMIC). It is, without doubt, my favorite. Banana ice cream(mmm), chocolate chunks(big ones), and walnuts(right?)
Being Sunday(after church and before NFL football) the place was packed and the checkout lines were long. Too many people. No matter, I kept saying. Just get the ice cream and GTFO. Unfortunately (or fortunately as I would have eaten the entire pint at one time) they didn’t have Chunky Monkey.
As I wandered through the store, dodging people, I found myself in the seafood dept. Could it be? Salvation. I noticed the lobster tank. So… I got me a 2 pound male. Yea, baby. I also got a lemon and some butter.
At checkout, when the cashier asked me if I had found everything I had wanted, I resisted the urge to scream “there’s no fucking Chunky Monkey ice cream!” and instead put on my sane face and said “Yup”.
So, sadly, no CMIC. But there is a lemony, buttery lobster with my name on it.
Yup, this will do.
Doc

Gains and Losses

In 1993 I graduated with honors from vet. school at Virginia Tech in Blacksburg, Va.  I enjoyed and thrived in the academic arena and was eager to start my new career after 13 years as a critical care nurse.  During graduation, I was approached and offered an entry level job as an associate veterinarian in private practice.  Incredibly, the job was in the county where my parents grew up and where my extended family lived.  I was thrilled and relieved to have found my first job so easily.  Really no work on my part, just say yes and move back to home base.

Over the years I learned how to be a good vet. and about 10 years ago I took over the role of chief of staff after the practice owner retired and sold the practice to a veterinary corporation.  My staff consisted of two other vets., nine vet. techs, and four receptionists.  I was happy.  We did good work and enjoyed each others’ company greatly.  We were successful and well thought of.  And we were friends.

 When my closest companion, my dog W, died in 2008 I became ill for the first time.  It’s hard to remember all that happened during this time, but I eventually sought psychiatric help in 2009.  I was initially diagnosed with BPD (likely secondary to the self harm), and my diagnosis eventually changed to MDD.  I started anti-depressants and talk therapy.  But it didn’t help me and I was eventually hospitalized with a suicide attempt in Dec. 2009 for meds. and ECT. 

Initially, my corporate managers were encouraging and assured me that my job was secure – “just concentrate on getting well.”  I did try to heal but on my second hospitalization in June 2010 a shift occurred in their “compassion” and while hospitalized I received a letter informing me that, unfortunately, my job was no longer mine and I was dismissed.

Two and a half months later I was discharged to face a frightening and confusing future.  Jobless and on my own.  As my depression deepened I slowly withdrew into my own space and my world collapsed and shrank smaller and smaller.

To their credit, my former friends and colleagues tried to maintain contact and periodically extended invitations to me to socialize – a wedding, an outing to go bowling, drinks and a meal.  During this time I continued to worsen despite a variety of meds, a couple more admissions and several courses of ECT.  As I continued to decline, I found interacting with my peers too difficult to maintain.  Not surprisingly, their offers of kindness and support began to evaporate.

Now, four years later, the only people I talk to are my immediate family and my therapist.  I haven’t worked a day and because of memory loss issues after repeated ECTs I came to realize that I was no longer safe to practice medicine.  During the last few years I have kept my veterinary license current and could legally go back to work at any time – stupid pipe dreams.

Like many other people with mental health issues I really believed that one day I would/could return to work.  My family and therapists have expressed theirs beliefs that I could work if I wanted  to.  But they don’t know how much of my mind and intellect I have lost.  I know that the longer I am away, the farther away I am from any chance of returning to my former life.  

I, of course, know that I have failed.  Failed to be strong enough in the first place, failed to bounce back, failed at therapy, failed to improve despite treatment, failed to meet life’s challenges.  I am on Social Security disability and despite efforts on my therapist’s part to get me out and “doing something”, my failures have lead to my world shrinking away.  Depression – you are a heartless bitch.

Today I received some innocuous literature in the mail for a veterinary conference.  I was struck with the realization that this is no longer my life.  I won’t be going back.

My therapist said recently – “You may not get your old life back, but you can have a new one.”  I know better, it’s over.

So, what have i gained because of my illness?

*  I have gained first hand experience of the mental health world – so very odd and artificial and confusing.  Experience of hospitals, medications, ECT, psychiatrists, and therapy.

*  I have learned about expectations – of others, of myself.  I have learned about failure.

*  I have learned that other people, while good intentioned, can only wait and watch while you eventually fall further into the hole.

*  I have always loved medicine and I have now gained the knowledge that that world is no longer open to me.

*  I have learned that despite all the time, money, effort, and patience I have spent on recovering my life that I am forever changed.

*  I have discovered that I am not strong enough or clever enough to beat this.

*  I have learned that wanting is not enough.

*  I have gained an appreciation for British comedies and Bugs Bunny cartoons.

*  I have learned that I alone am responsible for myself and that I can no longer expect any real changes.  I can’t see my life becoming anything different.

*  I learned that sleep is not a guarantee.

*  I learned that the occasional squirrel will eventually trust you enough to take peanuts from your hand.

*  I learned new and brutal ways to self harm.

*  I learned that overdoses don’t reliably kill.

*  I learned that psychiatrists don’t want anything to do with you if you won’t take their drugs – “don’t come back.”  They don’t talk to people anymore and don’t seem to want to get to know you.

What have I lost?

*  I lost my sense of belonging in this world.  My chosen role.

*  I lost my ability to think critically and rely on my mind.

*  I lost the respect of my colleagues, my family, and myself.

*  I lost my friends.

*  I lost my financial security.  Disability provides about one-quarter of my former income.  I was stripped of my sense of personal accountability – Social Security determined that I was incapable of handling my own finances and forces me to send my monthly bills onto my sister who, alone, has access to my account.  (Thanks so much, sis.)  

*  I have lost my sense of humor.

*  I have lost my way and I have lost my life.

Doc. 

 

*  

Cookies

Today I was sitting on the carport steps smoking when I heard someone knocking on a door a few houses down the street. There were two middle schoolers, girls, which I decided were Girl Scouts selling Girl Scout cookies.  Score!  I could do me some Samoas.

No one was home at the first house and they walked to another – no answer and a third – same.  Then one of the girls walked into the street and looked right at me.  Then they both turned around and went the other way.

Okay.

And then I remembered.  They probably saw or heard about me being removed from my house by sheriff deputies and “escorted” to the local ER for a psych. evaluation a while back.  Two neighbor girls did walk by just as I was lead to the waiting patrol car (in handcuffs) and you know how girls talk.

Aha…fame at last. 

But no cookies.

Doc.