New Black Box Warnings: FDA

I have a hell of a toothache.  A couple of months ago I broke a tooth, and went to a franchise-type dentist who took emergency cases.  One of the down sides of being a professional vagrant is I don’t have a regular dentist. 

For a little over $1000 I walked out with a new crown and instructions to call if I had any problems.

I did have a problem, before I even left the office.

I felt that I should have had a root canal before the crown went on.  I know my teeth.  They are ornery, pesky things.  They operate in strict accordance with Murphy’s Law:  anything that can go wrong, will go wrong. 

The dentist assured me that the nerve looked fine, and he hated to mess up a basically healthy tooth.

A couple days later, the thing started hurting like a sonovabitch.  I called the dentist, who immediately assumed I was a drug seeker and blew me off, saying that it might take a few weeks to settle down.

It hasn’t.  In fact, it’s getting worse.  Now I have to look for a dentist who will…but wait, it’s Labor Day Weekend!  No dentist till next week, when I have to run up to Michigan to get some warrantee work done on the old brand new RV.  Maybe I’ll find a dentist there, with a lot of luck.

So, in order to buy some time and have at least a few hours out of misery, I took two of my hoarded tramadol tabs.  Now I have maybe 20 left.

Then I opened my email, to find a bulletin regarding a new FDA policy, intended to protect ourselves from ourselves:  black box warnings on both opioids and benzodiazepines, warning that they must not…Black Box MUST NOT…be taken together, because of the potential of respiratory depression leading to death.

A Black Box warning is the strongest labeling there is.  This means that in a time when even being prescribed pain medicine is becoming a remote possibility, those of us who take benzos for anxiety disorders and/or movement disorders, seizure disorders, or insomnia, will have an even more difficult time obtaining effective pain management.  Doctors who prescribe both meds at the same time will open themselves up for censure and lawsuits.  Pharmacists are being given increasing power to simply refuse to fill prescriptions.  They don’t have to, and if the FDA issues black box warnings, they are fully within their rights to refuse to fill prescription A if the patient is known to be taking prescription B.  In fact, if they do fill it and the patient has an adverse effect, the pharmacist is liable, can lose their license, and can be sued.

This is of direct concern to me.  My neurosychiatrist, who unfortunately has retired due to failed back surgery, hammered out a drug cocktail during the course of our 12 year clinical relationship, that effectively treats my bipolar, PTSD, and social phobia.  It includes 3 types of benzos.  All at once.

It also helps with the muscle spasms that cripple me day and night.

Now I fear that when my prescriptions run low, I won’t be able to find anyone to prescribe these lifesaving medicines because they are “too much.”

Worse, the degeneration of my spine is getting to a critical point.  One of the bones in my neck is rotating in such a way that it is pressing against my spinal cord.  I’m going to need surgery soon.  Major surgery, to fuse three of my cervical vertebrae and lift them up off the nerves they’re pressing on.

I won’t describe the surgery, because it makes me sick even to think about it.  I’ll just say that it involves lots of chopping up bone and remodeling.  Very, very painful stuff.

So…in today’s anti-pain med climate, what’ll it be?  Black Box Warning ahead!  Do I get to continue my benzo regimen so I can maintain a semblance of normalcy, and not be a hypervigilant mess, or do I get a modicum of pain relief after having this spinal carpentry fest?  Do I have any say in this matter?

Last time I had spine surgery, I got sent home with zero pain meds.  None.  And that was in 1987!

Why on earth did this happen?

Because I happened to joke to the pre-op nurse who was taking down my then very short med list (one med!) that I took Xanax for the three days before my periods, and that I was addicted to not having PMS.  She wrote down that I was addicted to Xanax!  It was recorded in my chart that I had admitted to being a drug addict.  So when I called the hospital to ask for some kind of postoperative pain relief, the neurosurgery intern scolded me about being a drug addict seeking drugs.  No pain meds.  And that was a relatively minor procedure, compared to the one I’m facing.

I really don’t know what to do.  Sometimes I wish I’d just die in my sleep, so I wouldn’t have to face this surgery and the prospect of being helpless, in agony, without the possibility of comfort.

Antiepileptic Drug Suspected of Causing Psychosis

http://m.brain.oxfordjournals.org/content/early/2016/08/07/brain.aww196

There has been much discussion in the bipolar blogging community regarding the pros and cons of different medications in our treatment regimens.  We wonder whether our symptoms are caused by our brains…or maybe, and this terrifies me…from the drugs we take to pacify our unruly grey matter.

The debate has largely focused on the role of antipsychotics.  Many people find their bipolar symptoms are not controlled by certain drugs: but when they try to discontinue, their symptoms rebound, or they even develop symptoms they didn’t have before, like auditory or other sensory hallucinations, tremors, and so on.

I had been skeptical of the extreme descriptions I’ve been reading, of people literally crippled by psychotic symptoms after even a very slow wean from certain drugs.  After all, how could antipsychotics CAUSE psychosis…could it be, thought I, that these people were simply experiencing a resurgence of their own “native” psychosis upon withdrawal of the “anti”?

This study, which focuses on psychosis caused by, or by withdrawing from, certain antiepileptic drugs, has literally changed my mind.  I’m now thinking about the way the brain is able to change the way it functions in its environment.  We bathe it in a substance; it learns to use and depend upon that substance for everyday function.

Sometimes, in the presence of a substance that is supposed to do one thing, our brain rebels and does something else.

This might explain why a person with temporal lobe epilepsy, as represented in the article, given a certain antiepileptic drug, might go ahead and have sensory hallucinations. 

I’m not going to stop taking my lamotrigine (an antiepileptic), because it really does help me feel better.  But this article did give me pause, since I also have temporal lobe epilepsy that causes sensory hallucinations.

Jeekers crow, I sure don’t want to have my days and nights haunted by the smell of baked goods burning in the oven, which is my main sensory hallucination.  It’s damned hard to sleep when your brain is tugging at you yelling “Get up, asshole, and take those cinnamon buns out of the oven before they’re ruined and the house burns down!”  Never mind that I don’t eat baked goods and don’t even have a house, much less an oven.  Stupid brain just goes on and on. 

Combine that with the constant intrusive music that isn’t there, and the bouts of disabling paranoia…I’ll take my chances with my  L&L cocktail (lithium and lamotrigine).

Just not that other stuff, which you will find in the linked article.  I encourage you to read it for yourself, and please do comment here!  I have some private thoughts, which I’m sure will spill over into the comments somewhere.  But I want to hear what all y’all are thinking about these critical issues of what we are putting into our nervous systems.

Tired Puppy

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We had a big day today and both of us are beat.  However, if you look at the above photo you will see two squiggly lines.  The red one on the right points to Atina’s “squirrel.”  She has to have it in order to sleep.

The blue line on the left points to my foot.  She is using it for a pillow.  This means that I cannot move, or else I will wake up Sleeping Beauty and then what would happen?

What I want to know is why I get all excited about some new Bipolar management strategy that’s working, and immediately get rid of one of my drugs.  I do that frequently, and frequently pay the price.

For instance, I just started Clonidine for my blood pressure, and it has the side effect of relaxation.  I was getting over-sedated from the benzos I take plus the Clonidine, so I decided to start weaning on the benzos because I hate them anyway.

So after a couple of nights of half doses, last night I skipped the lorazepam entirely.

All well and good, I fell asleep just fine.  But it turns out the Clonidine has a very short duration of action, so I found myself irritability awake and looking for someone to kill at 4:30 in the morning.  Well, the only person I found at that time of the a.m. was me, so I lay in bed till it got light, and then I remembered that someone did me the favor of stealing all my camp furniture yesterday.  Kill!  Kill!!  But I had to wait till the office opened, so I guzzled coffee and planned my angle of attack.

It didn’t work any better than the last time I got robbed in that particular campground, which unfortunately has many advantages, which is why I stay there a lot. 

Last time, someone stole my one good pair of chinos and six pairs of blue Smartwool socks, only a couple of years old.  Fuck, fuck, fuck.  That was the find of a lifetime, Smartwool socks in the most lovely shade of blue.  I guess somebody else thought that too.

I told the incredibly rude cunt bitch fuckhead office person about it, and she just sneered at me, so I asked to see the manager, who was very nice and promised to look into it for me but I doubt she will.

I don’t know why, but the office staff all treat me like I have leprosy even though I’ve been paying to stay there intermittently since February.  I stay there when it’s really cold so I can plug in my little electric heater instead of using the propane furnace, which makes these unholy clicking noises all night.  I don’t think I do anything weirder than any of the other weird campers.  I don’t even allow myself to go around having a running conversation with myself like I normally do.  I think they’re all afraid of my dog, who wouldn’t even bite them unless they threatened me, which is one of the reasons I have her.  The other reason is that she’s sweet, sweet, sweet.  Maybe I’m creepy without knowing it.  Oh well, I’m paying them, and all they have to do is take my money, so I get to be myself.  But I miss my camp furniture and socks.

Tonight I’m in a way over my head expensive and chic campground that is far too near Sedona, which is why.  That’s OK though, because tomorrow I’m off to the Mogollon Rim.  I’ll explain more about that later.  I can’t look down to write anymore tonight.  My neck is killing me. 

Miss Biggess Doggess Has A New Toy!

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Flagstaff loves me.  The ball of yarn keeps getting bigger and bigger: that is to say, I am becoming more and more deeply involved with the workings of this tiny city that perches on the Coconino Plateau, at 7,000 feet above sea level, nestled among a flock of young volcanoes.

After my thirty-first medical provider visit this month, I was overcome by a sensation that something was lacking.

For one thing, I was drained to the tips of my finger and toenails from my appointment with the new Family Practice Nurse Practitioner.  I hate to think how drained she must have felt!

The purpose of this appointment was allegedly to seek a solution to my stubborn high blood pressure.  High blood pressure is bad.  It damages one’s kidneys, causes strokes and heart damage, eye damage, and basically messes you up, usually without any symptoms at all.

Having symptoms, like headaches and blurred vision, means the high blood pressure is getting to one’s brain.

God knows, I don’t need any more brain damage, so when I realized that my permanent headache and inability to read the Louis L’Amour paperback borrowed from the campground laundry room because my vision was blurry might just be high blood pressure symptoms, I went to the Walgreens and bought a fancy blood pressure machine.

The first time I tried it out, the damn thing read 165/106 (normal is about 120/75).  I ran it a couple more times and it said approximately the same thing.  I didn’t like that at all, so after a couple of hours on the phone I got the soonest primary care appointment available, which was two weeks away.  In between times I did all the things one is supposed to do to lower blood pressure, like exercise, breathing, meditation, cuddling with one’s Doggess, and fiddling with medication doses.  And hoping like hell that nothing bad would happen.

Last night my BP was dangerously high, so I took a rather large dose of my medication (don’t try this unless you’re medically qualified), and my usual dose this morning.  My BP in the office was perfectly normal, so of course I felt like a fool.

To make matters worse, I disclosed all of my psychiatric diagnoses and their respective meditations, and the NP completely unraveled.  Poor thing, who can blame her?

To her credit, she did a great job of picking out a team of specialists to help figure out what in the hell is wrong with my immune system and nervous system and skin, and whether all these are part of the same problem, or whether they are separate problems.  As for my blood pressure, she told me to keep doing whatever I did to bring it down, and gave me a script for more of that particular medicine.

Driving back from that exhausting appointment, I spied a grocery-store-cum-gas-station I’d seen before but never stopped at, because it looked down-at-heel and sad, like one of those discount groceries that appear and disappear in a matter of days like mushrooms after a good rain.  Today I needed gas, though, and the price was right, so I waited in line till a pump opened up.

After filling my gas tank, my mind returned to my own stomach.  The grocery had a Starbucks logo on the wall.  Hmmm, a green tea soy latte might perk me up!  I went in.

Have you ever had the experience of going into a drab, shabby building, and finding the inside bright, beautiful, and full of your favorite fresh fruits, veggies, and gluten free foods?  Heaven.  I got my green tea soy latte and headed for the aisles.

Half an hour into the orgy I came to the pet stuff aisle and was struck by a largish wave of guilt, since Atina had spent most of her day in the van, while I was enjoying my medical appointment and now shopping my heart out; therefore, I sprung for the $8 on sale “un-stuffed” furry critter with a squeaker at its head and tail.

I paid for my order (Jeezus Kreezus, $120 for those few things?  And this isn’t even Whole Foods!) and hauled my cart out to the van with my one good hand.  Atina glared at me from her spot on the bed.  She had good reason to be sick of being locked up!

The moment I cut the tag off the new Critter and threw it at her, all was forgotten.

She caught it.  It squeaked!  Just like the squirrels that taunt her all day around here would do if she could ever get her pearly whites on one!

Since then, the Critter has been relentlessly shaken, chewed, squeaked (my ears, my head!), and is sodden with Doggess spit.  Now she sleeps, worn out with worrying the new Critter to death.

The best $8 I’ve ever spent.

Today Is Another Day: Rapid Cycling

As you may remember, yesterday I was painting my toenails in the middle of the night.

Alas, that was not to last.  I woke up this morning with a feeling of dread in the pit of my stomach.

After I finally went to sleep last night, with the aid of more Seroquel, I woke up a bunch of times because my arms were numb and tingling.

Fuck, you know, this has been going on in one form or another for several years.   I’ve been writing it off as probably due to my arthritic collar bone, but this is different.

My medical experience gives me all kinds of terrible fears.  MS is the main one these days.

I remember the day in medical school when they taught us all the bad things that can possibly happen to breasts.

My then-husband came home to find me huddled in the bed hysterically crying.

“What’s wrong?” he asks.

“My breasts!  They’re a ticking time bomb!  I want them off right now!”

“There there,” he said, not knowing what else to say.

The next day I ran to the Student Gynecology Service to get a pre-operative exam.  The kind Nurse Midwife examined me and assured me that at the moment my breasts were not explosive, and offered to re-check them whenever I started feeling breast-anxious.

I felt rather foolish, but relieved that at the age of 29, nothing was wrong with my breasts.

Why do I make these digressions when I’m depressed?

Maybe it’s because I don’t really want to engage with the depression.  I know it will pass, and something else will take its place, but when it’s on me, it’s literally on me, and all over me, and in me, and I can’t shake it off.  All that happens is I start crying and feeling like someone is trying to rip out my guts, and doing a pretty good job at it.

Then it passes, just as quickly as it came.  What follows might be a period of “normality,” meaning, neither hot nor cold, and this is heavenly.  But it never lasts.

Hypomania, or frank mania with psychosis, tends to raise its ugly head at night, about bedtime; which for me is at 9 pm because my meds take 12 hours to wear off.  Actually they take 13 hours, but that is an embarrassing amount of time to sleep, so I actually set an alarm for 9 am.

I can tell the (hypo)mania is on its way because my bedtime knockout cocktail doesn’t do a thing.  I’m awake playing Solitaire on my iPad, which usually bores me to sleep, except now I’m totally awake: uncomfortable in my skin, twitching, restless.  I don’t want to look up because sometimes my wallpaper turns into ugly faces.

I follow the protocol my shrink and I developed for these very occasions: more Seroquel.  Another 50 mg till it knocks me out.  And a double dose of my benzos for good measure.

Sometimes it takes a couple hundred more milligrams of Seroquel to do the job.  I have an incredibly low tolerance for Seroquel, so my maintenance dose is only 100 mg.  I know, I know, some of you take 600-800.  That would put me to sleep for several days.  I usually get to 300 before it’s knock-down time.

The good thing about hypo/mania is that it can be controlled, if recognized early enough.  Depression, though…that’s another beast.

Bipolar depression is different from “regular” depression for reasons I don’t know.  I was treated with regular antidepressants for years, and was pretty much suicidally depressed the whole time.  Vitamins “L” (Lithium and Lamictal) saved my life, quite literally.  Blessings upon the quirky head of my neuropsychiatrist, who was on call when I was hospitalized the first time, and got my bipolar figured out.

The only adjustment we can do for the depression part of the roller-coaster is to up the Lamictal by 50 mg, which puts me at 200.  More than that pops me over into mania.  It’s a delicate balance, as you can see.

So the only thing I can really do with this depression is to wait it out.  Sometimes it does get suicidally bad, and then I have to think about my dog and my son, and what my suicide would mean for them.

I put them in that order, because my dog is helpless without me (although yes, I could put her in Rescue, but that thought makes me cry harder) and my son second, because even though it would tear him to pieces, he is at least able to provide for himself, unlike my dog.  I know that makes no sense but that is how it happens to fall out in my brain.

I’m starting to feel tired now, which means this part of the wave is coming to a close–I don’t know exactly when–and what happens next I cannot guess.

Enter The Black Dog

Normally I’m pretty good at cloaking my moods.  I’m trained in the art of dissembling.  One of the hidden maxims of medical training is, “Control your face.”  Don’t let the patient know that you’ve just found a….you’ve just done a……and barely got yourself out of it….your surgical assistant is the most beautiful thing in the world…you just farted.  Etc.

One thing it’s hard to conceal is The Black Dog’s visits: depression.  I’ve never been good at it.  I cry at the drop of a hat anyway.  So I’ve gotten good at noting which exam rooms are empty, so as to duck into one for a good bawl, and exit red-eyed.

“What’s wrong with your eyes?”

“Allergies.”

Yesterday I woke up feeling like somebody had clubbed me over the head.  I couldn’t tell where I was in time or space.  My brain felt like chocolate pudding, but not at all tasty.  Actually, I didn’t wake up at all.  If a friend hadn’t texted me at 1:45 pm, I would probably still be asleep.  Poor starving Noga lay next to my head, resolute.  If I had kept right on sleeping, I don’t think she would wake me up to feed her.  I don’t know if that’s good or bad.

I felt kind of like I felt when I took my bedtime medicines in the morning, except this was even worse.  I was hoping it would wear off as the day (what was left of it) wore on, but no.  At bedtime last night I resolved only to take those medications which if you do not take them you might get a seizure, which happened to be the same meds I go to sleep by.  How convenient.

I was quite sure that after a good day’s/night’s sleep, certainly whatever I had taken would have worn off, but no.  Well, it did, to some extent, but then I started feeling cross and weepy.  I yelled at my dog.  I’m very relieved that she seems to understand, and cuddled up with me for a lie-down-not-nap after I got from the grocery store.  I’m amazed that I got back, since I really, really should not be driving in this condition.

I still have not put away the groceries, six hours later.  I have not put away the enormous piles of laundry that I took to the laundromat the day before the day before.  And I just read an article about the habits of Brown Recluse spiders, that they sequester themselves in the fingers of your work gloves (!) and in piles of laundry left on the floor (!!).  Well, these are in black plastic bags, if that helps.  (The reason I was reading up on Brown Recluse spiders is that I found one uncomfortably close to where I sleep, the other day.)

Last night, the night between Days One and Two of the Feel-bads, I had one of my thankfully rare episodes of chest pain.  They occur sometime in the middle of the night, and are so intense that I can’t move.  Even if I thought it was a heart attack, I would not be able to move to call the ambulance.  So I have learned to have the attitude that if it’s my time to go, it’s my time to go, and I am a Do Not Resuscitate specimen anyway.  I toy with having that tattooed across my chest, but my religion specifically forbids tattooing.  I mean, come on, like 5,000 years ago there was a law against tattooing?  What, Moses was afraid we would all become, like, Goths?

Where was I.  Oh yes.  This episode of chest pain occurred between Days One an Two of the Feel-bads, and I was not at all sure I was going to wake up at all, but in fact my alarm did rouse me, as it hadn’t on the previous morning.  I rose, feeling hopeful, but a wave of nausea washed over me and I sat down on my bed again, uncertain, until I remembered that my mother had to go and have some tests at the hospital and I was supposed to go and sit with Dad so that the morning caregiver could go to his second job.

I managed to crawl out of the house at noon, after waking at nine.  Given that I don’t even have a shower to loiter in, which I would have done had I had one, I can’t account for the time at all.

My mother was at home already, triumphant that even though they had done the wrong test, it was negative and therefore she knows more than me.  But she needed tomatoes, so if I were going to the store, would I get her two?

I hadn’t really been planning to go anywhere, given my foggy mental condition, but I caved in to her request and got in my car, very slowly and carefully, and in that condition drove to the store, where I discovered that I needed at lot more than just her two tomatoes.

On my return to the P’s house I caught my wrist in the tailgate of the Outback as I was closing it, and my paper-like skin split over the back of my right wrist.  I didn’t notice the blood until I got home, though, which is what prompted yelling at the dog, because I was bleeding all over the place and she was blocking the passage between myself and the sink full of dishes, where I wanted to wash my wound and see how bad it was.  It could be that she knew something was up and was concerned about me.  That is probably the case.

As you see, I have diverted you from thinking about the fact that somehow or other, The Black Dog has made his way to my doorstep.  Ah, that was what Noga was bugging me about!  It was really as if it hit me right as I walked in the door: the wall of depression.  Smack.

I don’t know what triggered what, in the Feel-bads scenario.  Could have been either one, doesn’t matter.  This morning I took my meds as usual, and I think I did on The Lost Day before that.  If I don’t feel better tomorrow I’ll increase my Lamectil by 50 mg.  My shrink, who has been my shrink since 2001, he and I have protocols for everything.  Depressed?  Add more Lamectil.   Psychotic and/or manic?  Seroquel.  Anxiety?  Clonazepam or Lorazepam.  And so on.

But tomorrow is another day, and this one ain’t over yet.  My lie-down with Noga helped, and I know she’ll want to cuddle at bedtime–she always does.  She’s very predictable.  She runs on ritual, on routine.  And by default, she causes me to have a modicum of routine, which I would not otherwise have, being unemployed and an undisciplined writer.  She has just had her evening bit of obedience training–she demands this every evening at 8:30, not because she so much enjoys the training as she does the treats that accompany it.

And now it’s time for evening meds, brush the teeth etc., arrange the nighttime necessary things in the sleeping area: tissues in case of crying and its accompanying snot, bottle of seltzer (I really like my water to sparkle on the palate) bottle of Ouzo (I like a little Ouzo before sleep, if I don’t fall asleep from the meds before I have a chance to drink it), pee bottles (pee bottles?  Right.  I don’t have a toilet).  And one little fuzzy golden Lhasa Apso, who will no doubt jump up in the spot where my feet are supposed to go and give me the “Apso Look,” which is indescribable; if you have seen it you’ll know what I mean.  But what she means is: “Show me that you love me and haul my 13 pounds up to your face and give me kisses and hugs.”

Which, of course, I will be delighted to do, at the peril of soaking portions of her fur with my tears.

Mania Strikes Again

Why does it always happen the night before I have an appointment?  Not even an anxiety-inducing appointment, just a regular one that I simply need to get myself to and show up for.

Last night I took my bedtime meds at the usual time, did my whole pre-bedtime ritual: take meds, brush teeth, give Noga the Wonder Dog her brief nightly training session and resultant treats; get into bed with a book.

In general, by the time I make it into bed, I’m crashing, and sometimes don’t even make it through the “putting on pajamas” stage, but wake up in the morning to find myself half naked and freezing. The nights here are still chilly and I might not have got to far along as to pull up the covers.

The important part out of all of this is sleep.  I have never been good at sleeping.  Even as a child I spent many nights wide awake reading by flashlight under the covers.  At about dawn when the birds were waking up and sleepily cheeping, I might fall asleep for the two or three hours before it was time to get up for school.

Last night there were warning signs.  An hour after my bedtime cocktail of 50 mg. Seroquel, 1 mg Clonazepam, 1 mg Lorazepam, 10 mg Ambien, plus 300 mg Lithium, I was not remotely sleepy.  Not good.  I waited another hour.  No dice.  The book I was reading became hilariously funny, and I convulsed with laughter.  My Psychiatric Service Dog, Noga, alerted, and left her spot at the foot of the bed.  She peered into my face, assessing my condition.  She parked herself nearby, keeping an eye on me.

Noga, the Angel Puppy

Noga, the Angel Puppy

I started my prescribed protocol for incipient mania.  First try to knock it down with benzos: a couple more milligrams of Lorazepam, another milligram of Clonazapam.  Wait another hour.  Nothing.  I’m starting to look for a wall to climb.

Time to pull out bigger guns.  Another 50 mg of Seroquel.  Wait another hour.  Nothing.  Another 50 mg.  Nope.  Another 50 mg.

All this while, I am feeling like I have bugs under my skin.  Antsy, fearful that this is going to go into full-blown mania with hallucinations and everything.

It has started to pour down the rain, buckets.  By morning my rain gauge would measure two inches, and the river below my dwelling raging out of its banks.

My whole-body arthritis, aggravated by the weather, is making it hard to play solitaire on the iPad.  That’s my usual ticket to boredom leading to sleep, but after a couple hours of painfully tapping cards, I give up and take a pain pill–a very mild one, ten mg. codeine and 500 mg. acetaminophen.  Not enough to dangerously interact with the piles of pills I have already ingested, but by this time the only thing that concerned me was what would happen to my dog if I died.

Meanwhile, Noga the Wonder Dog has glued herself to my side and won’t budge, even when I jockey for more room in the bed.  I move her over and slide over myself so I won’t fall out when the drugs finally (hopefully) hit. She immediately sticks herself back in position against my body, licking whatever parts of me are exposed.  We snuggle and smooch for what seems hours.  She loves snuggles and smooches.  She is my Angel Doggie!

I send my morning appointment an email apologizing for canceling.  Of course I lie, saying that I was sick due to something I ate.  I turn my alarm off.

It’s three o’clock and I’m finally slowing down and getting sleepy.  Noga is cuddled up by my head.

I wake up around noon.  Fine, except that I really do have to go into town today (town is an hour away) to get some things for Friday night dinner.  I struggle out of bed, make a strong cup of coffee, get into my recliner under my “happy light.”  I’ll go as soon as I’m safe to drive, when the muzzy druggy feeling wears off.

Noga starts vomiting.  Why do they always have to throw up on the carpet when there is a perfectly good expanse of bare floor available?  I catch her before it comes up and place her on the floor, petting her while she pukes.  Lhasa Apsos routinely vomit when their stomachs are empty for a long time.  She’s been watching over me for 14 hours now, setting her own needs aside in favor of taking care of me.

After she gets done puking I call her over to the “treat station” and put a few yummy things into her tummy.  Her food is in her dish, but she ignores it until her dog treat hors d’oeuvre piques her appetite. She gobbles down her breakfast and hops up to her usual place on the left arm of my recliner, where she is now firmly established.

She literally stuck with me all night, watching over me and caring for me as if I was a sick puppy (I was).  And now she’s back on the job, after a bit of breakfast and a drink.

Through depression, through mania, she is my Psychiatric Service Dog, always on the job. She takes her job seriously.  I would love her anyway, even if she weren’t my Service Dog Angel, but the psychic connection between us is so strong that she’s like an extension of me.

I wish everyone could be so blessed.

Sleep, Precious Sleep

Yesterday morning my phone rang way too early.  It was a friend who probably though I get up at a normal time for a human being; but I don’t.

You see, my meds last twelve hours, and I have to sleep them off if I want to be functional the next day.

More than that.

If I don’t get the right amount of sleep, I turn manic.  Pretty simple, eh?  Meds>sleep>functional.  Not enough sleep (even with meds)>manic.

I needed to get up earlier than usual today, because there is a lot to do in preparation for Passover, and I needed a full day in which to do it.  This can usually be engineered by taking my night-time meds early.

So I did.

But nothing happened.  I didn’t get sleepy.  Instead I started feeling wired.

Uh-oh.

I thought, maybe I actually forgot to take my meds.  I looked in my pill box: tonight’s meds gone.  So I did take them, after all.

So I did what my shrink tells me to do under those circumstances: I took an extra Seroquel.  That usually knocks me down.

But not last night.  May as well have taken a sugar pill.

I took another, and a milligram of Ativan to keep it company.

Nothing.

By the way, in case you’re wondering, I left an hour between doses, sufficient to feel the effects of the drugs.

I was getting very concerned by this time.

So I took yet another Seroquel, an Ativan, and another Ambien (those are in my usual bedtime hammer cocktail).

Not one fucking bit of “sleepy” coming my way.

So I got out of bed, where I had been passing the time by watching Betty Boop flicks on Youtube, and began doing my Passover chores, since it was clear that I was going to have a short and shit day.  I got everything ready for cooking, chopped mountains of veggies, did all my prep work so all I would have to do is throw the brisket in the slow-cooker, throw the veggies on top, and not worry about it.

Finally the sledge-hammer anti-mania drugs took effect (oh for a few milligrams of Haldol, for quick knock-down) and I managed to get in bed before the blessed drugged sleep overcame me.

I still had to wake up earlier than usual this morning, to call the clinic and cancel my 11 am appointment for ER follow-up with my primary care doc.  I woke to my alarm, made the call, and lay back down to go back to sleep for a couple hours, since I’d already done my prep work and had the time for a longer sleep.

Nothing.

Not gonna happen.

So I got up, feeling cross and speedy, and made my oat matzah (gluten free), singed the meat, sauteed the veggies, made a sauce, threw it all in the slow cooker and sat down to write this.

I really want a beer, but now they’re assur, forbidden, because of being made with yeast.  Anything leavened is forbidden for one week.  Damn.  Oh well, maybe I’ll get up and clean.

 

Turn the Lights On, Will You?

Hey everybody, this is Chattery the Chipmunk here with an Arctic News Blast from Canada.  No, really!  Some of you may know that I’ve been down in the Black Hole for a long, long, long, long…..time.  I keep going to my psychiatrist and he manages to make me laugh somehow, so he knows I’m not hospital material yet.  But since I’m maxed out on the meds, there really hasn’t been anything to do except for hang on tight and think about my son and my dog and some other people who might be seriously bummed if I checked out.

Last week, though, Shrink-O-Matic had a brilliant idea!  Light therapy!  He gave me a “prescription” for a 10,000 Lux blue spectrum light made in Canada, where they really know from Seasonal Affective Disorder.  It mimics the light of a beautiful blue sky!

Now, I am so sensitive to light that my mood changes for the worse if a cloud even covers the sun for a few seconds.  I think one of the reasons I love to be in Israel (one of the many, many reasons) is that if I’m feeling down all I have to do is step outside into the Mediterranean Middle East blue sunny skies and I’m much better.

The instructions that came with the lamp say to use it for 20-30 minutes once a day in the morning.  So I’ve been doing that, and it has been helping some.  Then my therapist on Thursday had the bright idea that I should try using it twice a day.

So today I used it first thing in the morning, and again around 2 pm.  So far I have gone for a long walk with The Dog, swept and vacuumed the entire house (if you can call this a house–it’s actually an unimproved barn-like structure, but it keeps the rain out and has heat), and redid my fan page on ReverbNation, and tried to learn something about investing in stocks, and…I am not at all tired, and it’s 10 pm, and I don’t think I’ll do that again.

It feels something like being on steroids, which is why I hated being on steroids when I had to take them because of inflammation.  I think it could definitely lead to mania if continued.

So, tomorrow will be a one-dose day.  Nevertheless, it is such a relief to NOT be depressed–you know what I mean–that I’ll take a hypomanic episode every now and then if that’s the way it has to work.  I just have to write it on the inside of my eyelids: don’t buy stocks when hypomanic!!! 

Well, That Was Fun…Wasn’t It?

Look, I love my psychiatrist.  I think he’s a genius.  He thinks he’s a magician, so he’s all right by me.  In my opinion, you have to be crazy to be a psychiatrist in the first place–a good one, that is.

We’ve been riding this boat called my brain in more or less rough waters for, oh, twelve years now, with a few breaks for me to galavant across the country or the world.  So he knows my inner clockwork pretty well, and I know his pretty well, and most of the time it works out.

See, I have always lived an inner life, and never much paid attention to my environment.  I chalk that up to my considerable Aspergerian tendencies, and unless someone comes to visit and I am painfully reminded that I haven’t cleaned in years (you think I’m kidding?), I don’t even notice it.

My shrink thinks my essential disorganization is due to inattention.  He thinks that stimulants will fix it.  He’s had me try dexadrine in almost every form there is.  In fact, he just mailed me an Rx for Dexadrine Spansules, which is what you give kids mixed in apple sauce.

So I have this whole amphetamine pharmacy that I can’t quite bring myself to take to the “medication recycling day” at the drug store.  Hmph.  I know what THEY do with it anyway.  They get ripped, is what.

So last time he gave me the long-acting dexadrine I thought it worked pretty well, but never remembered to take it after that.  You must know that I am the mother who had to give the school nurse my son’s bottle of Ritalin because I could never remember to give it to him and the phone would ring reliably at 10 am:  “Doctor, did you forget to give your son his Ritalin again?”  Because without it, he was just like a top bouncing off of everything in the room and crying at the same time.  Five milligrams of Ritalin, and the sun came out all smiles.  So I had his doctor write the prescription for the school nurse to give, and life was good.

Ooooh-kaaaay, back to my story.  Yeah.  So I saw my magician on Thursday, and he encouraged me to try the stuff again, and he also prescribed a light box, 10,000 lux, for my persistent depression.  All good so far.

Yeah.  So yesterday I took a long-acting dexadrine 10 mg in the morning, which is what he said to do.  Only, you gotta understand, my mornings start at around 11 am because my night-time meds take so long to wear off.  So I took it as soon as the coffee kicked in, which might have been noon by that time.

About four o’clock I was sailing.  I was literally cookin’ along, because I prepare a big family dinner every Friday night and so I was choppin’ and marinatin’ and having a general good ol’ time.

Eight o’clock and I was still buzzed.  I started feeling a little cranky so I took an Ativan.  No dice, did nothing.  Ten o’clock, I took my usual night-time sledgehammer dose of Ativan, Clonipine, Zolpidem and Seraquel.  That usually results in unconsciousness within half an hour.

Nope, not last night.  Instead, I went into a state of half-wake, half-dreaming.  I think that’s what vampires must do.  It’s certainly not anything I would call sleeping.  I lay on my pillow, eyes lightly closed, alternately shivering and drawing the blankets up to my chin, and breaking out in sweats and throwing the covers off.  Haven’t had anything like that since I laid off menopause.

Finally at seven (seven!) I turned over and said to the dog, “This ain’t goin’ nowhere.  I’m gettin’ up.”  She opened one eye and shut it again.  She’s a late sleeper too.

Noga, my Lhasa Apso PSD, getting her beauty sleep

Noga, my Lhasa Apso PSD, getting her beauty sleep

I made coffee, drank it, and went to work deleting emails.  If you knew how many thousands of unread emails I have in my many email accounts, I’m sure you’d think less of me.  But anyway, that’s what I did.

Long about 11 o’clock, the sun came up over the mountain like it usually does.  The dog stretched and yawned and demanded her morning petting session (kisses and hugs too) before she went outside to take care of business.

After she came in, I fed her, and then we both went back to bed and slept till it got dark.  Now it’s 11 pm, and I’m waiting for the nighttime meds to kick in.  I might try that stimulant shit again, at seven in the morning like you’re supposed to.  Then again, I might not.