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. 

I’d Do Anything If Only

Atina!  Stop shredding your bed!  Atina!  You can’t have chocolate!  You’re a dog!  Chocolate is NOT good for doggies!  Atina!  Get that goddam wet ball out of my face!  Atina!  SHUT THE FUCK UP!!!

Sigh.

Last night was a total wreck.  For some reason Atina spent her night growling, woofing, and outright barking, at something that I could not see. 

We are in a well-lit campground, so if there was, like, a bear strolling around, or a bull moose, or a hedgehog, I’m certain I would see it. 

Maybe it was some perv hiding behind a tree, whacking off.  All night.  Sheesh.

On this premise, I chalked Half #1 of the night up to Virtuous Vigilance on the part of the Pup.  But when Night Half #2 rolled wearily around, I got cranky.  I shushed.  I gave orders.  I YELLED.  I cursed. 

As grey dawn faded into a grey rainy morning, I felt worse and worse.  If there’s one thing that kicks me right out of orbit, mentally and physically, it’s sleep deprivation.

And of course my baby still needed her walkies, and breakfast, and more walkies, and playtime…And I needed large quantities of thick coffee, and something to force into my queasy stomach so I could take my pills, and I needed to use the bathroom, and brush my teeth, and put on clothes…And Atina, none the worse for her own sleepless night (who knows, maybe 🐶 s only take 😸 naps anyway…), was red hot and rarin’ to go, while I was dragging serious ass.

I got to feeling cross and cheated and just plain ill-tempered, and then I thought about something that happened, and my mind changed.

Here is what happened.

1989. I was pulling a two-week stint in the Pediatric Intensive Care Unit–the PICU. 

My residency program was working us like slaves because we were down four warm bodies.  One, my sweet ward partner, died in a car crash.  One got meningitis from a kid she was treating.  One got hepatitis from her dear boyfriend when he got back from India.  And one was on a sort of permanent leave, because he had miscalculated a chemotherapy dose and the child died.

So the house staff were stretched much thinner than usual.  Instead of every third or fourth night call, we were on every-other or every-every night.

In the PICU we usually did every-other-night, actually 24 hours on, 24 off.  But since we were so badly strapped for staff, the PICU director came up with a brilliant plan:  he would live in the PICU for two weeks, and I would live in the PICU for the next two weeks, and then we’d switch off again for another month.  That way we’d both get to see our families, for the two weeks we’d be off.  And of course if things were slow, our families could come and visit us in the call room, which was an 8 x10 ft luxurious affair made of beige-painted cinderblock, with a tiny bedside table to hold up the phone, and a worn metal chair.  

When you switched off the overhead fluorescent lights, you were instantly plunged into darkness.  Fortunately, every doctor carries a penlight, so at least you could find the bed, if you ever got a chance to actually lie down.

Hypervigilance is a common symptom of PTSD.  Therefore, since half of my consciousness was always scanning the PICU for problems, I never really got to sleep. 

One night when we had a truly puzzling and terribly critical case on the unit, I lay staring into the velvety black of the call room.  Everything had been taken care of, rounds, orders, and the nurses were wonderful and right on top of things; so there was no reason not to catch a few winks.

But I was in the grip of free-floating anxiety, so I felt my way along the wall until I found the light switch, and lacing up my Rockports, I sidled out into the unit.

We’d received a case that day that came in via the ER.  It was a little three year old boy, who presented with a high fever and blueberry muffin looking rash.  I mean really, he looked like a blueberry muffin.  But unlike muffins, which are good, he was not good.  He was in very bad shape.  Septic shock of some kind.  Our usual tests could not detect the pathogen, or anything that could have caused his condition.  This was 1989, remember.  We’ve learned a lot since then.

We ran through every possible infectious disease that we knew about, and every form of toxic ingestion or exposure, and every possible cause of bleeding and organ failure, but nothing came out positive.

So we did the only thing we could do: we put the little guy on life support, gave him fluids and antibiotics and steroids, and prayed that with supportive care, his body would come through whatever it was, and heal itself.

This was not to be.

Even with maximal supportive care, his body deteriorated.  He had been unconscious when he came in, and never opened his eyes or gave any indication of awareness.  His kidneys stopped working, and fluid was backing up into his organs and tissues.  We tried our hardest to keep up with that too, but soon it was clear that this little boy was not going to make it.

I can’t remember who we were waiting for.  His mother had died, I remember that.  It was just his father alone who took care of him.  We must have been waiting for someone else…to be there…when we took him off the vent.

As I turned the corner from my call room to the unit, I saw the boy’s father sitting on a hard chair, his knees up against the bed, stroking his little boy’s swollen hand and weeping, his shoulders heaving.

I laid my hand gently on his shoulder and said nothing, waiting.

“Yesterday,” the father sobbed, “He was running around making so much noise, I told him to shut up…Oh, if he would only make that much noise again!”

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.

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.