Night on the Rack

Sleep is supposed to be restorative, or so we are taught.

Last night proved anything but.  I lost count of the awakenings occasioned by the loud complaints of various joints and their wounds. 

At 0230 I arose and rummaged through my bandage box, half asleep but unable to finish the job because of the excruciating hypersensitivity of the skin overlying the destruction in my wrist.  It feels like a remake of the RSD from 30 years ago…can that be?  I don’t know, but it is so stupidly sensitive that the mere touch of my well-padded wrist brace feels like liquid fire.  That’s what RSD feels like.

In between excursions to the bathroom and to the bandage box for a piece of biogel to put over my wrist bone, my night was spent in my mind’s idea of a torture chamber.

The scene:  I am conscious that I have been brought to this torture chamber to be “interrogated.”  I have no idea why.  The torturer is probing my mind for vulnerabilities.  At the same time, I am probing my mind for strengths and strategies for survival of what looks to be a prolonged ordeal.  I have no facts to give up, no-one to betray except my own autonomy.  

For that’s what’s at stake, isn’t it?  That’s the thing we, or I for one, most fear losing: autonomy, self-determination.  Aside from mobility and self-expression, that’s what I stand to lose from prolonged torture.

He is sizing me up.  He’s making pleasantries.  I play along, playing for time.  I know he knows that’s what I’m doing.  “Just doing his job,” that’s all.  I ask about his family.  He laughs.  

He wants to know which kind of pain I fear most.  What??  Does he think I’m actually going to answer that…correctly?  Surely, if I say “burning,” he’s going to burn me?!  But wait, if I say “burning,” he’ll know that I’m trying to deflect…no. I’ll say “all kinds.”  I fear all kinds of pain!

He laughs again.

Maybe, he muses, what we need to do, in order to properly sort this, is to try…a sampler.  That way we can explore a variety of stimuli, to see what works best for you.  Pain is such an individual thing, you know…

I’m awake again.  The sky is growing faintly pale.  I decide to get up and enjoy the coolth of the dawn morning.  It’s going to be another blazing day in Paradise.

Tired Puppy

image

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. 

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.

 

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.

DPchallenge: 2 AM Photo

Sleep is always a challenge for me.  To achieve it, I take five (5) medications: Seroquel, clonazepam, lorazepam, zolpidem, and lithium.  Yes, I know there are six pills in the picture.  That is because of the two Seroquel.  For those who are new to my blog, I take all these poisons due to PTSD incurred courtesy of childhood abuse and a stint on the streets as a teenage runaway, complete with serial rapes.  You can read all about it here.

Nighttime Knockout Pills

Nighttime Knockout Pills

And as if all those pills weren’t enough, I use about half an ounce of some kind of liquor as an adjuvant (enhancer).  My favorite is Ouzo, as it leaves a lovely trace of anise on my palate, as my knockout pills waft me to sleep.  Thats one of the reasons I don’t practice medicine anymore: you just can’t field nighttime medical emergencies while hammered on six kinds of meds (I regard the Ouzo as one of them).

Adjuvant

Adjuvant

If something manages to wake me at night, an earthquake for instance, or the part of the ceiling directly above my bed falling down, or a painfully full bladder (thank God I do wake up for that), I stumble through whatever is necessary to remove myself from the annoyance.  I imagine I would look, to an innocent observer, rather like a hapless zombie that has feasted upon too many alcoholics, or perhaps upon me: too full of sedatives to even try to escape.

So imagine my annoyance when my Galaxy SIII, only slightly smaller than an iPad, rumbled to life at 2 AM, buzzing and tinkling its bell tone indicating an incoming text.

I must have been in the light part of my sleep cycle (otherwise it could have hit me in the head and I wouldn’t have turned a hair), because I awoke with a start that sent Noga, my Lhasa Apso, scurrying to the foot of the bed, as I sat bolt upright as if on springs.

Noga refuses to get out of bed on a rainy morning!

Noga the Lhasa Apso 

My first thought was it must be some mother who had fed her baby strawberry jello, and now its diaper was shockingly red.  Then I remembered: I am no longer in practice as a pediatrician, due to my mental illness and its Machiavellian treatments.  Then a more chilling thought occurred to me: what if something had happened to some family member, God forbid?  But that would entail a phone call from the appropriate authorities, not a text.

At last I wrenched myself far enough away from drugged stupor to actually look at the phone.  MMS, it said.  I touched the “view” button.

Oh fer cryin’ out loud.  This had to be from Floyd, my pervy neighbor.  Who else would send me a photo of his large and rampant, uh, you know….in the middle of the fricking night?  He must have been pickled.  Deleted the goddam thing and lay back down.

Then I sat up again.  I was thirsty.  All these drugs make my mouth dry.  I felt around for my bottle of Gerolsteiner that I usually keep by the bed.  I love Gerolsteiner:  it has lots of minerals in it, good for your body.  And it tastes good, too.  Shit, it wasn’t anywhere around.  I got out of bed and stumped into the dark kitchen.  Ah, there was the bottle: right next to the sink.  Why the hell did I leave it there?  Must have got distracted while brushing my teeth.  Ah well.  Here it was, anyway.

Gerolsteiner, yum

Gerolsteiner, yum!

 

I unscrewed the cap and took a deep chug.

Jeezus Christ and all his disciples, what the hell was this!?  Oh fuck, it was the Ouzo!  What was is doing next to the sink?? What am I gonna do now?  I musta just ingested a cup of it.  And on top of all these meds….should I make myself throw up?  That’s what I would tell someone else.  I hate to throw up.  I’ll do anything to avoid it.

Well shit, if I’m gonna die I may as well go back to bed.  But now I really need the Gerolsteiner, to quell the burning in my stomach.  I found a new bottle on the shelf and drank as much of it as I could, hoping to dilute the Ouzo enough so I wouldn’t die immediately of drug interactions.  Maybe gently in my sleep, to be found some days later when I didn’t answer my phone.  Morbid thoughts.  Damn phone.

I stumbled toward the bed, holding onto the furniture to keep from falling down.

Damn.  Now my bladder was grumbling and required immediate attention.  I looked outside.  Raining cats and dogs.  No effing way I was going to make my way to the outhouse in this storm, especially in my present compromised condition.  For you newbies, just to let you know, my plumbing situation is non-standard.  ‘Nuff said.

2012-10-25 09.13.51

I got out the pee jar, which I keep under the bed for such emergencies.  (No picture of the pee jar, sorry.  Too personal.)

Squatting over the pee jar, I let the excess water drain out with relief.  Shit, shit, and more shit!  Apparently I had not remembered to empty the pee jar since its last use, and now there was pee all over the floor.  Time to get the mop.  (No picture of this either.)

After cleaning up as much of the mess as I could in my present condition, I fell into bed and drifted into a semi-comatose state resembling sleep.  But not for long.  “Brrrr, bling!” went my phone.  I picked the damn thing up and threw it across the room.  It smashed into the closet door.  Good thing I bought the insurance.

http://dailypost.wordpress.com/2013/03/18/writing-challenge-nighttime-photo/

Sleep PTSD

Michael Jackson died of sleep.  More correctly, he died of trying to get a good night’s sleep.  Notice the expression:  Good Night’s Sleep.  Not a Bad Night’s Sleep, or even a Night’s Sleep.  A Good Night’s Sleep.  That is important, and I’ll tell you why later.  First I have to say that thankfully, the only thing I have in common with Michael Jackson is off-the-charts insomnia.  Michael Jackson was a sad, sorry, probably bad, person.  He was a great singer, a brilliant choreographer and dancer, an insomniac, and a pedophile.  He was horribly abused as a child, but that does not excuse his pedophilia.  Now I am ranting about Michael Jackson.  I will stop now.

I don’t know.  Maybe I do have something else in common with MJ.  I think something happened to both of us when we were little children, before the age of talking.  I have noticed in my life as a pediatrician and specialist in child abuse, focusing on child sexual abuse, that things that happen to preverbal children often cannot be healed, because there is no way to access them.  Sometimes you can get to it through modalities like hypnotherapy and NLP; I’ve done them both.  In fact, I’m a certified NLP practitioner, and during my year’s training I had many hypnotherapy and NLP sessions focused on my inability to sleep, and all of them made sense, and none of them worked.

You see, I am a professional non-sleeper.  When I was a child I often took a book and a flashlight with me under the covers and read till dawn, then went out to enjoy the morning birds’ chorus until it was time to go in the house and pretend I’d been asleep.  Not sleeping was a sin, in my house.  “You go to sleep right now!”  As if that were something voluntary.  I don’t know, maybe it is, for some people.

Sometimes I would get so scared at night that I would cry, and my dad would sometimes come in and make me “an Army Bedroll.”  (He is a World War II veteran.)  He would make me a tight cocoon with my covers, a comforting blanket embrace.  Then he would like down on the floor next to my bed and fall asleep.  He can sleep anytime, anywhere.  How I envy that.  I would listen to him snore, and find myself awake in the dawn, having slept soundly, and he had gone back to bed with my mom.  (For the record, I will say here that my father never, ever did anything that could be remotely considered to be inappropriate with me.  Ever.)

From the Army Bedroll I learned to make a mummy case out of my bedding.  I would get all the covers tucked under me as tight as I could, including over my head.  I do not know how I breathed, but since I am still alive that is proof that I did (hmmm, maybe my brain dysfunction is due to chronic nocturnal hypoxia).  This seemed to work for a while, but soon it wore off and I found myself just lying there mummified until early morning, when I would drift off to sleep until the alarm clock of my mother’s screech “Get up, it’s time for school!” would wake me and I would struggle out of my tangled prison.

(Aside: When I was ten I got hit by a car and spent a week in the hospital in a minor coma.  When they moved me into a regular room my parents came to visit.  I was trying to get some sleep, so I had mummified myself.  I was rudely awakened by my mother’s shrieks when she saw me lying there with the white sheets over my head.  I still get a satisfied snort out of that.)

The hormonal armageddon of puberty seemed to bring about a welcome shift in the sleep department.  Instead of being permanently wired, I became permanently sleepy.  That was nice.  I had a few years’ respite from the night-time nasties.

Then I ran away from home, and endured a series of nocturnal intruders in my bed.  No more sleeping at night for me.  Night was not a safe time to sleep.  It was a time to be vigilant.  And so my nocturnal PTSD reawakened.

As those of you who read my blog with any regularity know, when I am not writing about electric toilets or outhouses, I generally write about my own boring alphabet soup of psychiatric diagnoses: BP, PTSD, OCD (what, I haven’t written about that one yet?  Oversight.  Note to self.), ASD, MDD, blah blah blah, boring.  I’m just so sick of it.  I just want to go back to work and have fun being a doctor like I used to, not sit around being ashamed of my life, the way it’s turned out.

Yes, I am ashamed that I have to take four different kinds of medicine in order to fall asleep (read: pass out from drugs).  Seroquel, which also helps me not feel anything the rest of the time; clonazepam, which helps with the night terrors; lorazepam, which helps calm me down so I don’t leap out of bed and run out the door if I hear a noise; and zolpidem, which has recently had some very bad press in the medical literature, but since I don’t seem to be able to sleep without it, and since bipolar disorder is known to be worsened by lack of sleep, I am stuck.

I just read a great article on how to retrain yourself out of insomnia, using a combination of NLP and DBT techniques.  It looks like it would work for anybody who has “normal” insomnia.  The problem is with me, sleep is associated with being raped, so I don’t think it’s going to work.  I’m going to give it a try, though.  Nothing to lose but a few drugs, and a great deal to gain.