Tag Archives: wellness

Better

I’ve spent the better part of the last decade in therapy and on meds. Going to therapy, takin’ my meds. Rescheduling therapy, adjusting my meds. Adding more therapy, adding more meds, then backing off a little on both. Though I’m still a habitual marijuana self-medicator, I’ve more or less stopped drinking over the past year. I definitely stopped that shit where I pick up a 6 pack on my way home and drink alone in my living room with my guitar before the sun even goes down. A bottle of gin in my house has a way longer shelf life these days. I been good. A model prisoner of my illness (or whatever poetics you wanna stamp onto this situation).

A week or so ago in therapy, my doctor commented on how much better I was doing. I’ve been on Depakote for like 5 months. No hair loss or anything! I’ve had some kinda funky depressions and at least one pretty awesome hypomanic episode, but overall things have been less sharp and less rough. I’ve been writing a lot. I’m working on a collection of poems and I’ve been writing some essays just for shits. I feel stupid and wordless a lot. Then I don’t. Sometimes I feel proud of myself. It’s real weird.

But my doc says I’ve been doing better. She has my chart. She’s been treating me for 8 and a half years. I told her I didn’t really believe her, but that she’s the expert. So here we are. I’m better. Yikes.

Part of me is upset by this prospect: better. It makes me wanna destroy myself a little and I certainly know how, but there’s a large part of me that feels I owe it to my psychiatrist – to all the hard work she’s done and all the shit she’s put up with from me – to stay better. Why don’t I feel beholden in the same way to myself?

Couple theories: Firstly, and most obviously, if I’m doing terribly, I probably can’t get a whole lot worse. There’s nowhere to fall from rock bottom. It’s paradoxically comforting to know there are no threads left to cradle you. You get to lie all the way down.

Secondly, I’ve had more experience with depression than…almost anything else over the past decade. I know how to navigate it. Sure, it hurts like hell, but it’s a hurt I’m used to. I can change all the dressings ‘n everything. I’ve been ill as a full time job for years and years. I’m getting fired or something. Additional metaphors relating to the unknown, etc.

But I think my biggest problem is: what now? My identity is kinda shifting away from simply Bipolar Laura to _______ Laura. Not sure how to fill in that blank. I mean, I’ll always have bipolar. I didn’t get here by magic, I worked toward this. I don’t think, though, I ever really thought concretely about what I was working toward, just that I needed to keep pushing in an upward direction. Now I have more time and energy (most days) and I don’t need to use those circumstances to patch myself up the same way. I can do things!

I told my doctor that I’ve arrived at the downside of up and she said, “Yup, that’s the downside.” She recognizes that the new imperative I’m facing to do something with my life is not an easy thing to tackle. Maybe it’s even complicated by the fact that there are like a hundred things I wanna do with my life. Basically, I’m having a Sylvia Plath problem:

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The Bell Jar

‘Cept I’m starving not just because I can’t decide, I’m starving ’cause even if I do decide, I can’t rely on my own self-motivation which has been directed entirely at my mental health for so long that I don’t really know how to use it for anything else. I just haven’t really had to, and though people keep telling me to be easier on myself, I still insist that I’m awfully lazy.

So let’s not confuse “better” with “cured.” I still have to take care of my illness, but the difference is that it’s not the sole thing I have to take care of right now. I still have mood swings and panic attacks and episodes. Like, that shit’s never going away entirely. Not unless I cloister myself in completely perfect behavior and probably take some stupefying meds that I don’t want. But that’s not a life. I’ve always been scared of the future for the same reason I’m now scared of being better. I don’t know precisely how to move around in it.

That’s basically where I’m at. And don’t think that I won’t stretch my indecision and cowardice and self-doubt into months and months of soul searching or some bullshit, ’cause I definitely will. Out of fear and hesitation. I have some thinking to do. It’s probably gonna be a minute.

-LB

Yeah, It’s Another Post About Poop

You guys. YOU GUYS.

No, wait, I don’t even wanna say it….I’ll jinx it.

Nah, fuck it, I’m enjoying this too much…

I’M VERY SLIGHTLY CONSTIPATED!

You have no idea what this means to me. I’ve been the opposite of very slightly constipated for like 7 months and it sucked super hard and I was taking Imodium almost every day (which is expensive) and I saw a dietician who recommended that I cut out a number of food items temporarily which made me cry in the grocery store at least once because you try removing garlic from your diet. It’s in fucking everything and it’s delicious and also I wasn’t supposed to have gluten or mangoes which is inconvenient on the first count and just plain mean on the second. Mangoes are angel poop. I’d say I’d eat my weight in mangoes, but I don’t weigh very much and I’d go to town on a more-than-a-Laura-sized helping of mangoes.

So, since I’m feeling a little better for the first time in months, it might make sense for me to maintain the dietary restrictions ’cause they might be the cause of this. But also, IBS is somewhat like bipolar in that people usually have episodes and then are fine for a while. I super hope I’m fine for a while. I’m gonna start wearing alarmingly formfitting clothes. Like so tight that my organs will have to shift to accommodate the garments. STOKED.

For those just tuning in, Irritable Bowel Syndrome and bipolar occur together a lot. Same with either of the aforementioned two and migraines. I have all 3. This unfortunate circumstance can be both a good thing and a bad thing. Bad because they’re a lot to handle and can get really uncomfortable, but good ’cause if they’re related, hypothetically, you could get to the root of the problem and maybe deal with 2 or 3 at a time. Right now, I’m double dipping with Depakote which is a mood stabilizer that also prevents migraines. That’s pretty cool. Migraines are frequently debilitating and I’ve sacrificed entire days to my migraines.

Then again, my mood’s been looking up and I haven’t been spending a nonconsecutive 90 minutes on the toilet in the morning. Wondering if that’s coincidental or not. Trying not to care. I’m not typing from my toilet right now (you guys, sometimes I write these posts from my toilet, you probably should’ve just assumed that, though). So, I may be back here tomorrow to tell you that my victory shits were short lived and I’m back to mainlining Imodium again (I don’t actually inject my anti-diarrheals intravenously, that’d be weird), but that’s a problem for Friday Laura.

So, my sisters and brothers in defecation, I hope you’re pooping like a rockstar today. I know I am.

-LB

Obecalp

About 2 weeks ago, my doc upped my Welbutrin dose from 300mgs to 450mgs because we’re trying to stay on top of my depression and this was the only compromise medication-wise that I’d make because I didn’t wanna change any of my other meds or add new ones.

Welbutrin (bupropion) is kind of a neat drug. It tends to give me a little extra energy and it prevents me from smoking (mostly). Other people sometimes find it helpful for issues like weight management and sexual dysfunction. I think John Oliver once referred to it as the “happy, horny, skinny drug,” though he was mostly lampooning its off-label overuse. Including my dad before he died, all of my immediate family members have been on Welbutrin at one time or another, all for different reasons related to depression. I know I mentioned in the LBD that antidepressants are usually ineffective in treating bipolar depression and can even have some hazardous effects, but that’s not always the case. Partly ’cause everyone responds to meds a little differently and partly because, at least in my case, combining Welbutrin with a mood stabilizer and anxiety meds seems to be a workable balance. The Welbutrin handles the grogginess I experience with my other meds and my other meds seem to keep the Welbutrin from making me hypomanic. (It’s more nuanced than that, but I’m not getting into it.)

So when my doc offered to increase my Welbutrin as a means of handling my worsening depression, I went for it because I wasn’t comfortable with my other medication options. Increasing my olanzapine makes me really tired and I oversleep. I was not keen on introducing Depakote – an anti-seizure med which also works as a mood stabilizer – either because the last couple of times I took anti-seizure meds, they made me stupid. That’s really my biggest fear. Some medications make you a little slow. One of the notable side effects of many psych meds is having difficulty finding the word you’re looking for when you’re speaking or writing. This is a really big deal to me because I’m not good at most things. Language is kind of all I have and there’s an easily roused part of me that would rather be sick than stupid.

Last week, during therapy, after I’d been on the increased dose for about 5 days, my doctor mentioned that a newly documented side effect of Welbutrin is that hard to find words thing. I asked her if it was one of those side effects that tend to go away as you adjust or if it’s just part of the nature of the drug. She said it was likely the latter and I told her I wished she hadn’t shared that with me ’cause now I’m hyperaware of everything I say and write, constantly checking things to make sure my vocabulary didn’t shrink.

The annoying thing about this situation is that it doesn’t matter if my lingual capabilities are taking a hit or not, I just assume they are. It’s this reverse placebo type thing…or just the power of suggestion and and I’m suggestible. We bipolar folk are notoriously hard to medicate and it’s not just for one reason. This is a complicated illness.

I think a lot of us have this warped notion of losing ourselves to wellness. At least for me, I see such a radical difference between myself as I am untreated vs. myself with a fairly controlled mental illness, I naturally assume that getting from the former to the latter requires a deep sacrifice on a fundamental level. Instinctively, I always assume the thing I’m sacrificing is of value, I almost never think of this shit as shedding symptoms of my illness via modern medicine. I also cling to fears that are irrational because the idea that everything is gonna be OK consistently strikes me as entirely ludicrous.

There are some parts of my life that are a bit too black and white. If I can’t do something I deem important perfectly, I’d rather not do it at all. I take the adage, “anything worth doing is worth doing well” and stretch into a preposterous shape. I’ve been like that since I was a kid. I understand that I’m frequently my own roadblock. I contemplate this nonsense as I’m constructing yet more roadblocks. If I can’t write good songs, I shouldn’t even play instruments. If I can’t write good stories, I should turn off my computer. I also have a very strained relationship with mascara ’cause my eyelashes are like a foot long so if I accidentally clump my enviable fringes, I wash that eye off and start over. I will do this even if I’m running late. These things are a shitty combination of obsession and self-defeatism. It’s gross. I hate it.

My doctor asked me to give it about a month before I make any decisions about changing my medication dosage. So that’s like, a little over 2 more weeks. I don’t get dizzy anymore. I’m starting to adjust. It’s easier. But I’m still paranoid. I’ve been reading over some of my older posts and thinking, “Why don’t I write like that anymore?” when there’s no real discernible difference between the talents I had last October and the ones I have now (’cause they’re the fucking same, Laura).

Even if I operate a little differently at the moment, my first assumption is that my meds are messing with me, not the more likely scenario that it’s super fucking hard to do things when you’re depressed. Why is that? Why am I like that? Why do I have such a complicated relationship with help?

So, fine, I’ll stick out out mistrustfully for the next ~2 weeks. If I’m still in this big, dumb depression, if it stays the same or gets bigger and dumber, then I’m gonna have to revisit this Welbutrin thing with my doc. No sense in being sad and stupid.

-LB

You’re More In Charge Than You Think

I may write about this some more because I feel really strongly about it, but I want to address a specific aspect of the doctor/patient relationship. In order to get the most out of your efforts, you need to be an active participant in your healthcare. You’re not a lab rat. You’re allowed to say no to things you don’t wanna do. You’re allowed to fire your therapist if (s)he is not working out for you. When you’re prescribed a medication, do your homework. Knowing what to expect makes medication a lot less daunting. Know your body. Know your meds. I’m practically a pharmacist at this point because I won’t take a pill or a dosage adjustment before I ask every question I can think of. Your doctor might be the one with the medical license, but that doesn’t mean you have to be uninformed. You’re smart enough to understand the things you need to know to be a knowledgable and participatory patient. You also have every right to negotiate your treatment options. The only time you can’t really do this is if you’re hospitalized, but you can do it once you get out.

I’ve seen a few people who have been cowed into submission by a doctor or therapist. This is not how it’s supposed to work. You’re not a car in need of a mechanic. You have agency. Work with your doctor, not for your doctor. I got pretty lucky and found a doctor/therapist who’s honesty and leniency are at a good ratio. She tells me things I don’t wanna hear all the time, but she’s not punitive if I decided to push back.

There are a few red flags that I think are deal breakers when it comes to choosing a doctor:

1. Your doctor admonishes you for drinking or using drugs instead of non-judgmentally advising you not to do those things and then explaining how they actually affect your symptoms. My doctor knows I drink moderately (but less so lately because I’ve been having migraines more frequently for some reason) and that I use marijuana occasionally (I said “use” instead of “smoke” because I recently got kinda into edibles). She also knows that, once in a blue moon I’ll use hard drugs or hallucinogens, most likely MDMA, but this only happens a few times a year at most because hard drugs get really boring eventually. BUT: really important PSA about hallucinogens: if you’re taking lithium do not take mushrooms, LSD, DMT, Salvia (which I don’t think anybody even uses anymore, but whatever) or anything that makes you trip because if you mix hallucinogenic drugs with lithium, you’re basically asking for a seizure, even if you’ve never had one before. I found this out just in time before I went to visit my sister which is pretty much the only time I take acid. But my doctor doesn’t berate me when I come home from a Big Sis bender and tell her I was high for 4 days straight. She explains to me what the intoxicants do to my brain, how they affect mood disordered people differently and what the potential consequences are if I decide to get messed up. She’s my doctor, not my nanny. I have a friend whose doctor likes to take up valuable therapy time by chastising my friend for having a single fucking drop of alcohol. This doctor, in my opinion is overstepping her bounds partly because she assumes my friend is completely unaware of the effects of drugs/booze (which my friend is not because she’s not stupid) and partly because it’s your therapist’s job to help you learn to take care of yourself. Condescending to a mentally ill person is the worst idea ever. If your doctor doesn’t treat you like the grownup that you are, then find somebody who does because, rather than a slap on the wrist over a tallboy, your therapist should be equipping you to make healthy decisions.

2. Your doctor dismisses the side effects of the meds (s)he prescribed you. If your doctor doesn’t think that medication side effects are a quality of life issue, then (s)he is a crappy doctor. One of my older meds made me so tired that I never had the energy to go out. As a result, I was alone a lot, and being alone constantly cancelled out whatever positive effect the medication might have because being isolated – willingly or not – makes most people’s depression worse. And, speaking of quality of life issues, there is no issue too small if it’s really bugging you. I refuse to take SSRI antidepressants (see LBD: antidepressants) because when I take them, I can’t have orgasms. Maybe that’s not a big deal to some people, which is fine. But some people think it’s frivolous and it’s not. Do you wanna not be depressed or do you wanna get off? is a false dichotomy. I can come and get proper medical attention, the two are not mutually exclusive. But if you have a problem re: side effects that you think is trivial, it’s not. Tell your doctor about it and then discuss what your other options are because you’re not short on options.

3. You doctor doesn’t monitor the long term effects of your meds. Prolonged use of antipsychotic meds (see LBD: antipsychotics) can cause a condition called tardive dyskinesia which is a neurological disorder that causes involuntary, repetitive and aimless movements, mostly in the face and the hands (which are things I assume you don’t want messed with). The really scary thing about TD is that, in some cases, it’s irreversible even after you’ve stopped using the drug that caused it. TD can present as something as mild as a mouth twitch and as severe as involuntary jerking of the head and neck which is extremely noticeable. My doctor tests me for TD like twice a year. I started to show minor symptoms of it the last time she checked so we’re trying to come up with a better long term solution (together). If you’re taking lithium, you’ve probably already been warned about what lithium can do to your thyroid and kidneys. Lithium will trash your thyroid pretty thoroughly if you take it for many years so you should have blood work done roughly twice a year to make sure your organs are still doing their job. I know a couple of people who are stuck in medication limbo because their prescribing doctor is myopic. If your doctor doesn’t keep an eye out for what your meds are doing to you in the long term, find a doctor who will.

4. Your doctor talks more than you do. You didn’t go to therapy to get a weekly lecture. You went because you need to work out your problems with someone who’s trained to deal with them. Working out said problems begins with articulating them (which is way harder than most people think) so you need to be able to talk. Ask for advice when you need it, heed your therapist’s recommendations, but don’t get run over. You may have an illness that several million other people also do, but your illness is your own and it’s different from anybody else’s. Cookie cutter therapy only works if you’re a literal textbook and not a human being. You are allowed to tell your therapist to shut up. They’re not your boss and you’re paying them. A good therapist will let a pregnant pause sit until you’re ready to squeeze out a thought because, in the long run, those awkward silent moments can rouse some really important feelings that you didn’t even realize were part of the bigger picture. Everybody needs to learn to speak for themselves and that voice should not be sequestered to therapy. So say anything. You have no idea whether or not the loose thread you just tugged will unravel the whole garment. Sometimes it does and sometimes it doesn’t. But you’re not hurting yourself by babbling. In the long run, you’ll get better at dealing with the bad shit on your own, which is pretty much the entire point of therapy.

All said, I’m not bitching about doctors in general. Doctors are great (a lot of the time). You should not cavalierly ignore a doctor’s advice just because it sounds like no fun. Much of the time it is no fun. But you decided to get help from a professional because you probably realized you couldn’t do some things on your own. But it’s your life. You’re not too stupid to wrap your head around your situation and you’re not too stupid to understand the process of dealing with that situation. Bipolar disorder can make it really hard to feel like you’re in charge of anything. Depression can too. But you are in charge. Do your homework, ask every question you need to and remember that nothing – not meds, not doctors, not therapists – is indelible. You’re the boss, so act like it.

-LB