Pills to Poetry: The Burden of Non-Compliance

The conversation between my wife and I when I don’t want to comply with medication or sleep. A bipolar dilemma. A caregiver’s burden.

Pills heart

~The Burden That No One Sees ~

“It’s late.” She’s barely awake, squinting.
“I’m not tired”, I tell her, and continue working.
“That’s the point”, she says under her breath.
“What’s the point?” I’m lost.
“With your condition…” she’s exhausted. I’m making it worse.
“Seriously I’m fine.” I insist.
“Take your meds.” She isn’t giving up.
“I’m not tired”, I say.
“You have a big day tomorrow.” She’s more patient than I deserve.
“I know. But I’m wide awake.” I continue working.
“That’s the problem.” Her face is pretty, even half asleep.
“What’s the problem?” I’m lost still.
“You’re getting manic.” Her tone is serious.
“Not manic. I’m just really busy. It’s a project…”
“It’s 2am”, she informs me.
“Okay. In thirty minutes I will.”
“No. Take them now.”
“Fuck. Okay. Fine.”
The bedroom door closes behind her as I pour a handful of perfect little pharmasanity shapes from the burnt orange, child-proof bottle. I choke them down with a large swig of beer. She hates when I do that but does not complain because at least I’m taking the goddamned medication.

pills heartt

After a week or so of these types of conversations, she usually ends up putting me on a bedtime schedule with a tight ritual involving complying with meds. Because I love my wife and trust her, I often go with it. Well, okay, I put up a fight half the time, which occasionally puts her in the position to give me ultimatums. This is love. This is bipolar disorder. This is a bipolar marriage. And I still fucking hate taking pills.

Advertisements

Ambush Drug Test at my Psych Appointment- Wait, What?

I’m still shaking off my first experience with Medication Monitoring. This took place a few days ago, and I was completely bombarded, with no explanation, no warning, no consideration for my personal space.

FullSizeRender (10)

My pdoc appointment went quite smoothly. I talked about my grandfather’s funeral, about the baby, about being a temporary stay at home mom. We went through the checklist about side effects, mood fluctuations, and if I have any thoughts of harming myself (I don’t). Pdoc agreed we should keep my medications the same as they’d been, and he wrote up the new scripts. I gathered my wallet and keys, and started for the office door. Just before I hit the front desk, he informs me that everyone is taking a urinalysis for medication monitoring. I was a little confused. He laughed and said it’s to make sure people are taking their meds, and not selling their Adderall. Well since I take my meds and I don’t sell anything, I just agreed that it wasn’t a problem. I was also under the assumption that he would write me a prescription to take to a lab for the test proceedings. Those of you on Lithium know about this all too well. Was that what happened? Nope.

Surprise! As I walked through the second set of doors into the lobby, a woman I’d not seen before was standing there waiting for me with a little piss cup in her hand. She gestured toward the waiting room bathroom. I felt ambushed. No opportunity for questions, no discussion. I’d been at this psychiatric facility for almost ten years and never felt so put off. Honestly, I felt as if I were in trouble.

After I provided my little sample, she had me sign a form, supposedly for them to bill my insurance. This is also when I was given an informational card entitled, “Medication Monitoring Explained”.
Some key points given include:

  • Helps to understand what medications you are currently taking which could interfere with your prescribed medications.
  • Provides essential information for the safe and effective use of your medications.
  • Your doctor will determine how often you will be tested based on your medical needs.

The kicker in my situation is that in all definitions of the term, I failed my drug test. Yes, I had other substances in my system. I had been treating two pinched nerves in my back with a narcotic pain reliever for about three days, and I occasionally self-medicate with marijuana. During my grandfather’s death and funeral days, I smoked pot in the evenings. (For those of you just tuning in, I’ve always been a cannabis advocate.) The biggest clincher here is that I would have absolutely disclosed this information to my doctor had I any idea it would be relevant. (*Note: I do not promote the notion of self-diagnosing or self-medicating. In my instance, I have had much experience with these substances and I know how my body reacts, on prescribed meds and off.)

All in all, I understand and agree with new advances in patient treatment. If urinalysis is a tool in helping doctors help patients, then I support it. I really think, in my case anyway, that there needs to be a much different procedure in collecting the samples. I already feel vulnerable, as it is when working on my mental health, so in some ways I felt my trust had been violated.

Have any of you had experiences with medication monitoring? I’d like to hear your stories.

Saying it Aloud Makes it Real

Apparently I’m fighting mania. Apparently I didn’t realize this until I talked about it. Apparently.

a6a276d290f616545d955f27e362ed21

 

I knew a few factors were surfacing, but I didn’t realize just how many signs of mania were actually present in my life until I shared my current state at my DBSA support group meeting last night.

Let’s begin by examining the facts – the manic stuff.

  1. It’s Spring. My witching season. Well, the start of it anyway. Summer is equally lethal. Warm weather heats my blood something good.
  2. I’m suffering from chronic boredom. Bored with work. Bored socializing. Bored at home. Bored in my marriage.
  3. I’m overstimulating in order to combat the boredom. Drinking. Music. A dozen social networks. Heavy involvement with friends.
  4. Becoming hypersexual. Collecting new erotic photography. Flirting. More self-stimulation than usual.
  5. Planning. I’m planning a mini vacation by myself next month to stay with a friend and attend my favorite band in concert. Okay- my obsession in concert. Which brings me to number 6.
  6. I can’t help the obsessions. Tegan and Sara have been my loves for over a decade. I can’t get enough. Literally. I’m also obsessing over my marriage. And the lack of sex.
  7. My mind is racing. I struggle to focus at work. My ideas are flying around. I’m quite forgetful.
  8. Irritability. I’m moody and irritable. I seem to get annoyed easily with customers. And traffic. And television. And a few acquaintances.
  9. Fleeting desire to skip meds. I don’t want them. I don’t like them. So there.
  10. Spending money. My wife is our financial manager, but I have managed to find an unusual amount of reasons to need money lately.

Let’s examine things further – the not so manic stuff.

  1. I am indeed still taking the meds. I toy with the idea of stopping. Regardless of those thoughts, I comply with treatment. My wife is mostly to thank for this.
  2. I have a job. And I go to it. Every day. On time. It’s often difficult to function with a spinning head and chronic restlessness. But I’m there.
  3. I take excellent care of my son. For some reason, this part really works for me. He’s healthy. He’s happy. He’s dressed, changed, fed, and snuggled. I manage to drop him off at my sister’s every morning. It’s a miracle, maybe.
  4. I’m not as bad as I’ve been. Maybe the meds are preventing me from falling into full-blown mania.

What is my next step? Well, that is a good question because I am conflicted. Right now I am incredibly tempted to succumb to the manic triggers that pacify my boredom. I flashback to last summer- too much booze, too much pot, too much fraternizing for a married woman, never needing sleep, and rounds of fighting with my wife. I look at how things are right now and I’m not where I was last year.

Am I heading there? I guess I can’t say for sure. I will try to vow to stay on the meds in order to prevent it. My psychiatrist already doubled my Seroquel to balance me out. The fact that I really am chronically bored and I crave excitement may be what drives my actions. It’s a vulnerable thing to feel so unpredictable.

 

Lithium’s Ugly Side Effect: Acne

Occasionally I bring up the topic of medication side effects, and this is one that affects my daily life. I’m referring to acne as an irritating side effect of Lithium. Screen shot 2014-02-03 at 5.38.09 PMLithium is the most widely used and studied medication for treating bipolar disorder. Lithium helps reduce the severity and frequency of mania and helps stabilize moods. It has a list of common side effects, including hand tremors, increased thirst, weight gain, drowsiness, muscle weakness, hair loss, decreased thyroid function, and acne.  While the side effects are not always easy to live with, Lithium can be a life-saving medication for so many people. The side effect I want to focus on is one that is often overlooked because it is not always considered medically troublesome. This side effect is acne.

I have been taking Lithium for almost a year and a half now and my skin hates me for it! Prior to taking this medication, I would have an occasional breakout, but nothing like I do now. At the time of being prescribed the Lithium, my psychiatrist didn’t really explain any side effects. I think this is due to the fact I was in crisis mode, suffering a severe mixed episode. He also prescribed two other medications to take with the Lithium, while discontinuing the meds I was already on. There was a lot of change going on and I probably wouldn’t have been able to fully comprehend anything too detailed anyway.

When I first started noticing my skin breaking out, I didn’t connect it to my medication. I used several different drugstore brand cleansers and ointments. I make sure to drink plenty of water and eat healthy. I wash twice a day and remove all makeup at night. I learned how to use concealer and other makeup tricks. I cried on occasion and I sometimes avoided going out with friends. My biggest problem wasn’t necessarily that I had the acne, but I really wanted to know why I had it. Then I started thinking that maybe things I put on my face aren’t working because it has to do with what I put in my body. The chemicals I put in my body. Since I don’t smoke or drink or anything like that, the only chemicals I’m really ingesting are my medications. After doing some research, I found that acne, sometimes chronic, is definitely a side effect of Lithium.

Not everyone who takes lithium develops acne, but many do. The reason lithium triggers acne is counterintuitive. It increases the activity of the immune system which in turn increases skin inflammation.

Lithium causes a condition called leukocytosis. The technical definition of leukocytosis is an increase in white blood cell (WBC) count due to any cause. When people who have bipolar affective disorder take lithium, the drug causes them to produce more stress hormones (which is actually a good thing) when they are depressed. These stress hormones make it easier to find the energy to function day by day.

Stress hormones in the skin, however, increase inflammation. They trigger the release of histamine from storage packets in the skin. Histamine is the same chemical that causes allergies. It breaks down skin cells or cells in the membranes lining the nose and throat to remove foreign bodies and germs. When the release of histamine is induced by stress, however, histamine destroys healthy tissue that has not been penetrated by foreign bodies or infected by germs. The result is redness, itching, and even pain in the skin that is worse in pores that are affected by acne. http://www.facingacne.com/lithium-acne/

Okay so now we have a cause for the ugly blemishes, but how do you get a handle on the situation?

If your acne is bothersome, decreasing your lithium dosage with your doctor’s consent can often help your skin improve. If that’s not possible, it’s best to consult a dermatologist about acne treatments, since lithium-induced pimples are generally harder to get rid of than other types of blemishes.

One possible treatment for this type of acne is tretinoin (Retin-A, Renova, Atralin), a topical drug that works by unclogging pores and promoting peeling of the affected skin. However, it is important to talk to your doctor about possible side effects before using this medication.

The drug isotretinoin (previously marketed as Accutane, but now available only as a generic) should be considered only if absolutely necessary, since its reported side effects include birth defects, depression, and psychosis (feelings of delusion and hallucination). This can be especially dangerous for someone with bipolar disorder. “You should proceed with caution so you don’t have some sort of manic or depressive episode,” says Amy Derick, MD, a dermatologist in Barrington, Ill.

Having a good anti-acne skin care routine can also be helpful in fighting breakouts while you are taking lithium. An over-the-counter cleansing product that contains salicylic acid, which reduces swelling and unclogs pores, should be used twice a day for optimum results.

When buying beauty products, such as moisturizer or foundation, be sure that the label says that the formula is “non-comedogenic,” meaning it has been formulated to not clog pores, which can lead to breakouts. Also, choose a sunscreen that uses titanium dioxide or zinc oxide as a physical barrier against the sun, rather than chemicals that absorb UV rays. “Those types of sunscreens are usually better for people who have acne problems,” Derick says.

Finally, try not to get too down about your acne. Some patients on lithium have found that their skin problems decrease after about six months of treatment, as their bodies adjust to the new medicine. “It can get better,” Derick says. http://www.everydayhealth.com/bipolar-disorder/when-lithium-causes-acne.aspx

So what am I going to do? While I would like to be able to decrease my Lithium, it simply isn’t an option. I will continue to practice healthy habits like washing twice a day, using clean towels and pillow cases, and eating healthy. I also ordered an acne cleansing system, Proactive Plus. (I do not endorse any products.) This product has gotten good reviews, so I figured it can’t hurt to give it a try. I don’t expect to get rid of the acne completely. I just want to feel attractive again. I hate being self conscious over my skin. I feel a little less stressed about my complexion since knowing the assumed cause of the issue. Hopefully this information helps out any of you with similar side effects.

Medication Report!

I’m writing this to check in, with myself mostly, but also with those of you taking medication for Bipolar Disorder. It has been almost one year on my current cocktail of Lithium, Seroquel, and Abilify. As a reminder, I was put on (varying doses) of this combo after a terrible mixed episode last fall. In the beginning it was considerably difficult to build a new med routine since I was so used to taking only Trileptal twice a day. But with the assistance of my amazing wife, I was able to get on board. After about 6 months, I even began sorting and distributing them myself. I know many of you know what a small victory that can be!

Medication management can be challenging. Important factors include making sure each script is filled, that you have enough for tomorrow, how many you are taking, how often, knowing what to do if you forget to take it, being aware of and dealing with side effects, whether you need to have blood drawn or not, having effective communication with your doctor and pharmacist, and of course being able to monitor how your meds are affecting you. Whew! It really helps to have someone close to you that you can talk about your medications with, or that can lend a hand in monitoring and managing your meds. Also, utilizing calendars or alarms on your cell phone (like I do!) to remind you what time to take your pills is really handy. Developing a solid routine that works for your schedule is important so taking your meds becomes like second nature.

These are just a few tips I picked up within the last year that have worked for me. So far, I am doing well, and I feel pretty stable. There will always be ups and downs and mood swings, but the medication change was definitely necessary and saved me from a trip to the hospital. Every so often we all need to check in with ourselves and take personal medication inventory.

Image  

Hair Loss Is Just Another Side Effect

Let’s talk side effects for a minute. Common ones are dry mouth, tremors, sleepiness, upset stomach, and weight gain. What about hair loss? I’m talking constant loose strands, hair falling to the floor every time I touch my head, handfuls when I shampoo. I keep a Swiffer vac by my side whenever I blow dry and straighten my hair because otherwise the bathroom is decorated with what has released from my scalp. For months now I have been attributing this to everything from what I was eating, to needing a haircut, using the wrong shampoo, not washing it enough, washing it too much, not brushing it enough, brushing it too much- you catch my drift.

Then it dawned on me that this began around the time my medication was switched and I started on Lithium. After doing a little research, I have now learned that I’m not alone in this situation. According to bipolar.about.com, Lithium and Depakote are common culprits in the hair loss manifesto.

Lithium can cause thyroid problems which are associated with losing hair. Other than that, it isn’t specifically known why certain drugs cause thinning hair, but what happens is a process called telogen effluvium. Normally, most hair is in the active growing phase, while a much smaller proportion is in the resting, or telogen, phase. Growing hair pushes the resting hair out. When a medication causes many more hair follicles to enter the resting stage than is usual, there is less hair growing and more to be pushed out — or pulled out, whether by shampooing, brushing and combing, or just running your hands through your hair.

Image

At this point, I am really getting tired of dealing with this. I also find it interesting that it is a side effect you don’t hear about very much. I have been on several different cocktails and have experienced a rainbow of side effects, but this is new for me. I just had an appointment with my psychiatrist and I didn’t think to mention it, but at my next appointment I definitely will see what he says. As for everything I’ve read on how to remedy this situation, decreasing or discontinuing the medication is the most effective solution. Unfortunately, this will not be an option for me right now. I feel better than I did 6 months ago, and I know the meds play a huge role in that. Now I’m just curious if anyone here else has experienced this and how you’ve handled it.

Hello, Antidepressants

My Bipolar depression forgot to do the laundry. And the dishes. And the cat litter. And the recycling. Again. Meanwhile, overanxious thoughts remind me to not starve the dog, to shower so I don’t repel others, and to basically get my ass out of bed. Let me welcome you into my neurotically depressed existence.

First I’ll start off by saying that this depressive bout has been going on for almost two months. I know I’ve written about it a little bit in past posts, and last week I finally talked to my psychiatrist. He prescribed me a healthy dose of happy in the form of a beige pill. Antidepressants. His directions were to start by taking half a tablet as to not induce a state of mania. Yeah right. No mania here. Not a chance.

The thing that got me is while I knew I really did need something, I also had the urge to pretend everything was fine. Like I didn’t need more drugs and I didn’t need to schedule another visit in such a near future. Why do we do that? Deny ourselves the truth of our disorder? Like every time we get assigned a new prescription, we’ve failed in our behavior somehow. Whether it’s rational or not, we still toy around with these notions.

So far, I’ve been taking my antidepressants for a week and I don’t feel any difference in my deflated mood. No cheer. No miracle. But no mania either so I suppose there is a bright side. Ironically, I have a degree in this subject so I know it can take 2-3 weeks to begin working. It’s difficult to apply these things to myself sometimes.

I’m just trying to get through each day and trying to have faith that this medication will help. I admit it is tough to keep track of so many pills and adding this one didn’t exactly lighten the load. I also know that is part of the deal sometimes. Until next time, I want to send well wishes to anyone out there currently dragging through some type of depression.

Parade of Pills

Just a little ‘ol poem flirting with lunacy and pharmaceuticals…

Screen shot 2013-01-14 at 7.41.46 PM
PARADE OF PILLS
The drama mask,
Tie it tight.
Toxic prisms
In the light.
Choose your mind
Blue, pink, white.
Wash it down,
Pose no fight.
Happy, shiny
Crystal height.
My jester hat
Falls off at night.
Behold my thoughts,
And take a bite.
Smelling voices,
Tasting sight.
Dance on arrows.
Choke me right.
Bells are screaming
Crash down kite.
Veins are ticklish,
Flesh so bright.
Parade of pills.
Test that flight.

Serenity and Lithium: A Saga about Personal Management

So one thing we have all been taught is that in order to manage your Bipolar Disorder, you must be sure to practice good sleep habits. It’s crucial to get adequate sleep to avoid unnecessary irritability, avoid agitation, and prevent potential triggers. Many of us are on meds that either control, conflict with, or conduce our sleep schedules. Another thing we’re taught is to be aware of potential stimulation triggers around you, or to pay attention to your surroundings. We also have the understanding that meds must be taken on schedule and it’s against the BP commandments to fuck around with meds. This is where my story of last weekend begins..

I take 600mg Lithium and 300 mg Seroquel at night before bed, no later than midnight. Then 300mg Lithium and 5mg Abilify during the daytime. Ok so while I usually have my wife on pharm patrol, I went away to a convention this past weekend, where I spent two nights away from home. Of course while I was away, I was on my own to remember to take my pills.

Now let me fill you in on the convention I was at. It was a very large organization of support groups and motivational speakers, discussion panels, an array of activities, and lots of intensely inspiring people, strong emotions, and an impossible amount of interaction- at all hours of the day…AND night. The convention consisted of several hundred members of Alcoholics Anonymous and affiliated groups, and I was in attendance as a guest of a loved one. I can say, while I genuinely enjoyed offering my support, the intensity of the emotional experience was a bit hefty a tab for the Bipolar gal who’s currently in the process of trying to color inside stability lines.

I did take the meds- just not quite as directed- I took half of a Seroquel 2 days in a row, and washed the others down with my 13th cup of coffee (it is AA, after all)- somewhere around 4am. Somehow I managed to be the first one up, at 7am, took more Lithium and Abilify, and I was eager to go absorb the empowered desperation of the first speaker. This went on for the remainder of the weekend.

Little did I know, this convention was triggering my Bipolar Disorder. While I thought I was simply being supportive and gaining new inspirational perspective (and I did), I was actually nourishing my disease. Flashback to October where I was full blown manic in my psychiatrist’s office, with my wife pleading for him to do something about me. We’ve been working on managing my treatment for the last two months. This emotional ambush sent hypomania into overdrive and my brain decided to go numb, race my thoughts around, and offer the gift of crying spells all the way home. This opportunity I wouldn’t have passed up for anything, however, life gave me a nice bitchslap pertaining to my own personal management.

Personal management in those with psychiatric illnesses, such as alcoholism or Bipolar Disorder, is imperative at all times, not just in the comfort of your home or workplace, or while with friends and family. But at all times. This, ironically, is a topic that many speakers touched on in their panels. Words I absorbed but didn’t apply until now. Once I got home, I acknowledged my triggers and made the commitment to get myself back on track, something that is extremely difficult for those with Bipolar to do. I put myself into a dramedy of caffeine, insomnia, and the serenity prayer. I’m still practicing serenity, just washing it down with a reality check and a side of Lithium.
IMG_8158

Psychopharmocology

This poem is dedicated to the psychotropic medication soap opera that many of us have faced. Bipolar medications are very specific and often a method of trial and error, and most usually a frustrating adventure. My loving (and very patient) wife helps manage my medications, which I am eternally grateful for! Anyway, I wrote this little poem with the world of meds in mind.

Psychopharmocology:

Little pills just like candy,

Gagged and bound, forgotten code.

Simple thrills and what they would be

Altercations a la mode.

Sweet and salty syndication

Reclaimed a garter at the seams. 

Climb the ladder’s big sensation

Pharmaterror sugar dreams.