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remission
  • Nevertheless, She Persisted

    From time to time, I struggle with writer’s block. I think to myself that I have nothing to say and that I have nothing to say in which people want to hear. I often view it as normal and part of the process of a writer/blogger. In the advent of a rare snow day resulting in the closure of my office, I anticipated spending the day writing and drinking tea. The reality is I spend the day binge-watching Empire and asking my husband what I should write about. He suggested politics. I laughed.

    Until I didn’t. This week, a quote making the rounds in the news has sat with me as I rolled its words and meaning around my head.

    “She was warned. She was given an explanation. Nevertheless, she persisted.” This was a statement Senate Majority Leader Mitch McConnell said in defense of his cutting off Senator Elizabeth Warren from remarks during a confirmation hearing for the position of Attorney General. Women all over have adopted this as a new rally cry in defiance of a new administration in Washington, which has been less than friendly to women’s rights. I digress however, as this is a blog about life with mental illness.

    “She was warned.”

    I was warned, sort of. I see this as more of the stinging rebuke once passed onto me by a therapist who chose to give up on me as a patient than take the time to assess if my diagnosis of postpartum depression needed to be revisited. I was deemed by the provider to still have the diagnosis, but that I was unruly, untethered, wild, and unable to be properly treated. And so, with the unruliness statement and the subsequent discharge from the practice I had my warning. I had the warning that I was too sick to manage, too sick to be treated and too sick for other providers to consider.

    “She was given an explanation.”

    In time, I was given an explanation. It took a second suicide attempt and hospitalization to get one. It was explained to my husband and I that I was bipolar. The diagnosis of postpartum depression, while once fitting, no longer applied. It was an explanation that I would need to hear over and over and over before I could really hear it. I would be hospitalized two more times before I would begin to understand what this explanation, what being diagnosed with bipolar disorder really means. This explanation still needs to be repeated to me from time to time as a refresher to best grasp the implications for my family and myself. I have an explanation no matter how many times I need to hear the words that I live with bipolar disorder.

    “Nevertheless, she persisted.”

    And how. This diagnosis, this challenge, has not kept me down. I persist due to my family. I persist due to the psychiatrist who thought “what the hell, I’ll take her on.” I persist due to my own bullish tenacity to prove others wrong. I persist to prove my old therapist wrong. I persist to prove any and all naysayers wrong. I can and did achieve a fragile state of remission. I persist to demonstrate to the attending psychiatrist during my last hospitalization that she was right. She told me I needed to get better and use my voice, my knowledge, my medical training for good rather than self-pity.

    Nevertheless, I Persist.

    And so can you.

  • Maintaining a Little Hope

    Next week is Thanksgiving and the official beginning of the hectic holiday season will begin. Since diagnosis, I have learned to live with a pit in my stomach and a hairball of anxiety in my throat from November to January as the trend is for me to have a setback during this season. It is simply stress and as much as I try to anticipate what needs to be done, my brain ends up defeated. I have been thinking a bit more about hope in the last few weeks as it pertains to me, to the season, to evolving moods and to 2017.

    Hope is all I have. Hope that medications continue to work. Hope that I can control my moods. Hope that my disorder remains in remission. Hope that I am a loving wife and mother. Hope that I am a patient and kind friend. Hope that I am a better, more effective provider. Hope that my patients keep hope for themselves.

    2016 has not been the best year for so many of us. I started off rough, with a deep depressive episode. Hope for symptom relief kept me moving forward and out of the hospital. Hope keeps me thinking the year will end differently than it began. I have advocated and spoken to so many congressmen and woman regarding the need for mental health reform. The hope of so many of us got HR2646 passed and we maintain hope that the Senate will soon act, continuing to push reform forward. Hope keeps me in action, showing the “world” exactly what I am capable of even if it’s not in the timeline I would prefer. 

    Four short years ago, I started spiraling down. Four short years ago, I could not recognize the symptoms nor understand that I had a problem. I could not understand I had bipolar disorder. I thought I had an ineffective therapist. Three short years ago, I believed my career was stagnant and over due to my diagnosis. I felt the knowledge of my disorder would preclude me from ever achieving anything further in this life and would ruin my family. Two short years ago I started writing. I started writing to change the way the public viewed mental illness, and in particular a nurse with a mental illness. I did it for myself, to hold onto the hope that my life was bigger than my diagnosis and would mean something to my husband, my children and me. One short year ago, I accepted a position that I never dreamed I would have. Hope always wins when you want it to.

    I suspect one has to be shown hope to have hope. I found hope when a psychiatrist believed in me and told me that during one of my hospitalizations. Prior to that moment I had truly believed I would be spending the remainder of my days in and out of the hospital. Recovering and relapsing repeatedly. I just may still. I cannot predict the future. However I have hope my new-ish pattern of stability and symptom remission will continue.

    What do I look forward to in 2017? I look forward to continuing this career I love. I look forward to working on my doctorate, provided acceptance to a program. I look forward to writing more. I look forward to presenting at a conference. I look forward to continued remission. I look forward to maintain hope.

  • Mania, the Remix

    Raise your hand if you love a good remix. Personally, I am all about the remix. My current favorite is the Mike Posner “I Took a Pill in Ibiza” See B remix taking a lovely acoustic song and transforming it into a jam worthy of the finest kitchen dance party one was ever invited to. There are always exceptions to the remix rule and the original holds, such as the current Calvin Harris /Rihanna collaboration “This is What You Came For.” Strictly the original please for my tastes.

    I Took a Pill in Ibiza, remix, Vevo        

    This Is What You Came For, Vevo

    Raise your again if you are wondering what this has to do with mental illness. I assure you plenty. Now I am in the midst of what feels like the Calvin Harris of all remixes – manic episode with mixed features.

    DSM V criteria of a manic episode with mixed features states: “Full criteria are met for a manic episode or hypomanic episode and at least three of the following symptoms are present during the majority of days of the current or most recent episode of mania or hypomania

    -       Prominent dysphoria or depressed mood as indicated by either subjective report or observation made by others.

    -       Diminished interest or pleasure in all, or almost all, activities (as indicated by either subjective account or observation made by others

    -       Psychomotor retardation nearly every day (observable by others, not just subjective feelings of being slowed down).

    -       Fatigue or loss of energy.

    -       Feelings of worthlessness or excessive or inappropriate guilt (not merely self-reproach or guilt about being sick).

    -       Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide.

    The mixed symptoms are observable by others and represent a change from the person’s usual behavior. The mixed symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication other treatment).

    Let’s review (briefly) a manic episode: a distinct period of abnormality and persistently elevated, expansive or irritable mood and abnormally and persistently goal-directed activity or energy, lasting at least one week and present most of the day, nearly every day (or any duration if hospitalization).

    During the period of mood disturbance and increased energy or activity or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior

    -       Inflatable self-esteem or grandiosity

    -       Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

    -       More talkative than usual or pressure to keep talking

    -       Flight of ideas or subjective experience that thoughts are racing

    -       Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed

    -       Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).

    -       Excessive involvement in activities that have a high potential for painful consequences (e.g.’ engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

    The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

    The episode is not attributable to the physiological effects of a substance or to another medical condition.”

    (Taken directly from the text of the DSM-V, section on bipolar disorders)

    How is my mixed episode playing out? I’ve met the criteria for mania through well over a week now of increased-goal directed activity, less sleep, more talkative, flight of ideas, distractibility and the buying sprees. The mixed component? Decreased mood, thoughts of worthlessness, crying daily, fatigue and thoughts of death.

    I don’t want to have another episode. I wanted to blame my irritable, hateful state on the state of the world today. That is not going to go over well either. People are going to be haters, but my disorder is life-long with periods of relapse and remission. My pdoc is on vacation and the coverage in his office always throws more benzodiazepines at me to solve the problem. That is not what I need. What I need is to lose the fear of speaking up about my mood and getting help with the team I trust the most is unavailable.

    When I changed specialties for my nurse practitioner practice, I guarded my stability and current remission state more carefully than the gold at Fort Knox. I slept, I deceased alcohol consumption, and I took my medications more faithfully than ever before. On a visceral level, I know that this episode is not my fault. I know this episode happened to just occur in spite of the best care possible.

    Here is what frightens me the most about this mixed episode. One, it caught me off guard and I could not recognize it for what it was for several weeks, as I have never experienced one before. Two, I am scared to speak up without my treatment team in town. I am a medical provider and people rely on me. Unless you stand in my shoes, you cannot possible understand what it is like to keep your brain held together for 8 hours every day, in a state of constant adrenaline because patients will always come first and to cause harm would cause you to go to the depths of hell. Three, do I need a medication change – AGAIN?

    Lastly, I fear I will become a victim of the system. I worry my disorder will claim me versus the other way around. I constantly worry about being just another statistic of this brain disease.

    It’s not quite Vegas for this remix and I don’t have a huge crowd cheering me on unlike our dear Calvin, though.

  • Learning to Savor the Small Moments

    I have found as I navigate this bizarre world of both patient and provider that it is the small moments that can make the biggest impact. We often are not even cognizant of the impact until much later, but they make an impact and a difference in our journey and path we forge trying to achieve the wonder that we call remission from symptoms. This week for me has been fragile, full of triggering moments leaving me feeling as if I’m dangling on a cliff’s edge one moment and then left speechless with a small moment of how far I have come the next.

    I encountered a woman this week who is the twin of a nurse I had during the last psychiatric hospitalization, back in June 2013. She was a kind white haired woman who took the time to sit with me during her shift and check in. She talked with me about how we were nearly neighbors, told me things about common threads we wove, and talked to me at length about sometimes how long it can take to find the right cocktail of medication for bipolar disorder. She knew because of a family member. She shared that with me. She shared that when it works and you find the magic combination it’s like Christmas morning.  It did not take as long for me to find the magic combination as it took for her family member. I digress. I was so excited when I saw this woman this week for I was sure it was my former nurse. I wanted nothing more to embrace her and tell her how her words helped me and were an integral part of the reason I am here today, doing what I do. She is one of very few providers from my inpatient stays who made a difference and I wanted her to hear that and see it in the flesh.

    I had one horrible psychiatric hospitalization in February 2013 that left me feeling disoriented and not ready for reentry when I came out. My husband, when he picked me up, handed me a Starbucks venti chai latte extra hot with soymilk along with a brand new iPhone 5 fully loaded with all the apps he thought I would like. Both have been my crutch ever since and typically not far from my hand. The other night, my youngest (by two minutes) informed me I spent too much time with my phone and that it was going to stop. I looked at him and agreed. Last night, I picked up all the boys and took them on a date. No phone. We had a ball. I learned so much about them and we laughed, played games, and talked through our meal. I didn’t pick it up again until I was in bed for the night. They have slowly been learning I am a safe, dependable parent, but now they can learn I am a present parent too. I just have to figure out what we can do tonight – phone free and without my crutch.

    The best part about my job as a psych APRN is when a patient finds their own small moment that is pivotal for them, helped them see the hope in a situation they thought otherwise and they bring it to me. My patients don’t know my story; they don’t understand the passion I pour into my career to see them succeed, as it is irrelevant to achieving remission for them. And they definitely don’t get to see my happy dance after they leave on their small moment days. But it’s there.

    Now I just hope my front office staff never figures out YouTube.