3 Med Changes

Yesterday, I saw my nurse practitioner. It had been two months. She knew that I was only taking 2.5 mg of the Zyprexa. She first suggested I just go off it completely now but then seemed to change her mind. I wasnt sure which way she was more convicted. We also talked about stopping lithium- Ive been on that for at least ten years. And then we discussed adding Lamictal starting Wednesday. It will be in a separate blister pack because ive already had current blister packs filled. So thats three changes. I hope they go well! Update: my nurse practitioner put me on 25 mg of lamictal titrating up for a month. All other drugs are to remain the same.tThe Lamictal is in a separate blister pack as we go up on the dose.

Curtain of Snow

I was sitting and relaxing at my favorite Starbucks when I thought I saw snow on the backs of a few cars in the parking lot. I mentioned this to a friend I was talking with on the phone at the time. The conversation continued and then a curtain of snow fell down with a defined bottom and sides, plain as day. I walked up to the cars with "snow" on their backs. Yup. It was real snow.

And that's a No.

I needed to get my blister packs for my pills refilled. I wasn't sure if my pdoc was going to make any changes before I went to the pharmacy before I went in. Nope. So I still have to cut the Zyprexa in half. (From 5 to 2.5.) That also means we're not starting any other med, including Lamictal. I did get Eloquis (New blood thinner instead of Coumadin. I don't have to get my INR checked with Eloquis). Two other meds- Propranalol and Metformin- have also been reduced in half. Yesterday, I saw a liver specialist. I'm doing better, but he wants me to lose weight. Seems that's what will fix everything.

The Biological Clock

I have sleep apnea and have for several years. I use a CPAP machine at night. I found this link that shows the role of the biological clock on bipolar disorder, including sleep apnea. For one thing, one wakes up continually when they stop breathing as part of apnea and this disturbs one's sleep. Definitely lack of sleep or just a shift change at work can affect how your brain deals with bipolar. Staying up all night or just not being able to sleep can push you over the edge into an episode- usually mania (as least for me!). Disturbing your biological clock in general and disturb your mood parts of the brain, especially if you're bipolar.

Lamictal / Lamotrigine

At my appointment a few days ago with my psych nurse practitioner we talked about going off Zyprexa for good. As of now, I'm down to 2.5 mg. But she wants to add something else after. First, she suggested Depakote, but that was my first "bipolar med" and I gained 60 pounds on it. The other idea- I've gone through trying many meds - was to try Lamictal. This was first suggested to me inpatient, but I was afraid of a rare complication where a rash gets so bad that your skin falls off. My "psych nurse" said you go really slow when you're titrating up on it, to avoid this. I'm not sure when this med change will happen as I'm not sure how long I'll be on this last dose of Zyprexa. (My file says I was already on Lamictal for a short time. I'm not sure why I went off if this is true.)

File: GAF Rating

5/02/2016 File marked with "Current GAF: 30".

From WebMD: The Global Assessment of Functioning Scale rating of 30 (-21) reads:

Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g. sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends).

A little Fun!

Singing crickets

A recording of crickets in 1992 was slowed down to human speed. The results are amazing! Enjoy!

Big White Bird

Today I was driving and saw a big white bird taking off from the ground. It flew up, then at my car, spreading its wings. Then it disappeared. (Key to prove a visual hallucination.) So clear. Driving is not safe while hallucinating!

Hallucinated Tiny Spider

Sitting in my recliner, I looked down on the left arm and saw movement. For a moment, I saw tiny eyes looking back up at me. A spider. Disappear! Just like that, it was gone. I looked all over, but couldn't find the arachnid at all. This is unlike the big black bulbous spiders I had been hallucinating. This one showed up clearly, then went away just as clearly.

Horrible Day, Beautiful Choir Day

Been having a horrible day. Filled out housing paperwork but my mom who was helping me called the mean worker at my apartment complex. Apparently my mom called her a *****. (Not to her.) Papers everywhere in piles on the table. Are they all there? Are they in order? Meanwhile I was feeling spacey and dizzy and completely confused. I had felt this way all day. My thoughts were confused and slow - full of molasses. The only thing that clears out my thoughts completely is singing in the choir, like I did yesterday. Rule after rule going through my head- vowel shape, volume, diction, meaning of the words, reacting to the other voice parts, not to mention the other members of your own part... A recording was made of the performance at 4:00. Nobody realized that we were being recorded until afterward. We were sent .wav files of the pieces, but I will have to wait to hear it until the person who recorded it gets back from vacation. Oh well. I can't wait to hear it- I thought it went very well! EDIT: Now its a few weeks later and we sang that same anthem this morning. It came out even BETTER than last time. (And I have yet to hear that recording.) I wish today had been recorded. Ah well.

Feeling Anxious - There's Still Time

This week I've been feeling anxious. I feel like the world is falling in on me. I have a ton of important paperwork to finish. I feel extreme anxiety without anti-anxiety medication. I've been posting on this blog once or twice a day for over a week, which my friend, C, says is a sign that I'm moving into an episode. Tomorrow, my youngest has a repetoire class for piano in the morning. In the evening my eldest and I are meeting for Starbucks for his birthday- 20! I just feel like the world is crashing down around me and there's nothing I can do to save it. This is leading to anxiety and anger. One of the people that manages the office at my apartment complex is always mean to me. She got angry that I was in the office a few days ago even though the paperwork I got from them SAID to come in and get a date set. She said, "Call before you come here again," she said. But tomorrow should be okay. I had an interview with the bipolar study I'm in a few days ago. This lady thought I seemed perfectly "even"- not manic or depressed. But this is my manic time of year. Huh. There's still time. Ha!

File: 5/02/2016 Paranoid, delusions, aliens, anxiety, balcony

[PDOC] 05/02/2016

F31.2: Bipolar disorder, current episode manic severe with psychotic features (Active as of 10/16/2015)

F29: Unspecified psychosis not due to a substance or known physiological conditioner (Active as of 11/21/2013)

F31.9: Bipolar disorder, unspecified (Active as of 10/29/2014)

F39: Unspecified mood [affective] disorder (Rule Out as of 11/21/2013)

4/20/15: Clt's current symptoms and presentation and symptoms are congruent with previous diagnosis.

11/21/13: Client reports paranoid thinking with delusions. (Thinking people are aliens and endorsing a hx [history] of beliefs that she can fly and that she will not die for long if she kills herself.) Client reports a hx of auditory and visual hallucinations, but none at the moment. Client reports anxiety related to personal relationships. Clients reports that she tried to overdose to kill herself last night with plans to do so again.

10/08/13:. Pt presents as preoccupied, possibly responding to internal stimuli, hears voices telling her to stab herself, reports some improvement in psychotic symptoms.

10/1/13: Client presents "ramped up" with thoughts of jumping into traffic or "Flying off her balcony" w/o specific intent of suicide. She is calm in presentation but she reports that she has felt increasingly "ramped up" over the last 2 weeks. She spoke with her psychiatrist this morning and she recommended she resent to PES. [Psych. Emergency Services]

File: Voices

5/19/15

Once a day she reports hearing a voice with derogatory manner, notes it is the same voice that told to OD on pills, she notes she hears the voice and then thinks about what it says. She is not bothered by daily occurence now and notes it is a distraction. She has not discussed coping skills in therapy regarding voice. She notes zoloft has helped decrease her anxiety and is not worrying as much. "I didn't realize I worried so much until I didn't worry as much." She notes she is able to care for her children and herself and recently had stylish new hair cut and manicure. She denies depression, endorses good sleep at night and "wakes rested".

4/30/15

Client notes having depression with AH/VH [audio and visual hallucinations] and heard voice in head telling her to OD on pills which were in her hand. She notes calling crisis line several days prior and was eventually hospitalized at XXXXX. Her lithium was reduced by 300mg. zyprexa increased to 15 mg, trazodone 50mg and zoloft 50mg added. She denies AH/VH, endorses good sleep and feels rested upon waking. "feels better". She questioned borderline personality dx [diagnosis] given in hospital and writer [pdoc/nurse practitioner] disagreed with this diagnosis as well.

Foregetful Lateful

II've been feeling very forgetful lateful. I type weird or double words. I'm tired all the time. My friends say I'm fat (but they're fateer???). I have so much to do that I feel like I can't anymore. I want off. I want a helper with life. So today I'm watching YouTube videos of my kids singing, waiting for maintenance. We were discussing drs calling you fat and I said my Pdoc put that in my file (obese). So they all went "oh yes yes mmm hmm yes you are" etc. But they're a hundred or two hundred pounds heavier.

Tomorrow, I'm going out to do impoartant things with my mom about papers and apaperwork,. I hate it. But it HAS to get done.

File: Mania and hospitalization from 12/19/2013 & 11/26/13

12/19/2013

Client seen today at xxxx for first time and was previously followed at xxxx but due to intensive treatment needs, will be followed by XXX and client was initially confused about the change and confirmed understanding after writer's explanation. [pdoc]

She recently was hospitalized at UM 9C 10/1-10/10 for SI [suicidal ideation], mania, psychosis and had zyprexa increased to 10 mg during admission then was at XX 11/12 for SI, psychosis.

Today she denies AH/VH/IOR/paranoia, endorses stable mood without hypomania or mania, low anxiety and depression energy, & appetite normal no wight changes, sleeps 8 hours, memory is variable and low at times.

She has history of mania with psychosis - VH-sees animals. "cat disappearing." AH [audio hallucinations] "someone talking, music playing" referential delusion-"sun giving me messages, I could fly". Grandiose delusions-I was invincible, could walk into traffic and nothing would happen", elevated and irritable mood-"everything is wonderful", agitation- "moving a lot," occasional thoughts of wanting to stab herself "reported this was a chronic issue that did not increase her desire to commit suicide," or inflict self-harm.

Client is not sure why she had episode this fall or last fall because she notes medication adherence and also remarked the last year in November, she had another manic/psychotic period and thinks the fall may be a bad time for her. Per [hospital] admission note during her two weeks prior to hospitalization, client was posting multiple blogs [I just have this one blog.] and writing more, internal restlessness, almost jumping off balcony, increased pressure to talk and stay up past midnight on phone with friends, racing thoughts, low concentration, increased energy, appetite decreased, mildly decreased sleep....

11/26/13

CURRENT SIDE EFFECTS< ADHERENCE ISSUES AND PREVIOUS MEDICATION TRIALS

latuda trial - akathisia, w 20mg dose

fanapt - tachycardia w 4mg dose

depakote - weight gain, worked well

seroquel - itching

nortriptiline

abilify - akathisia

geodon - induced asthma attack

saphris - "internal hallucinations"

File: Nurse Practitioner Notes of 2014 (Psych medical record)

Various reports during 2014/2015.

7/16/15

"I can't find enough things to do with my kids this summer."

Client endorses stable mood, good sleep, normal appetite, denies depression and anxiety, notes VH-sees cat, saw her daughter at end of bed last night while awake and she wasn't in room, endorses tactile hallucinations- felt her daughter touch her foot but she wasn't in the room. She notes it takes her a few minutes to process and realizes it is not real and does not think this it is bothersome, doesn't think this is prodome to manic episode. She does not want to change meds today. ..... and enjoys spending time with other friends at Starbucks. She recently received new tattoo, and explained the significance for hope when someone feels suicidal. She denies SI. [Suicidal Ideation]

"I made it through November."

12/3/14

Client notes stable mood, denies depression, anxiety, akathisia, denies SI.

She is able to care for her children and drive them to their activities and support them emotionally.

....She called crisis line, spoke with DBT therapist and a supportive friend and used ativan once when highly stressed. She continues with group DBT and individual.

10/29/14

Client "almost" back to baseline, endorses stable mood, denies depression, anxiety, denies SI [suicidal ideation]

Client has resumed zyprexa 10mg after trials of Latuda with akathisia and Fanapt with tachycardia over past several months.

She endorses being able to take care of her children, is receiving help for SSD [social security disability] application, has weekly therapy DBT and finds it valuable

"I want off zyprexa"

Client notes being stable "for most part", notes 3 days last week when she smoked which she normally doesn't do and thinks she was being impulsive. She notes mild anxiety, denies depression.

She denies AH/VH [audio hallucinations/ visual hallucinations] now and notes that she has experience these symptoms without being manic and notes a past psychiatrist was not sure if she had schizoaffective vs bipolar disorder.

Client has elevated triglycerides and has been on zyprexa for 2 years and would like to change meds- all past meds reviewed and she agreed to try Latuda.

She endorses having family/friends who see her often and notice changes in her behavior and she notes changes in herself too.

File: Another Medical Record Page

This is an excerpt of some entries from 2015/16.

01/18/2016. DANGER TO OTHERS WORKSHEET

DYNAMIC RISK FACTORS

*Severe anxiety symptoms/agitation

*Employment instability

*Impulsivity

*Lack of insight

*Relationship instability

*Lack of social support

STATIC RISK FACTORS

*Low socioeconomic status

*AGGRESSIVE OR DESTRUCTIVE BEHAVIOR

*None

04/20/2015

DYNAMIC RISK FACTORS

*Severe anhedonia

*Severe depression

*Hopelessness

*Suicide ideation or intent

**Suicide plan

STATIC RISK FACTORS

*Mood disorder *History of suicide attempts

AGGRESSIVE OR DESTRUCTIVE BEHAVIORS *Suicide Attempt

*Suicide ideation

4/20/15: Clt endorses SI w/plan to overdose on prescription and OTC medications. Clt reports two aborted suicide attempts earlier this evening, one in which she had 30 Benedryl in her hand ready to take but decided not to and once she had 50 zyprexa in hand. Clt was unable to contract for safety with this writer when the crisis plan was attempted.

9/16/15: Clt endorsers SI w/plan to jump for balcony or crash car. Clt reports that early today she was standing leaning over the balcony for "awhile" contemplating jumping. Clt mentions that she thought she may be able to fly and if not she was aware that this would probably kill her and reports "I was okay with that as long as I don't have to feel like this anymore.

General Behavior: Cooperative.

Speech: Unremarkable

Perception: She currently denies that hallucinations telling her to hurt herself but past E-II records indicate a history of [Me] reporting hallucinations telling her to hurt herself.

Thought Process: Mild paranoia.

Mood: Dysphonic [Dysphoria, "difficult to bear" is a profound state of unease or dissatisfaction. In a psychiatric context, dysphoria may accompany depression, anxiety, or agitation."]

Judgement: Fair

Impulse Control: Fair at present

Insight: Poor

Sleep: normal

Appetite: normal

F31.2: Bipolar disorder, current episode manic, severe with psychotic features (Active as of 10/16/2016)

F29: Unspecified psychosis not due to a substance or known physiological condition (Active as of 11/21/2013)

F31.9: Bipolar disorder, unspecified (Active as of 10/29/2014)

F39: Unspecified mood [affective] disorder (Rule out as of 11/21/2013)

DIAGNOSTIC Summary:

4/20/15: Clt's current symptoms and presentation are congruent with previous diagnosis.

9/16/14: Clt's current presentation and symptoms are congruent with previous diagnosis.

11/21/13: Client reports paranoid thinking with delusions. (Thinking people are aliens and endorsing a hx of beliefs that she can fly and that she will not die for long if she kills herself.) Client reports a hx of auditory and visual hallucinations, but none at the moment. Client reports anxiety, related to personal relationships. Client reports that she tried to overdose to kill herself last night with plans to do so again.

10/08/13: Pt presents as preoccupied, possibly7 responding to internal stimuli, hears voices telling her to stab herself, reports some improvement in psychotic symptoms.

10/01/13: Client presents "ramped up" with thoughts of jumping into traffic or "flying off her balcony" w/o specific intent of suicide. She is calm in presentation but she reports that she has felt increasingly "ramped up" over the last 2 weeks. She spoke with her psychiatrist this morning and she recommended she present to PES [Psych ER].

File: More from my medical (psych) record

This is from my medical record, again.

01/16/2016 According to [Me] and past E-II records, she was diagnosed with depression in 1997 when she was pregnant. She was prescribed Zoloft in [City] and went off the medications after she had her babies. She reported that she began to have visual hallucination in 1999. They started to see triangles that no one could see. She began to seek mental health services for her hallucinations in 2006 after she had gone for a walk and nature seemed more vivid and then she saw a little girl on a porch that disappeared as she was looking at her.... and has been prescribed Depakote. She reported that the hallucinations have gotten worse in the last two years. She now hears sounds like radio, a band, and voices saying "Look at me". The voice says nasty and mean things to her and he's become more persistent.... According to the Pre-screening assessment on 10/1/13. "Client self reports that she has been experience and increase in feeling "ramped up" as well as "another voice" telling her that she now knows everything there is to know and she will be fine. She had thoughts of walking into traffic "just because I want to see if the metal from the cars is cold" and "flying off her balcony because there is so much space and she thinks she should fill it". She was hospitalized at PES for 10 days.

Bipolar Plus

Schizoaffective Disorder

I posted the above link back in 2013. I've been hallucination quite a bit in the last month. I've read up on the symptoms of schizo-affective disorder. It all sounds like me. From the hallucinations to the moods. Its not just hallucinations on top of bipolar disorder. From in the link above: Common signs of the disorder include hallucinations, paranoid delusions, and disorganized speech and thinking. Schizoaffective disorder is defined by mood disorder-free psychosis in the context of a long-term psychotic and mood disorder.[2] Psychosis must meet criterion A for schizophrenia which may include delusions, hallucinations, disorganized speech, thinking or behavior and negative symptoms.[2] Both delusions and hallucinations are classic symptoms of psychosis.[9] Delusions are false beliefs which are strongly held despite evidence to the contrary.[9] Beliefs should not be considered delusional if they are in keeping with cultural beliefs. Delusional beliefs may or may not reflect mood symptoms (for example, someone experiencing depression may or may not experience delusions of guilt). Hallucinations are disturbances in perception involving any of the five senses, although auditory hallucinations (or "hearing voices") are the most common.[9] A lack of responsiveness or negative symptoms include alogia (lack of spontaneous speech), blunted affect (reduced intensity of outward emotional expression), avolition (loss of motivation), and anhedonia (inability to experience pleasure).[9] Negative symptoms can be more lasting and more debilitating than positive symptoms of psychosis.

Then it goes on to define the basic bipolar symptoms of mania and depression.It seems to you could call SZ (schizoaffective) "Bipolar Plus". (Literally, bipolar plus schizophrenia.) If this is not me, I don't know what is. The medical records from the psych ER that I've posted here could confirm a lot of this.

Jeh neh fehrrrr!

I was sitting in Starbucks this morning and heard my name whispered loudly, clear as day, over the din of the other customers. I've been having a lot of visual hallucinations lately, but not so many audio. My next appointment with my psych nurse practitioner is October 5th. God I hope she doesn't increase my zyprexa! I'm hoping she will DEscrease it! In case you're wondering, these types of hallucinations don't scare me at all. Well, the spiders a little because I imagine them crawling into bed with me later, but the voices? No not a bit.

How cannabis affects the bipolar brain

How cannabis effects the bipolar brain

It makes you hallucinate! We knew that.

From the above article

Clinicians have hypothesized several contributing factors including “heavy usage, length and age of users, and psychotic vulnerability.”6 In the report by Johns,3 it was felt that adolescents are more vulnerable to the mental effects of cannabis because they may “experience emotional problems that cue cannabis use” and secondly, regular use may “interfere with learning and personal development.” Although our patient had no genetic predisposition with a negative family history of any psychiatric illness, he did start smoking cannabis during his adolescence. As there is an increase in the use of cannabis among younger individuals and a rise in schizophrenia in this younger population, we must be aware of the potential harm of cannabis abuse.23 During his first psychotic break, he presented to the clinic with delusions of being persecuted, auditory hallucinations, and grandiosity, which have been well documented as prominent symptoms secondary to cannabis abuse. He soon recovered without any use of medications. The only insightful data we could gather about his vulnerability, aside from age of onset with cannabis use, was from his MMPI. The report gave evidence as to the nature of his personality. This was an individual who had elements of paranoia, grandiosity, risk of addiction, and antisocial traits. According to Regier et al,15 83.6 percent of individuals with antisocial personality disorder also have comorbid drug misuse. It seems that Mr. X’s cannabis use heightened these personality characteristics and may have been a contributing factor to his psychotic break. After his first discharge, he was nonadherent and did not follow up with the university psychiatrist. Review of literature has shown that cannabis use was consistently associated with relapse and nonadherence to treatment in psychotic patients.24 This makes it difficult to manage these types of patients with increasing relapses, hospitalizations, and progressive worsening of symptoms.

Spiders After Me

I've been trying to post this but my phone wouldn't let me. Had to log into the desktop. I feel like there are hundreds of the black bulbous spiders out to get me. Me. Just me. As in they have a plan. An organized plan. How am I going to sleep tonight? Already something bit me a few days ago on my leg in bed. Why do I keep seeing these spiders? I don't think its just that its Fall. No no. There's a bigger answer than that. Oh yes yes yes there is. They are after me.

Today was Weird

Today was weird. As I was driving home through my neighborhood, suddenly a man was sitting next to me in the passenger seat. He disappeared quickly. At Victoria's Secret with my friend, I had a revelation. Second one that day. Earlier I had realized that to park at church (tiny lot), all I have to do is do like the people who live on the street the church is on: Put our cars in our pockets and take it with us! So simple! (Except that they would be too heavy to carry!)

Saw Psych Nurse Today

Saw psych nurse practitioner this morning. We had a good conversation. I told her about my many hallucinations over the last two weeks and how I really don't want to go up on zyprexa. To my amazement she lowered my vitamin Z to 5 from 7.5 and said I seem stable otherwise. It was as if the fact that if these hallucinations didn't bother me she wasn't going to let them bother her. We also discussed my liver. Going off zyprexa is the right direction! We talked about patients reading their file- specifically psych file. She said some people refuse to believe what's in it! That they did what is written there. I must admit, its difficult at times.

Snow in August!

Today, August 22- I was driving and saw a car with snow on top. Looked back at it and yup still snow. Definitely snow not painted. I'm so confused!

Spider on DVDs

Staring at the book shelf full of DVDs (instead of books) for a moment, thinking of what to watch, I was wide awake. It was 12:45 in the afternoon, when all of the sudden, over the tops of the DVD cases crawls a medium-to-large black shadowy spider. It climbs face-down down the DVD case's spines and into the blackness of the shelf. It was so real that I gasped and asked my kids if they saw it or not. My youngest went and looked and said no, he could find no spider.

Hypnogogic / Hypnopompic Hallucinations

Last night, I was laying in bed and heard a distinct five loud knocks on the upstairs wall. Thinking the neighbors were miffed at us, I got up and looked around to see if it might happen again but it didn't. I asked my kids if they'd heard anything and they said no. When I say I heard them, they were clear as day, yes-they-happened woke-me-up hallucinations.

Turns out these are called hypnogogic hallucinations and happen when you are falling asleep. Why they were so vivid, I don't know, but they can involve the hearing, sight taste and a few other senses. Sometimes, I even feel like someone is violently shaking my bed!

This is a good explanation of the two common types of hallucinations that happen while going to sleep or while waking up.

Visual Hallucinations

Usually when I see bugs or animals they are distinct but fleeting. Just now I looked down at my leg while sitting in this chair and saw a large spider quickly run across my knee! I felt my knee with my hand but nope nothing there.

Just saw another long black bug on the couch that disappeared.

Now the side of my phone case seemed to be animated like a bug was underneath the side of the case. Things were quickly moving.

If I have any more of these, I will edit this post.

Hearing Voices

Hearing voices:

Last night:

Left Ear: Hear Talking on that side. Multiple voices.

Right Ear: Loud talking. Male voice.

Stikmen

Stikmen are found in various cities including mine. So far I've found three. They are aboutsix inches tall each. You can see they are quite distinct. They are found in the street in my town and also in San Francisco. They can also be bigger works of art.

Here are two articles about the Stikmen. Some are quite unique!

an article on the Stikmen

Mysterious Street Men

More Hallucinations

I'm still having hallucinations. Now, they are in front of reality and move like live animals/people. I see them on the ground, on my bed, on the road while I'm driving (which is very distracting). To me, they are real- until they disappear.

Snapshots

The last week, I've been having flashes of vivid images come before my eyes. They are bright, colorful, and last one to three seconds. They are images stopped in time; they are like a poster: colors and shapes in a snapshot. I don't know if these are hallucinations but they go just as quickly as they came.

My Depressions

We often hear the pairing "Anxiety and Depression". Why do they go together so well?

I was reading the posts here and thought, "You know, I rarely get depressed". In fact, the last time I remember being depressed was two, maybe three years ago when I was inpatient. They definitely let me know I was depressed! Somehow, I couldn't see it.

Then, I thought about anti-anxiety meds and how I've been posting about my pdoc not prescribing them- or if they work well, or if they're addictive.

Then it dawned on me: What if my frequent anxiety spells ARE my depressions! Just depression turned inward?

Yes, in the past, I've had spells of crying "for no reason", catatonia, feeling despondent, and generally just not feeling engaged in life. But, far more frequently, I've had this inside-out depression.

Thoughts?

Mental Health Days

Today I took a mental health day- something I'd never done before. I slept in, got a shower, got dressed and went to Starbucks. There I had coffee and read my book. Having taken my zyprexa in the morning instead of the evening I felt dozey which was nice. I just sat and read until it was time to go home. Later, I took my son to a make-up piano lesson and then we both went to choir rehearsal. I'm now in bed and sleepy. Tomorrow is lunch with friends. That's always enjoyable. I think I should take more mental health days- this one did me lots of good!

Anxiety Day 4

I'm still anxious. My younger two kids went off with their friends after school yesterday. Oh sure they called and asked if they could but didn't say it was a half day or where they'd actually be! The youngest managed to get himself miles away! (I ended up crying in the parking lot at the grocery store I was worn out.) Luckily, my children's grandfather went and picked him up and all was well but my nerves were shot. It's been four days of anxiety now. Pdoc upped my zyprexa to 7.5 from 5 again but it hasn't helped really. Talking to friends has helped for the moment. I just feel like the world will come crashing down any second. Imagine what I posted last entry but almost all day long. It hasn't gone away. I'm ok at the moment because I'm at Starbucks reading. (Helps get my mind off things; that, plus the din of Starbucks.) We will see what Pdoc says if she calls me back.

D'oh (Anxiety)

My son went to his piano recital with his dad step mom and Grandpa this afternoon..... Oh. Yeah. I just spent an hour freaking out that my son wasn't home yet. Totally convinced myself that their car crashed on the freeway. Picturing dead bodies. My youngest son! Nobody was answering their phones. I thought of hospitals they could be at. Would anyone call me? I have no prn at all even though my heart was racing my face was flushed my thoughts racing.... And then it dawned on me: they're at play practice. D'oh

Sleep

Woke up at 4 am to smoke alarm chirping. Tried sleeping through, tried taking battery out, gave up and left. By five I was at Starbucks. I read and posted. Then off to church. Getting sleepy now. Decided to not go to my son's recital. Sad. Walked to pizza with daughter. Drove to get batteries. Tired brain thought it would be ok to crash. It seemed dream-like. I'm still not tired now. I try to nap. I get maybe half an hour and now can't at all. Wonder if I can tonight. Washed laundry. How long will this day go? There's been longer ones. Wonder if the hallucinations of yesterday will come back.

Tactile & Turning

Just went to get a DVD off the bottom shelf. When my hand touched I said to my daughter "there are only books down here on the bottom shelf", my fingers feeling individual pages thick and thin. She said she thought I was going crazy. I felt again: hard plastic.

Organ Music

We have an electric organ. It's in my bedroom. I thought I heard my 15 year old playing it. Clear as a bell. Multiple parts, petals and all. Except when I leave the room I was in he was nowhere to be found! I'd thought he'd come home Frome school and begun playing in the distance. My daughter said no, he wasn't even home. And he still isn't. This was much more clear than the music in the shower earlier. But just as interesting and ornate.

Singing in the Shower

The penultimate best part to working out: the shower. There I was with loud individual noises coming at me just like the were earlier this morning at Starbucks. But now... Now they were music. Beautiful music that I'd never heard before. Music that I couldn't write down for it was too fleeting but music which sang to me almost like a greeting. When I got out of the shower I had different theories about what it could've been- maybe the TV, maybe I heard the TV wrong, maybe hallucinations. But one thing I know is I heard a singer and accompiast.

A Helper

Yesterday, I had to fill my bi-weekly pill boxes. I don't quite know why- maybe he heard me discussing that I didn't want to fill the boxes- bit my youngest, 15, sat down on the floor with me and read the labels of each one filling along side me, asking questions as he needed to. He was so helpful both in filling the boxes but mostly in taking a load of my mind.

Hallucinations Paranoia & Fun Conversations

I attempted to pay the bills but don't have them all yet. I'm feeling anxious about that. I had coffee with my 19 y/o and a great conversation about Thomas the Tank Engine of all things! And all through the visit with my son I was hallucinating various animals- mostly gray animals but very real. Andfriend of mine asked me to go with him to the mall to walk around for exercise but I said no. I've been getting strange calls lately and listened to two of t he voicemails. They were creepy and weird. Then I decided that they were after me. So I opened the door to go out but went right back in again, figuring that someone was monitoring my phone. I shut the bluetooth off just in case. So I'm sitting at home not cleaning and watching my new movie- Florence Foster Jenkins- yet again.

Good News: Going Down

Saw my psych nurse practitioner this morning. She thought my reactions (in "Sliding Toward Psychosis") were not paranoia, but normal. She didn't say anything about the audio hallucinations except to make note of them. Rexulti is staying at 3 mg for now and good news- zyprexa is down to 5!! There is a light at the end of the tunnel! I think I may be at this dose for a while, but its better than staying at 7.5 or having it put up. I thought for sure after the paranoia and hallucinations, she'd want to increase the Zyprexa, but nope. She said my reactions to a few situations I relayed were natural.

Sliding Toward Psychosis?

The following from my medical chart makes me sad. Apparently, they found these meetings more serious than I did. I remember being matter-of-fact. Could it get worse at some point? I saw everybody as aliens at the grocery store. That seems like only yesterday. And I completely remember how I felt. Will that happen again then? They said I was manic- severely. Was I? They never told me that. I have this report as part of my disability case: I was given a copy of my records. I'm sure this isn't everything they wrote, but its a glimps. I felt myself thinking someone was after me at the grocery store this afternoon, actually. I told myself, "No, no they're not" but I still hurried away from that person. Last weekend, I was walking toward my car in a parking structure when three people walked quickly behind me and my daughter, catching up with each pace. Into the structure they went after me. I thought for sure they were plotting to kidnap my child. When we got up to my car, they got into theirs- right next to mine. When does a person slide from thinking people are after them to severely psychotic?

10/28/2015

F31.2:Bipolar disorder, current episode manic severe with psychotic features (Active as of 10/16/2015)

F29: Unspecified psychosis not due to a substance or known physiological condition (Active as of 11/21/2013)

F31.9: Bipolar disorder, unspecified (Active as of 10/29/2014)

F39: Unspecified mood [affective] disorder (Rule Out as of 11/21/2013)

11/21/13: Client reports paranoid thinking with delusions. (Thinking people are aliens and endorsing a hx of beliefs that she can fly and that she will not die for long if she kills herself.) Client reports a hx of auditory and visual hallucinations, but none at the moment. Client reports anxiety related to personal relationships. Client reports that she tried to overdose to kill herself last night with plans to do so again.

10/08/13: Pt presents as preoccupied, possibly responding to internal stimuli, hears voices telling her to stab herself, reports some improvement in psychotic symptoms.

10/01/13: Client presents "ramped up" with thoughts of jumping into traffic or "flying off of her balcony" w/o specific intent of suicide. She is calm in presentation but she reports that she has felt increasingly "ramped up" over the last 2 weeks. She spoke with her psychiatrist this morning and she recommended she present to PES.

Client is a 41yo caucasian female. Client presents with flat affect, ambivalent in her decision making process, paranoid and delusional (Thinking people are aliens and endorsing a hx of beliefs that she can fly and that she will not die for long if she kills herself.) Oriented x3, denying any current ah/vh, attention intact during interview, insight and judgment arginal. Lithium levels reflect taking meds as prescribed. Negative for benzo's despite reports of overdosing on Ativan last night.Client reports paranoid thinking with delusions. (Thinking people are aliens and endorsing a hx of auditory and visual hallucinations but none at the moment. Client reports anxiety related to personal relationships. Client reports that she tried to overdose to kill herself last night with plans to do so again. Client has access to significant amounts of psychotropic medications including Ativan. Client denies any hx of substance abuse. Client receives MH services from XXXXXXX. Client was psychiatrically hospitalized in November 2012. Client was diverted from hospitalization in February 2013. Client was psychiatrically hospitalized in October 2013 for presenting manic and expressing beliefs that she could fly. Client reports to live with three children, her mother, and her mother's boyfriend. Client reports that her mother is both supportive and a stressor at the same time. Client reports that she has a friend that she feels is supportive, but also believed that he was an alien.Client reports to comply with medication tx usually, which was confirmed by labs, and reports to attend appts as scheduled.

Filling the Pill Boxes is Tedious On My Birthday

Today is my birthday. I'm 45. Yup. Now you know. My children will all be 20, 18, and 16 on their birthdays later this year. I've spent the day doing exciting things like paying the rent and taking a half-hour nap. My eldest did invite me out for lunch, so we went to Chili's. (I had fajitas.) He brought his girlfriend. That was nice.

So the one thing hanging over my head is that I need to do my pill boxes today. I have so many scripts I haven't even opened never mind filled the boxes with. If I don't do it, I'll have to take the pills out of the bottles each time I need to take them and that's even more of a pain than filling the boxes.

Day 1 down of the 7.5 zyprexa dose and so far so good. I hope it stays this way.

EDIT: I got the pill boxes done. It was a chore- there are a bazillion bottles, and a lot will need refilled before the next round. Side note: There are soooo many pills! I called the anti-coagulation clinic about my coumadin dose, and they said "Happy Birthday!", and told me that I should've had my levels checked back on the 5th! Guess where I'm going tomorrow? I have other blood work in the system for my thyroid, too, that needs doing. (My thyroid is low due to the lithium that I take.)

Weaning off Zyprexa Round 2

My psych nurse practitioner's nurse called me back this afternoon. I'd asked about how to wean down off zyprexa again. Once, NP called her back, I got the message that she's calling in some 7.5's again. I really hope this works. I can't mess up ONE pill a day. (Last time, I was doing it by 2.5s.) Tomorrow is my day to fill my pill boxes. I really don't like that job but it must be done so I sit on the floor surrounded by pill bottles and the boxes and spent about half an hour filling them.

As a side note, I'm taking my youngest (15) to his piano lesson tonight. He had a repetoire class Saturday that I went to also where he played beautifully! So musically and technically wonderfully! The teacher made a video which we are going to watch today at his lesson. I hope the teacher can make me a copy if I pay her $5 or whatever she charges. (She does this for recitals.)

In other news, I'm still going to the gym every Tuesday and Thursday. Last week, I went Friday because I got caught up talking with my friend Thursday morning. I always feel like I don't want to go, but I grab my stuff and go anyway. Thursday was the only day I missed and I made it up the next day.

Back to the original topic, I really hope I don't get those bad side effects from being at 7.5. I'm hoping I messed up the second week, like I guessed by seeing only one pill in the box one day. I just have to get off zyprexa.

Conflicted about Weaning off Zyprexa

My psych nurse practitioner said I could go up to 10 on Zyprexa if I wanted. I do feel some better, but I'm conflicted because I know what the Zyprexa is doing to my liver and my metabolism. (My liver tests just came back normal so I don't want them to be messed up again!) I want to try tapering off again. I have a feeling that the problem I had last time is that I didn't put the zyprexa in my pill box possibly. I can't prove that, at this point, but it would explain the bad withdrawal symptoms. If that's the case, I feel good about going ahead and trying to wean down again. Right now, my pill box is set up with 10 mg pills, one each night for two weeks. I don't even know if I have enough pills to support this weaning. I do have some 5's I could use. I'm conflicted. Psych NP is supposed to call me at some point. Not sure when. I don't see her for several weeks yet.

Musical Hallucination While Driving & Sports Radio Hallucination

As I was driving the kids to school today, it was silent. Usually, we ride with music on, but not this morning. In fact, they usually take the bus, but we were running late. So as I'm driving, I hear music. Singing. Sort of "modern" mid-twentieth century music: starts and stops phrases, sort of atonal. It was nice. But all in my head. Or rather, playing outside my head like real music, but really my brain was making it up. Unfortunately, I'm horrible at trying to write down music- and even worse while I'm driving with no staff paper. So, the music came and went without me. *sigh* It was nice while it lasted.

Five p.m. edit: I'm sitting in the recliner waiting to leave for choir rehearsal when I hear what sounds like a radio broadcast. Maybe sports. Its fuzzy and raspy and I can't make out what they're saying, but it keeps going even so. The washing machine is going in the other room, so that makes it hard to hear. I go upstairs to ask my younger son if he is playing anything in this room that I might be able to hear. No, he says, he's not playing anything. My daughter is in the room with me downstairs, but her phone isn't making any noise that I can't hear. More hallucinations it seems. It can't be the washer because I wash clothes all the time and it doesn't do this.

All Tests Normal

Almost a week ago, I saw my primary doctor. She'd run blood work a few days before. All of it came back normal! Even my pre-diabetes and liver levels! Going to the gym is paying off! I've also been eating low carb. Not no-carb, but as low as I can. That means no big plates of macaroni. (Ugh! Just the thought.) So I'm off to the gym this morning. I've also been taking walks in between workout days. Usually I get 6,000 steps in a day, but sometimes I get a little less. So things are looking up! I see the liver doctor in July, I think, so let's hope things continue this way. She had bad things to say about my liver- something about stage 3 something or other. It was bad.

Zyprexa is a hard beast to give up

Where are my keys? Oh they're there in my purse. Where is my purse? Oh its there on the backseat of the car. Where are my keys? Oh they're in my purse. Where are my keys? Better make sure they're in my purse. Someone is following me. Everywhere. I just started this piece of music but already I wish it were over. I just started this reading in church but is it over yet? Where'd I park my car? If I can't find it, nobody can help me!! I just sat down to this book; is it over yet?

These are some of the things my mind has been doing lately. I told my nurse practitioner and her nurse said she wants to UP my zyprexa. (We're trying to go down.) Down doesn't seem to be going very well. I feel this constant sense of anxiety- of vibrating urgency. Its as if my body doesn't want to give up the zyprexa. So up we go again. I'm waiting for her to call back actually, so see what she actually says. The last plan was to stay at 7.5 mg and reduce as I see fit. Now I'm at 10 mg (according to her nurse) for two weeks. Or maybe longer. I do NP on April 10th. I'll come back after NP calls me this afternoon.

EDIT: NP never called back. But her nurse said to stay on 10 mg of Zyprexa and that NP will call me some time this week. Oh- and I have now lost 20 pounds. Still going to the gym twice a week and trying to walk 6,000 steps on days in between.

My New Favorite Recording- Review and Audio Recording

My new favorite recording is a 1990's version of Allegri's Miserere. The French soloist, Patrick Husson, was about 30 years old when this performance was captured digitally to be played in perpetuity. He sang the "top solo" which reaches a high "C": two ledger lines above the treble staff, and which repeats several times. The rest of the choir was a typical boychoir. I like Husson's version of this famous piece for two reasons. One, I like his tone quality. It is larger than a treble (boy) and has a darker, fuller color. Second, his breath capacity is larger than that of a boy. During the solo sections, the high C falls step ward down to an F, where every boy I've ever heard will take a breath and continue on with the solo. Husson does not take a breath there, but carries through giving a chilling effect as he follows through to the G and holds it seemingly indefinitely.

Patrick Husson sings "Miserere Mei Deus"

Pill Trouble

I talked with my psych nurse practitioner's RN. She's going to talk to my NP about my zyprexa dose/prescription. I don't have enough to last at the 7.5 rate (the rate she told me to stay at rather than reduce to 5) for the month. I just need a new script for 7.5 but the insurance might not pay for that as its only been 15 days since I got the last one. (But I thought that didn't matter since its a new script??)

I also found that one of my pill boxes broke. The top came off and pills were out of three of the compartments. What a puzzle! I think I got it back in order, but I need a new box. Probably time anyway, as I've had these two for years.

Not trouble, I got my lowered Rexulti dose. (I had been on 4 mg, now on 3 mg.) I didn't take any for the last 2 days because I couldn't get my script. The half-life of Rexulti is apparently 91 hours, so no big deal. I took a dose after I picked up the med this afternoon.

Voices in My Head

They are telling me to stab myself in the heart and in my chest. I'm not listening but it does show that my meds are messed up.

Friend asks if I'm safe and I reply: If it happens again I'll call PDocs nurse back I guess.

She replies: Good plan. Try distractions too

What are some distractions? Reading, tv, talking to a friend on the phone, singing... Definitely singing! Its not choir day today though. Oh well. I could at least listen to music. That would help a lot!

I listened to one of my favorite CDs - Peter Schrier- and I feel a lot better now. No more voices. I thought the music would take up the synapses that the voices were and it seems to have worked. I'm going to talk to my friend who is a therapist and who used to be a behavioral pharmacologist about this (including what I wrote about in "Pangs of Impending Disaster" about the "doom" feelings.)

One Step Back, One Step Stays the Same

I got a message from my psych nurse's registered nurse. She said she'd emailed my psych nurse practitioner who said to keep my zyprexa the same for a while (don't decrease it tonight) and decrease Rexulti to 3 mg from 4 mg. I haven't taken the Rexulti at all today because I don't have the 3's; I was just at the pharmacy and they said they were talking to my psych nurse's office about the script. So I dunno how that will turn out, at the moment. Not taking any can't be good either.

Pangs of Impending Disaster

I keep feeling faint but it only lasts a few seconds and then I'm OK. I try to eat small meals throughout the day. My primary dr says I have pre-diabetes but hopefully with continued weight loss (I've lost almost 20 pounds) that will go away. I hope it's not the Rexulti. I reduce the zyprexa to 5 mg tomorrow (!).

Plus I constantly feel I've forgotten something important like my keys or purse or cell phone and don't know where they are. I'm constantly checking for these items. I also don't want to drive for fear I'll get lost.

I have had a good day. Amazing performance in church choir, then hung out with my son and a friend.

I feel like something bad is going to happen. I'm constantly on edge and anxious- unless I'm singing. I notice it doesn't happen in choir.

Pangs of impending disaster keep happening.

Up Rexulti Down Zyprexa

Saw my psych nurse practitioner today. Told her about the menacing girl. She upped my Rexulti to 4 mg (max. dose) and decreased my zyprexa down from 10 mg to 7 1/2. I'm getting a script for 2 1/2 mg of zyprexa for the remainder of the time that I'm on it so I don't have to keep cutting pills in half and such. I just called the pharmacy: They don't have the Rexulti in stock so they'll get it in tomorrow. So that means I'll take the old dose today. (Edit: I found a left-over 1 mg tablet so I added it to a 3 mg tablet and voila! Four mg!) We talked about exercise and Fitbits. She said my weight and cholesterol should drop once Zyprexa is out of my system. Yippee! Let's hope they do. The scale at their office, by the way, says I weigh 7 pounds more than I do at home. Is that my clothes or what? (Do home scales have a built-in "niceness" margin of error?) I should be off the zyprexa in six weeks. Good riddance!

Malevolent Grin

I was sitting in one of the "comfy chairs" at Starbucks drinking my Venti latte when a 20-something girl came and sat across from me. She kept staring at me and grinning this malevolent grin. I'd look up, she'd grin; I'd look down again. Quickly, I looked at her and then down and then back up again, whereupon I found her to be gone! The door was behind her with glass walls and she was nowhere to be seen. I don't know where she went or how. I'm tempted to think she was a very vivid hallucination: she wasn't very complicated, but she did look very real. That smile though- I'm not sure what that meant; it was like she was going to hurt me and she knew it. I'm glad she disappeared!

And Zyprexa Makes its Exit

Here I am weaning off Zyprexa, and this happens. The last two days I've had a nasty cold (with fever) and had to go to the ER because I had chest pain and my INR was subtheraputic. (I.e. my blood was too thick.) Then I get a call from the doctor I saw a few weeks ago about my liver. I knew I have fatty liver disease. But now, they say its the next stage up and the only other stage left is cirrhosis. Cure? Lose weight. Why did it happen? They didn't say, but I looked it up and it seems that Zyprexa is well-known for fatty liver disease. Imagine that: Very high cholesterol and now one step away from cirrhosis of the liver. Zyprexa is evil! I hope Rexulti doesn't do this.

Anonymous Before Diagnosis

Three years before I was diagnosed, I had an online affair with a man my father's age. This went on for months. I told myself it was only online not for real. Then, soon after, I got divorced. I started sleeping with many strangers recklessly. I would also talk really quickly and insist that the person listen to my important ideas. You could find me on my bike riding and singing at the top of my lungs. Years later - after diagnosis and meds - I finally met the man I wrote the sex stories with. I was with my then-boyfriend. It was awkward. Nothing like I'd pictured. There was also a man I talked with every day on the phone that I took off to meet. I live in Michigan ; he was in Georgia. After 3 days of my refusing his advances he sent me packing- literally. And there were many one night stands in between as "dates". Some of them unprotected and most of them very anonymous. I'm glad I finally got diagnosed in 2006 and put on Depakote. (And started therapy.) I'm lucky I didn't get into more trouble than I did.

Sleep and Meds: Working against Each Other

You take Zyprex, which is soporific, but at the same time take Wellbutrin AND Rexulti, which both can cause insomnia. And if I understand correctly, you plan to taper off Zyprexa completely in favor of Rexulti. But then what will happen with your sleep? If you find it hard to fall asleep now that you still have some Zyprexa in your blood, what will happen when you don't? What's the pdoc's plan wrt sleep?

Yes, you are correct about my meds. I have no idea what pdoc's plan is re: sleep. I had insomnia pretty bad when I first started Wellbutrin. I am having some again. I did sleep last night. Its hit and miss. Melatonin is hit and miss too. I'm using my weighted blanket every night. What will happen without zyprexa indeed. I am determined to get off zyprexa and stay off it! I see pdoc in two weeks, so I'll bring this up, even though I don't think I'm going to be completely off zyprexa for another couple months at the rate I'm going.

The above was a post conversation on a bulletin board I had today. The second paragraph is mine, the first is another member's. She brings up a good point. As I think this through, or get more information- especially from my psych nurse practitioner- I'll post more.

Ways I SHOULD know I'm manic

I know I'm manic when I've figured out the thread that binds the meaning of my life. And then I start jumping in circles. And water in the shower feels orgasmic on my skin. And I stop sleeping and don't feel like I need any sleep anyway. And I can't stop talking a mile a minute, and tapping on things over and over. And I want to scream and so I jump in circles some more. I start hallucinating angels, or aliens. These are just a few ways I should know I'm manic. Emphasis on "should".

Rexulti & Zyprexa Dose Changes Again

I talked with her nurse this morning to report how the (total) 2 mg increase since Friday is working. I told her I'd been sleepier but my symptoms have improved. So now I wait for Pdoc to call back and hopefully call in a new script of the new dose as I'll be out of this one (1 mg) soon at the new rate.

I'm waiting for pdoc to call me. I'm beginning to think she won't. (It's 5:35 p.m.) I thought she said to call her nurse this morning and report how I am doing and the nurse would email her and she'd get back to me about my Rexulti. I need my new script in the next few days because I will run out of the other one.

My psych nurse is usually really understanding and nice. Her nurse is usually businesslike and today was no exception. I mean, maybe its just a case of her being slammed today, but tomorrow, I'm calling again and telling them that I'm running out of pills the next day. That's something I didn't realize or tell them today.

January 25: I had an appointment with a doctor at the hospital today. We were looking at my liver because I have fatty liver disease, I think in part from zyprexa. But we went over everything. They did an ultrasound. I was told to eat more fruit and veg., exercise, cut carbs... basically everything I'm already doing. They weighed me and although I've lost weight according to my scale at home, this scale thought my jeans and sweat shirt should be counted too. Above all, they took a detailed medical history, including my premature birth, all my surgeries, my asthma, my drug allergies, etc. But they just finally came up with "You're fat; lose weight". They did blood work- a bunch of it. I don't know the results of my ultrasounds. My primary doctor will get back to me with the results and what to do next.

On the Rexulti front, I called the pharmacy to see if a script had been called in but after being on hold for 20 minutes, it hadn't. My psych dr. hasn't called today again. I'm not sure that she needs to call, but just to get straight what the plan is would be nice. I see her on Monday. (Today is Wednesday.) But tomorrow is my last day of pills and I would go three days without until my appointment.

January 26:My nurse practitioner called back!!!

We switched my appointment to two weeks from now instead of Monday because she switched my dose of Rexulti from 2 mg to 3 mg (I had only been on 2 for a week) and my Zyprexa is down from 12.5 to 10. (Baby steps.) I'm going to go to the pharmacy asap. Gotta go pay bills at my mom's. Have something to eat, too.

I'm so happy now!!!

The pharmacy had to order my Rexulti (guess they didn't have 3mg) so it will be in tomorrow after 2. That's right before I have to get my daughter to take her to the doctor. I'm also having lunch with friends at 12. Whirlwind day. And I'm just home from an intense church choir rehearsal. Sight reading a Haydn mass. I'm beat.

January 27: Picked up new dose of Rexulti and lower dose of zyprexa. We're getting there slowly but surely! I had a sleepless night the night before last, but I am not sure if it was related to Rexulti (happened before the higher dose) or something else.

Rexulti Change Effects On a Long Day

Today I made a late start but made it to church/choir with my youngest. We had lunch with my ex between church service and when we are meeting to leave for another church to sing another service. Personally, I'd like to nap now but I can't. No time, no CPAP, no bed. My lunch wasn't exactly on my diet but I'll be good later. It was nice of my ex to buy us lunch.

Drowsiness sedation fatigue.... All listed as side effects of Rexulti. I just took my second increased dose of Rexulti about an hour ago and I feel so dozey. My choir is supposed to leave in 45 minutes for a gig. I'm not driving thank goodness! But still I just want to be in bed.

I pushed through the gig. Pdoc just increased the dose to deal with anxiety and guilt.

Sang gig. Was so disorganized. Missed half of one piece!! I couldn't find it!

I think I'm gonna explode! My daughter is at her boyfriend's and is ignoring me when I said I want to pick her up. My son is talking to my friend here and I want to leave and go to bed. I want to scream at everybody.

Omg my friend won't shut the hell up about politics!!

**********************

These are a few posts I made on a bulletin board today. I had to be up for church choir at the normal time, but we had an extra service at 4:30 about 45 minutes away at another church. Between the time that the service at our church ended and the time we had to leave, my ex husband and our youngest and I went out to eat. I took my second day of increased Rexulti. (Double the original dose.) About an hour later, I began to feel very drowsy and fatigued. Not just tired, but as if I were ill, without actually feeling sick. I pushed through and went to the service. However, I couldn't track very well. I wasn't sure what was coming next to sing most of the time and even one piece I couldn't find until we were half way through it! Then later in the evening, I became agitated at my daughter for not answering her phone (turns out she lost it; is that better?) and I became angry at my friend for not shutting up about politics. He just kept going on and on and on! That might be part of my problem: I'm tired. Makes one grumpy. Starting out tired from meds then going on a trip then doing a lot of work (singing) then more driving (even though I was a passenger) takes it out of you. That plus I visited with a friend for a bit after. The politics talk further exhausted me.

So I'm not going to call my "pdoc" about this because I prefer it to feeling guilty and anxious and I do so want to give Rexulti a chance. Feeling drowsy mentally and physically is an ok side effect to doubling a dose, I think. Maybe tomorrow, things will even out a bit, though.

Anxious

Maybe it's my money snafoo or my EBT card taking days to come in the mail* or something I can't put my finger on. I went to church choir rehearsal but I'm still anxious tonight. The singing did well at distracting me I'll give it that. And now I'm under my beloved weighted blanked which is touted to be great for erasing anxiety. I just dunno where it came from. I feel like something (s) is going to go really wrong and my brain won't stop trying to figure out what it is.

*My original card wore out. The strip wore right off the plastic card in several spots.

EDIT 1/20/17: I just called my pdoc's nurse. I told her that I've been feeling anxious for the last week, that its random and not to do with any one thing. I keep feeling guilty by random things I've done. She said she'd talk with my pdoc and get back to me. I hope they don't change my meds; well, if they want to up my Wellbutrin, that would be okay, but I like the Rexulti and I'm happy going down on the zyprexa. I'll update when she gets back to me. Its weird though because my mood, in general, is my silly chipper, more hypomanic self, today. That mixed with anxiety is a weird combo.

My psych nurse practitioner just called! She wants me to double my Rexulti to 2 mg through Tuesday and then call her and report how I'm doing. Actually, she wants me to report to her nurse who will then email her and then she (pdoc) can call me back. She thinks that I need more Rexulti in me since the Zyprexa is being lowered and that this is why I'm having anxiety and guilty feelings. Once I decide that the Rexulti increase has helped, she will call in a new script for 2 mg so I won't run out early.

Diagnosis

They say it takes an average of 10 years to get diagnosed as bipolar. I was showing symptoms early in life, but was not diagnosed. I even asked to see a psychiatrist at age 16 but was told I was "a normal teenager".

At age 27, I decided that I needed to work through being an adult child of an alcoholic. I found and saw a specialist in this. As I recall, we didn't get very far, and I never went to any meetings with other "ACOA"s. There are definite traits to being an adult child of an alcoholic and I bought books about this a few years later and tried to work through this. I also bought books on "highly emotional people". I thought I was just full of emotions and "extra sensitive". Of course, I read only a few pages of each.

When I first started having more symptoms at age 33 or so, I saw a doctor that worked with my primary doctor. He thought I had PMDD: Premenstrual Dysphoric Disorder. My primary reviewed this and referred me to psychiatry. There, I was seen by a student psych. nurse who diagnosed me with "bipolar NOS". (Not Otherwise Specified.) (The diagnosis of PMDD was thrown out.) It took several months for them to finally give me the specific marker of "bipolar I". I remember being psychotic before my first appointments, but you don't just walk into an appointment and say, "Hi. I was psychotic 2 months ago. Give me drugs." I was put on Depakote and the rest, they say, is history.

I'm still ACOA, but the symptoms that I thought were because I'm ACOA, and emotional person can be attributed to being bipolar.

Sideways

Usually I feel great but today I feel anxious and intrusive thoughts have entered my mind at the thought of losing my health insurance. Didn't I just go through this a few weeks ago with DHS? I can't not take my meds. After church today, my ex-husband teased me about "You'd better get all the tests you can before your health insurance goes away,". He was referring to Trump cancelling- or severely paring down, I suppose- Medicaid. I think he's going to do it to Medicare, too, if I'm not mistaken. This has made me anxious. I know! Go use my blessed blanket, right? The weighted magical blanket that's supposed to cure anxiety. Well, I just might! I just dealt with my insurance maybe being cancelled a few weeks ago, and now this rumor is flying around like wild fire. If I have to go without my meds, serious shit is going to hit the fan. I don't want to know what I'm like off meds, and I'm sure the people who know me don't either. I know how I am with breakthrough symptoms- like hallucinations- on meds, I don't know what my brain would do with no meds at all. Destabilize is all I can think of.

I was feeling great yesterday, because I got up early and got new tires on my car. Then I got new jewelry for my nose and my lip. Now today, I'm feeling depressed and guilty for doing that, even though the car needed tires badly. I didn't need new jewelry. So up down up sideways (anxiety) down.... Plus, last time I paid the rent, I went out and had a check made out for what I thought the rent was (what it had been previously) plus a guess on my water bill. (Included at the same time as the rent.) When I got to the complex office, they told me I don't owe rent this month. (Section 8 paid it all.) But I already had the check and made out to the complex. So I just gave it to them figuring they'd give me a credit like they did another time. Now I'm worried that, even though they gave me a receipt, they'll take that credit and say it never existed. Sideways thinking? See? I'm not always on top of everything. I'm going to panera with my younger son in a bit. Maybe that will calm me down.

She thought I was weird

Spent $201 this morning...

...on two new tires for my car. The left front had a nail in it, leaked (ya think?) every 2 or 3 days down to half inflated, I hit a pothole (HARD!) the other day, and the wear indicator in the tire was showing very well. They don't fix them, either! You have to see them coming and go around them (without going into traffic in the other lane of course). Unfortunately, last Sunday or whenever it was, I didn't see that pothole for ANYthing. I banged right into it full speed. It made a noise I don't want to hear again. I thought for sure we were 100% flat. Bent-the-rim flat. But, nope. Tire was okay. A little scraped up maybe. The thing making it flat (slowly) was that nail that was in it, come to find out. The right front was just as worn as the left, but no nails or potholes or leaks. So in I went for new tires. Warranty on them plus a snow-grade version added up to $201 total. Only problem is, I asked them to rotate them; they hadn't. They left the new tires on the front. My friend said that's best because its a front-wheel drive, but my mom's husband said you have to rotate every six months and mine hadn't been in quite a while. I'm conflicted, but I did have them rotated. Cars are expensive. This has something to do with bipolar how? Just about spending money - should I have gone for the cheapest tires? I went for a tiny bit more expensive. I just feel like I should never spend money. I just spent money on shoes for goodness sake! I know the car is safer now especially if it snows. It certainly seemed to handle better on the way home. I did kill the half-hour wait while they fixed it up by walking a few businesses down the street to Starbucks and back. Probably didn't burn the calories I drank, but oh well. I talked with a lady who was doing Tunisian crochet while she waited. It looks like a mix between crochet and knitting. Its very interesting to watch. She told me about it for a bit. I'll have to tell my mom, as she crochets. I was my usual talkative self with her. Conversation with her was fine, but by the end I think she thought I was crazy. I do tend to talk about weird stuff and at a weird pace sometimes.

Monsters Waiting for Me

I get to feeling like there are long stretches with nothing to do. I will have choir tonight but right now it feels like an eternity until we have to leave. Then I start feeling anxious. This extra space scares me. Like there are some sort of monsters in it waiting for me.

Day 7 on Rexulti & Antipsychotics I've Been On

I haven't noticed any side effects on Rexulti. This is HUGE! I tried so many other drugs a few years ago (wish I'd documented them here) that didn't agree with me. The only one I wrote about is Latuda, but I didn't write what my side effects were. At any rate, I must've tried seven atypical anti-psychotics before Rexulti: Geodon, Latuda, Abilify, Risperdal, Seroquel, Saphris, and Zyprexa. I had different side effects to each. I remember Geodon made me feel like I'd eaten the sun, or an atomic bomb, or just plain a bunch of radiation! I had akathisia with Abilify. Seroquel I had hives and a swollen throat (I believe). Risperdal raised my prolactin; I was walking around looking for "the baby". "Where's the baby?" I kept asking myself. Of course, I had no baby. My body was making milk from the Risperdal! Zyprexa, of course, the one I've been on the longest and am weaning off now, gave me very high cholesterol (to the tune of 700+) and a fairly large weight gain. I've heard Rexulti has the ability to do this, too, but my psych nurse practitioner sings its praises so I'm going to do so also. I'm getting to the end of the list of atypicals. I have never tried a typical antipsychotic, and I probably won't unless we run out of options. I feel like I've left out a drug or two that I've tried. I'm just happy that I haven't had any side effects on Rexulti after seven days on it! Tomorrow, I get to start titrating down off Zyprexa. Yay!

And Finally.... The Weighted Blanket!

My weighted blanket finally arrived via UPS. I had arranged to pick it up at the store today. The box was very heavy. They said it was 21 pounds. I went on one stop on the way home. When I got home, I took a shower and started some laundry before I got the blanket out of the box. I sat on couch with it. The material is a lot thinner than I thought, even though it is flannel. The whole thing is very heavy, which is its purpose, so that's good. The pellets in the pockets are very tiny; I had pictured them a little bigger for some reason. I tried it sitting on couch watching tv. It is a twin size. If I'm sitting with my feet tucked up next to me, it covers me feet and up to my arm pits. I sat in it quite a while. Its kind of cold, actually. Maybe it will warm up at night with other blankets over it, or it won't matter because I have a heated mattress pad. I had thought that they hadn't taken the money out of my account, but I did a search on my online banking account and found that they indeed did- the day after they accepted my order three weeks ago! How did I miss that? Which reminds me: It wasn't cheap, so I'm extra particular about the final product. I haven't tried it while anxious yet. I haven't let my kids try it to see what they think. (Even though its technically too heavy for them.) I almost want to see about making a pocket for the whole thing in a thicker flannel that's softer. I wonder how that would work. This blanket is cold. The people who run the site that I bought it from say people who have hot flashes shouldn't get flannel but I find this blanket not warming at all. I will give it plenty of time before I make a final yay or nay on this blanket.

I just tried it in bed for a few minutes. Its much better this way. It still covers my feet up to my arm pits, but the weight is evenly distributed and I can feel the weight better that way. After only a few minutes in bed like this (and with my heated pad on), I started to get pleasantly dozey and fell asleep. More points in the positive for the blanket. Its still cold, but with a comforter over me and the heating pad under me I was plenty warm.

I had a thought about why it might be cold. Its been in delivery trucks and warehouses for the last five days and its winter. I know it at least sat all night at UPS here in Michigan last night. I'll let it warm up in the dryer tonight before bed and see if that helps.

The blanket's makers included a small letter with the blanket in the box. One of the things it says is please write and give your feedback soon. I think I'll give it a week to be sure.

There are many things that the blanket is said to help with. For me, I am hoping it will help with anxiety, stress and tension. On the outside chance, it may help with my sleep apnea. (I still will wear my CPAP.) And, happily, I look forward to it helping with menopause when that day comes. (I'm relatively close, but haven't reached that year yet.) Other things they say it helps with are alzheimer's, parkinson's, post traumatic stress disorder, restless leg syndrome, ADD/ADHD, asperger's and other autism spectrum disorders, and sensory disorders of any kind.

EDIT: for January 10: I slept with it last night. I'd put it in the dryer on low for just a couple minutes before I took it up to bed. It was a little too warm that way. Probably because I have the heated mattress pad and it had been laying on that, too. Once I got under it, it was too warm. I stuck my feet out and that was better. I think its either put it in the dryer, OR put the heated pad on- not both. When I woke up this morning, the first thing I noticed was that I remembered my dreams in a detail that I had not in years. In fact, I hadn't remembered them at all for time out of mind. I took this to mean that I slept very well with the blanket. Even now that I type this, I feel more awake than I have in ages. I'm not planning my next nap or day dreaming about when I can go to bed tonight. For me, that is huge. My criticisms of the blanket at first are giving way to love.

Insurance Answer & Weighted Blanket

After two days of being closed, I finally got to go to the Social Security office. I wanted to ask them about what DHS said about my Medicaid being cancelled. After little to no wait- yay!- I was told that yes I still have Medicaid but its through Social Security now instead of DHS. I won't have Medicare until I've had disability for 24 months. Furthermore, nothing will change! My insurance cards should be the same, and my insurance should tick on just like it has. So nothing is getting cancelled.

My weighted blanket has shipped! The last time I checked, they hadn't charged my card, but I'm sure that will change soon. Its supposed to arrive Monday at the earliest. (Today is Friday.) I arranged to pick it up at the UPS building, because I can't be sure I'll be home when they try to deliver it. (They don't just leave packages at apartments.)

Rexulti II - Side Effects?

My appointment with my psych nurse practitioner was good. We discussed Fitbits- they track your exercise habits. I would get one were they not $125. (And had I not just spent more than that on a weighted blanket!) Seems like a utility bill to me. Apparently, my mood is good, which, considering what I've had to go through lately, I'm surprised about! Of course, we talked about Rexulti. She sang its praises and said it has fewer side effects and many benefits. We are weaning of Zyprexa very slowly, but that's okay because I think I have enough to do that. The Rexulti ended up costing insurance $1152.xx! Plus, now someone tells me you can have Medicaid and Medicare at the same time, so I need to go to the Social Security office and talk with them about that and about getting my cards. Then, I need to go back to DHS and see what's up with them telling me my Medicaid is cancelled because I have Medicare. After I realized that Social Security closed at 12:30, I went to the mall and waited for my friend, K, to call. He did, not long after I got there and we went to Panera and had lunch. Still no weighted blanket (or email from them) and still no check from the bipolar study, but I have this hunch that one or both of them will arrive on Friday while I'm out at Friday Lunch. Oh- I did take the first Rexulti pill around 12:45. No side effects yet, except I'm a little tired. Maybe the side effects will add up as the days go on, or maybe I won't have any at all! (Yay!)

Medicare, Disability & Social Security

The Department of Human Services was finally open today. I brought the paper that said my Medicaid was cancelled as of January 1st. They told me I need to reapply as I do still qualify for Medicaid. Then, someone else looked at my paperwork and took it away for a bit. When she came back, she said that I now have Medicare and my Medicaid ends on February 2nd. That is good news as far as my appointment tomorrow is concerned. (Can have the appointment with my psychiatrist/nurse practitioner and pick up the Rexulti.) But I still don't have any Medicare cards for February. A friend said they will come in the mail, but I looked through everything I have from Social Security and while it is helpful, nothing mentions Medicare. I may go to the Social Security office in town in a few weeks if I don't get my cards in the mail. I am guessing that I'll have the infamous "Part D" for my prescriptions. Whether this will pay for Rexulti - I looked it up; its about $1000/month!- is still up in the air. (I was debating paying in cash, but that obviously wasn't going to happen!) My appointment tomorrow is in the morning, so I'll have an update for what we decided earlier than later. If we decide to keep Rexulti, I'll go to the pharmacy and pick it up. (Through Medicaid.) If we decide to stay with Zyprexa, I'll be disappointed, but what can you do? Medicare is a new beast. Its better than a sharp stick in the eye. I wish I could have both Medicaid and Medicare, but apparently not. I'm also not sure how long SSI/SSDI lasts. It will only be a year on the back payments, I believe. As for the monthly payments, I don't know. My friend says you can keep Medicare as long as you're still disabled. I don't know how you undo bipolar disorder. So far, even my stable periods always come crashing down when mania or depression come to haunt me again.