New nurse practitioner & Scripts - & lots more!

 Listening to my favorite “boy band”, Libera, as I write this.  Look them up.  They have their own site and a YouTube channel.  

Been five months since I last wrote.  Been doing very well.  I feel like myself!  Yesterday, I listened to “The Hidden Spirit”, a CD of 16th and 17th century choral pieces by women for women.  I was five and a half months pregnant with my youngest child the two days in May, 2001 that we recorded this album.  I have a solo on Track 2  and I can hear myself in other tracks even though we are blending flawlessly.  I used to love to sing Gregorian chant with this group: such power in uniting our voices as one big voice!  

As far as my voice is concerned I have been seeing a voice therapist since March this year.  I don’t feel that I’m making much progress and I still can’t sing above about an A or B-flat.  Very disappointing.  I am singing every day and doing my exercises several times a day yet my upper range is still messed up.  Gone are the days of my women’s choir- that voice was 22 years ago!  

I got a new psychiatric Nurse Practitioner back in March.  My old one retired at the end of April- she called me about that time to say an official farewell which I thought was kind of her.  After all, we’d been a team for at least fifteen years.  The new NP is very nice and though I’ve only seen her for one session so far, I saw both her at my last appointment with my old psych NP.  In fact, I see her tomorrow morning- a month after my last appointment.  My old NP had added Klonopin for sleep back in August and it has been a miracle drug!  Not only am I not staying/waking up at all hours of the night, but the terrible anxiety that followed me everywhere and consumed my every thought is gone!   She also added Ingrezza for bad akathisia.  Although I’ve gained ten pounds from not constantly rocking back and forth and shuffling my feet and legs around, my tongue hasn’t been moving around in my mouth (except to eat and talk of course!) so much at all anymore, too.  

I have annual paperwork that comes around about the end of April.  I always seem to dread when I see it in the mailbox because there is so much to it.  However this year I mailed it off yesterday- only three weeks out of six that I had between when it arrived and when I had to get it back to them.  There is so much to do- it’s practically a full-time job in itself!  It should arrive either tomorrow or early next week- three weeks before the deadline.  

I went to the eye doctor a week ago.  I got an eye exam plus a contact lens exam because I wanted to order more contacts in my updated prescription.  I also got glasses.  The frames are plain black but don’t look too bad on me considering I only had six pair to choose from that my insurance would pay for. Both my glasses and contacts came in today but I was only able to pick up my glasses as they didn’t call to tell me that my contacts had just come in until five-to-five- right before they close.  I will get them on my way to my appointment tomorrow.  

For about three months now, Caleb and I have been getting a lot closer.  He came to see me about a month ago and in one more month he is coming to see me and we’re going to a concert of one of his favorite artists that I’ve never heard- not even a recording.  I’ve also set out some of my DVDs and CDs that we’ve talked about on the phone.  We probably won’t play all of them in their entirety except maybe “Office Space” because we both love that movie and he hasn’t seen it in a long time.  

It’s Been a Year!

 It’s been a year since I last posted!  

The year was ok in general.  But 3 months ago I saw my voice specialist.  Last time I’d seen him was 4 years ago.  I still can’t sing past C above middle C and on that particular day last October I was getting over a cold so I could sing down to the C below middle C.  This is exactly a tenor’s range!

The voice specialist had me read a short story while he was making a video of my vocal cords.  He compared it to the exact same thing from 4 years prior. I had zero memory that I’d read that very same story before but I had.  

In his notes, the voice doctor noted the tremor in my hands and wrote that my voice now has a tremor! I showed these notes to my primary doctor and to my Pdoc.  Pdoc decided to take me off Haldol and the cogentin that was supposed to be for side effects from the Haldol.  The cogentin I’d taken myself off because it gave me such a dry mouth! 

Now I’ve been off Haldol for a couple of weeks and I can’t tell if my voice has a quaver in it or not because I couldn’t hear it in the first place.  Maybe if was from the cold I was getting over at the time.  Or maybe it really was the Haldol.  

Pdoc also put me on Ativan for akathisia.  I take it twice a day.  

Hallucinations wise, I haven’t had any except maybe today when I thought I saw someone standing nearby our table at a restaurant but they vanished right before I turned my head up to get a proper look.

This is my update for now.  I guess no one reads this except my dad and my friend in Florida.

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.