New pdoc?

I'm planning on switching pdocs. I was a bit displeased with mine at my last appointment.

(To refresh your memory, she told me that meds won't work on me and that sometimes people have a black cloud over them and are suicidal all the time and you just have to get used to it)

That rubbed me the wrong way. And by "rubbed me the wrong way", I mean pissed me off, had me sobbing, and stole away any hope I still had left of managing my depression. I couldn't believe she told me that. I mean, even if she was thinking that she shouldn't have told me that. Not when I'm depressed, suicidal, and losing hope on my own.

Not the best thing to say.

Hubby and a couple of my friends have told me to find another pdoc. That what she said was unacceptable. That it seems she's throwing in the towel. Meds won't work on you.

I am torn though. I keep thinking, what if this is all me? What if meds won't work for the depression and that I do just need to do more trauma work? What if this is a situational type of depression, that I have to buckle down and plow through and it's all on me?

What if?

What if I'm changing pdocs because I basically didn't like what she had to say? Maybe changing pdocs won't help anything. Maybe the new one will say the same thing. Maybe I'm just chasing meds, looking for the easy way out.

I look back at myself over the last 3 years, trying to see patterns, trying to see what I'm doing right and what I could improve on. I'm trying to be open and bluntly honest with myself. I need to be if I'm going to get stable.

One thing Ive noticed (and I picked up on this about a year and a half ago) is that once I start to get better I'll be better for a couple of months and then relapse. I get depressed again. And a year and a half ago M (therapist) and I discussed this. We talked at length my "not wanting" to get better. We worked through it, we found and worked through a few triggers, and having me identify this flaw within myself had curbed that tendency to self sabotage.

And I look back and I see no self sabotage for my mania (and hospitalization) last November, no self sabotage for my suicidal depression (and hospitalization), last December, and no self sabotage for my suicidal depression (and hospitalization), last May. I find no trigger, no form of self sabotage - it just happened.

July and August this year I was starting to become more stable. In October I started to slide, by November I was down and getting worse, and December has been horrid. I know I had one trigger: a piece of Al-Anon literature I read on forgiveness. It gave me icky feels. I worked through these feels in Al-Anon, in therapy, and with my hubby. I worked through them. I laid them to rest.

Now, knowing that was a trigger, I was doing all the proper things to counter the emotional response. I talked about it, I journaled my feelings and thoughts, I countered my negative thoughts, I didn't catastrophize, I did everything right.

I worked through it. I felt better about it, and felt that I had nothing more to say on the matter.

Several weeks later is when I really started to spiral. I did all of my CBT stuff that I've learned about, I talked to hubby and in therapy. I didn't let myself isolate - I forced interaction. Again, doing everything right.

So what the hell is going on?? Did I have a PTSD trigger that threw me into a bipolar mood episode? Is this just PTSD? Is this just a bipolar shift with no real trigger? Does it really matter?

Because here in lies the rub: I'm doing all my CBT things, I'm trying to stay present, stay in the moment, take it day by day (sometimes moment by moment), counter my errors of thinking, not isolate, trying to "fake it till I make it" . . . all the things I should be doing.

But they're not helping.

They should be helping. If this was all me, all PTSD, all a trigger, then this shit should be working. And it's not. M pointed out that that one Sunday at work where I was crap and laid on the floor for 2 hours because I was suicidal and didn't know what else to do was most definitely not a trauma issue - it was most definitely a chemical imbalance issue.

If all my behavioral therapies are not working that would lead to a chemical problem, right? So meds, right?

But my pdoc won't prescribe me anything else because she believes this depression is all trauma, all in my head. That if I do more trauma work I'll be fine.

I don't even know what to talk about trauma wise anymore. I really don't. We've gone over my abusive relationship and rape. We've gone over my dad's death. We've gone over stuff with my (alcoholic) mom several times. I don't what else to say on these matters. I have no idea. I don't even know what to say in Al-Anon anymore (I've been silent the last three sessions cause I have nothing to add).

So what more trauma work do I need to do??

There's only one area I see where I need more work: fake it till I make it. I've been faltering in this area. Why? Because it's hard to pretend to be positive, to be okay, to be well, to be not depressed. It takes so much energy and it's so much easier to give into the depression. It's better for me to fake it, it is. But I've been so tired lately, the past few weeks, that it's gotten harder. It's easier to give in. To not fight. See, part of me wants to give up. I'm tired of fighting my moods everyday. I'm tired of the knowledge that I'll do this for the rest of my life. It's too much to handle and so I'm slacking on forcing myself to seem okay (even when - especially when) I'm completely broken on the inside.

What the fuck do I do? Change pdocs I guess, see what the new one has to offer. I don't know. I don't even know. This is all very frustrating as fuck.

Also? I've noticed that since I've been on 600mg of seroquel my cognition is suffering. I forget letters in words or add extra letters, it's taking longer for me to think things through, to respond. Joy.

Hey I'm at work!

No really - I'm totally at work right now.

And I'm bloody exhausted. I'm in disbelief at how drained I am right now. The morning was busy - very busy. I didn't get a chance to sit down and eat breakfast until 1:30 (meaning I ate my lunch instead). And it wore me out.

The sad thing is, 4 months ago that wouldn't have been a problem. It wouldn't have phased me one bit. I've been forgetting things all day. Lots of things. Printing face sheets, calling a physician, calling the NNP about a c-section, giving report, putting in orders . . . I charted things under the wrong time and had to go back and fix it. Luckily I've caught all these little errors and nothing was major. But the fact that this is happening . . .

It frustrates me to no end. To know that my level of functioning is so deteriorated so much from what it has been. From what it used to be . . .To know that I'm struggling more than I ever thought I would. It frustrates me and depresses me - and I'm trying desperately not to become depressed about this (and sadly, it would be easy to slip).

I've reread this post 3 times because there have been so many errors - missed letters, extra letters, words completely left out, words out of order. What the fuck is going on??? I shouldn't be having issues like this.

And yet I am.

To be healthy I should accept my new level of functioning and move on. But that's near impossible for me right now. Maybe someday I will - but I can't now. Not now. Maybe it's my pride. Maybe it's my high standards for myself. It's probably both. And maybe more.

All I know is that I'm tired and drained and frustrated and down.

So About Work . . .

Yesterday was my first day back at work. I was in the nursery (meaning going to deliveries - every delivery) and we were steady - we did 6 deliveries. Overall, I would say that it was a good day.

Now, having said that, I did noticed some definite deficits.

First and foremost - cognition. I was processing things more slowly. Luckily, in a life or death situation (I did a resuscitation on the baby in my first delivery), I was good. Snap, on-the-fly decisions came without hesitation - my critical thinking wasn't affected.

When it came to prioritizing things - charting, making charts, phone calls, lab draws, circumcision checks . . . I was not so good. I was slow to process and I had a hard time focusing and concentrating. You might want to say "but Cami, it was your first day back after 5 weeks off." And I would say yep, you're right - but I shouldn't have issues with this kind of stuff. I'm the most organized, efficient person at work.

Or at least I was.

Next - exhaustion. By 1pm I was done with people. Done. The fact that I had to interact at all was too much for me. I became withdrawn and flat, saying little. I felt mentally and emotionally drained. I felt tired. I found it difficult to be present.

And lastly - myself. Yes, I was a problem. Which is quite stupid, if you ask me. I was a problem because I had high expectations of myself - and I didn't meet these expectations. The day was both harder and easier than I thought it would be. I had a preconceived notion that I was going to fail miserably - and I didn't. So easier. But I didn't meet my high expectations, so harder.

See, my problem is the deficits. With each mood episode you get worse. Where as 2.5 years ago I was 100%, now I'm functioning at maybe 87%. And it will continue to get worse. I notice these deficits. I've been noticing them get worse over the last year (most notably over the last 4 months). And for me that's devastating. To not be able to function at my best, especially at work, is just not okay.

And I'm starting to beat myself up over it which could cause a downward spiral. I'm doing my best to curb the negative thoughts and for now I'm succeeding. It's just that they keep coming. Negative thoughts, what-ifs, and doubt is all trying to creep in. I don't want to function at 87% - I want to be 100%. I should be 100%.

"Shoulds" are bad. "Shoulds" make you feel bad. Part of my problem.

The other issue is whether or not I go part time. I honestly think that for right now, part time would be best for me. A little less work, a little less stress, a little more recovery time. I think it's what I need.

But I have a strong work ethic. And I feel like I'll be letting people down.

I also feel I have an obligation to my family. If I go part time we'll have a major shift in how we're living - namely, foreclosing on our house, filing bankruptcy, and moving into a rental house. That's a lot to process and that whole situation is based on what I chose to do.

How fucking terrifying is that??

I feel all this pressure to perform, to perform well, and make everything be okay. Most of it is probably put on by myself and my expectations, but I can't change that that's how I feel.

And I'm not catastrophizing - I should get that out there. I'm actually trying to minimize everything. I'm trying not to catastrophize. I'm trying to be practical.

Well, there you have it. There are deficits. I'm at 87% instead of 100%. I'm terrified of what going part time means, even though I think it would be better for me. Boom. Done.

Worried about work . . .

I start back to work next Saturday (the 11th). Now, keep in mind that I'm an RN and I deliver babies. TOTALLY not a high stress job. Nope. No stress here.

And I'm worried. I am seriously worried about going back. Everything overwhelms me. I'm supposed to be going to a friend's house on Saturday to visit and her kiddos are sick so we had to postpone. I lost my shit people. My world came crashing down. Anxiety, despair, anger, confusion, and the feeling like I couldn't possibly go on. Seriously.

My hubby and son wanted to teach me how to play Minecraft on the Xbox (I don't play video games). After 5 minutes of play trying to figure out the dumb controller I about lost my shit. I held it in because of my 6 year old son sitting next to me, but the feelings were all there.

I almost embedded my sewing bobbin in the wall and then broke down sobbing because it wouldn't feed correctly.

My mind still races. I have difficulty concentrating. I'm agitated and irritable and feel restless like I need to MOVE. If I don't stay constantly busy, depressive thoughts try to steal their way back in. They slink around in the background, waiting to pounce, waiting for me to let down my guard.

And I'm supposed to go back to work. In a high stress job that I absolutely LOVE, but that requires me to be at the top of my game. That requires me to focus and concentrate and make snap (sometimes life and death, literally) decisions.

My manager is awesome. She's a godsend. She'll support me in whatever I need. For this I am lucky. For this I am grateful. But I can't afford to be out on leave - and I only have 6 more weeks of FMLA available anyway. After that . . . nothing. And with my track record of hospitalizations . . .

So I'm worried. I'm worried about how I'm supposed to go back to work. Maybe next week I'll be more stable. Maybe next week I won't be overwhelmed by everything.

And maybe I won't be better.

And so I worry.

I should be in bed . . .

I should be, but I'm not. I'm farting around on the computer until I get tired. My mind is racing but I am starting to get drowsy now.

Good.

I have an appointment with Dr. C tomorrow. I'm most definitely mixed again. And my hypomania is getting a bit out of hand. And by "a bit out of hand" I mean I almost lost it tonight. Almost uncontrolled hypo. At work. Yay.

I was hilarious, I really was. And that's the problem - making people laugh in that state just elevates me further. Which is not good. I'm not going to go into detail, not right now. Mainly because I actually am getting a little sleepy and so I want to take advantage of that.

I'm nervous about my appointment. I know Dr. C will want another antipsychotic. And I don't want another antipsychotic. Too many side effects. I'm going to talk to him about a drug holiday - which I'm sure will go over great since I would have about a 90% chance of going psychotic if I did that.

I still want to though. Because I'm an idiot. Apparently.

I'll write more later. I'm going to try to sleep, if my mind will let me.

Still Cycling

I'm still cycling. It's mild, but it's there. Which is annoying. Can't I just be better already?

Also:

On Nov. 20, the first day of my last hospitalization, I was started on Zyprexa (I was manic and delusional and it was decided that an antipsychotic is a good idea). This is my first time being on an antipsychotic.

Now, I've been having some slight cognitive decline over the last 2 years, but nothing to write home about. But since the 20th . . . sweet mother of GOD what the hell is going on?!?!

First - memory. I'm forgetting everything. EVERYTHING. Things that I know inside and out - forgotten. I've done discharge instructions with patients literally THOUSANDS of times, but now I stop mid sentence not knowing what the hell I was just saying or how I should proceed. It's gone. I just stand there like an idiot stumbling over what I'm trying to say.

Second - concentration and focus. Yeah, totally not there. I get distracted easily. I just can't seem to focus or concentrate AT ALL.

Third - typing. Yep. Typing. Cami, what the hell are you talking about? Well, when I type I randomly leave letters out of words. For no reason. I don't know if my brain is moving too fast for my fingers to keep up or if I'm just literally forgetting letters. (I had to go back and reread this several times to make sure it made sense).

I know some of this is the disease itself - I've had some of these cognitive deficits already. But they haven't been to this extent. And I've declined so quickly.

Could it be the Zyprexa? I'm thinking yes. I emailed Dr. C about it and I'm guessing we'll be taking me off of it (which I'm perfectly fine with).

How stupid is all this???

My Poor, Befuddled Brain

That's right. Befuddled. I like that word. It's a good word. And under used too. We should change that . . .
Anyway, this is a little rant about my brain (Clancy. I named my brain Clancy. Don't judge). I've noticed a steady cognitive decline since last February (2013). That's when I was hospitalized the first time. My second hospitalization was last week, and it's gotten worse.

I have a hard time concentrating. I get distracted easily. I'm having memory issues (I don't remember who told me what, if I'm repeating myself, what did I need at the store?) - if I don't write it down, I tend to forget (this is soooooo not how I used to be). I get overwhelmed easily (again, NOT how I used to be).

I think this realization hit me hard tonight. So, it's Thanksgiving (but you knew that already, didn't you, you sly minx). My hubby and I decided to go to Walmart tonight for their 6pm "Black Friday on Thursday" sale. And guess what? It was bloody busy! Lots of people. Okay, fine, I'll deal (crowds have been making me anxious as of late). While standing in line, my sister called. I was trying to talk to her when I suddenly lost my ability to do anything. I'm not even joking. I was trying to concentrate on our conversation but there was so much going on. So many distractions and people and noises and lights and there's a screaming kid and that lady is being a bitch and what the hell did my sis just say?

It was too much. I babbled incoherently. Seriously. Words came out. Just words, no specific order. Let's just pretend that was a sentence. Yeah . . . that was TOTALLY a sentence. I finally stammered out that I would call her back when we left the store (we did, by the way, score a laptop for $278).

But, a couple years ago that wouldn't have phased me. At. All. And it's frustrating. I've started noticing little deficits here and there at work, too. That's not good. I'm an RN. I deliver babies. I have to be on top of the game. But it's creeping up there. Stupid Clancy. Clancy is an ass.

I know it's part of the disease progression. I know it can be side effects of the meds. But let's be honest - this shit is annoying. And it's affecting my typing!! OMG! WHY?? I mistype constantly!! And if my mind is racing . . . well, my fingers can't keep up. Lame.

Boom. Rant over.