NAMI Walk 2011

This post is dedicated to those who donated and walked with me in the 2011 NAMIWalks for Ventura County.  We had many generous donations and a fun walking team of eleven people and dogs.  Our team name was Walking on the Wild Side!

In all we raised $3405.00!!  Of all the teams that participated we ranked 6th in total money raised!  That's awesome!  Especially when you consider we were walking with BIG corporate teams like Ventura County Sheriff and Aurora Vista Del Mar Hospital.

I want to personally thank you for donating to our walk.  You are making a difference in reducing the stigma of mental illnesses and directly supporting the Ventura County chapter of NAMI.

NAMI, the National Alliance on Mental Illness, is the largest grassroots advocacy organization for those affected by mental illness.

To be sure Walking on the Wild Side is still on a mission.  We eagerly wait for NAMIWalks 2012!

Thanks again,

Jeff

Next Up - Psychiatrist Appointment

Every two months I have an appointment with my psychiatrist for "medication management."  That's what they call the 20 minutes I have to meet, discuss, and make any changes to my medications.

I met with Dr. G on Friday.  It was in the morning so I was sure to be groggy and miss some something.

We talked about the usual stuff: sleep, meds compliance, exercise, diet, and medication effectiveness.  However, we spent most of the time going over my disability retirement application.

Disability Retirement

The disability retirement program is for federal service, not social security disability.  However, as a condition of the federal program I also have to apply for social security disability.  I did this last month.  I am doubtful they will approve my application.

Social security disability has a higher bar or threshold for acceptance than the federal disability retirement.  They require that you must not be able to perform any gainful work due to a medical condition that will last at least 12 months.  However, for the federal system the applicant need only be unable to work in their current job because of a medical condition.

Anyway, Dr. G and I spent a lot of the appointment discussing how my bipolar impacts my ability to do my work.  For example, during a bipolar depression I struggle with concentration and memory problems.  This makes it difficult for me to effectively read and analyze technical reports, which is an essential function of my job.

Dr. G typed what we came up with in her notes.  The notes will be used to document how the illness impacted my ability to do my job.  When the notes are typed up in the required format along with some additional information it is called the Physician's Statement.

Medication

Dr. G and I discussed possible changes to my medications.  She mentioned Seroquel and Remeron.  I am reluctant to start another mood stabilizer at this point.

I am trying to reduce my psych meds.  I recently got of Abilify and now I am considering stopping Cymbalta.  I don't think it is doing much anymore.

However, I do want to try the supplement N-Acetyl-L-Cysteine or NAC.  I recently did some research into NAC and it seems worth trying.  So we agreed that I'll try the NAC and see how things go.  In the meantime I will research Seroquel and Remeron although I'm not very excited about either of them.

That's about it.  Won't be writing about Dr. G for a while since my next appointment isn't until May.  She's overbooked.

Another Disorder

As a component of my mental health treatment plan I try to consider and investigate problems that are not related to bipolar depression but could contribute to depression.  One area of concern is the quality of my sleep.

It doesn't seem to matter if I get 7, 10, or even 12 or more hours of sleep each night.  Regardless of the amount of sleep I get I still wake up tired and fatigued.

So, back in September I started the process of determining whether I have sleep apnea.  Sleep apnea is a disorder of the sleep process where the body strains to get air.  It can have very significant effects on an individual including high blood pressure, heart attack, and stroke.

Because of my health insurance I had to see my GP to get a referral to an ear, nose, and throat (ENT) physician.  In October my GP referred me based on my conversation with him (no testing).

Next, I setup an appointment with the ENT physician.  She talked with me and stuck a probe thingee up my nose.  This confirmed something I already knew.  My left nostril does not allow for the free flow of air.  My septum is deviated.  I also have some flow disruption from nose inflammation caused by allergies.

Finally, at the end of last month I took a sleep test.  It confirmed that I have moderate sleep apnea.  I didn't get many details but the results from my sleep study affirmed I need some help in this area.

So, this week I got to try out a sleep machine.  The machine is called a continuous positive air pressure (CPAP).  I tried a CPAP when I was previously diagnosed back in 2008.  I returned it because I was having a difficult time getting used to a mask around my face.

Also, I was a little overweight and drank alcohol back then.  Being overweight constricts the airway.  Drinking relaxes tissue in the airway also causing the airway to collapse.  So at that time I decided I'd get in better shape and quit drinking to see if that reduced my apnea.  It did some.  My snoring decreased.

Well, I tried the CPAP overnight this week and have not received the results.  I struggled to keep the mask on during the night as I did back in 2008.  Each time I woke up during the night I could tell the CPAP wasn't working as designed because there were air leaks at the mask seal.

From all the testing I have bad, good, and possibly more bad news.  It's bad that I still have apnea.  It's good that it is only moderate and treatment should reduce my tiredness.  And it could be bad if I continue to struggle with the CPAP.

The bottom line is with apnea I now have two disorders going on in my head: bipolar depression and sleep apnea.  I wonder if there are other things causing depression that I don't know about?  By the way, because of my insurance it has taken four months and counting to get this far.

Bipolar Depression Recovery

The ultimate goal of everyone with bipolar depression should be full recovery.  I define full recovery as the absence of bipolar depression symptoms, being fully functional, and participating in society.

You may have a different understanding of full recovery and that is fine.  The important thing is to be striving towards recovery and working out problems.

Aspects of Recovery

The absence of bipolar depression symptoms is necessary to be fully recovered.  For me this means eliminating fatigue, excessive sleeping, depressed/negative mood, cognitive difficulties (e.g., concentrating), hopelessness, and low energy.

Fully functional will be different for each person.  My concerns are to be well enough to work, take care of myself, and doing things I enjoy.  Take care of myself means being financially independent and successful with my management of bipolar disorder.

Participation in society is a broad area.  It could mean regular attendance at support groups.  It could include being active in church.  It may be going to public places without too much anxiety.

Measures of Recovery

I think of bipolar recovery as a continuum.  At the lowest point would be in the throws of deep bipolar depression.  At the top is being fully recovered.  I have divided and defined recovery as:

Fully recovered.  Reached my definition of fully functional; participating in society; and no symptoms.
Mostly recovered.  High level of functionality, some participation, stabilized, and few symptoms.
Work-in-progress.  Some functionality, little participation, mostly stabilized, and symptoms present.
Stabilized.  Limited functionality, minimal or no participation, currently stable, and strong symptoms present.
Destabilized.  No functionality, no participation, hospitalization or other intensive treatment needed, and strong, unmanageable symptoms.  This is the bottom of recovery.

I have been at all of these levels.  At this point I would say I am a work-in-progress.  I am stable and have some functionality (e.g., this blog).  I minimally participate in society.  I have many bipolar depression symptoms present.

Recovery Plan

A plan for recovery is an effective tool for becoming fully recovered.  It is a tool recommended by many folks who specialize in mental health treatment and self-help.  I've heard them called treatment plans, road maps, and wellness plans.

My plan is pretty straightforward.  It is to continue medication management, psychotherapy, lifestyle management, and using coping skills.

• Medication management is both medication compliance and active management of medicine.  Medication compliance means taking your prescribed medications as prescribed  without missing doses.  Active management of medicine means working with your prescribing physician to optimize the therapeutic benefits available from modern medicine.  It means trying new meds, withdrawal from ineffective meds, and adjusting dosage(s).
• Psychotherapy is an important part of my recovery.  Here I will be working with my therapist to tackle challenges, better understand social implications, and come up with solutions.
• By lifestyle management I mean the creation and active management of lifestyle aspects that effect bipolar depression.  Important aspects include diet, excercise, sleep, and my faith. 
• I also use various coping skills I have learned over the years.  For example, you may need to address excessive stress from work if it is exacerbating bipolar depression symptoms.

Remember to be patient with your recovery.  Don't compare yourself to others.  We all are adveresely effected by the various elements of bipolar depression in different ways and significance.

Nobody told you there will be days like these.  Your parents, teachers, and health care professionals did not and could not have taught you how to navigate the bipolar waters.  It is part of your uniqueness.

On Psychotherapy

I have a psychotherapy appointment this week.  I suppose this should be seen as an event that will add hope toward remission of my symptoms.  Sadly, at the time of this writing I see it as another tiny step in an infinitely long process.  I hope to change this before my appointment.

I have been seeing the same therapist since 1996 on and off.  I see her usually when I'm coming down from a manic episode or in a long-term depression, like I am now.

When things are going well I find there is no reason for therapy.  However, in the last 14 months or so I have been battling the big bad moods of depression.  I am at a time where I continue to need psychotherapy.

A typical session with her goes like this:

1. Update.  I give a brief update on the major things in my life.  For example, I assure her I'm taking my meds as prescribed, tell her I am still sober, and inform her of any major life events that have happened.
2. Reflection.  I reflect on things going on in my life.  As I do this hopelessness, guilt, and sadness towards things in my life occur.  
3. Analysis.  I then work with her to understand these underlying feelings associated with the things in my life.  By talking about my emotions I am actually releasing built up tension and inner turmoil.
4. Strategy.  The last thing we do is create a strategy for moving forward.  This stems from the results of the prior reflection and analysis.  This part creates hope out of hopelessness.

The therapy I use most often is cognitive behavioral therapy (CBT).  CBT is the process of analyzing and reevaluating erroneous thought processes.  These are thoughts that I say to myself about myself and the world that are in reality not true.  Not only are they false, they are also damaging.

For example, let's say I feel guilty about the DUI I got the last time I was manic.  I am saying to myself what a bad person I was for getting the DUI.  I'm a failure.

Using CBT I am able to better "see" the event in the context of which it happened.  It happened when I was not myself and not in complete control of my behavior.  I was full-blown manic!

Instead, I need to realize that the offense was done in a state-of-mind that I had little or no control over.  I didn't make a rational choice to become manic and start drinking again. Yes it was irresponsible but it not something the responsible and thoughtful me would not have done this.  The me I am now would have made better decisions.

So I replace the negative thought of "I am a failure" with a more realistic thought of "I did something out of character while I was manic."  The replacement thought is both (a) more accurate a depiction of what happened and (b) keeps me from dwelling on the negative and beating myself up over it.

I find the best thing you can do to improve your therapy is to be an active participant.  Sitting (or lying) there waiting for the therapist to ask questions about your life works okay but is not really efficient.  What is better is to try and figure out before your appointment what some of your issues are.

It's even better if you can actually spend time reflecting on them, looking for insight and answers.  If you do this you will be able to address deeper, more elusive feelings associated with a particular problem.  The goal is to have a clear and realistic look at yourself.

If you can't do are having trouble identifying problem area it's okay.  Therapy will reveal your troubles.  If you are in some sort of therapy I hope it is going well for you.  If you are not participating in psychotherapy, then perhaps it is something you should try?

A helpful article reviews bipolar depression treatment using psychotherapeutic techniques to augment your psych meds.

Court Kills Mood

I appeared in court this morning.  I have some court matters that stemmed from my bipolar mania during the summer of 2010.  

Going to court really affects my depression, as I suppose it would to any other depressed person.

I drove to court this morning in a moderate/mild depression and left with more like a severe depression.  Being in there for two hours, listening to all the cases, and just sitting in that environment was a real bummer.  

In court you have things to listen to and see.  All of it is negative.  I would look over to the inmate cell and wonder what the heck they did to end up in jail.  I look to the judge and watch him ram cases through the system at rapid speed.  I'd see the bailiff constantly surveying the people to make sure they were quite.  No cell phones please. 

I watched and listened to all the attorneys, conferring with their clients, practicing their best manners when talking to the judge.  Some of those guys and gals strut around the courtroom as if they own the place.  That bothers me.

I left the courtroom, walked to my car, and drove off in a haze of negative thinking.  Now everything I saw, experienced, or thought about had a dark tint to it.

I was less patient with traffic when driving home.  I turned on the news and it all seemed hopeless, like it's all a waste of time.  I mean who cares if a dude dressed like a Walmart greeter person was actually a thief who stole four big screen televisions?  This isn't helping at all.

I often take a nap when things get like this.  I get sleepy, feel fatigued, and things look hopeless.  I just want to escape.  In the past I would probably grab some beer, but I quit that over a year ago.

So now I am writing about that experience.  It is helping me get clearer, seeing more of the big picture.  I get some momentum to keep carrying on.

I wonder how it's all going to work out?  Acquittal?  Guilty?  What is God's role in all this I wonder? Is this a learning process?  Is this supposed to help me stay on the right track?  

I just want to get over this but it's dragging.  Most of it is my attorney's fault because he has felony cases that take a higher priority.  Now we're looking to March 1st as a possible trial start date.  

Moral of the story: do your best to stay out of trouble.

Reflecting on Mom

Yesterday was the 2nd anniversary of my mom's death.  She died January 2, 2010 from cancer.  It started in her lungs and then spread very rapidly throughout the body.  By the time the doctor's figured things out it was too late.

The loss of anyone's mom is devastating.  It has taken me a long time to process her death.  At first I was angry at the health care system and her doctors.  Why didn't they take a more aggressive approach toward treatment?  It seemed as if they were dragging their feet while the cancer ate away at her.

Now anytime I see something about moms or cancer I immediately reflect back to her dying days.  She was in the hospital for less than a month.  They were doing all they could just to keep her alive.  There was not enough time left for even the most aggressive treatment.

The loss of my mom was a double blow for me.  Not only was she my mom and dear to me, but she was a critical part of my mental wellness team.  I could call her any day or night and she would be right there ready to talk about anything.  She was like a therapist and available seven day a week .

Fortunately, my family and friends are very supportive, understanding, and do what they can to help.  I am very grateful for that.

My sister put a picture of my mom and my niece on facebook in memory of her.  I looked at it yesterday morning and cried.  I very rarely cry, but couldn't hold this back.

In memory of mom my sister and I went to In-n-Out burger yesterday.  That was her favorite.  We reminisced about the past, talked about childhood, and shared stories we remembered.  We went by the house we grew up in and drove around the old neighborhood.

When I think of her I try to remember all the good things about her and the joy she brought into the world.  It's better to focus on the life rather than the death.

I don't know what else to say.  Life is tough on many levels.  For most of us we have an added layer of difficulty living with bipolar disorder.  I hope you are managing any difficulties in your own life well.  God bless.