Contentment With a Side of Panic Attacks

Life is fairly good these days.  I’m attributing it to plenty of sunshine and DBT and working hard in therapy and having more structure to my days.  There are some big changes on the horizon, like moving, and QoB *finally* retiring (maybe), but those are good changes.  While my mood has been fairly neutral, I have been having some physical symptoms that have been giving me trouble.

Physical symptoms that I decided were lithium poisoning, because that is where the problem  usually is, but when that wasn’t the answer (after a blood test) and the urgent care provider sent me to the Emergency Room, I was stunned that I hadn’t thought of this:

from http://www.slideshare.net/mwalley/panic-attacksatnight

I was having every single one of these issues, a minimum of three separate episodes each day.  So, apparently, my anxiety (that I *knew* was high, but, um, it always is!) is manifesting into more physical problems.  Also known as, multiple panic attacks a day with very high anxiety between attacks.

So while I thought that I was mentally very healthy, because I was not feeling extremely depressed or extremely elevated, and because I was not having more than my usual amount of generalized anxiety, I misdiagnosed myself as having lithium poisoning or something wrong with my heart because it has been so long since I have had full-blown panic attacks.  I should note that these attacks almost always additionally come with gasping, sobbing, and cursing on the side.

I beat myself up that I didn’t realize my anxiety was so out of control before having this little Emergency Room epiphany, but I think that I was just so grateful to not feel extremely depressed, that I decided everything else was “fine” and that I was just “physically ill.”

I still “don’t feel good” physically and am going to need to get in to see my psychiatrist this week, but I am really not looking forward to that.  I reported increased anxiety at my last appointment, and I do have a PRN for anxiety that generally works.  It is only when the anxiety gets really blown up and into a full-on attack that seemingly nothing makes me feel any better.

I am curious.  Have any of my readers ever had something like this blow up out of nowhere?  I mean, it probably isn’t really “nowhere” and I just can’t pinpoint where it started.  Thoughts, feelings of commiseration, home cures (hahahah!!!)?

 

Open Letter to My Local Mental Health Center

Prepare for some rambling…

When I first sought your  help in 2009, I was worried I would not be accepted because I was considered out of your cachement area.  As it turned out, CMHC’s could not deny Medicaid clients based  upon cachement area.  This is a good thing, because in 2009 you allowed me to start your Intensive Outpatient Program in Dialectical Behavior Therapy (DBT).  I attended five days a week, for three hour days.  I can honestly say that this formal introduction to DBT saved my life.

You brought wonderful therapists into my life, some whom I thank God each and every day for.  There are too many to mention just one, but each of the IOP therapists are very special to me.  They gave me hope when I had none and taught me the skills necessary to survive with bipolar in a unipolar world.  The IOP program was just the tip of the iceberg.

After graduating IOP, you wanted me to do weekly DBT classes.  I was working at that point again and had difficulty with coordinating my schedule.  I hopped around to a few different groups, and then I gave up.  I went back to seeing the pdoc at my county’s CMHC, and continued therapy with Goddess of Mindfulness.

For a few years, my needs were fulfilled at my local CMHC.  It wasn’t the same, though — the therapists were not as invested, it was difficult to get a med appointment where the pdoc didn’t continuously cancel.  It was a fight to get any medication change.  It was if I would just come in to get the rubber stamp and then would be sent off on my way.

In 2012, I had a major bipolar meltdown and came seeking help from you again.  I needed that Intensive Outpatient Program, I needed those caring therapists, and I needed the care that I knew my own local CMHC couldn’t provide.

I started IOP again, and stopped seeing Goddess of Mindfulness, instead seeing Marty for individual DBT therapy.  IOP was very different this time.  The classes were extremely small, participation was minimal, the therapists often didn’t keep the group under control.

The times had changed — there was no longer a ten minute break after every hour.  I don’t think the therapists realized how difficult it was to sit for 90 minutes without a cigarette or a soda or a break when you are in such a mind-addled state.

One thing for sure — IOP wasn’t the same.  It wasn’t as helpful, I didn’t feel as successful, there was not much group interaction or cohesiveness, and frankly, most of the therapists seemed bored, as if they lacked passion for the subject now.

I moved quickly through IOP this course and started just seeing Marty individually.  She was a very different therapist than what I was used to.  She called it like she saw it, and the way she saw it was often very different from my view of things.  After about a year of seeing each other, she announced to me that she would be retiring the following summer.  After that, her heart wasn’t in it.  She certainly didn’t seem to care anymore, and it was like she had given up on me.

I decided to switch tactics and go for a non-DBT therapist there at the center.  That was worse.  She seemed cold and unfeeling, judgmental even as I would describe what was happening in my life.  I started to avoid appointments, and go for long periods of time without checking in.

During a time of mini-crisis, I attended a “Building Structure” group in which you basically made plans for each day and the day after.  It was a very useful group for me and I went for three weeks, then graduated.

I ended up going back to see Goddess of Mindfulness after that.  I couldn’t afford it financially in my budget, so I had to take $15 out of each weekly allotment and put it toward therapy.  In my eyes, it was a good use of money that I may have just frittered away elsewhere.  It still didn’t add up to what Goddess of Mindfulness should really be paid, but I was beyond thrilled when she accepted my request to be her client again.  Over the moon, really.

And since my 2012 return to the CMHC, there has been Dr. Wizard.  I kid you not, the man is a genius when it comes to medication.  He listens, makes small adjustments, is encouraging, worries that I am on too much medication, and, here recently, hospitalized me when it seemed to him like I was under too much duress.

I have never had a problem getting in to see my pdoc, and I thank the wonderful front desk staff for that.  Sure, calling the nursing line works sometimes, too, but the front desk staff are better at prioritizing clients and slipping people into time slots quickly.

When I came out of the hospital on Monday, I was in a daze.  I knew they had started me on a downturn of Geodon and had started me on Abilify, but I wasn’t given any titration recommendations.  I was just told to follow up with my pdoc at my next scheduled appointment on July 9th.  That was three weeks away.  I was feeling a bit better, but as a couple days went by, it was clear I needed more  support, possibly more medication.

On Wednesday, Goddess of Mindfulness had me call the CMHC to try and get an appointment.  I called the nurse’s line first, and left a message.  They called me back thirty minutes later and tried to tell me that there were no openings and I would have to “sit tight and wait” until the 9th.  The woman I spoke to barely spoke English and I actually ended up screaming into the phone, “I hope I don’t flip out before then!” and hanging up on her.  I know, real classy, Rose.  I’m out of my mind, I guess.

I then tried calling the front desk and asked to be put on the cancellation list.  I explained my situation and I was put as an “emergency priority I.”  I told them I only needed one hour’s notice and I could be there.  The front desk girl assured me I should be able to get in soon.

Much to my surprise, I received a call at 9:15 the next morning, asking if I could be there by 10:30.  Of course I can!  I made it down and Dr. Douglas kept the Geodon the same, but bumped up the Abilify.  He said, if all goes well, we can do it again at my next appointment on July 9th.  He was very understanding and caring, and we had a nice chat.

All in all, this is a good CMHC.  I think the DBT therapy program has possibly fallen by the wayside a bit, and I can tell you that the individual therapists like my last one should be fired, but what I really need is my pdoc and Goddess of Mindfulness, and I know I will be fine.

Widely Vascillating Mood Changes

Over the past few weeks,  I have had many successes.  Progress has been made, indeed.  The mixed episode is still going strong, unfortunately, and sleep and social interactions have been quite bothered.

Yesterday, I was very up and I was very down.  I was angry and pissy and entitled.  I rode roughshod over people’s feelings, and I do feel badly about that.  I didn’t realize just how much my moods were swinging until it all came to a crash today.

Today, I went to visit my mother and, although I had already apologized in an email, I apologized face to face for being so hateful.  I explained that it felt like people don’t want to deal with me when I am at my worst, especially her, and that sometimes all I need is a 30-second phone call or text to put my fears to the side.  She tried to explain to me how this wasn’t possible.

I really lost it, swung completely into a depression where I actually pondered checking myself into the local psych hospital.  I mean, REALLY pondered it.  I felt, in that moment, like I had no hope and that no one around me cared.  Like I had no one I could reach out to.  Of course this is not the case, but this is how I was FEELING.

I felt like being totally self-destructive but I couldn’t get out of the crying jag I was in.  A little bit of talk down the road, and I’m back to fine and don’t recognize the me crying my eyes out and talking about being through with life.

I hate these mood swings.  Up and down and all around.  Sinking me into a pit of despair before being lifted up into a mixed mess of hypomania and agitation.  Surely bipolar disorder isn’t meant to be like this.  Surely I am alone in my symptoms and my mood swings.  I mean, I AM special, after all.

It seems like I don’t talk about these mood swings with Goddess of Mindfulness because we are so busy talking about other things.  Well, these mood swings might just be the MOST IMPORTANT things to talk about.  If I swing really low and I am by myself, I cry and cry and cry.  If I am with other people, I cry and swear and am very angry.  When I’m up, its as if nothing is wrong except some extra energy and a bit of agitation.

I told my mom earlier that I can’t keep going on like this.  I don’t mean that as a suicidal statement, just as a fact — I can’t keep doing this.  It’s killing me and it’s hurting the people around me.  I don’t know how to stop doing it and I can’t get in to see my psychiatrist until the first part of August.  Almost two months away.  I don’t know that I should wait that long.

So, depending on what time of day it is, you may or may not get a Rose that  you are otherwise unaccustomed to.  There is the happy Rose and the free spirit Rose and the crying and devastated Rose and the hopeless Rose and the goal-centered Rose.  They are all the same person, but each one of them comes and goes of their own volition.

I try and  use my DBT skills when I start feeling an episode coming on, but it’s hard.  It’s fucking hard!  Like I said before, maybe I should go back to diary cards.  I really hate doing them, but I know they will help.  What I do know is that I’ve got to get this ship on an even keel because the lows can be a killer, as can the highs.  I need somewhere in between.