Sunday, July 29, 2018

Blessings and Hope

It's been a couple of weeks since my last post and I must admit that I wondered what I might say this morning.  There have been so many times over the last few years that there were such significant concerns to write about.  But today, life is good.

First of all, I continue my ongoing effort to wean myself from my smoking habit.  I've smoked for a long time, and this time, I've decided that I will succeed in breaking the habit.  I'm using the patch and that has been effective in allowing me to greatly reduce my smoking.  I struggle still with eliminating the smoking entirely.  It's not the nicotine fix that is the problem.  It is the pattern and behavioral issues.

Let's see, I've smoked for over 4 decades.  And virtually every single time I had the opportunity for a break from work, or study, or anything, I smoked.  That is what you do on break.  That is the hardest thing to overcome.  Last week we spent four days on a trip to Bend to visit my brother and sister-in-law.  Four days and no smoking whatsoever.  Probably the only challenge was golfing.  It struck me that golfing eighteen holes without either a smoke, or a beer, was quite a new thing.  It was fine.

But then this week it was back to work.  The most difficult thing about altering the behavior at work and smoking on breaks is, ironically, that we cannot smoke at work.  So when I show up to work at 5:30 am, I know that I will not have the opportunity to smoke again until 9:00 am.  And then at 11:30, and 2:00 pm.  At issue is a lifetime of making sure that I took advantage of the opportunities that I had to smoke so as not to experience a nic fit.  The patch takes care of the nicotine withdrawal.  It's the behavioral modification that remains an issue.  Still, I am delighted with my progress so far.  A few smokes a day is better than a pack and a half.

But a clear break is going to be necessary.  My goal?  I see my psychiatrist in mid August.  She's the one who has cared for me from the moment I entered chemical dependency treatment till now.  I'd love to be able to report to her that I have succeeded in quitting smoking.  But one of the things I will not do is set an absolute date.  Some may disagree with this.  My reason goes back to countless efforts to quit smoking over the years and attempts at going cold turkey.  What would happen is that I'd 'quit', and then amid the struggles of withdrawal, give in and have a smoke.  This would result in my feeling that I had failed, and so I'd resume smoking again.

Today my attitude is that every smoke I do not have is a victory, even if I continue to have a few.

But the goal is none.  It's just going to require diligence.  And not getting discouraged or allowing myself to feel a failure because I don't live up to other's or my own hopes and expectations.  And also, I rejoice that even now, my lungs are clear and the cough I've been experiencing is gone.

A byproduct of this effort is that I am sleeping better.  I'm not sure that I woke up to smoke, but when I woke up I always smoked.  Now, at 1:15 am I've discovered that one can roll over and return to sleep, most of the time.  I've slept through to my alarm a few times.  The thing is that when waking up requires getting dressed and going outside for a smoke, it is naturally more difficult to get back to sleep.  And at the same time, getting to sleep without the smoke is also hard.  Today, things have improved.  Another reason to continue the effort.

One final word on this today.  From the standpoint of chemical dependency I'm still on the patch.  I will not consider myself a non-smoker until that time when I neither smoke, nor use the patch,  But again, my commitment this time is to continue the effort even if it takes a few months.

Life is good.

One of the things that I did this last week was to rearrange my schedule so that I could participate in the weekly text study that the pastor's in Spokane have.  It's a reminder for me that there are things that I can do to improve the satisfaction and overall quality of my life.  Connecting with colleagues is important.

I have begun a couple of projects in my own shop.  That is rewarding.

The bottom line is this, that there is light at the end of the tunnel.  Being bipolar and struggling with chemical dependency issues is not a death sentence, or at least it need not be.

And so I'm grateful today.

Saturday, July 14, 2018

Two Questions

One of the things our health insurance plan has is a nurse case manager to assist regarding our health issues and so I was contacted after being discharged from the hospital following surgery.  I have to admit I'm a bit sceptical of the benevolent nature of such calls, as they come from the insurer.  I rather anticipate that the outcome is some suggestion to limit costs.

And actually, there was one such suggestion.  I was asked what I would do if I experienced complications after hours.  My immediate response was that I'd go into the emergency room.  The nurse quickly pointed out that I should call the doctor's office and likely they'd have an after hours number to refer me to.  Cost savings.  (I don't know if such a number exists, but I would check.)

But mostly what the consulting nurse did was to review my case, ask pertinent questions, and otherwise inquire how I was doing.  We also reviewed my overall health history, and the  medications I am currently on.  She inquired whether I had any difficulty getting those medications.  I shared that I had some difficulty getting Rozerum, a sleep medication, and went on to explain that because I have a chonic sleep disorder we were using Rozerum because it is one of the only sleep medications that is non-addictive and safe for extended use.

At the conclusion of the interview there were two questions left.  "Have you become less interested in activities that you used to enjoy?"  "Do you feel down and depressed?" This most basic of mental health screenings was welcome.  I expressed my appreciation for the questions, explained that as a bipolar person I am well aware of the signs of depression, but that no, I was not feeling depressed at this time.

Mental health screenings-- they should be more prevalent.  They should be part of every comprehensive 'physical', and to an extent, all medical examinations.  I say that because often the mentally ill first seek professional help for physical issues that are related to mental illness.  The tendency is to treat the symptom, but overlook the problem.

My chronic insomnia is one such issue.  I remember one visit with my primary care physician in which I shared that I was concerned that I had become dependent on alcohol for sleep.  I was adamant that I could chose not to drink, its just that I didn't sleep well if I didn't drink.  OK, well there are a number of red flags there.  My doctor prescribed a sleep medication, first Ambien (which produced nightmares) and then Lunesta, which worked better.  Unfortunately, there were issues that were not discussed that should have been.

"If you are dependent on alcohol for sleep, you are chemically dependent."  That should have been pointed out to me.  I wouldn't have wanted to hear it.  But the truth is that I was in the early  stages of my alcoholism.  This was most evident in that when I was given the sleep medication, I still relied consistently on the alcohol as well.  My pharmacist, unfortunately, told me that Lunesta was habituating, and potentially harmful to my liver if I used it every night.  It would be best, he said, to only use it when I needed it, perhaps 1 out of 3 nights.  If I used it every night, it would lose it's effectiveness.  1 out of 3 nights.  Ok, then, I had a solution for the other two nights.  Scotch.

Another issue is that insomnia is often a symptom of deeper issues.  For me, it is and has been the most enduring symptom of being bipolar.  Unlike some, I don't sleep away my depression.  I am more likely to experience sleep deprivation, both when depressed, and when in manic phases.  The only difference is that my sleepless nights are more productive when I'm manic than when I'm depressed.  My experience of this is such, that I'd recommend a full psychiatric evaluation for anyone that seeks out treatment for insomnia.  If you cannot sleep, SOMETHING is going on.  Normal people can, in fact, sleep.

Actually, when I was first diagnosed with depression/insomnia, the physician decided to treat the sleep disorder in the hopes that if I could sleep better, the depression might subside.  I was given Ativan, an anti-anxiety medication for sleep.  It worked.  Unfortunately, Ativan is addictive in its own right and paved the way for my alcoholism.  Alas. . .

It all boils down to this.  Mentally ill people are most likely to first seek help because of another issue that is a symptom of their mental illness but not for the mental illness itself.  Mental illness tends to hide behind other health concerns.  Weight gain or loss.  Ask the question why?  (I lose weight when depressed, others gain.)  Can't sleep?  Why?  Loss of appetite?  Why?  The list could go on and on.  That's why health screenings for mental illness are so essential.  And we need to remember that mental illness is a potentially fatal disease.  Fatal.

This last week I was diagnosed with a bowel obstruction that turned out to be the result of a strangulated hernia within my abdomen.  I've since learned that those conditions are potentially fatal if not treated in a timely manner.  Hence, my surgery on a Sunday afternoon.

It is also necessary to recognize that a timely response to mental illness may be critical to insuring that the condition does not become fatal.  Its that important.

Thursday, July 12, 2018

Blockage and other such incidentals

I was hospitalized on Saturday of this last week. Thankfully, not in the psych ward.  I felt bloated and had a lot of discomfort in the abdomen.  Antacids and anti-gas medication did nothing, so, on the advice of my daughter-in-law, the nurse, I went to the doctor.  The initial diagnosis was that it could be diverticulitis, appendicitis, or a blockage.  A CT scan confirmed the latter.

And so on Saturday I went into the hospital, armed with my list of medications, my lifeline as a bipolar person.  The plan was to put me on IVs for a day and see if the blockage resolved itself.  Meanwhile I was on NBM status: Nothing By Mouth, period.

What about my meds?  Big concern for me.  The nurse said that I could have enough water to take the pills.  The doctor said no, but offered a reasonable explanation.  Nothing was moving.  The medications would not be absorbed into my system anyway.  Tomorrow we will give you the meds.  OK, so tomorrow it is.

Sunday came with no movement in the GI tract, and so the decision was made to do surgery.  Prior to surgery, I spoke to the hospital pharmacist and explained my meds and why I was taking them.  Oh, and no substitutes.  She went about her business.  I had my surgery.  Thankfully, everything went fine.  The doctor was able to correct a strangulated hernia of the small intestine.

As evening approached, I asked for my meds.  The nurse replied that the doctor had not ordered them.  A call to the doctor, and orders.  Then the call to the pharmacy, whom I had spoken with that morning.  Meds were not available.  In the end, they decided to have Karla bring my meds from home.  This is not normal procedure.  The hospital personnel gave me my meds for the evening and then went to the pharmacy to confirm that they were what I said they were.  That checked out OK.

Then they decided to send the rest of the meds home with Karla.  Finally, on Monday, I saw a second pharmacist and by evening they had managed to get my correct medications.  2 days, 2 pharmacists, all for four pills.

One of the things I learned from this is how important it is as a bipolar person to be proactive in making sure that one's medication therapy is followed.  Secondly, that even hospitals are not always equipped and supplied to care for the mentally ill.  Thankfully, they were willing to bend the rules and allow for me to take my own meds.  But I couldn't help but feel like had I not advocated for myself as I had, they would only have concerned themselves with the medications directly related to the surgery.  As it was, they simply ignored the other medications I was on, for cholesterol and arthritis pain.  No big deal, I'm not going to die of a heart attack because I missed a couple of doses of cholesterol medications, and I was on another pain meds.  (A non-narcotic:  Toradol)

But I could easily been hospitalized for up to a week, and to miss my psychiatric medications that long would have consequences.  Advocate.

One other thing about hospitalization.  I've shared the last couple of posts that I'm quitting smoking.  Turns out that hospitalization is one significant aid in that process.  They were very good about accommodating the patch and supporting that therapy.  And need I say that it is not 'convenient' to smoke on a non-smoking campus.  I was not tempted, with my butt hanging out of the hospital gown, to venture off campus to have a smoke.  It was encouraging to me that I had no strong cravings.  Maybe I'm making progress here.  Although hospitalization is an expensive aid to quit smoking, I must say.

Finally, just a word or two about life.  We often don't realize what a blessing the most basic matters of life are, such as eating and pooping, until you can do neither.  To experience that is also another sign of aging.  After all these years the old intestines are just prone to getting into a tangled mess.  Not fun.  An lastly, I never knew what a culinary delight simple beef broth could be.  I imagined I was eating prime rib.  But so it was after the NBM day.  Fluid and flavor.  For that moment, that alone was enough.  But I am looking forward to the real thing, again.


Sunday, July 1, 2018

Path to Freedom-- Addiction II

Last week I wrote:
"And so the battle begins.  Can someone like myself, who has battled addiction throughout my adult life be free?  Can I do so without complicating other areas of my life, such as my metal health and tendency toward depression?"
I am in the process of stopping smoking.  I wish I was at the point that I could say I'm done, over it, free and clear, but the reality is it is going to take more time.

One of the difficulties of breaking free from smoking that has plagued me over the years is that it is so easy to feel like you're failing.  And rather than fail, just don't try.  It's not unlike my experience drinking.  When I was in treatment, they asked "Well, how many times have you tried to stop and relapsed?"  My response was a simple "None."  I had never relapsed because I had never tried to stop. 

With smoking it has been a different story.  I've tried numerous times, but failed.  And feeling like a failure is the number one reason for abandoning the effort. 

I'm following my psychiatrist's advice this time in recognizing that this is a process and specifically, I was too heavy of a smoker (pack and a half a day) to have much of a chance going cold turkey.  The body simply needs some time to adjust.  Or it is at least easier, in her opinion, to decrease and then stop.

Over the course of the last week, I've succeeded in drastically reducing the number of times I smoked, but I haven't succeeded in totally stopping.  It's easy to feel a failure because of that, but in truth, a few cigarettes a day is a lot better than over 30.  I refuse to succumb to feeling a failure when in fact I'm succeeding in moving toward my goal. 

The most difficult time is at work.  We can't smoke in the shop, but breaks are extremely difficult.  "Where have you been?" my colleagues with whom I smoked at break asked.  "I'm trying to quit."  "We miss you, but hope you never come back."  Were it not for work, I'd have progressed more than I have.  This last week I chose to have one smoke, as opposed to three or four, during break.  And a smoke before I started and after I finished.  Five a day.  Much better than 30.  And next week will be better.

One of the struggles with quitting smoking at work is that the smoke break represents such a welcome relief to the drudgery of the job.  And there is a now or never element in play regarding breaks. 

It is getting easier, and the times I do smoke are less satisfying.  This is different this time.  One of the difficulties I experienced before is that as I cut down, the occasions I did smoke produced a level of satisfaction much greater than when I was constantly smoking.  So I'm hopeful.

I am not failing.  That's something I have to remind myself about.  The first step in ceasing my smoking habit actually came, at the recommendation of my doctor, last year.  "Dave, just try not smoking in your car."  Her advice, coupled with having just bought a new car, provided the incentive.  I haven't smoked in the car since.  Now that might seem like a small victory, but when one spends a couple of hours a day commuting, and when one smoked almost continuously during the commute, it was a big deal.  But I succeeded in that step toward freedom.

Now its all about going the rest of the way.

The benefits are already showing up.  My lungs are noticeably clearer.  The persistent cough has gone away.  And in the back of my mind I start wondering if perhaps I might one day die in old age from something other than smoking related causes. . .

And yet there are miles to go before this journey is done.  I'm using the patch.  (I know that one is not supposed to smoke at all when on the patch, and that's my goal, but I tell myself that I've already reduced my smoking by nearly a pack and a half a day, so it's not so bad.)  Oh, and I will not let you tell me I'm failing.  If I listened to those voices, I'd be back at it in an instance.

The purpose of using the patch is to allow one to address the behavioral aspects of quitting first, and then gradually reduce the amount of nicotine to become, over time, free from the chemical dependency.  Physically, withdrawal actually occurs as the dosage is decreased.  My pharmacist used to recommend against the patch, or other nicotine replacement therapies, as they are merely "alternative delivery systems",  Well, that kept me from trying, more than once.

There are medications that can help.  "Hah, been there tried that."   Amongst all the different meds I have been put on, those that help with smoking withdrawal have also been tried, for other reasons.  They resulted in an increase in seizure activity.  And so my psychiatrist has been very clear, that is not an option.   Period.

And so I continue down this course.  Yesterday I had two smokes.  Today, I'm going to try limiting myself to one.  That is a major accomplishment for me.  And one day, it will be none.  And then the next.  None.  And finally, I hope to be where I now am regarding drinking.  No desire,  No craving.  No longer an issue. 

Hope springs eternal.