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.