This and that

4:45 am and I awoke.  "Up early, again." some of you might say.  Well, no, actually, I slept in considerably.  But what is greatest about that is that it was a night that I slept without waking.  I'd stayed up a little later because of the Seahawks football game.  But even with that, normally I'd have awoken by 3:30 at the latest.  I leave for work by 4:45.  Nice to sleep.

I saw my neurologist, the sleep specialist, this last month.  He had been called by my insurance company.  Rozerem, the sleep medication  I'm on, is expensive.  They don't like that.  By expensive I mean approximately $10 a day.  He informed them that there is no other drug in that class, no other options, and so I believe that they have OK'd it once again.  One of the reasons I continue to see this doctor is that as a neurologist who specializes in sleep his word carries significantly more weight than would the word of a family practice physician. 

The reason for the expensive pill for my insomnia?  Well, for starters it is one of the few medications that can be taken long term without risk of addiction or significant side effects.  One of the others that I'd previously taken worked almost as well, it's just that there was a long term risk of liver damage and addiction.  I could just as well have continued with Scotch.  Thankfully, I'm good to go with Rozerem.  I think.

I keep on thinking to myself that I wish insurance companies would support medication that keeps me well, as opposed to risking my getting seriously ill once again.  For the most part they have.  And Abilify, the most expensive drug I am on is now available in generic form, and is but a fraction of what it once was.  It had been $30 a day.

My cynicism regarding my prescription drug coverage comes up from time to time.  I used to use our local pharmacy, and when I did Express Scripts, who manages the prescription drug coverage for our Church, would continually question every medication.  Even my latanoprost drops which I use because I'm pre-glaucoma.  Yeash, it's only a few dollars, why bother harassing my doctors about it. 

Well, you can also fill the prescriptions through Express Scripts pharmacy.  Funny thing, when they are selling them, and reaping the profit, they don't question them near as much.  Funny thing.  I wonder if Portico, the Church's insurance, knows that. 

On another note, I had my annual physical last month.  I'm doing well.  I've gained a little weight due to quitting smoking.  Doctor says I'd have to gain a hundred pounds to counteract the positives from quitting smoking.  It was also the first time he'd seen me since my bowel obstruction and surgery.  I was able to have laparoscopic surgery.  He shared with me how lucky we are to live today with all the medical advancements.  A hundred years ago I would have been told to just go to bed and die. 

I add that I do feel lucky.  A few pills a day and my bipolar disorder is well managed.  Yeah, they can be expensive, but the alternative of a lifetime of disability and going in and out of psych wards is more expensive.  Instead, I have my life back.

So life is good.  Praise God.

When Life is Good

There is hope.  Not just the hopy/changy kind of thing politicians promise but are unable to deliver,  but genuine hope in the face of a potentially disabling disease.

I have not always experienced this hope.  Early on in my treatment for bipolar disorder I was sceptical about the prospects of leading a 'normal' life, whatever that is.  I feared that any 'normalcy' would only be the inbetween phase during the transition from manic highs to depressed lows, or vica versa.  Even that was an improvement.  Sometimes as I cycled from highs to lows, the transition was abrupt and almost violent, like falling off a cliff.  Along with major shifts that might take months to cycle I experienced a daily cycle.  I'd feel tolerably well early in the day, only to descend into a deep depression around mid afternoon.  I described it as being like the San Francisco fog that rolled in each day at a predictable time.

Lately, that cycling has been gone.  I'm not sure why, nor do I care why.  It just is.

It's hard to describe the experience.  Just normal, stable, consistent.  I don't cycle.  I thank God for the medications that are a major help in that regard.  I have energy to be productive.  I'm currently working on a side project in my shop, in addition to my normal work.  This is a good sign. 

Two major issues remain, and they are somewhat interrelated.  Insomnia and nicotine. 

It has been two months now since I've had a cigarette.  This would be a great achievement except for the fact that I've only succeeded at that by using nicotine replacement therapy, either with the patch or more recently, with vaping.  My current goal is to put enough time in free from cigarettes, that when I address the issue of cutting down and quitting nicotine entirely, I will not be tempted to buy that pack.  This has been difficult, to say the least.

The most difficult thing about quitting nicotine is that it destabilizes my moods.  Withdrawal brings with it irritability, anger, depression.  I genuinely don't like myself at those times.  And the trap is that I am quick to seek relief.  And because using doesn't carry with it the catastrophic consequences that, for example, having a drink might, it is easy to indulge and to alleviate the moods.  Because I'm bipolar, there is probably no greater fear than that associated with uncontrollable mood shifts.  This intensifies the issues concerning withdrawal and quitting.

My hopes remain.  My game plan at this point is that I will probably use lozenges to ease the transition from the vaping.  Either that or just attempt to gradually reduce the amount of time spent vaping.  Vaping has some advantages over smoking.  In that it is just water vapor that carries the nicotine, much of the negative issues around smoking are eliminated.  Yet it also has the same habitual behavioral issues.  I go out and take a break.

One of the differences is that when smoking one tends to commit to at least one whole cigarette.  At least I did.  With vaping you can take a few puffs and be done with it.  Or you can vape for an extended period of time.  That's the down side.

My main motivation for breaking free is the impact on the rest of my health.  When I first went on the patch my sleep patterns improved drastically.  Now with vaping, I'm back to my old patterns. 

Insomnia.  I first struggled with this during my teenage years.  I always had a hard time falling to sleep, though early on, once asleep I could sleep.  As I aged, and as the bipolar disorder became more pronounced, remaining asleep became a problem. 

Added to this is that these middle of the night times have become a part of my spiritual experience.  I crave the time for reflection and meditation.  The peaceful silence is golden. 

Also, in that sleep is a struggle I often feel relieved to wake up.  One of the things I experience is frustrating and repetitive dreams.  Not nightmares, just repetitive and irritating.  Getting up for a while interrupts this.

These two issues aside, life is good.  Much improved over what it has been and for that I'm grateful.

One of the best things is the confidence with which I can live these days.

One of the fears I had when I was first diagnosed is that I might experience highly undesirable symptoms which might have devastating consequences.  Mania can manifest itself in inappropriate sexual drives and behaviors.  My concern regarding this was related to, among other things, my profession.  In fact, during the time of my being on disability I questioned whether the Church could ever allow one such as me to function as a pastor again.  It is prudent for the Church to allow a bipolar person to be a pastor when one of the defining symptoms of mania is sexual indiscretions?  I thought not.

As I've stabilized on medications, this fear has subsided.  Just take your meds, dude!

That's something one has to remember.  I'm feeling the way I'm feeling in large part due to the medications I am on.  It's easy to convince oneself that 'I'm better now, and don't need the medications anymore.'  Nope.  Don't believe it.  Not for a minute.

Actually, the last time I determined that I didn't need meds, I replaced them with Scotch.  That did not have a good result.

The only downside to the meds is that my insurance company is not pleased that I'm on a lifetime regiment.  And my meds exceed my monthly premium, substantially.  They lose money on me.

On this matter I'm humored.  Portico Benefits is our church's insurance.  They use Express Scripts to manage the prescription drug plan.  Express Scripts has a pharmacy.  What I'm humored by is that when I was using a local pharmacy, Express Scripts, on behalf of Portico, was continually asking that my doctors justify the medications they were prescribing.  This was irritating as these are 'lifetime' meds.  I'll never get off them.  But when I started buying the meds from Express Scripts, they no longer question them.  I wonder if Portico knows that.

Well, its time to lay down again.  Sleep is good, when I can get it.

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.

Forgetting Memories

One of the memories that stays with me is the comments made by my wife, Karla, following the birth of our first child.  It had been a difficult childbirth, for sure, complicated by preeclampsia.  When everything was said and done, her very serious comments were "Dave, we need to talk.  I can't do this again.  I mean it.  Only one child."  My response was that we'd wait more than a few hours before we take permanent action.  I believe God blocks the memory of mothers so that they will in fact consent to more than one pregnancy.  Otherwise, the human race might decline fifty percent with each passing generation.

Forgetting is sometimes essential to life.

It's been two weeks.  Two weeks ago you couldn't open a news page without seeing multiple stories on the church shooting in Texas.  I checked this morning.  Not one mention on CNN's home page.  One of the reasons we don't act in response to these mass murders is that we choose to forget them.  Life goes on.  To an extent, this is necessary.  It would be hard for us to function as a church if our members retained their memories of such tragedies.  They would become captive to their fears.  The new visitors would be looked at with suspicion.  Locked doors would become the norm. 

Sometimes we cannot allow ourselves to forget, lest life not  go on. 

I've enjoyed a number of years now of mood stability.  I still see my psychologist and psychiatrist regularly to help monitor my moods, and to maintain my medication regimen.  But on a day to day basis it is tempting to forget. 

Yesterday, as is typical on Saturdays, I napped most of the morning and even some in the afternoon.  With my current work schedule, leaving home at 4:30 am, getting home about 6 pm, with just enough time to eat and then head to bed, the weekends are makeup time.  I try to catch up on my sleep.

But I remember a time when being couch bound was not for the sake of making up on my sleep, but because of being in a deep depression and being incapable of generating enough energy to even get up and shower.  And then there were the manic times.  Generally, my manic phases were quite enjoyable.  The sky was the limit.  Unfortunately, they also came with a  cost.  The last major manic phase cost me about $60,000.  Now I have some great woodworking equipment.  Probably would have been wise to just have some 'good' woodworking equipment.  That pales in comparison to my senior housing manic phase.  Millions of dollars spent.  Not my money.  And we did get one project complete. 

I need to remember.  Bipolar people can ill afford to forget. 

The cardinal sin of being bipolar is to forget, to believe one is all better, and to cease all medication and treatment.  The result is not pretty.

It's not unlike an alcoholic that forgets what drinking really was like.  When an alcoholic relapses after years in recovery they discover that while they were sober, the disease continued to progress.  No amount of time cures alcoholism.  One doesn't get to go back to drinking the way one did early in one's life.  In fact the experience of relapse is worse than the original 'rock bottom'. 

That's my understanding of being bipolar.  You think your moods were unstable before being treated?  Well, you haven't seen anything yet.  Try going it alone, without treatment, and see just how high the manic phases are and low the depression can get.  Ceasing medication is the most sure fire ticket to hospitalization that there is. 

I appreciate my wife's help, here.  "Have you taken your pills?"  Thankfully, my psychiatric meds are all taken at bedtime, and without them I can't sleep, so I almost never miss a dose. 

Insurance companies can be interesting.  They like to question whether certain medications are really necessary.  I take eye drops for glaucoma, and will for the rest of my life.  "Is this really necessary?"  Well not if your willing to go blind.  Thankfully, they have never questioned my psychiatric meds.  Apparently they too remember.  The cost of hospitalization exceeds the cost of medication by a fair piece. 

Forgetting memories.  Sometimes it seems to be essential to life to let memories go and move on.  At other times it is necessary to cultivate those memories lest one repeat them.  Wisdom is knowing the difference.

Culprit or Cure

So I just finished the weekly ritual.  Filling out my medications for the week.  Every week as I do this I'm just disgusted that my life requires this much stuff.  I know about chemical dependency.  Scotch was more fun.  None of these drugs are fun.  Just drugs.

Some of them are inexpensive.  On the other hand, one of those bottles contains a ninety day supply of Abilify, which in its generic form is somewhere in the neighborhood of $2,000.  Rozerem, a sleep medication, is also up there.  Thankfully there is insurance.

I struggle with the medications, though I know they are necessary and my life is manageable because of them.  The struggle is that the human body doesn't always respond well to this amount of foreign chemicals being introduced to it.

Side effects.  The small print at the bottom of the page.  Some of those are immediately apparent.  Some develop over time.  

I'm on an alternative treatment for cholesterol because the statins created so much muscle pain I would have rather died young than lived like that.  The new treatment works.

Currently I'm dealing with another series of side effects.  

Let's just say that I'm discovering all the ways to 'dysfunction'.

Every time an issue comes up there is the mysterious little debate.  Is this a new problem on its own right?  Is this being caused by one of the medications you are on?  If so, which one?  And if you have that all figured out, what are the alternatives?  And is there any insurance that the alternative is better, or at least less harmful, than the original?

This last go round, I was sure that the culprit was my antidepressant.  When I consulted with my doctor the answer was probably not, but quite likely my blood pressure medication.  So I went of the blood pressure medication, and my blood pressure went up 30 points over night.

Then I visited with my psychiatrist who said, "Well,  yes, that's quite possible.  But did the Dr. tell you that you might have to be off the Toprol XL for over a year before you see any improvement?"

So what that means is that we could go a whole year and not know if the Toprol XL was the problem or not.  It is frustrating.

In the meantime, I will likely be put back on a different class of blood pressure medication, and perhaps even a new medication to counteract the side effects of the other medication.  Who knows?  And with every change of medication there is a concern about how that effects the overall balance with all the other medications.

Better living through chemicals.  

Well, sort of-- I'm stable.  But there's a price.

Election 2016, Good Medicine

No use belaboring the point.

No need for a well thought out argument.

Sometimes things are just intuitively obvious.

For those such as myself, who have been diagnosed with a mental illness such as bipolar disorder, this election is good medicine.

"Heavens!" you say,  "Pray tell, what could you possibly mean?"

Given the insanity that has been paraded before us throughout this election, I'm convinced that my own insanity is minor.

And a little bit of medicine takes care of my condition.

Would that the country could just take a pill and be restored to sanity.

Alas, that's just wishful thinking.

The first step in the healing process for a bipolar person is the recognition that the condition exists.  

And then, taking the pill, doing the therapy, being cautious and aware of the moods one is experiencing.

And though life continues to have its challenges, it levels out.

A nation that is bipolar.  At one point convinced it can solve every world problem.  At another point, depressed about whether even one problem can be solved.

Would that we could see this.

Would that there was a pill.

A little balance would be good.

Yup, there is a solution to my malady.  

Not so sure about the nation's.