Thankfully, negative emotions like anger do not last forever, or at least should not last forever. We can dwell on them, perpetuate them, and allow them to simmer. Anger can turn inward. It can also transform into a hatred.
A friend responded to last week's blog by asking how we deal with those negative emotions that often lead us to overeat, smoke, drink and otherwise engage in self destructive behaviors. In addition such emotions also can lead to harmful actions against our neighbor that destroy relationships and in the worst cases, are harmful to others.
I've stewed about it. I've smoked, and drank till I could do so no more. And then I've stewed some more, ruminating into the wee hours of the morning for days on end. Thankfully, I think that I've learned something through many years of therapy, through Alcoholics Anonymous, and simply through self reflection.
Here are my thoughts:
Name it. One of the least helpful ways to deal with anger is to not deal with it, to deny it exists, and to internalize it all with the hopes that it will just go away. I was not given permission to be angry when I was growing up. In general, emotions were considered weakness. One of the most difficult things for me to distinguish early in my therapy was the difference between emotions and thoughts, and to name the emotions. "I think" was often followed with an emotional outburst. "I feel" often led into a thought or a judgment. Getting those straight is part of naming. I think that our immigration policy is unjust and cruel. I am angry that children are taken from their parents and that we still are unable to reunite them. My thoughts and my anger are two separate things.
Own it. One of the most important lessons I learned in Alcoholics Anonymous is that my emotions are mine, and mine alone. They originate within me. I am never a victim to my emotions. Others don't "make" me mad. I experience emotions because I am who I am. I may resent others or their actions, but the resentment is mine. I react in this way, for example, because of a disparity between personal convictions about how things should be, and the reality of how they are. Injustice shouldn't be, but it is, and so I react. But the reaction is mine. I am not an emotional victim.
Discern. There is a difference between righteous anger and unrighteous. I get angry when innocent people are hurt. Child abuse, for example, results in my being angry. I also get angry when I don't get my own way. The first is an example of righteous anger, the latter of unrighteous. If I discern that my anger is just because I don't get my own way, perhaps I can let it go and experience a more appropriate emotion, such as disappointment. Also, righteous anger more appropriately has as its object actions, not people. When we focus on the people, we risk emotions becoming more intense. Anger becomes hatred, and hatred endures. For example, I am angry that a teacher abused me during my adolescence, but if I allow that anger to become a hatred toward him, it will consume ME.
Act appropriately. Regarding my history of being a victim of abuse: I remember that it wasn't until my own children approached the age that I was when I was abused that I was able to recognize and name my own abuse for what it was. I became angry. I imagined killing anyone who did that to one of my children. Not appropriate. To work at freeing victims from abuse, protecting children from abuse, punishing the perpetrators of abuse appropriately through legal means-- these are appropriate actions. I believe that righteous anger's appropriate role is to motivate action. But not just any action will do. "Appropriate" is the key qualifier here.
Let it go. My memory is one of my curses. I can name something my wife did within the first twenty four hours of our marriage that I got angry about. We've been married over forty years. If I dwell on it, I can resurrect that anger. Not good or helpful. When I forgive someone, I become free. The greatest impact of forgiveness is on the one doing the forgiving. By the time I recognized that I was a victim of abuse, the abuser was dead. Eventually, I was able to forgive him, or at the very least, I'm working on it. But that forgiveness is important for me-- he's dead and quite unaffected by it.
In all of this, a good friend, a spiritual guide, a confessor helps. In A.A. we have sponsors. For some people it will be a pastor. I've used a therapist extensively. The primary purpose is to have someone who can help who is not blinded by an emotional fog.
Related to this is prayer, at least for people of faith. Prayer, when offered for the one whose actions have resulted in our being angry, can help. It can change our attitude and our emotions.
Self destructive behaviors do not help.
This became clearest for me my last night drinking. No matter how much I drank, the rage I was experiencing did not go away. It was persistent. My "solution" nearly killed me. I hope that I'm in a better place now and more capable of dealing with those emotions.
Sunday, August 26, 2018
Monday, August 20, 2018
Anger and Righteousness
Anger is a powerful emotion.
Be angry but do not sin; do not let the sun go down on your anger,
One of the things we learn in A.A. is to beware of H.A.L.T.. That is to be cautious whenever you are hungry, angry, lonely, tired. Such experiences are potentially devastating to one who is seeking to remain sober, or in my case, at this time, to quit smoking.
Paul writes that we will experience anger, perhaps even that we should experience anger at certain things, but that we should neither sin, nor let the sun set on our anger. There is a righteous purpose for anger, and that is to motivate us to oppose and resist unrighteousness, injustice, cruelty, etc. Anger's righteous purpose is to motivate us to act now, before the sun sets.
And yet too often we fall prey to emotions such as anger and rather than deal forthrightly with the object of our anger in a positive way we seek other outlets to dissipate the anger, such as drinking or smoking. Worse, sometimes that anger gets turned inward, or toward others such as our spouses who are in no way deserving of being the object of our anger.
I got angry this last week. There's no purpose served in detailing that in this blog out of deference to those involved. But the simple fact is that anger was felt by me.
Powerful emotion.
Part of the dilema for a chemically addicted person is that our most natural response to anger is to turn to that substance, be it drink or smoke, as a means of dissipating the anger. We are angry and so we are then tempted to do that which is destructive to ourselves. My last episode drinking, now nearly 6 years ago was the result of a deep rage that had gotten a grip on me and which boiled over. Alcohol was not adequate to calm the raging beast, but was very much adequate to killing me. I'm lucky to have survived.
When I'm angry at the world, or any significant part of it, the temptation is to take a "fuck it all" attitude. (Sorry to be so blunt, but what's the purpose of disguising a word with ***'s) All of a sudden a Scotch in hand and a big cigar seems to be a perfect solution.
Sobriety is about learning more positive responses to life. Being angry at someone else and then engaging is self destructive behavior is not appropriate.
"See, now I'm angry, and so it's alright to smoke." I can't tell you how many attempts to quit smoking were foiled by anger. Quitting smoking itself, often results in anger, so it's an easy out to quit quitting whenever one experiences anger. I probably would have quit decades ago if I'd been able to handle anger. Most often the anger I experienced when trying to quit was focused inappropriately on my wife, as she, more than anyone, wanted me to quit.
And so the effort is to find more positive ways to confront the anger within us and realize that emotions are only emotions. Yes, in certain situations such emotions call for an immediate response to a bad situation. But a lot of times emotions such as anger need to be understood, dealt with, and let go of ASAP.
I'm reminded of God's dialogue with Jonah.
"But God said to Jonah, "Is it right for you to be angry about the bush?" And he said, "Yes, angry enough to die."
First of all, many times anger is not warranted. Secondly, self destructive behavior, or "being angry enough to die" is no solution.
Life is too precious to allow others, and emotions, to have that kind of control over us and our behavior.
Be angry but do not sin; do not let the sun go down on your anger,
One of the things we learn in A.A. is to beware of H.A.L.T.. That is to be cautious whenever you are hungry, angry, lonely, tired. Such experiences are potentially devastating to one who is seeking to remain sober, or in my case, at this time, to quit smoking.
Paul writes that we will experience anger, perhaps even that we should experience anger at certain things, but that we should neither sin, nor let the sun set on our anger. There is a righteous purpose for anger, and that is to motivate us to oppose and resist unrighteousness, injustice, cruelty, etc. Anger's righteous purpose is to motivate us to act now, before the sun sets.
And yet too often we fall prey to emotions such as anger and rather than deal forthrightly with the object of our anger in a positive way we seek other outlets to dissipate the anger, such as drinking or smoking. Worse, sometimes that anger gets turned inward, or toward others such as our spouses who are in no way deserving of being the object of our anger.
I got angry this last week. There's no purpose served in detailing that in this blog out of deference to those involved. But the simple fact is that anger was felt by me.
Powerful emotion.
Part of the dilema for a chemically addicted person is that our most natural response to anger is to turn to that substance, be it drink or smoke, as a means of dissipating the anger. We are angry and so we are then tempted to do that which is destructive to ourselves. My last episode drinking, now nearly 6 years ago was the result of a deep rage that had gotten a grip on me and which boiled over. Alcohol was not adequate to calm the raging beast, but was very much adequate to killing me. I'm lucky to have survived.
When I'm angry at the world, or any significant part of it, the temptation is to take a "fuck it all" attitude. (Sorry to be so blunt, but what's the purpose of disguising a word with ***'s) All of a sudden a Scotch in hand and a big cigar seems to be a perfect solution.
Sobriety is about learning more positive responses to life. Being angry at someone else and then engaging is self destructive behavior is not appropriate.
"See, now I'm angry, and so it's alright to smoke." I can't tell you how many attempts to quit smoking were foiled by anger. Quitting smoking itself, often results in anger, so it's an easy out to quit quitting whenever one experiences anger. I probably would have quit decades ago if I'd been able to handle anger. Most often the anger I experienced when trying to quit was focused inappropriately on my wife, as she, more than anyone, wanted me to quit.
And so the effort is to find more positive ways to confront the anger within us and realize that emotions are only emotions. Yes, in certain situations such emotions call for an immediate response to a bad situation. But a lot of times emotions such as anger need to be understood, dealt with, and let go of ASAP.
I'm reminded of God's dialogue with Jonah.
"But God said to Jonah, "Is it right for you to be angry about the bush?" And he said, "Yes, angry enough to die."
First of all, many times anger is not warranted. Secondly, self destructive behavior, or "being angry enough to die" is no solution.
Life is too precious to allow others, and emotions, to have that kind of control over us and our behavior.
Sunday, August 5, 2018
"I can't get no, satisfaction. . ."
Ah, the journey to be free of chemical dependency. (Although my son, the chemical engineer, would probably point out that we are all chemically dependent, its just a matter of which chemicals we are dependent on.) Also, as one who is dependent on medications, being free of chemical dependency is probably never going to happen. The goal is to be free from dependency and addiction to harmful chemicals, as in alcohol and nicotine.
"I can't get no, satisfaction. . ."
Whether one is an alcoholic or a smoker there is a pattern that has a grip on you. Craving, followed by satisfaction. It's the feeling of satisfaction that is so compelling.
For those of you who have never drank or smoked, this feeling is quite similar to hunger, and being filled. We don't think about this much, but imagine a life where you never experienced hunger, or thirst, and the satisfaction that comes from eating or drinking. Something would be missing.
It is this emptiness, this lack of satisfaction, that is one factor that keeps people addicted to alcohol and/or tobacco. Also contributing to this, of course, is that the cravings continue for a significant period of time after the consumption has stopped.
As I continue to quit smoking, one thought that I have is that I wish a deep breath, clear and full, had the same degree of satisfaction that dragging on a cigarette does. I've reduced my smoking to the point that I am very conscious of an improvement in my respiration, and you'd think 'breathing' would be a sufficient reward, but it doesn't have the same craving/satisfaction factor that smoking does. I suppose this is because I have not yet experience emphysema or other such breathing disorders. I hope not to.
Another struggle is that smoking is a response to outside challenges. It's a place to go, a thing to do, in response to life's struggles. Feeling irritated? Have a smoke, you'll feel better. Feeling anxious? A smoke will calm the nerves. Anger? Step back, relax, smoke, and it will subside.
Now some who have never smoked will say that smoking cannot do all this. And yet for those of us who have we readily used smoking as a coping mechanism. It was an effective diversion. Rather than lash out in anger, we smoked. When one is quitting this is especially noticeable. If my wife does anything that irritates me the immediate response of my system is to crave a smoke. Of course, then I have someone else to blame for my smoking. That's the addictive mindset.
I have a quit smoking app on my iPhone. Of course, there is one. What dimension of life is not addressed by a smart phone app?
One of the things the app does is tell you how your health is improving with each passing hour of being smoke free. Pulse rate: back to normal. Oxygen levels: back to where they should be. Carbon monoxide: gone from your system. Breathing: normal. Energy levels: improving.
It also has a clock that records the days, hours, and minutes since the last smoke. This is something that was effective when I stopped drinking as well. There are other features. It keeps track of the time and money you save not smoking. It has you set a goal for what you are going to do with that money. (I'd like to reward myself with a new set of golf clubs in anticipation of my retirement years.) And then, it records how many additional hours of life you are projected to have by quitting smoking. Everything helps.
And yet Mick Jagger's song still rings in my ears. "I can't get no, satisfaction. . ."
If it was easy, everyone would stop.
Jerry Kramer, inducted into the Pro Football Hall of Fame this weekend, related the advice of a coach of his back when he was at Sandpoint High School. "You can if you will."
I'll close with that.
You can if you will.
"I can't get no, satisfaction. . ."
Whether one is an alcoholic or a smoker there is a pattern that has a grip on you. Craving, followed by satisfaction. It's the feeling of satisfaction that is so compelling.
For those of you who have never drank or smoked, this feeling is quite similar to hunger, and being filled. We don't think about this much, but imagine a life where you never experienced hunger, or thirst, and the satisfaction that comes from eating or drinking. Something would be missing.
It is this emptiness, this lack of satisfaction, that is one factor that keeps people addicted to alcohol and/or tobacco. Also contributing to this, of course, is that the cravings continue for a significant period of time after the consumption has stopped.
As I continue to quit smoking, one thought that I have is that I wish a deep breath, clear and full, had the same degree of satisfaction that dragging on a cigarette does. I've reduced my smoking to the point that I am very conscious of an improvement in my respiration, and you'd think 'breathing' would be a sufficient reward, but it doesn't have the same craving/satisfaction factor that smoking does. I suppose this is because I have not yet experience emphysema or other such breathing disorders. I hope not to.
Another struggle is that smoking is a response to outside challenges. It's a place to go, a thing to do, in response to life's struggles. Feeling irritated? Have a smoke, you'll feel better. Feeling anxious? A smoke will calm the nerves. Anger? Step back, relax, smoke, and it will subside.
Now some who have never smoked will say that smoking cannot do all this. And yet for those of us who have we readily used smoking as a coping mechanism. It was an effective diversion. Rather than lash out in anger, we smoked. When one is quitting this is especially noticeable. If my wife does anything that irritates me the immediate response of my system is to crave a smoke. Of course, then I have someone else to blame for my smoking. That's the addictive mindset.
I have a quit smoking app on my iPhone. Of course, there is one. What dimension of life is not addressed by a smart phone app?
One of the things the app does is tell you how your health is improving with each passing hour of being smoke free. Pulse rate: back to normal. Oxygen levels: back to where they should be. Carbon monoxide: gone from your system. Breathing: normal. Energy levels: improving.
It also has a clock that records the days, hours, and minutes since the last smoke. This is something that was effective when I stopped drinking as well. There are other features. It keeps track of the time and money you save not smoking. It has you set a goal for what you are going to do with that money. (I'd like to reward myself with a new set of golf clubs in anticipation of my retirement years.) And then, it records how many additional hours of life you are projected to have by quitting smoking. Everything helps.
And yet Mick Jagger's song still rings in my ears. "I can't get no, satisfaction. . ."
If it was easy, everyone would stop.
Jerry Kramer, inducted into the Pro Football Hall of Fame this weekend, related the advice of a coach of his back when he was at Sandpoint High School. "You can if you will."
I'll close with that.
You can if you will.
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.
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.
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.
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:
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.
"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.
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