Making Time for Self-Care

Tonight I checked in with a friend who recently tried to commit suicide. Thankfully, she's doing much better and is in recovery. She then asked how I was doing. I told her balancing teaching and grad school is tough.

My current schedule is kicking my butt. I'm teaching middle school English full-time, 7:20am to 4:45pm. I'm at a charter school so the hours are extended. Plus, I'm in graduate school part time for my MSW (Master's in Social Work). And on top of both I have insomnia; I wake frequently during the night and I can't nap during the day. Surprisingly I'm alert during the day. But around 5pm I get tired. Which is no good for doing grad school homework or lesson planning for work.

After updating my friend on my current life, she asked what self-care I was engaging in. My heart melted at this question. I live for self-care. And I've written about it multiple times: Who Cares for the Caregiver, Self-Care as Revolutionary Action, How to Rebuild Your Life After a Mental Illness Hospital Stay, and How I Manage My Bipolar Disorder.

Right now, for self-care, I am:

• drinking 40 to 60 ounces of water a day
• exercising three times per week
• receiving an acupuncture treatment every three weeks
• taking my psychiatric medicine as prescribed
• keeping up with appointments with my therapist and psychiatrist
• spending quality time with my boyfriend
• getting my hair done once per week
• blogging again
• and I'm staying abreast of grading assignments at work

I also love getting massages. I'm hoping to book an appointment within the next few weeks. And I'm hoping to hang out with friends soon; I've been slacking lately. But I have to remember to schedule in social time.

So what are you doing for self-care? What restores you? What refuels your tank? Do more of that.

My 4th Mania and 4th Hospital Stay

If you go back and re-read (or read for the first time) the blog entries for March 2015 it's pretty evident that I was headed for a manic episode. I was having sleep issues, I was posting more to social media, I was extra productive and creative, I had pressured speech (speaking quickly), and I had racing thoughts.

The mania started to surface in February 2015. I was grandiose in a job interview, basically told the interviewer "I'm the shit." There were other signs too (as mentioned above).

March 11th to 14th I was in Kentucky presenting at a conference. While there my manic symptoms escalated. My sleep issues worsened and I became extra emotional. The pressured speech and racing thoughts were worsening as well. My acupuncturist said the spring-like weather (it was warmer in Kentucky than in my home state of New Jersey) and the excitement of presenting a workshop did not help the mania. As I've written previously, spring is a trigger for my mania. All my manias, all four of them over the last eight years, have happened in spring, March to June.

Leaving Kentucky further worsened the mania. The flight was delayed, causing me to miss my connection in Charlotte, NC. There were hold ups at the airport and hotel. When I finally got to my hotel room it was after midnight. I had to be to the airport at 7am, so I had to be on a 5am shuttle. I only slept three hours that night. This was Sunday March 15th. Sleep, like spring, is also a huge trigger for me. I knew I was in trouble. I made an emergency appointment with my psychiatrist and acupuncturist for that Monday, March 16th. My psychiatrist increased my meds and told me to let her know if I still wasn't sleeping. My acupuncturist tried to bring the mania down. This session was my most intense acupuncture session in the two years I've been receiving treatment. I cried during the entire session. From the pain of the needles - I never cry from the needles, they're not very painful, for the most part, but the mania had me emotionally sensitive and physically sensitive. Each needle was incredibly painful. I talked through most of the session, explaining to my acupuncturist that I did not want to be manic. I lamented the fact that every spring for the last three years I had been manic (and also hospitalized). I wrote how the gospel song Withholding Nothing was extremely cathartic for me. I listened to it on repeat during my treatment. After this emotionally draining session I felt tons better. Calmer.

The next few days I slept three to four hours per night. Then, Tuesday night/Wednesday morning I slept an hour, at 6am on Wednesday morning. I was up all night on the computer. Being hyperproductive. Researching and writing. I knew I was in trouble after I woke from the one hour of sleep. I don't drive, so I text five of my closest family and friends asking for a ride to the hospital. It didn't occur to me to call an ambulance. Even though I had seen my psychiatrist two days prior, I knew that the mania had progressed too quickly, too fast for her to treat me outpatient. I either needed IOP (intensive outpatient program) or a hospital stay.

Even though I was in the throes of a heightened manic episode, I had enough sense to pack my hospital bag: loose fitting, comfortable clothes; underwear; toiletries; notebooks; and my bible. My mother returned home, my aunt, who I text for a ride, must've called her. When I woke I knew my mom wasn't home, but I wasn't sure where she was so I didn't think to text her for a ride. But my mom is the one who took me to the hospital. My aunt met us there.

The ER visit was pleasant enough. Since it was still early in the morning (in the past I've gone to the ER in the afternoon or evening) I didn't have to wait in the ER that long. I'm not sure if you're familiar with the process for a mental health hospital stay. But first you go to the Emergency Room. They have a crisis counselor assess you: they ask you a bunch of questions about your behavior, mood, and drug use. If you were accompanied to the hospital they also talk to your family member or friend, to get another perspective on your behavior and symptoms. The crisis counselor might also talk to your providers (therapist or psychiatrist). Next, a determination is made: inpatient (hospital) or outpatient (a few days per week of intensive therapy, but you get to live at home). It was decided that I'd be hospitalized.

Once I got to the behavioral health unit, it felt like returning to a second home. I hugged the nurses that I knew from my three previous hospitalizations. I updated them on what had been happening since my last hospital stay, only 10 months prior.

I don't remember much from the first few days. But the salient memories for me from this hospital stay are:

• I really liked my psychiatrist. Every psychiatrist I've had while hospitalized has been great.
• The food is always really good. But it took me about an hour or so to eat each meal. When I'm manic I'm easily distracted. I'll do anything but eat: talk to another patient, talk on the phone, wander around, etc.
• I didn't get many visitors this time. I normally have at least one visitor per day. I don't know if people were busy with their own lives and concerns or had conflicting schedules or no babysitters or whatever, but for whatever reason, less people visited me. It snowed one day while I was there and no one showed. I cried. I was on the phone calling everyone trying to find someone to come visit me. Understandably, people did not travel in the snow to come see me.
• I was supposed to be discharged on a Friday. That morning the psychiatrist told me he was concerned that I was only still sleeping three to four hours per night. So he was going to keep me until Monday. Three more damn days. I cried hysterically at the news. So instead of 10 days, I was hospitalized 13 days. This would be my second longest hospital stay. My longest stay was 17 days. To give you some perspective, most people stay, on average, 5 to 7 days. I doubled that number. It is incredibly hard to be "locked up." Meal times are scheduled. Computer and phone time, your links to the outside world, are rationed. Visiting hours are only two hours per day. You can't have any technology: phone, laptop, tablet, iPod. And your expected to attend group therapy and process why you're there in the first place. Plus, you can't go outside; there's no terrace or courtyard we have access to. So 13 days is a long ass time.

New Psychiatrist

I have been with my therapist and psychiatrist for seven years. I love my therapist! He is a walking contradiction. He's tatted up, has piercings, and wears combat boots. He curses freely. And is awesome at what he does.

My psychiatrist on the other hand is different. We didn't gel as easily. He's a little stoic. And over the past few months I have not been happy with his care. I was hospitalized twice in a year on his watch. In February 2013 the Tegretol made my liver sick, so I had to come off immediately. (I've had a number of side effects over the years from my psych meds). I had been stable for six years so he did not replace the Tegretol with any other meds. I was only on 100mg of Seroquel. I spoke to my friend/colleague/acupuncturist about my sick liver. She suggested I increase my water and fiber intake and start adding chia or flax to my food. I took her suggestions and within two months my liver healed itself. The liver can do that.

The second hospitalization occurred in June 2014. About two or three months prior my psychiatrist took me off of Lithium because it was subtherapeutic (meaning, there wasn't enough of the medicine in my system to be doing any good) and it was also exacerbating my psoriasis. Again, he did not replace the Lithium. And I was only on one medicine. Within two or three months I was manic again and hospitalized for five days. I don't last long on one medicine. I need to be on two medicines at all times.

When I was in IOP (intensive outpatient therapy) I got suggestions from the nurse on great psychiatrists. She gave me two women. This past week I had my initial visits with both of them. They were both great. However, one is in my insurance network and one isn't. The one that isn't in my network charges $450 for the initial visit and $200 for each subsequent visit. The one in my network takes my insurance and I don't have a copay. Of course I liked the more expensive one more! Thank god I make a great salary and can afford to pay so much for my healthcare.

The psychiatrist that I ultimately chose was amazing. She was very thorough. She spent an entire hour with me. She painstakingly went through my medical history: asking about mental and regular health, asking about my family history, asking about my six episodes (three manias and three depressions). She then made some suggestions. I was impressed with her care and look forward to working with her. 

The psychiatrist that takes my insurance suggested I take a third medicine. I informed her that the Latuda has given me anxiety and restlessness, she said she could give me a medicine for the restlessness. I declined. My original psychiatrist lowered the dose and the restlessness seems to have gone away. I am not trying to add any more psych meds to my regimen. 

I just want to encourage you all to actively self-advocate when it comes to self-care. You have to control your care. Know what questions to ask. Know your rights. And don't blindly take any medicine. Listen to your body. Know how you respond to different medicines and medicines at different doses. To be quite honest with you, the majority of psych meds come with side effects. But the side effects can be managed or minimized. The sucky thing is that it is trial and error. So please be patient. It takes time.

Here are the holistic suggestions from my new psychiatrist.

How I Manage My Disorder

I went six years between my first (2007) and second (2013) hospitalizations. I pride myself on that. Through my three hospitalizations and three IOP's I've met people on their 10th or 15th hospitalization. Some people are chronically unemployed or on disability. They've let their illness dictate the course for their life.

It doesn't have to be this way.

To make sure I stay stable and highly functioning, I do a number of things:

1. For the past 7 years, I've seen my therapist every 3 weeks and my psychiatrist every 3 months.
2. I'm a compliant patient; I take my medicine faithfully, go to all follow up appointments.
3. I make time for leisure (reading, hanging out with friends, going out to eat, getting massages, shopping, watching TV, etc)
4. For the past year I've been getting acupuncture regularly. I'm trying to balance out my reliance on Western medicine with more holistic practices.
5. I'm protective of my sleep. Not getting enough sleep can trigger depression or mania.
6. I exercise two to four days per week. There are numerous health benefits gained from exercise.
7. I try to eat healthy. I can definitely do a better job at this. I'll be going to see a nutritionist next week.
8. I try to minimize my stress triggers. Grading my students' essays normally stresses me out. So I try to manage my procrastination. I don't always succeed at this. But I'm trying.

My Psychiatrists

During my first hospitalization in 2007, my psychiatrist's name was a popular acronym with a scary connotation. I remember being frightened by his name (remember, I was psychotic and irrational). I got offended when he called me psychotic. At this time, I only associated psychotic with the definition that gets thrown about in the movies. Psychosis (comes from the Greek ψυχή psyche, "mind/soul", and -ωσις -osis, "abnormal condition or derangement") refers to an abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality". People suffering from psychosis are described as psychotic (Wikipedia).

During my second hospitalization in 2013, my psychiatrist's name was an anagram of my personal psychiatrist's name. In 2014, I had the same psych from 2007. I came to love him this time.

I teach English so I pay attention to words. In fact, I love words. Words have power. Words convey deep meaning. Words are the building blocks of communication.

In 2013, I was also psychotic but less so than in 2007. I had a few very public arguments with my psychiatrist. When he did my initial meeting, he did not make eye contact with me. He kept his eyes on my chart or on the computer. I heard that he was brilliant when it came to figuring out the right medicine. After a couple of days, I was ready to leave. So I signed a 48-hour hold. This document ensures that the staff watches you carefully for 48 hours. At the end of the time period they make one of two recommendations: either to let you go, or, if you present a risk to yourself or others they will involuntarily commit you. This document goes in the first page of your chart. When it came time to meet with my psychiatrist I told him I would follow up the next day with my personal psychiatrist. He looked confused and asked me what I was talking about. I told him about the 48-hour hold. He became visibly upset and told me he could no longer treat me if I wasn't going to stay in the hospital and blindly accept his medical opinion. He walked out of the office. I followed him. This particular doctor doesn't do "story;" he only does data. If he had read my chart he would have noticed my 48-hour hold document on the first page of my chart, but he flipped right to the middle. By this time we are yelling at each other. I told him he has Asperger's and was probably hospitalized himself as a child or young adult. I know, harsh. I told you I was psychotic and irrational. Eventually, he talked me into rescinding my hold and remaining in the hospital. A few days later I started to respond to the treatment. After my severe skin reactions to the Lithium and Trileptal, he called me a "dermatalogic dilemma." Shortly thereafter, my insurance kicked me out of the hospital after 10 days. My psychiatrist frantically asked me what should he say to the insurance company to get me to stay. They weren't hearing it; I had to go. But you know what, by the end of my hospital stay, this doctor was making eye contact with me! A huge feat for him, I'm sure.

One of the patient care technicians told me the insurance companies kick people out of the behavioral health unit as soon as they show signs of getting better. So my 17-day stay in 2007 wouldn't be possible anymore. This same tech said that this new policy has increased the relapses they see. People get released one day and are then right back on the unit after a week or a month. Insurance companies do not care about people.

In 2014, I actually requested my doctor from 2013. But he was on vacation when I arrived on the unit, so I was assigned to another doctor. This doctor is charismatic and funny. I truly enjoyed meeting with him. I asked if he could be my personal psychiatrist, but he doesn't see private patients. He works at the hospital full time. He said a lot of his patients ask to see him privately; I can believe it. I told him that I lost weight (I always lose weight when I have an episode, whether depressed or manic). But instead of crying like I did in 2013 (because losing weight meant I was really sick), I was very happy. At my heaviest I got up to 171 pounds. When I entered the hospital on Thursday I had gotten down to 158! I would like to lose 23 more pounds (I'll be joining the YMCA later this month so I can continue exercising over the summer vacation). The doctor said maybe we can leave you manic for two more weeks so you can lose more weight! If only! We both cracked up laughing at this. I've been with my psychiatrist for 7 years. He's Korean-American and is very stoic and serious. My two meetings with this doctor showed me that I can have more out of my relationship with my psychiatrist. I asked him to recommend a new psychiatrist to me; someone with his temperament and personality. My social worker said that is a rare combination for a psychiatrist. I hope I can find a good substitute for this doctor.

I like to write thank you notes to express my gratitude. I wrote one to both of these psychiatrists. And I apologized for arguing with last year's doctor and telling him he had Asperger's. They both thanked me for my thank you's.