Summer Hospitalization

So, a week ago I started thinking about the psych hospital I usually go to, thoughts that have almost always led to a hospitalization. (Begging the question: Do I intuitively know when it’s time, or are the thoughts a self-fulfilling prophecy?)

Then, on Monday I started having an unusual amount of suicidal thoughts, some bordering on obsession. I noted it and knew I would call my psychiatrist if the thoughts got worse.
The thoughts got worse.

Tuesday morning while working out in the pool I realized how I was obsessing about suicide, had a rather sudden increase in energy and my racing thoughts increased velocity and were becoming more muddled. I feared how the obsessions were part of the muddle and also part of the clarity that occasionally occurred. And with so much energy I might/could follow through impulsively.

And so I called my psychiatrist who, instead of adjusting my meds over the phone as I expected, sent me to the hospital to get an assessment. Which 95% of the time has led to hospitalization.

I felt so defeated. How was I ending up in the hospital after only 3 1/2 months? That time frame was my usual M.O. I thought we had not only started a new chapter, but opened a new book where I lived a life without hospitalizations.
The only difference this time was that I was displaying manic symptoms instead of depression symptoms. All of my hospitalizations in the last 4 years since diagnosis have started with suicidal depression.

Good news! I was only in the hospital 92 hours with only one small tweak in one med. Had strange symptoms of random body movements due to excessive energy (and not working out every day?) and extreme sensitivity to sound. Sound physically hurt! And the unit was crowded because of a high census and there were some people who always have an opinion on everything and need to share it. At great length. Repeatedly.

Bad news! I’ve been out for 7 hours and still feel institutionalized, that feeling of being in an alternate reality with different and very structured rules and expected behaviors. Taking meds is harder in the hospital because the computers mess up what I take and when I take it, making me on high alert the whole time that I’m getting what I need. Then there’s the constant foul language and talk of alcohol and illegal drug use, even though all of it is verboten. And the misogyny among the male patients. Do you want your sisters, daughters, mothers talked about that way???

I’m glad it was a short stay. I’m glad it was one of my easier stays. I’m glad to be back in my regular environments and that I can trust myself in them.

Here’s hoping we can catch any other mood switches faster and change meds without hospital intervention. I thought I was catching it early and calling my doctor quickly. I guess I need to call on the first day of any symptoms. But it seemed like an anomaly. Maybe we don’t know whether it’s an anomaly or a pattern until it’s a bit too late because the tipping point of the mood change moves quickly.

Days in the Life – Not Up to Par, But OK

I haven’t written in a while because my days are dictated by a new routine and brainstorming solutions to a new health problem.

ellipticalI am exercising 5 days a week – 3 days in the pool, 2 on an elliptical. My care team reminds me that first and foremost reason I’m doing this exercise is for my mental health, and weight loss is secondary. I tend to think of it more as the routine is for my mental health, and the movement is for weight loss. I do not feel, nor have I ever felt, endorphins after exercise, no matter how hard or how long I exercise.

But I have a medical problem with the exercise. My lungs and windpipe hurt after a work out. I have asthma and it is completely controlled except for exercising. I’ve been taking albuterol before I exercise and it only helps sometimes. My current pulmonologist thinks bariatric surgery will help. Um, what??? How will that help my windpipe??? He had already referred me to a cardiologist for pulmonary hypertension, which we discovered I Do Not Have after an invasive angiogram.

So, I’m getting a second opinion. I’d like to workout to capacity and not have to take the intensity down several notches so that I don’t cause an incident with my lungs. Dealing with this medical issue (since mid-May) has taken an awful lot of mental energy, increased my anxiety, made me scared to exercise because I could hurt my lungs. All that’s not helping my mood, really.

Meanwhile in MoodLand, I had a plunge in mood in mid-June, two weeks after a change in meds. Called psychiatrist and upped one med back to where we started and I seem to be better now. I see her today for a check-up. I’m doing better, but I am having trouble with mood with having enough to do each day to keep my mind active even though I feel like my mind has its arms tied behind its back with the difficulty in memory, focus and concentration. I need more social interaction too. Taking exercise classes helps with social activity, but those are very superficial conversations – not the kind of real social interaction I crave. Intellectual stimulation and social interaction – crucial for my mood stability. I’ve applied to volunteer a few places. Starting over with work-related activities to see if that will help on both accounts.

So, I’m mostly stable, but still room for improvement. Overall, a decent place I think.

 

My Brain Doesn’t Work

So, I’m enrolled in a MOOC through Coursera.  Animal Behavior: “In this course we want to introduce you to the science behind animal behaviour, and to highlight topics of current active research. Since we can’t provide a comprehensive account of every aspect of behaviour, we will focus on the ecology and evolution of the behaviour of wild animals.” Two professors from the University of Melbourne are teaching it. The information is fascinating and as enjoyable as I thought it would be.

But I’m having a huge problem with concentration and retention. I understand the concepts in the video lectures (and articles) as they are presented, and as they build on each other in each 15 minute lecture. But by the next lecture – even if viewed only a few minutes later – I’ve lost my understanding. And I fall asleep during some of the videos or articles as I try to concentrate so hard to understand and integrate. And then – adding insult to injury – I can’t remember any of the main concepts by the time of the quiz.

This situation feels like proof of what I’ve been trying to tell people about all the problems I have with concentration, focus and memory in daily activities, reading and at work. My brain’s not working (a) the way I used to absorb information from many sources and (b) maybe at all. (A) makes me so very, very disappointed. I used to be a sponge and squeeze out whatever I needed whenever I needed it. (B) is what I’ve been expressing for years to my care team. I’m tired of hearing that it will eventually get better. It’s not getting better. I feel like it’s getting worse, in fact.

I’ll give the class another week or so and see if I can keep up or get something out of it even without full comprehension or retention. Disappointing.

The Financial Costs of Bipolar

<rant>

bill1. I just received my first bill for the 58 days I was inpatient hospital this winter (plus another 21 outpatient). It only covered the first 11 days and was OVER $30,000!! I have pretty good insurance, which knocked my deductible/copay portion down to $1200 – which again, is only for the First Eleven Days!

Eventually I will run into my co-payment maximum for the year as these bills come in, thank goodness! (I think it’s near $3000, again, I’m lucky). But I will be on an 18-month repayment plan. Do you get that? I will be paying on Winter 2014’s hospitalization until FALL 2015!

What if I need another hospitalization in 2015? Then 2015’s deductible and copay are in effect, and I’m paying on that until 2016, and so forth and so on.

This has been going on for nearly 4 years already. Just 2 months ago, I finally finished paying off Winter 2013’s hospitalization.

 

2. While in the hospital for 58 days, I had to resign my job because I couldn’t work then or with the projected state of recovery I’d be in. Another financial cost. My part-time job could have paid for the medical bills. It could have offered some cushion in my savings, which is fast dwindling. It could have gone toward philanthropic giving which is important to me.

 

insurance3. I’ve spent A YEAR arguing with an insurance company about paying a provider that I see several times a month. I pay a copay amount each time, and so the provider gets some money. But they have not been paid in Over A Year!

I’ve told the insurance company that Medicare won’t pay. I’ve shown them the Explanation of Benefits that shows that Medicare won’t pay. The provider has sent letters saying they don’t work with Medicare – all of which have been lost by the way.

And the insurance company keeps sending out forms to fill out “We think you have another insurance. Please fill out the information here for coordination of benefits.” I think I’ve talked with every coordination of benefits officer they have at the company.

And it seems straightened out. Until a bill is submitted. And a denial comes out. And I ask what do you need to pay this? And I do this and the provider does that, and the bill still doesn’t get paid.

Finally I talk with a super-supervisor (since the company won’t give me a dedicated account representative. “Any of our staff are qualified to handle any issues you may have” my ass.) She understands exactly what is going on, sees what I’ve submitted most recently, thinks all shall be paid.

And then I get a call from her. Nope. My provider needs to send in Another Letter, Identical to the Ones They’ve Sent In Numerous Times. This time it will directly to her and all the appropriate notes will be made so that there should be no more trouble.

A Year.

A Year this has taken.

And I have no faith that this won’t happen again with this insurance company or any others. I spend hours each month coordinating benefits between Medicare and my secondary carriers. What do people do who are not able to do that? At least I have the faculties most of the time to do it and follow what they are saying (even when it’s out of both sides of their mouths).

::SIGH::

</rant>

It’s Always Going to Be This Way, Isn’t It?

This is my bipolar brain.

I had a hard time sight-reading music at the end of a long handbell rehearsal. I couldn’t read the music, and I couldn’t count. That’s happened before, during a good rehearsal even, or at the end of a long rehearsal. And I immediately think, “My brain is always going to be this way, isn’t it?” I try to tell myself rationally that I’m still only a month out of the hospital and I’m still getting used to new meds. But I’ve already spent a few years dealing with running into thinking walls like this. And so I’m not completely out of line thinking this, am I? My brain really isn’t going to comprehend things the way I used to be able to. The struggle to comprehend happens when reading too, usually when nonfiction. I struggled with focus and concentration and memory when I was working too. It’s always going to be like this, isn’t it?

Another feature of my bipolar brain… Jumping to conclusions like my brain is always going to be this way. Or like I’m going to be lonely forever because I had a health scare that took me to the ER last night and I was alone (phone dying so not much time spent on social media). And I have a test tomorrow that kinda freaks me out and no one that I feel ok to ask to go with me. Some of that is grief from the marriage separation, and it’s also the jump to the conclusion that I’ll always be alone now.

I’m trying to tell myself that I’m setting a new rhythm, and last night’s ER interruption messed up that new system. And today’s day of rest messed it up, as well as seeing my dr and getting the news of yet another test just to rule out heart problems. And then having that test tomorrow, and will I be able to go to the gym again, and then go get my mani-pedi that I set for a fun thing for myself, and can I even handle going to an evening event on Friday, since tonight’s event being in the evening probably contributed to bipolar brain wall.

Do you see how the thinking goes into all sorts of directions? Some might be true. Most just projections, I hope.

I’m still stuck with the depressing thought, “It’s always going to be this way, isn’t it?” And how am I going to deal with it, if that’s true? How can I imagine a world with this limited energy and this limited ability in focus, concentration and memory? And accept it. How can I be optimistic about accepting it instead of feeling ashamed of not being myself, the self I knew for my first 35 years.

SIGH.

How to Spend Recovery Time

I’ve been doing pretty well prioritizing my energy toward physical wellness (See Building Blocks for the other commonly used “areas of wellness”). I’m even doing better having energy for other things in my life – dr appts, seeing some friends, household tasks, reading. This feels like progress toward my Balance with Bipolar, a dance that needs practice to get it right.

One challenge is still being reasonable about what I can really do – and not rushing what I can do so I don’t burn out and go back to start. I’m taking advantage of wise people in my life to help decide. For example, I have 8 opportunities from now through next Wednesday for things to do with MeetUp groups or DBSA or Handbell Rehearsal. CANNOT do them all – recipe for disaster! So, again, prioritizing that I’m going to workout in some way each day (30-75 minutes a day), I decided with others to immediately drop 3 opportunities, keep the 2 rehearsals, do 2 MeetUp groups, and one is up in the air anyway. I feel like this is a stretch and trial of what I can do. Yet I want to keep moving forward to get back to volunteering and eventually a part-time job again.

Because I’ve been doing well, I haven’t felt the need to sort anything out through this blog. I am still struggling through the grief of my separated marriage. I am still struggling figuring out who I am inside with this new start that I saw I needed while in the hospital so long this winter. But these seem like issues that need to be worked through offline. Sorry, friends. Some might appear from time to time, but one involves another person who didn’t ask to be put on the internet, and the other I’m trying to journal with no audience to see what happens. I might put it up though. It could be interesting to watch the process of “becoming” in a person with bipolar.

 

This Business of Starting Over

As I’m putting my days and weeks together, I’m finding that I still greatly overestimate what I’m able to do in a day. Energy is still low, even though my motivation has increased.

iphoneI knew I was being discharged from the outpatient program this week, and so I plugged activities into the week. Vacuuming, grocery shopping, filing.

And, on Tuesday, I joined the gym I’ve been looking at for several months now, making a commitment to myself to exercise 5x a week, at least. That exercise I make my primary activity for the day. All other items are secondary. This balance of energy is what I have been imagining for the last month.

Thinking of the 8 Areas of Wellness, I’m prioritizing physical wellness even though I’m aware of and trying to do something in the other areas each week too. Physical wellness has not been a priority for me in a long time. Now I use the app MyFitnessPal and I’m prioritizing energy toward exercise.

What is happening though, is that I’m not having energy for the other items I’ve put in my calendar. I’m breaking appointments with myself and shoving items off to other days. I know in my head this is a normal thing that most everyone does everyday. I just thought that when I was putting each small task into my calendar, I was being reasonable about what I could do in a day.

I guess I’m still getting used to my energy levels, and learning what “reasonable” means. Balance and Bipolar. A dance that is necessary to learn for longterm stability.