Hypomania and Physical Burnout

Oftentimes for me, having a revved up mind can lead to having a worn-out body. After all, jumping rapidly from a severely depressed, sedentary state into one of intense energy and hypomania has typically meant going from walking zero miles a week to walking 20 miles a week (with no real form of titration).

It isn’t uncommon for people to hit the gym harder than usual when hypomanic, and since we can’t seem to feel the strain or pain associated with working out we assume it isn’t there.

Fast forward a few days or weeks or months and what you’ve got is a total physical burnout.

It can be very difficult to rest (or sit still at all) when in the middle of a hypomanic state. Resting can feel uncomfortable, and for me it is a sure-fire way for negative thoughts to creep back into my life, something that keeping myself extremely busy tends to help block out.

Well, Saturday (in the wee hours of the morning) I went to the emergency room. Though the pain I was feeling was  not a product of strenuous physical activity, I believe my hypomanic fast-paced attitude the last few weeks definitely contributed to my situation.

I have a pretty intense case of Irritable Bowel Syndrome, something I normally regulate through what I’m eating and medication I take (errr, am supposed to take) several times a week. As I mentioned above, sometimes when my mind is revved up, I don’t pay enough attention to my body. Not only that, hypomania can often mask the physical pain that lets me gauge how well (or not) I am feeling due to IBS symptoms.

By the time I realized how severely my symptoms had gotten out of hand, I was in a hospital bed at 2 am loaded up on morphine after waking up an hour earlier at my apartment in so much pain I could barely speak or walk. It wasn’t until the doctor asked me how long the problem had been going on and I checked my notes (I keep notes for mood charting purposes on my physical and mental health) and I realized it had been escalating for three weeks and I hadn’t stopped to notice.

Ooops?

I was lucky that even though I was in intense pain, the problem wasn’t life-threatening. Still, as high as I was on morphine, all I wanted to do was kick myself for not taking time out sooner to pay attention to my own body.

Hypomania may make us feel invincible, but the truth of the matter is that we are not. Running our bodies into the ground is a sure-fire way to trigger depression, so taking a moment to rest a few times throughout the week can not only help maintain our physical health but may also help maintain hypomania longer by keeping physical triggers at bay!

I am still planning on going to Florida this week, I am just working hard to rest until then. I’ve already seen improvements in my physical health, and even though my mind keeps saying,

“Go, go, go! There is so much to do and so little time to do it in!”

I am taking my own advice and plopping myself down on the couch for as long as my brain will let me!

Pet Separation Anxiety

Luna, A Seattle Pup

Luna, A Seattle Pup

I’m sure it is no surprise to hear that having a pet cat or dog can help decrease anxiety and depression in most patients, and for the most part I find that having Luna in my life has helped my anxiety and helps me take care of myself better when depressed.

Spending so much time with my funny little dog friend has not come without its drawbacks though. After all, the folks I care about most are the ones I tend to have anxiety about… and Luna is no exception.

I was very excited to find out that this week Corey and his friends had set up a trip for the two of us to Florida to help celebrate our anniversary. We’ll be gone for roughly five days, that’s a time period five times longer than any we’ve ever left Luna in the care of someone else before.

I know that the issue here is not who will be taking care of her, how good a job they’ll be doing, or even really the state of her own health while we’re gone. I feel confident in all of those things, the area I don’t feel confident in is myself.

Even though Luna gets kind of bummed out when I’m not around, that isn’t much compared with the anxiety I feel (and the horrible conclusions my own brain jumps to) when I am away from her for too long. I find myself in a constant state of panic and total disbelief that she might be ok, curled up in a ball, sleeping on the couch.

This is not uncommon for me. These are the same feelings I have when Corey is away from me for more than 12 hours, and the difference is that I can’t exactly text Luna. Having to simply believe she is fine is very difficult for me… where, for some reason, believing she has burned down the house seems much more likely.

I know there must be some way we can meet in the middle, both me keeping as stiff an upper lip as I can (heh) and maybe working out some kind of daily update from our petsitting friends (something I generally require from Corey when he is away as well). All in all, this issue wont keep me from having a good time in Florida, but it is one more thing I wish I wasn’t worrying about! I just have to keep reminding myself that things will be fine, and I will enjoy myself much more if I can let this go.

Still Waiting for an SSDI Decision

After the SSDI hearing in February (but pre post-hearing mental breakdown) my attorney told me to expect a letter in the mail with a decision in 3-5 weeks.

In the midst of the intensely depressed meltdown that followed, I checked the mail each day (some days twice) in hopes of hearing something. Every day since February 13th I have put my mail key in the mailbox and experienced a panic attack being triggered. The faster I put the key in and open it before closing it again, the more quickly the panic attack ends.

This has been the routine every day (except Sundays, and as I mentioned, some days twice because the mail didn’t come on time) for nine weeks now.

The intense depression dissipated. The notion that my life would end if I wasn’t awarded SSDI has passed. I’ve formulated a new future in my mind, a future where I don’t have the things that I wanted… and that is ok with me now. I know that leaving my home and having to find a new one farther away from the city is part of that future, but in the last couple weeks (without the depression) it doesn’t feel like the burden it felt like before.

I am no stranger to a sense of paranoia, of distrust, and I admit I was beginning to become suspicious of my mailman. After all, he works so inconsistently… what if he lost my decision letter? What if he was sitting in his little white hatch-back eating fried chicken reading it? I know. But that is where my mind goes!

Two weeks ago someone (Corey? A friend? My sister? I don’t recall) suggested I call my attorney’s office to see if they had any news. I agreed this was a great idea, but was so hypomanic all this time the days kept slipping past, faster and faster, and I forgot (several times).

When I made up my mind to call the office, I couldn’t remember the name of my case worker. Once I remembered it, I couldn’t remember if I was remembering it correctly, and my fear of phone calls was compounded by the thought that I would call the office and ask for someone that didn’t exist.

I finally made the call on Wednesday. The name I remembered was the right name, but the case worker said it isn’t uncommon for the decision to take this long, if not longer. 

The words she said rung in my ears:

“They haven’t made a decision yet.”

As much as I want to know the conclusion of all this fun I can’t help but feel pleased with the fact that there is still some element of mystery. Mystery in the sense that if they want to approve my claim, take your time! On the other hand, if you want to deny it, do it as soon as humanly possible.

At any rate, I’ve been waiting to go into more detail about the hearing until I received my decision letter… which of course I thought would be sooner rather than later. At this point, if the deep contemplation going on over there has things leaning in any way in my favor, take nine more weeks. I really don’t mind.

“Black Box” Features Lead Female Character with Bipolar Disorder

This month abc is premiering a new show called Black Box featuring Kelly Reilly as a leading neurologist with a big secret; she has bipolar disorder. 

This move by a big network name would be more surprising if it weren’t for showtime’s six emmy winning hit Homeland, a drama featuring Claire Danes as a CIA officer who (you guessed it) also has bipolar disorder.

I believe this interest in characters living with mental illness is both because of the increase in exposure Americans are having to celebrities, charities, and positive media concerning bipolar disorder, as well as the evolution of American television anti-heros. Let’s face it, we love it when our main characters have a secret to struggle with (i.e. Dexter, Breaking Bad, etc).

Really, whatever the reason, bipolar disorder is about to be back in the spotlight, and with abc’s new show it will be available for more people to watch than ever before.

Personally, I would say that I was a little confused by the initial preview I saw (a commercial on tv) as I am always a little skeptical about how realistically portrayed bipolar disorder is on television, but I checked out a few clips on the website and saw character Catherine Black displaying several symptoms I have personally experienced (and experience regularly).

At any rate, this is something you may want to keep on your radar. The first episode airs on Thursday, April 24th at 10, so check it out!

The Switch

I’ve been flying high on a cloud made of hypomania the last couple weeks, so high I thought the wonderful feelings and extra energy might last forever.

Then, the switch happened.

A bipolar switch can easily be defined as the moment one mood or episode changes into another. The problem is that the way these switches happen is usually much less straight forward.

Realistically, there are times when folks (myself included) wake up one morning and things have changed. I would say this is the most polite way bipolar disorder can make a shift in mood, but for me that is very rarely the case.

There might also be times where the switch occurs sometime over the course of the day (or night). This seems to be the case most often when an episode is triggered by something, or when one has been holding everything back all day only to get home and have it all explode out in a flurry of emotion. To have your day thus interrupted is certainly inconvenient, and feeling your mood change from one extreme to the next can be uncomfortable, if not totally maddening.

The third (and my decidedly least favorite) option the switch can take is to playfully leap back and forth between moods for hours, days, even weeks before finally settling again on an opposing mood.

This was how my day went down Sunday (yesterday). It was as if my mood had been sent through some kind of cheese grater, switching six times between delightful hypomania and a horrible mixed state.

One minute I was intensely irritable, throwing things in the apartment, stomping around like a child and yelling at the dog, then I would be delightfully enjoying a burrito and moseying along in the Seattle sun. An hour or two later, more scowling, throwing, and stomping, followed by a casual, relaxed couple hours watching a movie.

Unfortunately, this isn’t entirely uncommon for me. There are times when it seems like my brain either wants to ease me into the next type of episode by giving me little hints of it at a time, or wants to “spice up” an episode by sprinkling in all kinds of unwanted turmoil. Either way, going from feeling elated to self-punishing and back to elated within a series of a few minutes can leave one feeling very confused at best, and certainly scared as to what might happen next.

I woke up this morning very alert. I had a dream last night about Las Vegas, which meant mostly waking up with a smile on my face (and you know, I’m not going to speculate why Las Vegas, in my dream, was populated solely by the Chinese) so I feel tentatively optimistic. The problem is that after a day like yesterday, I’m starting my week off very nervously.

After all, will today be a repeat of yesterday? Are my joyous recent days of hypomania over soon, or might I be lucky enough that yesterday’s mixed moments were a product of something fleeting like… hormones? Either way, I suppose being prepared at this point is half the battle, and after yesterday’s roller coaster I don’t expect to let the rest of this switch take me by surprise!

Finding a Primary Care Provider

Recently, more and more health insurance providers are moving toward a system where signing up for care means being assigned a primary care provider (general physician) until you choose to change that physician to someone else.

The trouble is (and I’ve found this on more than one occasion) many of the lists these primary care providers (or PCPs for short) are coming from are outdated. These lists on record often contain the names of physicians that no longer work for the hospitals and clinics found on the list, or they are no longer accepting new patients.

Yesterday I found myself in something of a pickle. My medicaid plan (signed up for near the end of the affordable care act enrollment time) assigned me a sub plan automatically (until I chose another) which also assigned me a primary care doctor that didn’t exist.

What’s worse is that when I tried to fix this (and pick another plan under medicaid) I found out it wouldn’t kick in until May, leaving me a window through April with a wonky plan and no doctor.

Fifteen minutes of tears and a panic attack later, I made an attempt to find a new primary care physician under the plan I was stuck with, only to have the plans’ customer service people assign me a second, non existent doctor. 

The point of this story, to me, is pretty clear. Relying on someone in a cubicle and a phone to choose my doctor for me is ridiculous. Trying to pick a doctor out of a list of names also seems ludicrous, after all… how do I even know which ones are good?

In a blog about mental health, you might be wondering just how important general physicians are anyway… but there are many reasons having a good primary care doctor can work in your favor.

Primary physicians can be the gateway to mental health treatment. I know several people who are prescribed mental health medications by a primary physician (though I’ve had terrible luck with that myself). On top of that, many insurance plans require a primary physician to refer (basically give you an “in” and a stamp of approval for mental health treatment to your insurance provider) you to mental health specialists before you can get treatment.

Primary physicians are often a gateway to all realms of physical health. If your insurance doesn’t require a referral for mental health services, it is much more common to require referrals to all other specialists, including anything from dermatology to neurology to allergy specialists. Doing what we can to help our minds is only half the battle, we need to be able to take care of our bodies as well. This might even include a primary physician helping counteract physical side effects of psychiatric medications, something that has been super important in my own search for better health!

Yes, these people are important, but when being assigned phantom PCPs, how do we find good doctors accepting new clients who also take my insurance??

My advice is not to start too small. Start by looking for locations that generally accept your insurance. You can do this by doing a search online at your insurance provider’s website (usually, you might have to google the addresses you find to see the actual locations), or you can call your insurance customer service line (though I’m warning you, this can be a huge headache). Something that worked for me was calling the office of my phantom PCP (via a number on my new insurance card) and finding out there were several (real) doctors there that do take my insurance.

I find that if you need to choose between calling insurance people or calling clinics, you will often get much more help from the clinic receptionists. As long as you try to remain calm and friendly, they can usually point you in the right direction.

We have several hospital systems in Seattle, so finding out what hospital system takes the health insurance in question can also help you find primary care doctors and specialists in your area. I called my usual hospital (who didn’t take my new insurance) but found out another hospital down the road who does. 

Don’t underestimate the knowledge of friends, family, or co-workers who have the same insurance as you. If you know someone on your plan who claims they have a great doctor, ask for their information! This rings true for not only primary care doctors, but psychiatrists, therapists, and any other specialist you might be interested in seeing.

Once you’ve found out if a location (or if doctors at a given location) take your insurance, you can call and ask the receptionist if anyone is accepting new clients. I’ve met some really wonderful receptionists who have even gone so far as to give me brief descriptions of the available doctors dispositions!

Writing down the name of the doctor (with correct spelling), the phone number of the location, and the address is important. Once you have this information, you can go back to the insurance website or customer service line and request a change of primary care physician.

This last step is IMPORTANT, because if you don’t follow through with the choice that you’ve made your insurance company can potentially deny your claim (aka not pay for it) if the doctor you see doesn’t match the doctor listed in their database.

Some insurance companies will allow you to change this information on their website, while others have an automated phone system. On occasion you might need to speak to a customer service representative (who may also put you on hold to call the clinic you just talked to and verify the information). In any case, once you have finished the process you can expect to receive a new ID card in the mail with your new (and correct) PCP information listed.

I realize this is a lot of information, and I know nobody likes insurance nonsense, but finding and selecting a primary care physician before attempting to interact with insurance representatives can save you a lot of hassle. I know it would have saved me a panic attack, and three hours of yesterday’s morning!

Hypomanics Just Want to Have Fun

I’ve been hypomanic, but I didn’t realize to what extent exactly. Yes, there has been hilarious dancing, yes I have been walking up to strangers on the street and talking to them, and yes, my anxiety around spending money has been lifted and I casually bought a pair of shorts.

When I got into my therapist’s office yesterday (our relationship renewed by medicaid’s promise to give me 33 free sessions) I said,

“Well, I’ve been having trouble sleeping and I’ve been running all over the city for two days straight, but things don’t seem too intense.”

I shrugged and wrote off my symptoms. After all, I wasn’t experiencing any agitation (or even racing thoughts), and things hadn’t reached the point of mania (where people couldn’t understand what I was saying anymore) so things seemed fine.

After about fifteen minutes of talking and filling out some paperwork my therapist looked at me and said,

“I realize this may be coming out of left field, but you’re speaking rapidly, using much more exaggerated hand gestures than usual, and your volume is just short of yelling.”

I was shocked, not that she said that to me… but that I hadn’t any idea that I was doing any of these things.

To be fair, two years ago I couldn’t pinpoint manic symptoms in myself short of starting a fight with a pharmacist or believing I was a werewolf. It seems so much easier to pinpoint symptoms of depression or mixed episodes, because they feel unpleasant. How difficult is it to notice I am experiencing something or doing something that feels great?

When it comes to hypomania, I can recognize insomnia, or a lack of hunger, or high waves of energy, even giddiness and elation. Less straightforward is the part where this becomes funneled through me and introduces itself to other people’s lives.

I don’t really know how to pinpoint symptoms like rapid speech and exaggerated hand gestures, short of someone pointing them out to me. Even then, my therapist asked if he pointing these things out made me want to change my behavior. At the time, sitting there, I said no.

As much as I am afraid of coming off wild and intensely, I know this period also lends itself to a certain hilarity that I can’t embrace quite the same way at other times. It becomes easier to tell jokes, easier to laugh at jokes, and easier to take conversational risks.

I know this can ball itself up and transform into mania (or even a mixed state) but it seems as though the acting excitedly itself isn’t an issue. Just because I am paying close attention, monitoring my sleep and eating to try to keep things wrangled in doesn’t mean I can’t have a little fun.

And after a little depression, don’t we all deserve a little fun?