Tag: mental illness

No Hospital

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders, suicide

No Hospital

I met my new PCP. I really like him. I had to correct him on a few things in my history but for the most part, he got things right. Unfortunately, he had no new news for me as to why my ankle hurts, which I didn’t expect him to. He has agreed to treat my pain and the best news is that I don’t have to see him every fricken month for a script. I can ask electronically and then pick it up, which is easier than mailing! We talked about my weight and he said the thing was portion control and making a few cuts to the diet. I told him I switch drinking mochas to having espresso with soy milk. He liked that idea. I told him my appetite varies with the depression. He was understanding. He didn’t go into a frenzy when I brought up my suicidal thoughts. He felt I was covered with a psychiatrist. He did ask if I ever overdosed on my medication and I said no. I will never do so. I didn’t have to give a reason as he was satisfied with that answer.

He gave me a tetanus shot because I was overdue for one, which was fine. He asked me if I wanted a flu shot and I said no. I don’t like them. The last one I was sick for two weeks and refused to go through that again. I am glad he didn’t want to do anything special about my pain like send me to a new doc or something. He does want me to look into CBT as a way to help with my depression and pain cycle. Dude doesn’t know me so I will let that pass. Even my psychiatrist was like it is not going to work for you. So I have that going for me. DBT might be the short term fix. We’ll see.

After the appointment, I headed over to my psychiatrist’s building and waited as I had an hour to kill. She sent me an email around 1 asking if I could see her at 4 because she was tied up at the dentist. I said sure. At this point, I still didn’t know if she wanted me to go in the hospital and I forgot two things I absolutely needed if I was going in tonight so I went home to get them. While I was home, I relaxed a bit and took a pain pill. I should have taken a trilafon but I fucking forgot. I got to use an app to remember to take it as I keep missing doses. I decided to pack a little overnight bag just in case my psych wanted me admitted. I packed some stuff and then left for the bus. It was fucking late and I was afraid I would be late for my appointment. I got there with ten minutes to spare.

She apologized for having to reschedule. I told her it was no problem. Seems she forgot what we talked about yesterday and the hospital was out of her mind. SCORE. We talked about the new PCP and she read his note while I was talking. By this point, I was getting edgy because I hadn’t eaten anything since 0900 and the waiting room got on my nerves. She is a child psychiatrist so the waiting room was full of kids. I was starting to feel paranoid and regretted not taking the trilafon when I was home.

I told her how anxious I was because I haven’t eaten and she apologized for keeping me out so late. I told her it was okay. I didn’t mind the delay. She asked what I felt because it didn’t appear to her that I was agitated. I explained how I felt and then got into describing how CBT isn’t going to work for me because there is no linear pattern to my pain. What causes it to hurt today, won’t cause it to hurt tomorrow. I didn’t bring up the hospital and she didn’t mention anything about the carryon bag I had with me. I wasn’t in the mood to be admitted. I just wanted to go home and put my feet up. I see her in two weeks and I got my trilafon order right. She gave me refills too, and I was happy. Now I just got to remember to take the suckers.

I got home to the Square and went to Chipotle. I wanted a burrito. It was quite messy and I got guacamole on my sweatshirt. I was starving and ate the whole thing. I made sure to clean my face and hands as best I could. Then I waited forever for the next bus. I stood because I didn’t feel like sitting. I knew either way I was going to hurt. My right Achilles started hurting while I was waiting. I went to the pharmacy to pick up my scripts. The trilafon wasn’t ready yet so I had to wait. My mother called me while I was waiting, wondering when I was going to come home. She made dinner for me but I told her I ate out. She got mad. Oh fucking well. She made spareribs, not my favorite meal. It can be her lunch tomorrow.

Throbbing pain and suicidal thinking

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders, suicide

Throbbing pains and suicidal thinking

I knew I was going to be in severe pain tonight. What I wasn’t expecting was the stupid pain to change course on me. I usually have three metatarsals (bones in the foot) that hurt me every night. Now there are six of them. If I didn’t just have foot X-rays, I would probably get them again. Of course, there is nothing wrong with my bones. They just throb and throb every single night. Then I have my ankle deciding to join in the fun and it keeps me awake when I want to sleep.

I knew I should have tried to take a nap earlier this evening. Around 1730 or so, I was really tired from the migraine I had and everything was bothering me, lights and sounds mostly. Then my face went numb so I took my migraine meds. I should have taken a nap but it was too early to sleep and I knew I would be up if I did. Now I am shooting myself in the foot, so to speak.

I have my phone on vibrate because I can’t stand noises, even though the migraine has gone away now. I need to change the ringtone for my text messages. But there really isn’t any good ringtones on my phone that I like. I would love to get the Star Trek Next Gen communicator ringtone but I haven’t been able to find an app that has it. I think by now they have come out with the real comm badge that is a Bluetooth communicator. I would get one but it’s $80. Way out of my budget. If I strike it rich on my birthday, I will consider getting it. That is if I don’t go through with my plan.

I know I have been talking a lot about my plan and yet I am still here. Honestly don’t know why I am still here, but I am. Guilt is one reason. My fucking idiotic therapist is another. And of course my psychiatrist, who I value her trust in me more than anything. I can’t whole heartedly go ahead with my plan knowing that a) it might not work the way I want it to (meaning I will survive) and b) if I do die, the pain I will cause those left behind. It’s a burden on me knowing that I will cause suffering to those I love more than anything.

I was reading a blog today from a friend I know in Ireland. She has DID and was in emotional turmoil. She needed to hear from her therapist to calm her down. I remember the days when I needed the same thing from my therapist or psychiatrist. But since the psychosis that has happened this year and the medication I take for it, I no longer feel that connection. I feel disconnected from my feelings, all together and it worries me because other than feeling really suicidal or depressed, I really don’t feel much else. Maybe anger occasionally and grief, but no sense of connection to the people I care about. There used to this connection but I no longer feel it. I have been cut off from it. I guess it started when I realized my father wasn’t going to make it earlier this year. I remember being in the hospital room with the PA while she was telling us the oncologist was not going to pursue anymore treatment options for my father and that it was only a matter of time that he was going to die. My father was wrapped up in the blankets in his hospital bed, trying to sleep. I have no idea if he was hearing the conversation or not. That is when we started looking for nursing homes for him. It was a hard decision and it was difficult to bear. I don’t think the month of April is ever going to be the same for us again.

While my father was dying from his disease, my depression was out of control. Then I became psychotic after his death, even while taking the meds for it. The voices told me to stop taking it so I did. I got worse. Then I went on another medication because I had to take something for it. The voices were commanding me to take bottles of my pills and telling me everyone was going to kill me, including my lovely psychiatrist. Now that I am back in control again, I feel different. I feel shielded, like I have emotion but I don’t. They are useless to me. My doc wants me to take a lower dose of this medication but I have tried to and it just doesn’t help me to be on a low dose. I need to take two doses a day to feel stable. It might be causing me to feel like a robot at times but it’s keeping the delusions, paranoia, and voices under control. It’s been five months now that I have been feeling disconnected but I really don’t want to be plugged in. It’s better this way. The only time I feel out of sorts is when my pain is out of control and the anxiety takes over. That is when I feel most dysregulated and suicidal. It is at these times that I come up with plans to kill myself because I want to end it all. Sadly, the way I feel right now, I could just toss a coin and see if I should die or live. Heads I live, tails I die. I don’t care anymore. If my favorite holiday wasn’t coming in the next few days, I might toss that coin. Until then, I will wait till next week and then toss that coin.

ASAD: Acute Suicidal Affective Disturbance

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders, suicide, suicide attempt

ASAD: Acute Suicidal Affective Disturbance

http://www.mdedge.com/clinicalpsychiatrynews/article/100017/depression/aas-acute-suicidal-affective-disturbance-proposed

I read the above article with interest. One of my Twitter buddies shared it with me and wanted my opinion on it. I think that it is right on queue and I hope that Dr. Joiner eventually sees this as a diagnosis. But I worry that if the stigma of suicide is not dealt with, it might just be an admitting diagnosis and thus cause more harm than good.

According to the criteria lined out, I meet this diagnosis, though at this time, I am unable to rule out whether a medical condition or conditions exclude the diagnosis. There have been many a times that while I am in excruciating pain, this condition is activated and I am acutely suicidal. The only thing that has saved me from actually making an attempt on my life is that I physically cannot walk and have refused to kill myself in my own home. Then in the morning (most of these attacks have occurred in the midnight hours), I no longer feel so suicidal.

It used to be that what I would call a “switch” would be activated and I would be suicidal until I fell asleep. Now I know that it’s this disturbance that occurs and it makes sense to me. But in every suicidal occurrence that has happened over the past two years, it has been because of physical pain or some kind of dissociative state brought on by physical pain. Very rarely has it occurred solely with psychache or psychological pain. Granted not every episode is psychache free and physical pain free. I will have what Shneidman calls the three Ps, Psychache, Perturbation, and Press as well as physical pain that causes me to be severely suicidal. These nights, I swear to myself I will end my life the next day when I can walk again. Fortunately, I don’t feel as suicidal the next day because I had a few hours or more of respite from these kinds of pain and perturbation. That isn’t to say that I won’t be activated the next night or come up with a suicidal plan to end my life the following day. These plans are usually a few weeks away to give me time to think things over and essentially put off today what can be done tomorrow. These plans have also given me time to work through my feelings and usually by the time that date comes, I no longer feel suicidal enough to go ahead with the plan.

Suicidality is a tricky business and not everyone’s suicidality is the same. What triggers my suicidality might not trigger someone else’s. There are mitigating factors that might be similar in nature like the criteria states but I would love to see the data in the context of ruling this a diagnosis. Just because I find this disturbance fits my suicidality, doesn’t mean that it will someone else’s and that is the difficulty with the nomenclature I think Joiner talks about in his article.

an upsetting chat

by Midnight Demon, posted in Bipolar Disorder, blogging, depression, mood disorders, suicide, suicide attempt

An upsetting chat

Nathaan Demers ‏@Doc_Demers 3h3 hours ago
We need protocols in primary care regarding MH & suicidal ideation. We flag pt records for med conditions- lets do the same for MH. #spsm

I came across this statement while going through the SPSM chat that goes on every Sunday on Twitter. What I find upsetting is that these suicide preventionists don’t realize that suicide and suicidal thinking are time limited. People who think of this in time of extreme distress are not going to think about it down the line. Now if they make an attempt, that is a different matter.

The way I see it, you can let the medical providers know that the patient has mental health issues. I am for that. But telling them they have suicidal ideation that won’t go on like pneumonia is just foolish. Sure you can document that the person had ideation but for what? So that some idiot insurance policy can deny claims because they were going through a tough patch and wanted to get out of it? To me, that is just perpetuating the stigma of suicide. If the patient attempted suicide, then that is cause for concern because the best indicator that we have right now is survived attempts leading to a death by suicide.

This isn’t the first chat that has called for the medical providers and mental health professionals to be working together. But once you place it in the patient’s chart, it’s there forever. You can’t erase it. More thought needs to go into this before I feel comfortable about my own thoughts going into my medical record. We’re not talking about a deathly reaction to penicillin. Those kind of things should of course be documented at every medical visit.

But passing suicidal thoughts that were thought of last week or last month or even ten years ago? Everyone has these thoughts. Not all go through with them. It’s the attempts that should be documented not the ideas if we want to save a life. Granted patients might be ashamed or embarrassed to bring up a failed attempt but it should be asked about. And again, this should all be done with dignity and respect and compassion. It shouldn’t be hurried and passed over once talked about. It should also be respected about the time. If the patient is currently have these thoughts they should be addressed. If it happened ten years ago and the patient is stable, then in my opinion, it should be documented but not be hounded and beaten to death. The crisis is over and dealt with. It’s what is going on now in the patient’s life that should matter, not the long ago past.