My Last Visit to the Psych Ward

last-visit-psych-ward

 5 weeks after my fourth and most recent hospitalization: May 21, 2010
  I shuffled into the day room, sticky soles of my grippy hospital socks licking the cold linoleum floor. Everyone mingled in this spacious room, the brightest spot in the house that we were living in for the time being. Sanity had begun to return to my foggy brain. Finally. There was such relief with being able to recognize a thought, rather than being led by a force hidden, so far beyond my control. For two days I had been aimlessly wandering the long, dank halls of the psych ward. Incoherent and lost. The perfect pharmaceutical cocktail was starting to even me out. And I was counting the hours until I’d be released to the care of my husband. I was desperate to see my son.

I noticed that the flowering plant on the counter of the open nurse's station had withstood my incessant plucking, as it still had about a dozen blooms, by some miracle.

“She loves me. She loves me not. She loves me.” I debated, pulling at the tender petals of a flower I had stolen late into the night on my evening of admittance. “I know it’s going to be a girl. But what will she name it?” I mused to myself out loud, lost in the psychosis which my pregnancy had spun me into.

Later that night, or maybe it was the following morning, one of the nurses tried to get me to eat. “You need to eat something, sweetheart. For the baby. Here, try this,” she urged, shaking the small box of Apple Jacks she had brought from the kitchen down the hall. We were in my sterile little patient room, a desk between us. She sat in a chair across from me, attempting to coax me into taking a few bites, as I sat in another chair, shaking, sweaty and weak from exhaustion. A small container of milk was ripped open on one side to form a drinking spout, but hadn’t been touched. I felt a little like Alice in Wonderland, staring at the items in front of me labeled "Eat Me" and "Drink Me."

I may have taken a few bites, a sip of milk, but my mind told me she was trying to poison me. I made sure not to eat or drink too much, for fear of never waking up.

Eventually I did decide to lie down and rest on the stiff single bed with the scratchy white sheets in the far corner of the room. No one slept in the other bed in the room. I had my own private room. Good thing, too. I needed to just sleep, to dream off the mania. It had taken two days of the nurses pumping me with antipsychotics until I finally relaxed enough to sleep.

I emerged a day later, after a long, hard sleep, to “meet” the other crazies in the day room. I might have met them a day or two earlier, but my memory was a slice a Swiss cheese when I was manic, so I didn’t remember. Two did stand out, though.

Tony was a big, burly Italian guy who chain-smoked and had the cough to show for it. He was warm and engaging, and I liked him immediately. He made me smile with his obscene jokes, a welcome escape from the situation we had all found ourselves in. Tony was constantly searching for a number in the phone book. When he wasn’t in the smoker’s lounge, he was on the phone pleading with the person on the other end to come pick him up.

Mary had left the day before. She was young like me, and claimed she was also very early pregnant, although I didn't believe her. Hell, I didn't even believe I was five weeks along. We had promised to keep in touch, but I knew there was no way I’d live up to my end of that deal. I didn’t like to take hospital memories home. Art therapy projects were an exception. Nothing like a glimpse into a mad mind for old time’s sake. So instead of giving her my number when she wrote down hers for me, I hugged her goodbye, telling her it would be too painful. She understood.

The exercise lady arrived in the afternoons, swooping in to lead the patients in yoga or dance sessions in the day room. She’d turn on 80’s pop music and we’d bop around, forgetting about the frustrations attached to having lost touch with reality. During those moments, everything seemed to disappear and for three minutes I was okay. Hips swayed, eyes closed softly so I could really feel the music. But as quickly as her sessions began, they were over, and we were back to waiting for our next activity to pass the time until we’d see the outside world once again.

Held for forty-eight hours of insanity, twenty-four for the meds to really start kicking in, and another forty-eight and I was good to go. A final meeting with the staff psychiatrist and I was given my ticket out of that joint. It had been my fourth stint in a psych ward, and it was a house of medicine I was hoping not to have to visit again for a very long time, maybe even never.

Ready to get back to my own home, to my family where I’d be nursed back to complete health so I could get back to being the kick-ass mama and wife they loved. This last visit to the psych ward solidified my commitment to staying well. For myself, for my husband and for our son and the unborn baby I was carrying. Not another day would pass without that little salt pill sliding down my throat before bed. My family deserves this promise. And they’ll get it, forever and ever.

last-visit-psych-ward

Living with bipolar disorder

I don't think a day goes by that I don't think about the fact that I am living with a mental illness. Not because I worry about what other people think of me, it's not that at all. It's because I have to constantly be taking the pulse of my mood so that I can manage my illness to the best of my ability. Over the last seven years I've gotten pretty good at it. I like to describe my experience living with bipolar disorder as a scale of one to ten. A simple ten point scale tells so much for someone like me. Think of it this way: 1 = completely depressed, can't get out of bed; 5 = in the middle, balanced (this is what I strive for every day); and 10 = completely manic, need hospital. I won't lie, I like being in the 6-7 range, but when I do have those times when I creep up to the 8's, I start to crumble. I know that when I get to 8, I need to make time for sleep or else I could tip over to 9 or 10 and that would be incredibly awful. Just because I've been there before. And now we have two kids and I would hate for them to see me in a manic state. Just as I would hate for them to see me depressed. But with my version of bipolar disorder, Bipolar I, my moods swing on the higher side of the scale versus the low side.

Nighttime is the hardest. The kids have been asleep for an hour and within that time I've cleaned up the kitchen and (of late) collapsed on the couch in front of my favorite show right now: XFactor. Some nights I am motivated enough to do a workout and then am filled with so much serotonin that it's almost impossible to turn off the endorphins enough to sleep right afterwards.

I'm trying to curb my evening leftover work/facebook surfing/twitter gazing/blog stalking to a minimum so that I can hopefully join the 10pm bedtime club.

When I do climb into bed, I get super jealous of my husband who, within exactly two minutes of us shutting off the lights, is snoring away happily. I'm a different story. My eyes close, my breathing slows down, and I shift around until I get into a comfortable position to try to nod off. Thoughts pop up and a running to-do list keeps flashing before me. I've learned coping mechanisms over the years so now I am able to turn down those things and find sweet sleep. If ever an hour goes by and I am still not asleep, I know that I must pop a sleeping pill to help me get the zzz's that I need.

I've just been thinking lately about how I live with this each and every day, and will for the rest of my life. Nothing I can't handle, just thought my readers might be interested in knowing a little bit about what it feels like.

4 years ago he changed my life forever

I'll never forget the moment I became a mom. 

Even though I was manic beyond belief by the time I finally got to hold him for the first time and for the entire four weeks following his birth, I still somehow knew how incredibly different my life was going to be now that he had arrived.

He made me want to be a better person. He gave my life purpose. He made us a family. He made my heart explode with love every time I held him to my chest.

Little Man, your Mama loves you more than anything in the whole world.

Over these past four years you have become such an inquisitive fire-cracker of a preschooler who challenges me to the core each and every day.

And I wouldn't have it any other way.

Your laugh makes me smile and within seconds I am laughing right along with you.

Your energy keeps me motivated to run along with you.

Your eyelashes make me so incredibly jealous.

I love the way you protect and love on your baby sister.

I get goosebumps when I see how happy you are when you're in the water. You are such a fish.

You are so passionate about fire trucks and fire fighters that I wouldn't be surprised at all if you become one someday.

Having you in my life is one of the most magical miracles I have ever experienced.

Singing you Twinkle, Twinkle every night these past four years is my favorite way to end the day.

In one hour you turn four.

Happy 4th Birthday, Little Man. I love you to the moon and back.

Love,

Mommy

xoxo

Two years ago today

It's been two years to the day today that I was last hospitalized for a manic episode.

And what a storm it was. I had just found out I was pregnant and thus was so excited I couldn't sleep for a week. You see, it had taken us ten months to conceive the little lady and being the impatient, total Type-A person I am, that was just way too long.

When I don't get enough sleep, it leads to mania. My thoughts race out of control, I start talking in circles, and I lose touch with reality. My husband knew the signs all too well. He knew what needed to be done.

Within thirty minutes, his mom was here to help with our 18-mo old son, and the EMT's and two police officers were standing in our bedroom trying to talk me into going with them to the hospital. When I wouldn't consent, my husband signed some papers, and they cuffed me and put me in the squad car. Luckily this time it was pitch black outside and they didn't have their flashing lights on. So hopefully the neighbors didn't see and think I was being arrested.

 

Crazy how far I've come in those two years. I've learned so much over these past six years living with bipolar disorder. I've learned how important my family is to me, I've learned which friends care enough to actually talk with me about what I've been going through, and most of all I've learned that I can overcome this "mental illness" to make my dreams a reality.

Six years ago I was so crippled by depression and anxiety that at times I didn't want to go on. I was being so selfish, but I saw how my condition was affecting my family and I hated that I kept bringing everyone around me down because of my mood. I felt like I had lost my identity because the career I had worked so hard to build over the past four years came to a screeching halt after my second hospitalization. I couldn't handle the pressure at work any longer - the pressure that had pushed me to work harder and smarter over the years was now causing panic attacks and driving me deeper and deeper into depression.

Ultimately, I had to resign from my job and with that I felt like I was a nobody. I was worthless. I was sad. I didn't feel like there was anything worth living for.

Looking back, it basically took me all of 2006 to pick myself up again. I went through so many weeks of crying hard every.single.night. It's hard for me to think about what my parents and husband went through during that year. I don't know if I would have been strong enough to stay positive and supportive to someone who was so incredibly sad.

But they did. And Thank God they did. I am eternally grateful to them.

I never would have imagined that I would be where I am today without the love and encouragement of my dad, mom, and husband. Along with my in-laws, brother, two sisters-in-law, and a handful of close friends, I trudged through 2006 and made it into 2007. I made it to see another day.

And now I know that there is so much to live for.

I am so thankful to have found a medication that works for me. I know that I am lucky. I take my medication religiously and stay on top of my moods to make sure I continue to stay stable. I have too much going for me to end up in the hospital again. I don't want to miss a second of this life.

Because it really is too short when you think about it.

Postpartum psychosis - how it happened to me (Part I)

I was online this afternoon and came across a story in our local online newspaper about a woman who had experienced postpartum psychosis after the birth of her second child. She stopped her car in the middle of DC afternoon rush hour traffic, took off all her clothes, and was running along the shoulder of the road towards a bridge over the Potomac River. She was convinced that she needed to be baptized in the water because the world was ending. The details of her story are eerily familiar to me. I feel for her that she had to go through something as embarrassing as stripping down naked in public. Could you imagine?

But at the same time I am so incredibly proud of her for standing up and telling her story - publicly. She is a brave woman and I truly respect her. She is not afraid of speaking out about this rare disorder that affects only one to two women out of 1,000. It doesn't sound like many at all, but when you do the math, that computes out to 4,100 to 8,200 women in a year based on the average number of annual births.

I think it's about time that PPP gets a voice. There is so much information out there about postpartum depression, but if you ask anyone if they know anything about postpartum psychosis, I would venture to bet that they'd bring up Andrea Yates, the Texas mother who killed her five young children by drowning them in the bathtub in June of 2001. But only five percent of women with postpartum psychosis commit suicide and only four percent commit infanticide.

Those numbers could be so much lower, if the general public were aware of the signs and symptoms of postpartum psychosis so that they could intervene before a tragedy could occur. When a woman finds out she is pregnant and begins reading the various pregnancy books out there, there is always a chapter on postpartum depression. I wish those authors would cover the other side of the spectrum too. There are lives at stake.

It happened to me after the birth of our first child in September of 2008. He was a healthy 6 pounds, 12 ounces, delivered via emergency C-section. (He wasn't tolerating the contractions since his heart rate was taking a nosedive with each one, and I wasn't dialating past 5 inches, so the decision was made and at that point I was so exhausted I just couldn't wait for him to be out.) I was absolutely determined to breastfeed him, yet had no clue what I was doing. I just felt all of this outside pressure to make breastfeeding work - all of my friends had breastfeed their children, the books and magazines you read all say that "breast is best" and of course all the literature at the doctor's office was the same. Even the formula company's marketing materials pushed breastfeeding. So of course I put a ton of pressure on myself to make it work. It made those first few days and weeks with baby boy so grueling, draining, and sad. Due to the C-section, and the added stress I was putting on myself to be successful at nursing, my milk took almost a full week to come in. I was breaking out in hives up and down my legs every night because I was so stressed out. Instead of enjoy my baby, I was feeling like I was failing as a mother because I couldn't feed him. The pediatrician had us start supplementing with formula at his 2-day check-up because he had lost too much weight. I was barely sleeping at all. That is how the mania started to spiral me into psychosis.

The days and nights started to mush together as I started to live life in 2-hour increments. The baby would nurse for 45-minutes, then we'd do a diaper change, then he'd nap, but in the hour that he napped I felt as though I had a million things to do so I never napped myself. And it wasn't as if I didn't have help with me. My parents stayed for a week after the baby was born and my husband was off from work for two weeks. So I did have times when I could hand over the baby, but yet, things still had to get done.

It was about seven days after he was born that I remember breaking down in tears in front of my mom with the phone in my hand, outstretched to her, pleading, "Please call my OB and ask her what med I can take that will help me sleep! I can't sleep!"  My mom called and they said I could use Tylenol PM while nursing, and so I did that afternoon and slept four hours straight, the longest stretch of sleep I had gotten since having the baby. The next day my mom changed her flight so that she could stay a few extra days to help out.

I remember feeling as though my mind was starting to race uncontrollably at times during those first four weeks after my son's birth, but somehow I was able to hide it from my husband and my parents. I wanted to be able to breastfeed my son and I knew I couldn't do that while taking medication. So I continued to fight the racing thoughts, but they quickly caught up with me in a big way.

We had our son baptized when he was four weeks and two days old. My parents flew back into town for the ceremony, and stayed with us for that weekend. I drove them and my brother and sister-in-law to the airport on Monday morning. On Tuesday morning I had become manic to the point of psychotic, and had to be hospitalized because I refused to take medication.

I spent a week in a psychiatric facility where the doctors stabilized me using a combination of anti-psychotics, sleep medications, and the mood-stabilizer Lithium. I could not believe that I had missed out on my son's fifth week of life. Completely.

The insomnia was the first and most prominent symptom for me. The delusions and hallucinations are a close second. I refused to eat at times. Each and every sound I hear is amplified one hundred percent. These are the symptoms that I experienced every time I had been hospitalized. Which up until that point had been twice.

The common theme that I experience when I become manic to the point of psychotic is the feeling that the world is ending. Let me tell you - it has got to be the scariest feeling in the world when you are absolutely convinced that it is happening. The time I lost touch with reality after our son was born, I remember that I had been sleeping upstairs since my husband said he would take care of the baby so that I could get some rest. I woke up at some point in the middle of the night and went downstairs to find him asleep on the couch, the gas fireplace blazing, with our son snoozing peacefully on his chest. For a split-second I thought about grabbing my camera to take a picture, but I had no idea where it was or else it seemed like too much of an effort to find it, so I didn't bother. I just woke my husband up and we went upstairs to bed, putting the baby down in the bassinet by our bedside.

A few hours later I couldn't sleep because I kept thinking I heard the baby crying. But he wasn't. My husband kept telling me to go back to sleep. But I couldn't. When he woke up an hour or so later to get ready for work, he knew right away that I wasn't right and he needed to call for help.

(To be continued...)

 

Journaling your journey of life with bipolar disorder

After I experienced my second manic episode over Christmas in 2005, my Dad had a brilliant idea. It was something so simple, yet so tremendously important in the process of helping us to figure out what was going on with me. Over the course of five months I had been put on so many different medications and the doses were constantly changing as we worked to find what ultimately would be the one to "fix" me. To try to keep track of it all, my Dad suggested that I keep a small daily journal with details on just three things: what medications I took that day, any side effects I was experiencing, and how I was feeling. I began in April of 2006 and have continued today. Those journals are my life in a nutshell. I have looked back through them many times through the course of managing my illness to recall the medications and dosages I was on at different points in my history of living with bipolar disorder. They have been an incredible resource to me and the doctors I have seen over the years. I am forever grateful to my father for coming up with this idea.

The amazing thing about these journals (I have 5 small notebooks filled by this point) is that when I open to a page and read the entry from that day, I can be instantly taken back to that day simply by reading the words that are written on the page. I usually stuck to one page a day, so as not to make the process too time-consuming that it would seem like a chore.

Most of 2006 was filled with pages of me describing crying spells and anxiety attacks. I get sad when I read those pages. But it also helps me to stay focused on my goal to stay healthy and balanced, so as not to have to experience that pain again. When I read my entries from the times I was in the hospital or from my days back at home immediately following the hospitalizations, I recall how much stress and heartache I caused my husband and family and I know that I don't want that to happen again.

Usually after a hospitalization when I'm working with my psychiatrist to get my meds back to a good point, I'll use a mood chart for awhile until I become stable. I tried to find the exact one I used online, but wasn't able to locate it. I did find an online mood chart that looks similar though. I'm pretty sure there has got to be an iphone app for a mood chart, but since I don't have an iphone I don't know for sure. I used to bring my completed charts to my doctor so that she could review them in our monthly sessions. She found them helpful, but I seemed to prefer my journaling technique, so I did both.

I find it therapeutic and over the years it has pretty much become a habit - something I do right before I go to bed. I do enjoy blogging, but it's nice to have my paper journals too. Something about putting a pen to paper I guess. My journals are an invaluable resource to me in documenting my struggles and successes over the years. Lithium may not always work for me, and in the future I may have to transition to a different med. It's nice to know that I have my history written down, from my viewpoint. It is something that can never be taken away from me.

Do you keep a journal of your experiences managing your illness? If so, how do you think it has helped you?

National Pregnancy Registry

My daughter turned 8 months old yesterday. About two weeks ago she started crawling and just yesterday she started babbling non-stop. I am continuously amazed at how quickly she is growing and changing. And I am intensely grateful that she is a happy, healthy baby. I was hospitalized for bipolar mania when I was just five weeks pregnant. My husband and I had been trying to conceive our second child for seven months and it had finally happened, only to cause me such excitement that I couldn't sleep which lead to my mind racing beyond belief forcing him to sign me into a psych ward for four days. I had been working closely with my psychiatrist to come off the Lithium for the first trimester once I found out I was pregnant and then once the mania took over from the excitement of finally becoming pregnant, I continued to refuse medication because I thought I was doing what was best for the baby growing inside me.

Looking back now I know how very wrong I was.

The main risk that the baby faced if I stayed on Lithium was Ebstein's anomaly, a heart defect. The general population has about a 3% chance of this particular congenital heart condition, and the risk increases to around 6% for a person taking Lithium during pregnancy.

In my case the benefit of staying on medication greatly outweighed the risks of me becoming manic and needing hospitaliztion, and I definitely knew this having done a ton of research beginning back before I became pregnant with my son. But with his pregnancy I was able to somehow stay medication-free throughout those nine months and one month after his birth. And I think I was feeling some mommy-guilt in wanting to give this second baby the same drug-free environment in which to grow and thrive. It only seemed fair.

After spending four nights and five days in a psychiatric facility near our house, I was finally released to the care of my regular psychiatrist after being stabilized on Haldol via injections because I was very resistant to oral medications at the beginning of my hospital stay. They also used Zyprexa since historically I responded so well to it. Of course I was scared to death about how these medications were affecting the baby's development, especially because there is so little research out there on the use of a-typical antipsychotics during pregnancy.

This is what lead me to find the National Pregnancy Registry via an online search. They are collecting information from women who have taken certain antipsychotics during pregnancy and after childbirth to hopefully shed more light on the safety of these medications during pregnancy. They also need women who are currently pregnant and NOT taking these medications, to serve as the control. If you know someone who is willing to participate in this on-going study, please direct them to the site to sign up to join.

It is easy to participate - just a series of brief phone interviews and some completed paperwork releasing medical records is all it takes. They do a baseline interview during the beginning of the pregnancy, a 7-month interview, and a postpartum interview. Simple. Once you finish it will give you a good feeling knowing that you are doing something to help improve the quality of healthcare for pregnant women in the future.

A little history - the first half

In writing my blog posts, I'm not planning on going in chronological order, because that would be kind of boring, don'tcha think? The first half is about my first two hospitalizations which occurred within two weeks of each other and were before it was determined that I was Bipolar. The second half details my second two hospitalizations which occurred after the birth of my first child and during the first trimester of my second pregnancy.

However, I do think that it would be helpful to give a quick little summary in order to kick-off the launch of my blog, so here goes. Back at the end of 2005 I suffered my first mental break when I became manic beyond belief and had to be taken via ambulance, screaming and strapped down to a stretcher I might add, to the hospital because my poor husband had no clue whatsoever as to what was happening to me. I had barely slept a wink that entire week and it all came to a head on Sunday night. Two nights in the psych ward, a week off from work to recoup, my first visit to a shrink who attributed the entire episode to sleep deprivation and told me I could discontinue the Risperdal I was taking, and yes folks, believe it or not, I was back at work the following week.

Two weeks later when I relapsed and suffered another manic episode, it was clear that something really was wrong with me and it wasn't just sleep deprivation. But with no real history of mental illness in our family, we didn't know where to start to begin seeking answers. My parents spoke with some close friends of theirs who were able to find a recommendation for a psychiatrist in Florida and got me an appointment while I was there with my husband visiting over Christmas. Spending Christmas Day and the two days after in another psych ward was not my idea of a holiday. In fact, that Christmas was probably one of the worst days, if not the worst, day of my life.

After emerging from that second hospitalization, and sitting down for just an hour with the psychiatrist we were referred to, he was able to determine that there was a very strong likelihood that I was suffering from Bipolar Disorder and that I needed to start taking an anti-psychotic medication immediately to bring me down from the mania that I was still apparently experiencing. That evening I began taking Zyprexa.

Once back in Virginia and back at work, I started having anxiety attacks on an almost daily basis. The feeling of waves of panic coming over my body were so intense that it became impossible for me to be effective at work. I was forced to resign from my job as a successful employment agency recruiter and in turn felt like I had lost part of my identity. Crying spells then became part of my daily routine, in combination with the anxiety, and I remember wondering if I were going to be feeling that way for the rest of my life. It was a scary time for me. I don't ever want to go back to that. Ever.

I remember back in the fall of 2006 when I was incredibly against going on Lithium, but yet, at my wits end with the way I was feeling I was ready to give in and try anything with the even the slightest probability of helping me feel like my old self again. For pretty much the entire year I had been depressed and anxious and thus I had reached a turning point. My psychiatrist at the time had been suggesting Lithium for a few months, but it just seemed so final, so imperative. But who was I kidding? It was obvious to the three different shrinks I had seen, one being a renowned specialist in the field, that I was bipolar and that a mood stabilizer was what I ultimately needed to function at a normal level.

So fine. I caved into going on a Lithium regimen the day after my husband and I had a consultation with the specialist. He didn't even see patients any longer, only did continuing research in the field. So when my dad's friend was able to get us an appointment as a favor, we jumped at the chance. At the time I was on Prozac and Zyprexa, along with Ativan for anxiety and Ambien for sleep. Nice cocktail of meds, right? The Prozac caused some suicidal thoughts, though nothing I ever remotely was going to act on. So my doctor had cut that dose back quite a bit. After seeing the specialist I started on Lithium and my regular doctor began to wean me off the Prozac and Zyprexa one at a time until I was eventually just on Lithium.

Within a matter of four months I found myself feeling like the old me again. I was ready for a fresh start and finally felt more confident. It was what I needed in order to launch a job search and in a few short weeks I landed a job as a corporate recruiter for a Fortune-500 company and I couldn't wait to get started.