This includes the life and times of a bipolar MD. The blog was started when I was in medical school- the previous title was Highs and Lows Bipolar in Medical School. I'm changing the focus of the blog but keeping old posts
As a medical writer, I end up having to research topics I wouldn't ordinarily think to research. Lately, I've been writing a lot for plastic surgeons so I've learned all about hyaluronic acid fillers. These are injected under the skin to "fill things out" and smooth wrinkles. And, they all have names that conjure images of fresh faced youth, like Juvederm. There's even a new product, called Radiesse, that stimulates the body to actually produce its own collagen.
Growing your own collagen isn't always a positive. Elephant Man, who some believe suffered from Proteus Syndrome, was very adept at growing his own collagen. That would not be a good way to explain the way Radiesse works. "Did you ever see the movie, The Elephant Man? Well, a lot of the way he looked had to do with collagen overgrowth, and actually, the stuff that I'm about to inject under your skin with this giant needle, causes your body to start growing more collagen... Hey! Where are you going?! Don't you want to get rid of your wrinkles?"
I'm happy to report, though, that if you are not happy with the way you look, there are many solutions including Accent skin tightening, Juvederm, Radiesse, Botox, face lifts...
I just got a shipment of medications from Glasko Smith Kline. Whenever I get a package, I excitedly shake it like a little kid on Christmas. And when I hear the moroca-y sound of lots of tiny pills tumbling around inside their plastic bottles, I get very excited. Because this means that another month has gone by where I will NOT have to pay twelve hundred dollars for my medications.
Yes, my medications cost 1200 per month. And getting help from the drug companies was like pulling teeth. I HAVE insurance, so I didn't technically qualify for most of the programs. The fact that my insurance caps out at 2,000 dollars a year didn't seem to count when I first applied. So I appealed. And in some cases, I appealed again. Finally I'm at the point where most of my drugs are supplied for free through some of these prescription drug charity programs.
This makes me really mad about being bipolar. Most things can be fixed. Relationships can be repaired, tattoos can be lasered away (If I were to so desire), but I will always be a slave to the pharmacy. Always always always. In day to day life, it seems easy enough. I get my prescriptions, I go to the pharmacy (or as is the case right now, I get my drugs from the companies), I take my pills... everything's fine. The trouble comes when I realize I'm running out of medication and I forgot to tell my doctor I needed another prescription. Sometimes when I'm planning to go on vacation, I realize I'm set to run out of medication right smack in the middle of the week. And sometimes, if you've got your 90 day supply, you can't get another batch of pills until that 90 days are up. So if you're going on vacation at day 85, and you need 10 days worth of pills during your vacation, you may not be able to get those extra 5 pills before leaving. That means you have to carry a prescription with you, and make a visit to the pharmacy wherever you happen to be.
The inconvenience isn't a big deal in and of itself- I don't sit around thinking about it, crying over it... it's just that it's a reminder.
In the past, whenever hypomania has struck, I've come up with the brilliant idea to start a business. And the business I'm starting always involves buying a printer. But not a printer that I already have, the five printers from the previous episodes won't work. Nope, if I already have an ink jet, I need a laser printer. If I have a black and white laser printer, I need an ink jet. If I have an ink jet and a laser printer, I need a printer that photocopies. A printer that photocopies in color. A big printer, a small printer... And then by the time the printer arrives, I'm back to a more level state... and my dreams of writing chemistry text books, making biology flash cards, and authoring a book of pneumonic devices designed to help people learning English as a second language, have dissipated.
I'm super on top of my moods and medications right now so I haven't been buying printers. Instead, I've developed an insatiable appetite for study aids. I'll pick out the perfect study aid on Amazon, buy it, and then when it arrives, I'll decide that another study aid must be better. And you'd think that eventually I'd run out of study aids to buy. Apparently it's a booming business, the business of making study aids. And I'm probably the best customer.
As of now, I haven't decided whether I want to crush step two, learn all the secrets associated with step two, step up to step two, learn first aid for step 2.
At the clinic where I'm rotating now, the weirdest complaints tend to be due to some medication side effect. It's like we prescribe medication so that people can get rid of their symptoms, and they end up with all new symptoms from the medications. And then they medicate that... It's like a perpetual motion machine.
For instance, it's been reported that people taking voriconazole (a fungus medication) have experienced hallucinations. So it is suggested that doctors tell patients on this drug not to worry if they see flying Christmas trees or Ewoks. "You're not crazy," the doctor should say, "It's just the medication."
I actually blame everything that goes wrong with my body on my medication. Stomach ache? Medication. Headache? Medication. Stubbed my toe? Must be related to medication... I'm on quite a cocktail.
Lamictal is technically an anti convulsant. So people use it for seizure treatment. But it's also one of the only drugs "officially" designated to treat bipolar disorder. It helps with mood stabilization, just like Lithium and Depakote. Lithium is sort of the gold standard, it's what everyone in the medical community thinks when they hear someone say "bipolar." Sometimes people are surprised when I'm not on Lithium. But, for better or for worse, I'm on Lamictal. It has its advantages- it's not famous for causing weight gain, water retention, or mental "fogginess" like some of the other drugs. It is famous for causing a rash, though. A certain percentage of people who take it do get a rash. Then, a certain percentage of those get this horrific thing called Stevens Johnson Syndrome. I've got a Stevens Johnson Syndrome flash card for Board Review. It's got this guy on the front with a disgusting, scabby face. On the back, it says, Stevens Johnson Syndrome, and then lists causes which include medication, like Lamictal. Stevens Johnson Syndrome is serious, and you do NOT want to end up like the guy on the flash card. When I first went on the drug, I called my doctor in a panic, furiously scratching my stomach and wondering if it was pink because of an itchy rash, or if it was pink because I was scratching myself and therefore creating a rash. My doctor told me to calm down and that I did NOT have Stevens Johnson Syndrome. So far, the Lamictal has worked out well. My moods are stable, and I'm not going to end up on a flash card.
Seroquel is an "atypical antipsychotic" that is being sold to treat everything from anxiety and insomnia to bipolar disorder and schizophrenia. It's also being sold on the black market as a drug of abuse in some prisons. I'm still trying to figure that one out. So, the label "Anti-Psychotic" is a bit of a misnomer, and that's one of the drugs on my regimen. It's famous for causing the "wet blanket" effect where you feel like you're under water, you can't think, you can't read, you can't concentrate. In short, it can make you feel slow and stupid. It can also make you gain weight. I take it at night and it has the immediate effect of helping me to fall asleep, as well as a more long term mood stabilizing effect. I was really careful to watch my diet when I started the drug so I didn't have the misfortune of gaining weight, although my mind was dragged under water to a place where I could no longer think or read. Luckily, this "extreme wet blanket" phase didn't last. I'm sort of in a chronic, slightly damp, blanket phase. I'm not as sharp as my sharpest hypomanic state, but I'm also not as dumb as my dumbest depressive state. The one really annoying problem that has persisted is the dry mouth. I awake in the middle of the night with no saliva. "Oh, no Emily, surely you have SOME saliva when you awaken in the middle of the night..." Nope, I'm not exaggerating. It feels like I tried to eat 10 saltines in under a minute. It's that sort of dry. Tumble weed dry. So I have to keep half- diluted Gatorade by my bed. And I have to go to the dentist quite frequently. A dry mouth is conducive to cavities.
Next, the anti depressants. Lexapro is an SSRI, in the Prozac family. It's the usual- sexual side effects, causes some people to be sleepy, causes insomnia in other people, causes overeating, undereating... All the side effects are mild. I don't think this pill gives me too much grief.
Wellbutrin works on dopamine and norepinephrine. It has the distinction of NOT giving sexual side effects. In fact it makes some people hypersexual, not that it had this particular effect on me. It also helps people pay attention, it's good for ADHD. But, it lowers the seizure threshold so it's not so good for people detoxing from alcohol. And it's not so good for people with bulimia. Those two groups are particularly prone to seizures, so when you add Wellbutrin to the mix, it doesn't always turn out so well. Actually, one positive effect that this drug has is that it makes you LOSE weight. Almost every single psychiatric drug known to man causes weight gain- except for Wellbutrin. It actually made me disgusted with food for a while. I lost about 5 pounds. But I gained it back. I stayed in equilibrium.
My roommate just told me about a "Mad Pride" movement. It’s sort of like Gay Pride, apparently, except it’s for those with “differently balanced” chemicals. I’ve never heard of any medical conditions that have associated pride movements.
Asthma Pride- the members get together to take beta blockers and smoke in an enclosed area, gasping that they deserve acceptance too, that they shouldn’t have to hide behind inhalers.
I guess Asthma Pride lacks a certain glamour, nobody proudly says, “Van Gogh had asthma,” while puffing away at an inhaler. Nobody attributes any great literary works of genius to hyperactive airways. And nobody claims that asthma attacks are accompanied by bursts of creativity.
I’m bipolar. I’ve had the bursts of creativity, the midnight tattoo runs, I paint, I write, I have great stories… But then there’s the bank account, overdrawn by 2000 dollars, there’s the fact that I now have what I refer to as the “Take-Your-Medication-For-The-Love-Of-God” tattoo, there’s the trail of worried friends and relatives, the hospital stays, the medication…
It’s sort of like when they show these beautiful snowy scenes in movies and on television shows. They don’t necessarily show the day after, when the snow has turned gray and slushy, when your shoes aren’t quite warm enough or waterproof enough to keep your toes safe, leaving you with little white prunes at the end of the day, and when you can’t even shop for groceries because the cars that are turning the snow gray and black are all stuck and blocking traffic, wheels desperately screeching and spinning. But it seems so romantic the day before, little white flecks gently floating out of the sky, children sledding, snowmen… There’s a day after with mental illness too.
I’m not proud of being mad. I accept it, I medicate it, and I manage it so that I can graduate from medical school and become a doctor, hopefully without accruing any more debt, tattoos, or bizarre collections of items that seem like a good idea to purchase at 2 in the morning.
