Hell in Paradise – Part Two – Seeking The Real Aloha

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Our family in front of the Kona Inn Restaurant in Kailua-Kona at sunset, November 2013

To read the revised version of Part One please visit here

December, 2013

I know it sounds ridiculous to complain about being in Hawaii, but anyone who has experienced bipolar depression can empathize with this seemingly narcissistic attitude. No matter where you are, it doesn’t matter – being in such despair is a malady of the spirit that turns heaven into hell.

There were moments when I was able to acknowledge and appreciate my family’s joy during their various activities, but I was leaden and ashamed that I couldn’t be like them. 

We arrived at a gorgeous beach in Kua Bay that was perfect for boogie boarding. My girls and husband Craig made a beeline for the gentle aquamarine waves. I used to love to go boogie boarding when I was a teenager in the (much) colder waves in Santa Monica, California. In Hawaii I watched my family play in the waves from afar, unable to join them.  

I baked on the sand and people-watched instead, envious of the beach-goers glued to their books under umbrellas. I was so apathetic that I hadn’t even bothered to bring a good book with me. This was the complete opposite of how I behaved when I wasn’t depressed. Normally I’d never travel more than a couple feet without clutching a riveting book or my Kindle Fire.

Each day in Hawaii I desperately hoped for my unrelenting depression to lift so I would feel the Aloha spirit I heard so much about.  While the word “Aloha” is often used to mean “goodbye”, “hello” and “I love you”, there is a deeper meaning to the word.  The website http://www.huna.org explains:

Aloha is being a part of all, and all being a part of me. I will not willfully harm anyone or anything. The earth, the sky, the sea are mine to care for, to cherish and to protect. This is Hawaiian – this is Aloha!

I was full of anti-Aloha sentiment. That attitude felt all wrong in such a glorious setting.  In an attempt to feel better, I self-medicated with food and beverages.  On a humid, seventy-five degree day I inhaled a bag of “Donkey Balls”.  Yes, they were called Donkey Balls consisting of macadamia nuts covered with multiple layers of chocolate. The balls were a temporary sugar fix and they left me feeling nauseated and plumped up.

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My psychiatrist discouraged me from drinking caffeine due to the contraindications associated with the MAOI (monoamine oxidase inhibitor, a class) medication I recently starting taking with lithium. The  MAOI, called Parnate or tranylcypromine, was known to help treatment-resistant bipolar depression and like lithium, was old-school. MAOI’s were the first type of antidepressant developed, but Dr. D. didn’t think the Parnate would send me into mania as long as I took the mood stabilizer lithium.

My meds didn’t stop me from sucking down the famous Kona coffee of the region.  

High-quality Kona coffee often sells for at least $30.00 a pound.  Once I sipped some of it I understood why java addicts with cash to burn paid such an astronomical price for these beans. When we arrived at Al’s Kona Coffee Farm rental, Al left us a bag of his Kona blend.  I made a pot of it every day on his farm, and all that tasty coffee left me jittery and contributed to my insomnia.

Parnate’s dietary restrictions also prevented me from binging on certain comfort foods which I previously enjoyed such as aged cheeses and cured meats. MAOI’s require that patients relinquish eating anything high in the amino acid tyrine. I made up for that restriction by gobbling a large bowl of granola each night – it was a temporary sugar high.  Not to mention gross. Of course the sugary cereal also worsened my sleeplessness.

I was desperate to feel better, but since I felt so hopeless, I didn’t have much self-restraint.

To complicate matters, I obsessed about mortality.  We had brought my mother-in-law’s ashes and planned to scatter them in a spectacular location.  This type of ceremony was a fitting way to memorialize her because she loved the region. I knew she would have appreciated it.  But I was sickened by the macabre fact that her ashes were hidden a mere room away from where I slept every night.

We found the perfect place to disperse her ashes. It was a reef just off the Puuhonua o Honaunau National Park.  Also known as the Place of Refuge, this park was once the home of royal grounds and a place of refuge for ancient Hawaiian lawbreakers.  Kapu, or sacred laws, were tantamount to Hawaiian culture.  (If you’re thinking of that Brady Bunch Goes to Hawaii episode you’re not the only one!)

Seriously, the breaking of kapu could mean death. A kapu-breaker’s only chance for survival was to evade his pursuers and make it to a puuhonua, or a sacred place of refuge. Once there, a ceremony of absolution would take place and the law-breaker would be able to return to society.

On the surface, this park was a gorgeous, peaceful spot. As I learned a bit about its intense historical background, that distracted me a little bit from my depression   

Near the visitor center I walked by a huge plumeria bush and I surreptitiously picked a handful of the lovely, fragrant blooms.  Upon my return to the beach once again I was a passive observer rather than a participant.  I gave a few white and yellow plumeria blossoms to my husband and daughters and then I plopped down on my towel.  They walked out onto the reef together and tossed the plumerias into the ocean in remembrance of my mother-in-law.  (Craig decided to scatter her ashes alone.)

Less than ten days after we returned home, once again my bipolar depression lifted.  How did that happen?

A few days after our return my insomnia grew even worse and I experienced two completely sleepless nights.  Even one sleepless night could trigger mania and I could end up in the hospital, so I called Dr. D.  He prescribed Seroquel (generic name: quetiapine), a heavy-duty atypical antipsychotic.  It nipped my insomnia in the bud. As controversial as Seroquel is, I’ll always be deeply grateful to this medication for helping me in a crisis.

I noticed that my depression subsided a few days after I started taking the quetiapine.  It seemed to me that there could be a connection between my depression vanishing and starting the quetiapine, so I remained on it  despite the side effects  I had of daytime grogginess and some weight gain/nighttime hunger.

I was able to laugh again – not fake laughs, but the real deal. I had fun with my girls and Craig, and I felt hope trickle back into my brain. To my utter relief, I could write again. I stopped waking up every day wishing I could escape back into an agitated sleep. I knew that life would continue to be difficult, but I hoped with every cell in my being that I wouldn’t return to the hell of bipolar depression ever again.

10/9/15 Meds Update: I’ve been taking 900 mg of lithium/night, 30 mg of tranylcypromine/Parante a day ever since Hawaii. I slowly tapered off Seroquel, but I resumed taking it last August when I became hypomanic at the Catamaran Writers Conference. Today marks the second week I’ve been off Seroquel. So far, so good, but if I find myself becoming hypomanic I’ll take it again in a heartbeat! 

Dyane is completing her memoir Birth of a New Brain – Healing from Postpartum Bipolar Disorder with a foreword by Dr. Walker Karraa (author of the acclaimed book Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth).

Medications| International Bipolar Foundation & More, Oh My!

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 Lucy, stick to dog kibble!

 There’s something in the blogosphere air this week…

After months of my faithfully posting every Friday, no more, no less, these past few days I’ve been full of blogging & re-blogging excitement! I just can’t help myself, especially when it comes to the topic that my good friend Kitt O’Malley addressed today in her acclaimed blog.  Kitt’s post contains an International Bipolar Foundation post written by our our mutual friend Susan Zarit.  I also have been blogging for the International Bipolar Foundation once a month, but I haven’t tackled the slippery slope of medication yet.  What has dissuaded me in part is that bloggers aren’t allowed to mention specific medications in our posts, so it’s a good thing I have my own blog! 🙂 Please read on…

I’m on a mission to let people know about a rather “obsolete”, unsung bipolar medication combination that DID work to lift my years-long, insidious, evil bipolar depression.   I’ll tell you one thing, my friends, it wasn’t no gift! 😉

What still boggles my mind to this day is that none of the numerous psychiatrists I consulted with ever thought to mention this medication until my most recent doctor, Dr. D.  Since I was diagnosed with postpartum bipolar one disorder in 2007, Dr. D. is the best psychiatrist I’ve ever seen, bar none, and a big reason why that is the case is because he thought out of the box, he had extensive experience, he was patient, and most importantly…he cared.  

In late 2013, per Dr. D.’s suggestion, I started taking an MAOI (monoamine oxidase inhibitor) medication called Parnate, which is an old-school anti-depressant medication.   I’ve never had any anti-depressant throw me into hypomania or mania, but of course that was a concern. The fact I was taking a therapeutic dose of the mood stabilizer lithium was a safeguard in a way, but of course I needed to be closely monitored.  

There are a few different MAOI’s and they’ve been used for decades for bipolar-medication resistant patients!  So yes, again, I wonder why didn’t any psychiatrist think to tell me about MAOI’s as a possibility before Dr. D. suggested them?  I’d love your take on that one! For the record my father (who also had bipolar one) took an MAOI in the early 1980’s, but it didn’t work for him as he drank alcohol while taking it, which is a BIG BIG no no.

Parnate works especially well when used with lithium; I take 900 mg of lithium a night and I’m extremely lucky that my blood tests have all been normal and I can tolerate it very well..

I never like to give false hope when it comes to bipolar & meds, but this combination of an MAOI and lithium has been nothing short of miraculous in my life. It hasn’t been perfect; there are sacrifices I’ve made (some good, i.e. the nixing of alcohol!) but dammit – these sacrifices have been completely worth it.  Read on for more info. – and I’ll try not to blog again until my regular Friday. Famous last words….. 😉

p.s. feel free to ask me any and all questions about MAOI’s & if I don’t know the answer I’ll ask my psychiatrist when I see him on Thursday.

Kitt O'Malley

My friend Dyane Harwood of Birth of a New Brain responded to a recent IBPF blog article by Susan Zarit entitled Medications: To Have Or Not, That Is The Question! Susan Zarit of Bravely Bipolar has struggled unsuccessfully to find a medication combination that works. I can only imagine what Susan must go through mood cycling on a daily basis. Neither Dyane Harwood nor I are medical doctors. Please see a psychiatrist for psychotropic medications and to discuss medication changes. Medication of psychiatric illnesses requires the expertise of a psychiatrist. In my opinion, serious mental illnesses, such as bipolar disorder and schizophrenia, are best treated with medication by board certified psychiatrists. Supportive psychotherapists should be expert in working with our populations. We need more specialized support than, say, relationship counseling.

Dyane Harwood | Tue, 2015-03-03 09:34

Hi Susan! thanks so much for writing about this topic!

I know you wrote…

View original post 239 more words

Groggylicious

 

Bobs #!

 

Good Monday morning, everyone,  how are you?

This past week I’ve gotten off to such a slooooow start in the mornings.  If it wasn’t for the roaring LifeFlight rescue helicopter I heard at 5:00 a.m. (we live across the street from its landing field) I wouldn’t be up right now.

The time change threw me off, which I expected, but I still hoped it wouldn’t affect me to the extent that it did.  Despite using my cheery Sunbox light as soon as I get up, I resemble a cast member from the film “Dawn of the Dead”.  I kind of look like this fellow, but with long brown hair.

imagesIt ain’t a pretty sight!

I suspect another culprit for my sluggification is the change of seasons.  I’m simply not a cold-weather gal; I was born and bred in balmy, 70 degree Los Angeles for heaven’s sake.  Although I still live in California, it gets very chilly up here.

Adding to the fun is the advent of “Leak Week”.  As my husband lovingly told me the other day, our bed looked like the setting of a hunting accident.  A visit from Auntie Flo always makes me tired.  (Sorry for T.M.I., but please believe me, this post could be much worse.)  

Case in point:

https://proudlybipolar.wordpress.com/2014/02/18/my-freaky-malodorous-urgent-care-life-lesson/

I’ve been trying harder to be healthy in order to boost my energy level.  I work out almost daily on my elliptical and  I usually get enough sleep.  While I take lithium, tranylcypromine and quetiapine, all notorious for causing fatigue, I haven’t made any med changes up to now.  

But I’m still exhausted.

I need to reduce my sugar intake, as I know that causes “sugar crashing” and I eat too much of it. It seems like there’s always something new, sugary and tempting that hooks me in.  The latest product is Marley’s One Drops with Jamaican coffee.  I could rhapsodize all day about how tasty these One Drops are. (I don’t work for the Marley Beverage Company, LLC.  I’m not being paid to advertise for them – I wish!  I could use a little cash to buy a new laptop.)  

Anyway, apart from that, I promised to report on how the book writing is going.  I’ve been plugging away.  It helps immensely to have a virtual writing mentor in Wendy K. Williamson (bestselling author of “I’m Not Crazy Just Bipolar” and “Two Bipolar Chicks Guide to Survival”). Wendy holds me accountable.  Moreover, she truly understands the challenges of writing a bipolar-themed memoir.  But as wonderful as she is, Wendy can’t write my book for me.  She’s writing two or three of her own books at the moment, and promoting her most recent book “Two Bipolar Chicks Guide to Survival” so she’s a bit busy.

If any of you have energy-boosting tips, I’d love to read about them.  Also, if you’re participating in “NaNoWriMo”  (National Novel Writing Month, an annual writing project in which writers complete a novel in a measly month!) I want to know how the hell you do it, especially if you have young children running around your house.  

I wish you all an energy-infused week in which you make progress on the creative projects close to your heart.  

take care & thanks for reading as always,

Dyane 

Bobs #2

Please endorse me for the WEGO Health Award – if you want to share the link that’s fine too. 😉

I was nominated by the super-awesome bestselling author/bipolar advocate

Wendy K.  Williamson. It takes  about 20 seconds to endorse nominees. Visit:  

https://awards.wegohealth.com/nominees/4811

The Power of One Pill

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Pills.  Ah, pills.  “Pill” is such an innocuous-sounding word, but anyone with bipolar disorder who takes medication knows that pills are anything but harmless.  However, unless you depend on medications to keep you stable, and unless you’ve experienced a med horror story, it’s hard to understand why someone highly sensitive to meds would TOTALLY freak out at missing just one dose.

(***Trigger Alert: suicidal ideation***)

Over the past year I’ve become used to taking my MAOI med Parnate (tranylcypromine) three times a day.  That hasn’t been a big deal – I’m incredibly grateful for it since this drug brought me out of bipolar depression when twenty other meds did not.

But as ridiculous as this may sound, refilling my Parnate has been problematic. Here’s a little backstory…please forgive me for it being tedious!  It’s difficult for me to spice up the topic of medication!

When I first started taking Parnate, my psychiatrist wasn’t willing to arrange refills.  His rationale, which he explained to me rather apologetically, was that he wanted to keep close tabs on me.  While I was frustrated with his philosophy (and I told him so!) I understood where he was coming from.  Eventually I asked him to arrange refills and he complied with my request, which was great.

Last week I noticed my bottle of Parnate was getting on the low side and I called Costco to refill it. (Unfortunately, I didn’t think to ask if their pharmacy offers an “auto-refill notification” system so I could be contacted when my medication was ready.  CVS has an auto-refill system that I use with my lithium, and it’s awesome.) In any case, I thought I would be able to get my Parnate without missing a dose.

I forgot that a holiday was coming up, Memorial Day, and that the Costco pharmacy would be closed exactly when I needed to pick up my medication.  That meant that I was going to miss at least one dose, which sent me into a panic.  I was furious with myself because it was my fault for what happened!  Furthermore, I was also mad because I hadn’t thought to ask my doctor if he could prescribe me a few extra “emergency pills” in case this kind of situation happened.  (BIG DUH!)

My husband Craig was in the same room when I flipped out about my error.  We’ve been together for sixteen years and this poor man stood by my side after I was diagnosed with bipolar disorder.  He has been to hell and back in helping me with all my emergencies, care taking, my seven hospitalizations, you name it.

As I threw my tizzy fit, he casually said, “Don’t worry about it.”

What?” I screeched, just shy of a yell since the kids were outside.

Then I angrily muttered,”You’d probably feel differently about it if you were hospitalized seven times in the nuthouse!”

I could sense the hairs on his arms raise in aggravation.  He said nothing and walked away.

At that point I knew I needed to calm down, so I tried thinking rational, soothing thoughts such as:

“You won’t go off the deep end just for missing a dose!” and:

“It’ll all work out!” and even:

“Let go and let God!”

Lo and behold, my mood actually started to level out.  I released my anxious fears because there was absolutely nothing I could do short of robbing Costco.

I felt contrite for blowing up at Craig, and I tracked him down.  I told him I was sorry; luckily he accepted my apology and gave me a hug.  I know he’s burned out from having heard about my medication woes for so many years.  Anyone, even Mother Theresa or the Dalai Lama, would be tired from my numerous complaints, emergencies, and years of seemingly never-ending depression.

While I blame myself for not creating a good medication refill system, I do give myself a break regarding my feelings about missing doses.  I give myself another break for how powerful a pill can affect my system.  The following tale is why I’m letting myself off the hook for my tantrum one last time.

One, itsy, bitsy psychiatric pill made me suicidal.

My former psychiatrist prescribed me an antidepressant medication called Elavil (amitriptyline) and after I filled the script, I took my first pill. Literally two hours later I wanted to hang myself with my bathrobe belt and Craig, thank God, was home.

I told him I felt suicidal and he rushed me to the hospital. There is no way that anything else but that pill that made me feel that way.  I know the subject is so morbid to think about, but up to that very afternoon I knew that if I would ever actually take my own life, I would *never* use that horrific method.  I think that my brain played tricks on me, triggered by the medication, because someone I had cared about had hung himself just a month before that awful day.  I suspect my brain synapses wanted to do a copycat action in reaction to the medication. Who knows? Again, thank God Craig was home.

Because of what happened with Elavil, I’ll never underestimate the potential consequences of missing a single pill or taking a single pill.  I’m paranoid, yes, but now don’t you understand why I feel that way?

So there you have it.  “What’s the point of this post?” you may be thinking.  (I know that’s what I would think!) Well, if you have bipolar disorder and take medication, I implore you, don’t wind up like me.  See if you can arrange an auto-refill system with your pharmacist.  I know CVS does it and I’m going to call Costco to see if they offer the same program.  I’m also going to check in with Dr. D. about having an emergency supply of Parnate – at least a few days worth.  I’ve been wisely advised in this comment section by Rob to buy a weekly pill dispenser to give me more notice when I’m getting low on meds. (Thanks Rob!)

I do make a point of carrying an extra dose of Parnate in my purse in case I find myself away from the house unexpectedly for a chunk of time. These are all little things that can make such a big difference in my peace of mind, and yours.  Take care and may all your script refills go as smooth as silk! 😉

 

imgrescat pills(Hope this cat photo doesn’t offend you – I thought the expression was hilarious!!) 😉