COVID-19 Quarantine

The past few months have been strange. I saved up for two years and went on a cruise with ten friends in mid-February. We cruised from Ft. Lauderdale to Cozumel and back and it was fun! When I got back to Florida, I spent the day in Miami with one of my cruise friends before flying home.

Then, in early March, my father passed away after being in home hospice off and on for three years. We couldn't have his memorial service because of the COVID-19 pandemic just beginning to take off in the United States. We still have no idea when we will be able to have the service.

I've been working from home for three weeks now. This is a strange period of time and I wonder how long it could go on. I live alone and I'm social distancing so I'm not seeing many people at all. I have had some conversations with neighbors, from a safe distance, when walking around outside. I've had teleconferences for work and also with friends. That's the only socialization I have had besides phone calls with some friends and family and also sitting on porches and far away from people in their homes when that was still considered to be safe. I guess I could also count socialization over Facebook, Twitter, and Instagram as well.

Now we have been advised not to socialize at all -- even if we are 6 feet apart. Today I played the daily briefing from our governor from a speaker so a neighbor could hear it from afar. I sat on my deck and she sat about 20 feet away in the common yard of our condominiums. We decided to listen to the radio together again tomorrow.

All of this has been kind of surreal. I know I am better prepared for this than a lot of people because my battle with bipolar disorder has put me in lots of isolating positions before and I have worked hard to develop coping skills. I have also developed a Wellness Recovery Action Plan that helps me plan for wellness every day. I also think my medication gives me an edge over my peers who are experiencing this level of trauma for the first time.

I am taking things one day at a time. I am happy with the way my governor is handling this pandemic. He is focusing on the health and the lives of the people in my state. I am not happy at all with the way the federal government is handling things. I try not to think about it too much.

Along with social distancing, I'm trying to stay as healthy as possible by eating well and exercising. That way, if I become ill, I will hopefully be able to get over it at home. I do fear anyone I know becoming extremely ill and possibly dying alone in a hospital. I hope it doesn't happen, but I am mentally preparing myself for that possibility. It seems like, by the end of this, most of us will probably know someone who passed away during this pandemic. Spring is usually my favorite time of the year. This year, it is pretty grim.

The Days Are Getting Brighter

It has been very rainy this winter. It has also been snowy and freezing at times. There have been a lot of dark days. And night comes so early. I think it is the great reduction in daylight that brings on my depression more than anything else about the winter.

I have always enjoyed the outdoors, but the older I get, the less time I want to spend outside when it's cold. I have bought some warm coats to compensate, but I often stay inside a lot in the winter.

Spending time outside in the winter becomes like a fight for me and I usually give in to staying inside too much sometime in January or February. Luckily, the days get longer as the winter progresses and I usually start feeling better by the end of March.

I had an appointment with my psychiatric nurse practitioner earlier this month and she determined by the questions I answered that I was experiencing depression. She said she thought I should try adding Wellbutrin to my daily medication regimen of Seroquel, Lamictal, and Deplin. I had told her that I was putting all of my energy into work and felt little motivation for socializing, cleaning, or working out. I have also been dealing with some knee pain that has been unpleasant and annoying, but thankfully, seems to be lessening.

I have been taking the Wellbutrin every morning with Deplin for about two weeks now. I take Lamictal and Seroquel at night. I do feel better. I am sleeping less, and I have more energy to get things done. I have spent more time taking care of myself after work and I have been socializing a bit more. I feel more activated but I also feel a little bit more impatient although it hasn't caused me any problems, it is just something I have noticed about feeling differently and will self-monitor.

The Wellbutrin seems to be helping but if I feel hypomania coming on, which I am good at recognizing after being treated for bipolar disorder for the past 29 years, I will stop the Wellbutrin and call my psychiatric nurse practitioner as she advised me to do. If all goes well, I will stay on my current medication and have another appointment next month. She had talked about me switching to Vraylar from Seroquel. She said that it might have fewer side effects and she said that some of her patients have done well with Vraylar.

I have been feeling better with my current medication. However, switching medications to reduce side effects seems like a good idea. I have done that several times over the years and I have been happier living with fewer side effects than I have in the past. My current worst side effect is weight gain. Changes with my medication that could help me to lose weight and maintain a healthy weight would be welcome changes.

It is Saturday and I have social plans today and tomorrow. That is an indication that I am already feeling better because I have mostly felt like resting and getting ready for the work week for the past few weekends and not doing much else besides sleeping, eating, reading, laundry, and grocery shopping. That is kind of natural for me in the winter, but I'm hoping that having added the Wellbutrin will make it easier to be more active for the rest of the winter. I am not sure if I will be taking Wellbutrin year-round or just taking it as needed in the winter. I will find out more at my next appointment.

Recovering From Conversations With My Mother

One of the hardest things I do regularly is talk to my mother. She is very critical. I don't make enough money, my hair doesn't look right, my lipstick is the wrong color, I need to lose weight, I need to be more social, I need to go to the gym more--the list goes on and on. There are always a quite a few things I am not doing right that I need to improve. If it is not one thing, it is another. Things are constantly being added to this list of complaints. Some of them are minor, but the negative energy and disapproval wears on me nonetheless.

These conversations full of unsolicited advice are very demotivating. They make we want to quit everything and give up. My hopeless and suicidal thoughts ramp up the more I talk to my mother. I have told her that I try very hard to stay positive and that these conversations bring me down. I tell her that I need support, not criticism. Yet these unpleasant topics come up again and again. The negative emotions that come up affect me for hours and days.

My parents are getting old. I feel like I should spend some time with them, but it is very hard. Lately, I have been limiting the time I spend with them. I do not enjoy the time I spend with my parents. I see it as a duty. Most of the time it is depressing, lonely, and painful.

I have taken to giving myself pep talks after I talk to my mother. I tell myself that I don't really want to give up everything and die. That is just a reaction I have when I am repeatedly criticized and insulted. I think of all that I have to live for. I think of how far I have come. I tell myself that I have a very good job. I do not make a lot of money, but I have good benefits and I have been getting raises.

It makes sense to keep my job even though it is not good enough for my mother. My job is flexible and I need a lot of time off to go to various health-related appointments. That is a benefit that is hard for people to understand if they do not have to live with a chronic illness. My primary illness is Bipolar I, but side effects and other health conditions have come up over the years, and other medications and treatments have been added. Taking care of my health has become a juggling act that not every employer would support.

When dealing with my parents, there is no joy, but I think of the importance of compassion. My upbringing was far from happy and stable, but without my parents, I would not be alive. You do not get to choose your family, and this is the family I got. Maybe the purpose was to make me stronger.

Saving Myself

It is hard to live with bipolar disorder. Even though I take medication, I still have symptoms. If I take enough medication to stay symptom-free, I can't hold my head up and work. That level of medication causes me to sleep all day. Medication takes the edge off of my symptoms and slows me down enough so I have time to think before I speak and act--and that has kept me out of a lot of trouble and has allowed me to develop better relationships and also to work full time. But I also have to use a multitude of coping skills to stay well, including setting healthy boundaries.

Because I experienced emotional and sexual abuse within my family, I have to limit the amount of time I spend with my parents to protect my mental health. I have had to keep very firm boundaries about how much time I spend with my parents, what kinds of activities we do together, and what we talk about. My parents are aging and now need extra help--which I give them one day a week at most--usually on a Saturday or Sunday. Sometimes I skip some weeks if they seem to be doing well. I also have to limit the time I spend talking with them on the phone--especially with my mother. My mother is disappointed by short conversations. She would prefer to talk for at least and hour, but I don't have time for that long of a conversation every day. I try to keep our conversations to less than 20 minutes and I call most days to check in on my parents. My sister, who is their Power of Attorney, lives in a different state. We have decided that if my parents need more help than I can give them, they will have to pay for that help by hiring helpers and nurses. I believe in helping my parents, even though I suffered abuse at their hands, but there is a limit to what I can do and still maintain my mental health. I have learned from my life experiences that saving myself is very important. If I am not careful, I can spiral up into mania or down into depression and end up not being able to work or take care of myself for weeks or months at a time. That is a great incentive to stay well!

Because I have a limited amount of energy, my focus is on work. I have friends, and I am involved in community activities, but I don't do everything I could possibly do because rest and sleep are very important to my staying well. I try to have fun every day and spend time with people I like, but I also try to be home by 9 p.m. every night. Sometimes, I make an exception to that rule and stay out late, but I always pay for it later with sleepiness and inconsistent moods. Currently, in my free time, I attend therapy one night a week, take a ukelele class, exercise, have coffee and dinners with friends, and go to movies, plays, and concerts. I am also a member of two social clubs, and I am on the executive committee of one of them. I stay busy, but I also rest and sleep quite a bit. Also, if I am not in a good frame of mind, which can happen at unpredictable times, I bow out of social events and work on maintaining my wellness. I would love to do more than I do, but experience has shown me that if I overextend myself, I cannot stay well. This is what led to me being on disability between 2008 and 2016. I am now trying my hardest to stay well and stay off of disability.

The Last Days of Summer

I'm enjoying the last days of summer. I feel like I've taken full advantage of the season. I've spent a lot of time outside, I took a 12-day staycation, and I've spent ample time hanging out at my condo pool where I exercised, sunbathed, and enjoyed talking with neighbors and making new friends. I also worked on decluttering my condo and having needed repairs done.

One reason I think I enjoyed this summer so much is that I focused on self-care, including working to improve my physical health, and it has paid off. I started taking Deplin for my MTHFR homozygous C667T genetic mutation and I also started taking iron supplements for an iron deficiency that I have probably struggled with for years. I switched doctors in the spring and my new doctor tested my iron levels, when I reported having heavy periods, which my old doctor had never done. Taking care of these health problems seems to have increased my energy level, and I also look and feel healthier. I have better color and my hair is growing in thicker (iron deficiency can lead to both paleness and hair loss).

I've also continued my weekly therapy sessions which I started in February of 2016. Although I've been in some form of therapy for years, this is the only time I have ever been able to afford weekly sessions. In earlier years, I tried to make it once a month, but that wasn't always possible. Having weekly therapy has helped me so much because I can work on problems I face every week. Before, therapy was overwhelming because I felt I had so much to rehash in my infrequent appointments. I have experienced a tremendous amount of personal growth over the past two years that I attribute to these weekly therapy sessions. I'm so grateful for them!

I also read two daily meditations every morning which help to give me a lot of clarity. It is a great way to start my days. I read The Language of Letting Go and A Restful Mind: Daily Meditations for Enhancing Mental Health. Both of these daily meditations have been incredibly helpful to me!

I love my job, but sometimes it is stressful. At those times, I use wellness tools from my WRAP. My favorite wellness tools to use at work are: taking a short walk, using some scented hand lotion, or doing a few rounds of square breathing. I also make sure to drink plenty of water during the day.

So, I'm feeling really good about the end of summer. I always notice seasonal changes since I feel so different at different times of the year. I'll miss the relaxing afternoons at the pool, and leisurely chats with my neighbors, but I'm ready to make the transition to indoor exercise and swimming at the Y. And, one of my new friends that I met this year at the condo pool is also a member of the Y, and we have already taken a trip there together. We are both going to miss the outdoor pool, but we both know we need to keep exercising!

Medication Change

In May, I took the GeneSight test and found out that I have a genetic mutation--MTHFR homozygous C677T. This means that I will have low folate levels no matter how much folate I consume. For this reason, my psychiatric nurse practitioner prescribed a supplement called Deplin, which is L-Methylfolate, and is recommended for people with this genetic mutation because it is a form of folate that my body can use. With enough folate in my body, I should have fewer health risks and my medication should also work better. A lot people with bipolar disorder, depression, schizophrenia, and ADHD have this genetic mutation and Deplin is considered to be a dietary treatment for these disorders.

Because I am now taking Deplin, I was advised to cut my doses of psychiatric medications in half. I am now taking 100 mg. Lamictal, 100 mg. Seroquel, and 15 mg. Deplin. I successfully cut my Lamictal dose in half, but I haven't been able to go lower than 100 mg. on Seroquel. If I take a lower dose, I don't sleep well, and feel very tired the next day. My psychiatric nurse practitioner suggested that a switch to a low dose of Vraylar, along with the Deplin, may work well for me and may end some of my dangerous side effects from Seroquel (whenever I take Seroquel, my blood sugar goes up, my cholesterol is higher, and I gain weight, and then have a hard time losing it). So, I may discuss making the change to Vraylar at my next appointment. Vraylar seems to work better than Seroquel for some people and have fewer side effects for some people.

Since this medication change, I've been feeling more alert. I've been enjoying the end of the summer, and I feel equipped to do everything I need to do with confidence that I can remain stable. I'm continuing to practice good self-care, which for me means drinking lots of water, eating well, limiting caffeine and sugar, exercising, getting plenty of rest and sleep, spending time with friends and family, avoiding alcohol, and taking things one step at a time.

Wellness

It has been 28 years since I was diagnosed with bipolar disorder, and I finally feel like I have figured out how to stay well for the rest of my life. It has been almost three years since I was  last hospitalized for mania. In the time since, I have made wellness the focus of my life. I work in the mental health field and my job is not too stressful. I work 37.5 hours a week and have good benefits and generous vacation time. It is never hard for me to get time off for doctors' appointments. It is a very good, healthy work environment. Having an interesting job that is easy to live with is very important to my mental health recovery. I have other health conditions besides bipolar disorder: PCOS, sleep apnea, psoriasis, allergies, and high blood pressure, and these health conditions are all well controlled by lifestyle changes and medications. I have found that keeping these conditions under control helps my mental health.

I am taking the lowest effective doses of my medications for bipolar disorder and they are working well: 200 mg. Lamictal and 100 mg. Seroquel. I have no complaints about side effects besides having to sleep a little bit more than I would like. It is much better than struggling with insomnia, psychosis, and mood instability as I have in the past though. When I think about the days when I was heavily medicated, being on such low doses of medications and doing well seems like a miracle. I also take the following supplements: a multivitamin, fish oil, vitamin D-3, and biotin. I take them because I believe they contribute to my overall wellness.

I stick to a routine. I have a regular bedtime and wake time. I believe that prioritizing quality sleep is the most important habit that keeps me well. I take my Lamictal and Seroquel between 8 and 9 p.m. and usually fall asleep between 10 and 11 p.m. I wake up at 7 a.m. on work days. I usually stick to the same routine on the weekends, but I occasionally stay out late with friends. Staying out late always requires sleeping late the next day because, with my medication, I always need 8-9 hours of sleep to feel rested.

I exercise every day. On Mondays, Wednesdays, and Fridays, I do a full-body strength training routine using dumbbells and a kettlebell. I have realized that I feel much better when I feel strong. Lifting weights also helps me to sleep much better. On the days that I don't lift weights, I at least take a walk, but I also enjoy cycling, hiking, and swimming.

I make time to spend time with friends and family. I am also friendly with my neighbors and people I encounter while out running errands and shopping. Having good relationships with people in my community is important to me. I eat well, limit my caffeine intake, and drink lots of water. I have made a Wellness Recovery Action Plan, and I follow it. I meditate twice a day -- in the morning and at night. I also take deep breaths as needed. I never realized how much these habits would help me until I incorporated them into my life. I go to therapy once a week. My therapist is encouraging and helpful and understands the challenges I face living with bipolar disorder. This kind of support helps me stay motivated to stay well.

Staying well is fairly simple, but it takes attention to detail and commitment. Doing all of these things regularly and keeping a routine is what keeps me well. Life is good. The things I am currently working on to improve my life are losing weight and decluttering my home, and these things are much easier to focus on when I am well.