Hidden Complications of Medications

Withdrawal has not been that kind to me lately. I’ve been going through approximately a migraine a day. On top of that is leg pain. It’s an old leg pain that I’ve had since high school and it largely went away as I got older. It would flare up now and again, but it was manageable. And by pain, I mean crippling pain that shoots through all my joints from the knee and below. My toes even hurt.

Before, it wasn’t a problem. I would take prescription levels of ibuprofen and that would take the edge off of it. Granted, it would tank my stomach and I would feel sick and have a lot of heartburn. But at least I wouldn’t be in crippling pain. And after my back injury, I was introduced to another NSAID called Ketoprofen. That stuff is wonderful. It took care of severe back pain, sciatica, and my leg pain. Also, for migraines, I could take excedrin. It wasn’t perfect, but it took the edge off and I could function again. I can no longer take these drugs. Any of them.

The reason for these is lithium. I cannot take ibuprofen, aspirin, or naproxen (aleve) because they will increase the serum levels of lithium and push me toward toxicity. In fact, besides tylenol, there are no over the counter pain killers that I can take that does not mess with lithium. But it gets worse. All NSAID class drugs do this. So no COX-2 drugs either. What I’m left with are anticonvulsants and antidepressants (and opiates).

However, anticonvulsants are not a reality because of possible complications with lamotrigine (lamictal). All of them score a moderate interaction on the Drugs.com interaction checker. Worse yet, the best ones not only take a while to work, but can decrease the amount of lamictal in my system. That could have devastating mood impacts. So anticonvulsants are pretty much out because they are slow and interact with another one of my drugs.

Finally, there are tricyclic antidepressants and SNRIs (like welbutrin). There are two problems with this. SNRIs make me suicidal and a little homicidal. Even at low doses they destabilize me. So no matter how effective they are, I simply cannot take them. As for tricyclics, like amitriptyline, they too are antidepressants with a risk of mania. This effect is exacerbated by taking olanzepine.

And there’s one other. A low level opiate, tramadol, also interacts with both olanzepine and lithium causing increased risk of seizure. This is because it acts on both the D2 and D3 receptors in the brain. So even low level opiates are off the table because of the medication cocktail that I’m on. Which is disappointing because tramadol is the least likely to get me hooked on another narcotic.

This just reveals the hidden complications of medication. Drugs like lithium and olanzepine interact with nearly everything. And once you throw in lamictal, everything goes out the window. And adding in bipolar disorder helps clear away the remaining drugs. The only things left for intermittent moderate to severe pain are powerful narcotics like hydrocodone and oxycodone. To some, that might sound nice. But after withdrawing from one drug, I’d rather not do it with another. They are also sedating, which is something I desperately want to get away from after taking clonazepam for so long.

However, I don’t advocate dismissing these drugs because of the complete lack of access to no nonsense pain killers. It would seem strange to jeopardize one’s mental health because you can’t take ibuprofen anymore. And I’m definitely not going to stop taking these drugs simply because I have days of pain. Even if right now I’m very badly medicating myself with a little alcohol and tylenol. What it means, in my opinion, is that if you have severe pain that isn’t handled by tylenol, get to a general practitioner and find out a medication right away that you can take. I was stupid and didn’t set up a primary care physician and am now in the lurch for not doing so. Instead, I’ll have to rely on my psychiatrist for pain meds until I can get into my July appointment, and that’s a position that I don’t want to put her in.

It’s also a very good reminder to double check every interaction with every drug because even common and safe drugs like ibuprofen can have relatively devastating effects. Drugs.com has a good one that lists the severity of the interactions and what it does. Also, talk with your pharmacist about these things. I’ve found several good ones and they know off the cuff what can’t be done or what little tricks can be taken to work around complications. It’s their job, and my psychologist informed me that there is a strong movement amongst pharmacists to demonstrate that they are more knowledgable than doctors about medication. Ask questions, they are more than happy to inform you about the latest research that they have read. Plus, and this is just me speculating, I think that they like the sexier drug cocktails that pose complex interactions. It’s a stretch to figure it all out. It’s like my experience with the university health clinic, where my doctor was more than willing to act as primary care after finding out that I had a herniated disk. I think it’s a break from the norm, which is always more interesting to intelligent educated individuals.

Watch Out For Food

This isn’t a diatribe about the merits of good nutrition and mental illness. It’s just a simple PSA. Watch out for the food you eat. Make sure your vegetables are refrigerated and smell and taste everything before cooking it. And trust your senses, we’re hardwired to detect problems through our nose and taste due to a long history of evolution. Why do this? Food poisoning.

Yesterday I was hit hard by what is almost definitely food poisoning. I’ve recovered fairly well and today I’m feeling around 60% ready to do things. I’m no longer as weak today. But believe me, food poisoning is really easy to avoid and it hits hard. There are a lot of gory details about what it did to me. I left my vomitous mark in one of the local parks when I tried to get some air. And all day I was sweating for no reason. Also, for most of the day I not only didn’t have the energy to do anything, but was so weak at times that I couldn’t even hold a pencil to draw. I just spent the day watching the first season of Mad Men (great show, always worth a repeat).

But it’s also really important for those of us taking lithium to avoid this at all costs. It wasn’t something that I thought about before, but it’s a dangerous factor. I lost a lot of fluids yesterday. So my usual one to two gallons a day was upped tremendously by me losing this without absorbing it. The last thing one wants when vomiting up their dinner is to then deal with lithium toxicity.

So do yourself a favor, just take an extra 10 seconds to test your food. And if it’s iffy, just get rid of it. I’m thankfully stabilized while this happened and I have felt no change in mood. But if I wasn’t on such a total regimin of mood stabilizers (4 at this point), I could be in mood hell since food poisoning devastates electrolytes that are key to brain functioning. Food poisoning was never something I really thought about before, but now I realize that I could have been in a hellish situation simply because I didn’t do something simple. But being medicated up to my ears does give me some insurance against stupid mistakes.

An Almost There Mania And The Allure of Pushing

I’m in an “almost there” mania right now. I’m not manic by any means, but I’m creeping in on one. I have several ideas that I want to do, biking, studying, writing, and camping with my telescope. I want to do them all, right now. Just set off and do something. But I lack that impulsivity that comes with any sort of mania. As a result, I have many things I want to do, and can’t get around to doing any of them. It’s all so close though. I can almost taste the heights that my mind could soar to if only I could push a little bit.

Part of this is definitely the side effects of the drugs that I’m on. Be it the lithium, the zyprexa, or the klonopin, one or all of them are pushing me down. It’s an odd reality to feel yourself not transitioning in anyway. In depressive periods, I call this a purgatory of moods. But that’s where I don’t feel much of anything. I’m in no mood state. Here, I’m trending into a mood state, but being resisted, heavily. Which is a good thing as my girlfriend pointed out. It keeps me sane. I’m still eccentric, but I’m very sane on these drugs. Which is a good thing over all, to be sane, but it doesn’t feel as good as being manic.

And that allure of being manic is something that I discussed with my psychologist. On these drugs, they don’t stop you from becoming manic. If I really wanted to. I could drink a six pack and load up on 2 pots of coffee and trigger the whole thing. I’d be completely gone and ready to take on the world for weeks. And in these states that I’m in right now, the need to push is so tempting. It’s like having a marvelous drug dangled in front of you and all you need is a little push in the right direction to get there. You don’t have to find some dealer, or shady access, or risk chemicals. Just a little alcohol and caffeine and I could fly as high as I wanted. It’s something I did naturally, before being medicated. I’d use those things to make me feel better and push my moods around as I wanted to. It’s almost a benefit that comes with being bipolar, while we are a slave to our mood swings, at the same time, we can push our moods around in ways that normal people cannot imagine.

Yet, as much as I want to push, I’m not going to. I’m resisting. One of the ways that I find useful is talking to my girlfriend about the things that I want to do, and have her organize it and tell me what I should do. As strange as it sounds, I cannot do that on my own. I need someone to tell me and process for me. And I’ll keep my klonopin going, even though I desperately want to end it and let my mania take hold. Instead, I’m going biking. And I’ll bike until I collapse. I’m shooting for 50 miles today. And after biking, I’ll feel relaxed and rested and ready to tackle something else. In the past, when I was slightly manic to manic, I would just bike my brains out and it felt wonderful. So I’m trying that again today. And hopefully, it’ll alleviate some of the desire to push the boundaries of what my meds can do.

Hypomania, Upswings, and Lithium

I was in a slump for a while, then I was swingin upwards only to get sick. So I’ve been a bit down. But yesterday, I saw the first glimpse of another upswing. It happened really quickly and I could see the wheels turning in my head as it happened. In the space of about an hour and a half, I went through two full cycles. That’s a good indication that a mood is breaking in my world and it did break. Thankfully, it was trending upwards. And today, the trend continues in a good way. I feel a little more motivated and physical. There’s a raw energy that’s in my muscles which indicates that I might go hypomanic in the next week or so. I’m rather pleased.

But I’ve also been wary of it because lithium has now seen to it that I have really three possible elevated moods. There’s what I just standardly call up, where I feel good about everything and get things done, then there’s hypomania which is a notch above that, and finally a full blown mania. Between the lithium and the klonopin, I’m probably not going to reach the heights of mania unless I go off the klonopin and really push the limits of my moods with alcohol. And that’s not a bad thing. Manias feel wonderful, but their consequences rarely are that nice. That just leaves an up mood and a hypomania in my future.

While talking with my psychologist yesterday, he and I really tacked down the difference between my up moods and my hypomanias. Both have a great deal of creative potential. I have strong aesthetic experiences in both. I love to write, to read, to listen to music. I’m also very adventurous and highly opinionated. Yet, in the output and mentality, there exists a difference. Writing is the best clue for detecting the difference. In a hypomania and a mania, I’ll write at nearly a stream of consciousness. And along with that is a bunch of jumbled nonsense that has no bearing on the subject at hand. I could literally cut out large portions of what I write and string together about a third into something really interesting. That’s something I love about hypomanias, there are so many ideas and I can pick and choose later on what I want to work with. It’s creativity at its best. But in my up moods, I’ve noticed a similar creativity and out of the box thinking habits, but my writing doesn’t suffer. While it requires some elaboration and goes by at the speed of light, it’s always on point. With just a little organization, it’s possible to get very good writing and creative solutions. And it’s all coherently put together.

The difference between my new up phases, created by the lithium, is that the noise is removed from my thoughts. The extraneous tangents and ideas no longer surface in my thoughts. While I think rapidly, almost too rapidly at times, it’s directed and controlled. It’s almost as if my hypomania is distilled into rapid thought on a single subject; rather than bouncing between a thousand and one subjects.

And I’ve noticed this in my behavior as well. I’m better at staying on track with a single task. I can clean and finish the dishes instead of starting it, getting side tracked, then side tracked again, then realizing that I have dishes to do and finishing only about half of what remains before getting side tracked again. Now it’s possible to have the energy to do something and finish the task, which is a whole new realm of wonderfulness when in a low mania.

Why do I bring this up? Well, part of me just wants to show that there is another form of constrained hypomania. One where you feel good and are still impulsive, but in a more refined and less destructive manner. I still start projects, but not a dozen at the same time. In many ways, I actually like this more than I like the hypomania, which borders on out of control in its impulsivity. But I also wanted to bring it up because not many people sing the praises of lithium. Before going on it, the web abounds with how it causes brain fog and memory issues (which are not founded in research). It also targets one of the best parts of being bipolar, our up phases. I didn’t want to have a condition where I only got depressed and never had another hypomania again. So I was reluctant to try it. Yet, here I am singing the praises of it. It’s refined hypomanias into a new breed of mood that sticks around and lets you function while also being fun and kooky (and heavily opinionated). It’s definitely worth the blood tests and the constant hydration to get a higher degree of functionality out of feeling on top of the world.

 

Addiction, Disease, Whatever You Call It, It’s Biking

I had a little hypomanic spending spree, but with really good intentions. I needed bike equipment to start biking again, but it totals nearly $200. So, being rather cheap, I had a hard time swallowing that much of a down payment on biking. Thankfully, my spend free attitude took hold and I really went at it. I got a helmet that I’ve always coveted so my head doesn’t swell up with the heat of biking. And along with several others items, I got all the gear I needed to really get going.

And then I started biking again. Wow, I was out of shape. I was still able to break 25 mph but for far shorter times than I used to. I lasted about 40 minutes of biking around at about 15 mph, which is a decent speed. My old muscles are still there and it’s nice to know that they’re not completely gone. Still, this is a far cry from what I used to do. 4 years ago, I was biking for 3-4 hours every day in the summer and weighed in at a very very lean 125 lbs (I’m 5’10″), I now weigh 165. I was scrawny and super fast. I was able to best triathletes and go for 100+ mile bike rides while averaging 18.5mph over hilly terrain. I’m aiming for that again. I have the spring and summer off, so it’s time to lose the weight and go at it.

And getting there shouldn’t be too much of a problem. Biking is an addiction, after you start doing it on a fast bike, or even a good bike, you cannot stop. On flat land, it’s wonderful to fly across it under your own power. It’s smooth and there’s nothing like the control. There are also the hills. There’s a mammoth one that I’m going to hit sometime soon where I can peak at 40mph going down. Mind you, I’m on a bike weighing in at only 20lbs and I’m covered in spandex. No leather for when I fall, just a helmet. Frightening, but awesome. I really get off on the speed and control that goes along with a race condition bike. Every muscle must be engaged to keep the bike stable and your shoulders ache with supporting your weight for hours on end. Really, I could talk for hours about how much I love getting on a bike and just tearing it up. I even love how sore it makes me. Biking is really like a drug that once it infects you, you cannot shake it. It consumes your thoughts and makes you think about it day and night. And here in Wisconsin, the best part is that in just 15 minutes, you can go from city to country and forests and lakes. The scenery is so much better when biking than when jogging, plus it’s a smoother ride.

But there’s been something holding me back. I’ve become dehydrated just from the heat and I don’t want my lithium levels to rise too high while biking so quickly. In addition to that, I have had tremors in my legs ever since I started lithium. I sometimes have difficulty going down stairs because they shake so badly. And those legs were present in the beginning of my bike ride. They just wouldn’t respond properly to exerting force. Thankfully, that went away after a while. Plus, with drinking a lot of water before and during, I was able to go without feeling the slightest bit of a problem. I’ll hold off judgment until I start doing my hour to two hour long rides. But the bug has bit me, and about two hours after finishing my first ride, I went out for a relaxing second ride, then a third.

In terms of mood and turning off, it’s helped me a bit already. Last night I just relaxed and read my book. My concentration had improved a bit too. I was able to really relax. But what is really important is that I didn’t wake up with any sort of irrational anger or irritability. I’m not ready to rule out a mood change yet, but it is peculiar that after some very strenuous exercise, my morning mood has changed. I’ve always been told that exercise is important since I’m bipolar, so it’s time to put to test this advice.

I’m Going to Die This Summer…

Well, in a metaphorical way. Summer is nearly upon us here in Wisconsin. It’s only mid March and we’ve hit 65 today, later in the week we could even hit 80. I love this weather and it makes me want to go outside and do things, lots of things. I really want to bike again, but I’ve realized that I’m facing something really really dangerous. The hour or so of walking that I did in a light jacket was too much for me. I forgot my water bottle and everything just went down hill.

I became extremely fatigued in class and couldn’t keep my eyes open. What was worse was I was slurring my words extensively and just devolving into a wreck of incoherence. My lithium levels shot up that fast with just a little walking and not drinking water along the way. And it isn’t even summer yet, where it’ll get far hotter. Anyways, I got out of the class during the break at the hour and headed over to a place that is often cool and has plenty of water at hand, and comfy chairs where I could recuperate.

I’m feeling better now that I’ve downed over 8 cups of water and taken a breather. But what really scared me was that I initially thought that it was simply the klonopin in my system making me loopy, so I got much worse than I usually would be. It was so bad that I couldn’t walk a straight line. Still, all is fine now. It just served as a very rude wake up call that hot weather and me will not mix and that I must always carry some sort of water on me at all times. If I had that water I could easily have avoided this situation, but I didn’t and now I have a splitting headache, my legs feel like mush, and my hands won’t stop shaking or respond properly. Why do I take something so poisonous? Oh right, it’s the only thing that seems to work. Really though, lithium is wonderful and has no side effects for me beyond these wonderful episodes.