Opiates!!!

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I got home from the University of Washington Pain Management Clinic a little while ago. I’d been sent there by my new doctor who wanted a review of my condition so she could treat me appropriately. It was an interesting experience. We went thru the usual tests of range of motion, gait analysis, mobility of limbs, needle pricks to see if I felt the sharpness (I did) and so forth. Nothing new from this testing and no new information about what was going on with me. But I did gain some important new knowledge.

I learned that the brilliant legislators in Washington State have decreed that no one shall be allowed more than 120 mgs. of opiates a day. Period. No discussion, no rebuttal, no recourse. This is a bit of a problem for me, you see, because for the last dozen years or more I’ve  been taking close to 300 mgs of Morphine as well as 15-20mgs of Dilaudid (Hydromorphone) a day. Imagine my surprise when they told me this. I was not shocked, because I know what the climate of the country is like these days around opiates. I was expecting something, but nothing this extreme. I mean they wanted to cut me back over 1/2 of what I’ve been taking for Years! Fuck!!!

Part of me wants to go down to Olympia and break the legs of every (probably Republican) legislator who voted for this draconian measure and leave them in pain forever while they beg for some relief. After all, that’s what I’ll be doing pretty soon – begging for relief – as soon as they drop me down to the 120 mgs. I’m now allowed. Sigh. I have what’s called Chronic Intractable Pain, so called because it’s constant, severe, disabling, and causes detectable changes in your heart rate, blood pressure, etc, and if it’s not treated it ends in death. Yep, a fun diagnosis for sure. I’m lovin’ it myself… I can function, but I’m always in pain and if I do much of anything it spikes so that I have to take some dilaudid for breakthrough pain. It helps a lot but it doesn’t make it go away completely.

I’d changed docs from the one I’d been seeing for 13 years because he stopped prescribing opiates. He never asked me to pee in a cup during that whole time because he trusted me not to mess with my meds, and I never have. Why would I? It’s Stupid! But the new doc at the UW clinic requires me to do that so that they can see if I’m honest. I am, and soon they’ll learn that, if they can keep treating me that is. I dunno if they will or not. Most doctors won’t touch me with the proverbial 10 foot pole. I sure hope the UW helps me or else I’ll be so sick I’ll be in the hospital for withdrawal symptoms. I mean 300 mgs a day is a Lot of morphine, let alone the dilaudid.

I understand that people are freaked out by the rising epidemic of opiate deaths due to mis-used pain medication. I feel badly about this. After all, addiction is a disease, and maybe they can’t help themselves. But a part of me is furious at them and at the politicians who seek to make headlines with new laws to keep people like me from getting the medicine they need to live a good life. Before I got the opiates I was a mess – I fit the portrait of Chronic Intractable Pain I described above. I spent a lot of time resting and I didn’t do a lot because I hurt too much. I still hurt, even with the meds. What will I do without my usual dose? I’m freaking out here!

No, I’m not – yet. I’m trying to stay calm. After all it’s only been a few months that I’ve felt relatively stable with my Bipolar Disorder. I’m not out of the woods yet and I still get suicidal and all, but I’m doing better than I have in ages. So imagine what this will do to my mood. Pain and mood are inextricably intertwined and if I hurt I often get depressed, and vice versa. It’s a vicious circle and I’m trapped in it for life. I’m not playing victim here – it’s just my reality. I do my best to live with it and I do pretty well, now – but what about 6 months from now? Where will I be then?

I hate that because some people overdose on opiates and die that the country is overreacting so severely as to limit what pain patients truly need to be OK. Obviously none of these politicians lives with severe chronic pain. If they did maybe they’d have some compassion for us. I’m angry at them and at the ones who abuse the opiates I need for survival, thus keeping them from me. The old rotten apple syndrome for sure. I never get”high” from these meds. I’m just in less pain is all. So for them to take my medicine away because some people do get high is totally unjust and wrong. Just because a few people screw it up for the rest of us is no excuse for this travesty. I’ll be writing my  congressperson soon, you can bet on it. Not that it’ll  do any good, but maybe I’ll feel like I’m doing something to change things that are so wrong. It’s an overwhelming feeling to be in this position.

I’m 65 now, and I’ve been living with chronic pain since I was 25. That’s a long time to live in pain. I hate it. But I have a good life because of the opiates that keep me functional and not in so much pain. I can live my life as I choose to. Maybe I don’t deserve to, I dunno. But that’s my depression talking. I do deserve to be OK and not suffer so much. We All deserve that. But the politicians who want to control our every breath don’t give a shit, and they make the laws so I have obey them. I’ll go along, because I HAVE NO CHOICE!! Such is life, eh?

Pissed off royally,

Steve

I Was A Different Person Then…

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I used to think of myself as a competent person. I started my first business in my early 20’s and created several more over the years, ending with a non-profit Healing Arts Center I founded in 1991. I thought I’d found my place in the world and would be working at it for the rest of my life. But it didn’t work out that way. I finally got “caught out” and had the worst breakdown in my life at 44. I was diagnosed with Bipolar and was forced to take a hard look at my life. What I found was that I hadn’t really  been as competent all my life as I’d thought. I was just Hypo/manic.

I don’t mean to say I never accomplished anything good. I did some good community service work and created some beautiful landscapes and gardens. But it was my headspace that messed me up. I’d thought I was good at what I did, and I guess I sorta was. I got by anyway, mostly by being a good bullshitter. I was good at projecting competence, even when it wasn’t real, as so often happened. People accepted me for who I said I was and who I pretended to be. I was good at it.

Now I look back at the work I did and see how much of it was fueled by mania or sometimes just hypomania. I doubt I ever had any real competence at all, tho I knew enough to get by, as I said. I was a con man, tho I never would have said I was or thought it at all. I always thought I was doing good work and helping to make the world a better place. And I did. But the cost was enormous. And not just to me. I cringe when I think of some of the gardens I planted that weren’t as good as they should have been. People live with my mistakes even now. It drives me nuts.

I know that hiding ourselves is a big part of being Bipolar. (Having bipolar?? – whatever…) A lot of us hide who we really are because we somehow know we’re not quite “right”, even tho we don’t know what’s wrong at the time. I always thought I was just a high energy, hyper person who was very creative and able to do amazing things that other people couldn’t do. I was a bright sparkly light in the darkness at times and I relished it so much. But there was a darker energy lurking just under the surface.

It didn’t stop me tho. I did a lot of good stuff and created some amazing entities. I did so much that was wonderful and I thought I was a pretty neat guy for doing it. I transformed the places I worked at. And the ones I started myself were unique and treasured. I got lots of compliments and good strokes on what a good role model I was for striking out on my own and creating good things for my community. It made me high I’ll admit. Too high sometimes… And we know where that can go don’t we?? Whoa!

I’ve always been a rapid cycler, tho I didn’t know that’s what it was of course. I’d do a big job and then I’d crash and burn for awhile and then I’d get it back together and try again. And the damn same thing again, and again, and again. What a mess! Those down times were awful, often going clear down to suicidal ideation and one time going even farther when I tried to off myself. A bit extreme but it fit my life at the time. Luckily I got caught – but not diagnosed correctly of course – not for years…

I have a diagnosis now – several of them fact. BP I, PTSD, Dysthymia, Chronic Intractable Pain, and more I won’t go into. It’s been 20 plus years since I got that initial Dx of BP and in that time I’ve been mostly a mess so that I really couldn’t function too well. I lived in public housing for over a decade until I met Louie and moved into his home. I’m lucky now but I wasn’t always so lucky. I’ve had to accept that who I am now is Not who I used to be. I just can’t pull it off anymore, and maybe that’s a good thing.

I think I’m more real now than I’ve ever been. More true to who I really am. But those hypo/manias are a thing of the past for the most part. I still get too high/angry sometimes and have to down myself with drugs, but mostly I’m more depressed than manic and stay at a low level of energy and interaction. I’m doing some volunteer work for the city right now and I try to keep something of a social life, tho I lost most of my friends when I had the breakdown and afterwards. But that’s mostly OK. I miss having more friends, but the ones I have are good ones.

I’m still a decent guy I think. I try to live a good life and not mess the world up too much. In fact I try to help it when I can. I garden a lot and teach people about trees and the like. But I’m so much more cautious now. I’m so scared that I’ll screw up again like I did so often in the past. I’m afraid most of the time in fact. That old Impending Doom thing so many of us have. It’s so debilitating at times I can’t even function. I walk carefully through the world these days.

It really does make life more difficult and I look forward to the day I heal from this attitude I have now that nothing I ever did was really real or that I was real myself. I know that can’t be true but it sure feels like it. Those damn feelings again. Not rational at all, but so overwhelming that you can’t ignore them and it feels like they’re all there is to life. I get caught in this so much. I’m afraid to even act much of the time for fear I’ll blow it. I’m not like I used to be at all really, when I had so much courage and self confidence to do such incredible things. I miss that.

That guy is gone and good riddance. He was a braggart and a poseur and a con artist and I’m none of those things in my heart. I’m not who I used to be tho I still have a core of Self that will always be inviolate and that will keep me OK forever, I hope. It’s real now, not some false mania or hyper action that I jump into without thinking of the consequences. I may still do that and I sure still make mistakes, but I feel like they’re really my own now and not some unreal thing I manufactured to get by and get ahead without knowing the results completely. I understand more now.

Yes, I was a different person then. A good one but not always solid and real and true to myself. I was so confident and I miss that confidence a lot. But was it real confidence or just mental illness? I guess it was a little of both, but I think it was tilted toward the illness. Now that I know what I’m dealing with I can do it better. I can’t always control my life, but I try hard and I try to be as real as possible. It seems to be working to some extent and I’m in better shape than I have been in a long time now. So I’m glad I’m different, but I miss the highs and the bravado and most of all the self confidence.

I’ll just have to get used to it, eh?

Steve

Is it Mania or Just Anger?

I’ve been struggling with some emotions that are too raw and close to the surface lately and I’m worried about my reactions to things. I seem to be on a hair thin trigger these days and my anger levels are right below the surface. I know that the current political landscape, in particular the race for president, is affecting me greatly. But it’s more that that, and I wonder whats going on? It seems worse since I got on this current regimen of Wellbutrin and I wonder if this is one of the subtle hints of fracturing that I’ve experienced before on it, but in more obvious degrees. It’s confusing.

I read an interesting article on mania and anger the other day. A leading psychiatrist here in Seattle said that it was wise to beware of labeling anger as mania in Bipolar disorder because it was more often caused by substance abuse. It’s an interesting theory. I’ve not been diagnosed with substance abuse, but I’ve smoked pot since I was in high school – some 50 years now- so obviously some would say that’s my issue. But I’ve always used it carefully and now it’s strictly medical and I smoke it sparingly. My psychiatrist doesn’t mind and my counselor and ND both suggested I use it. So I don’t put much stock into this notion myself. Denial? Maybe, but I think not…

I believe that it’s more than just that. It’s dreadfully close to wrecking me. It Feels like mania, not just anger. And it’s too sharp and too intense and takes me over so much that even little bits of angst can throw me into a fit of rage where I seriously want to hurt someone or myself or destroy the world. Typical, I guess, but it’s no fun at all. Not like the bright sparkly hypo-manias I’ve had so often in life that inspire me to do good work in the world. This is a destructive mania and I’m afraid of it.

I haven’t had a lot of florid manias in my life. Mostly they’ve been long term experiences where I entered into lands uncharted and tried new things that haven’t been done before. Like creating an innovative non-profit healing arts center with my credit cards, working myself to the bone and finally ending up in bankruptcy and disability. I had a Vision you see but I couldn’t see the whole picture and I ended up in disgrace and struggling with it’s futility. It hurt me badly. It was a 4 year manic episode. And no one even noticed, because I hadn’t been diagnosed yet.

Most of my manias haven’t been that obvious to other people. But they have still been filled with lots of anger and rage, thru my whole life. I can remember times when I was a kid that I would explode in rages that terrified my little brother and caused my parents to label me with ADD as an adult. They told me my anger was palpable and horrible when I was young and had those fits of rage. Sounds like the beginnings of Manic Depression to me, eh? I was a horrible little child I think, tho no one in my family is alive to tell me how bad it really was. I can’t remember much about it but I know I wasn’t a bad kid per se, just angry and unpredictable.

So back to my proposal here. Given my experiences in my life I can’t say what is causing me to be so angry these days. I know I can’t discount the situation in the world. It really does affect me. I’m super empathic and I feel the suffering of others deeply. It hurts me. It also makes me mad. This is a problem and I haven’t figured out what to do about it yet. I hope I can keep it under control but I dunno. I haven’t broken anything or slit my wrists, which I’ve wanted to do many times. I haven’t exploded at Louie or any of my friends. And I actually haven’t hurt myself, except with my thinking, which is bad enough.

I try to calm myself down when I feel this anger growing but it’s very hard to do. I often have to resort to drugs and take some Klonopin, or when it’s really bad, some Abilify, that will knock me on my ass and put me totally out of it. At least it’s better than the rage but it wastes me and I don’t  really like that. But it’s better than the anger for sure. If I don’t know where it comes from and what to do to stop it I can at least alleviate it some and that’s good for me. I also use CBT to tell myself to Stop It! But that doesn’t always work out too well. I’m often too far gone, unless I catch it early. Sometime I can, but not always.

I think this is a bit of a manic response to situations that I can’t control and that cause me distress to the point where I crack up and lose it. Or is it just anger? I’m still confused. It’s been there so long, but then maybe I’m just an angry person. I don’t think so tho. No one I know would ever call me that. But I would. I feel it so much. Sometimes I know that my anger is invigorating and it helps me come out of my depressions really well. But this stuff is out of bounds and isn’t connected to reality. It’s troubling. I’m at a loss as to what to do besides trying to just live with it and try my best to deal with it safely for myself and others. So far, so good. Maybe it doesn’t matter what it is, maybe what counts is dealing with it well. Sounds good to me…

How’s Your anger level?

Steve