The elephant on the arm

I love elephants. In my opinion, they should be called elovephants. These giant creatures are so amazing. I mean, how can you keep scrolling if a reel pops up showing a baby elephant learning how to elephant; trying to get itself out of a mud bath? Or, how about a video with a guy who had been working in human prosthetics who decides to venture out to create prostheses for animals AND does it for an elephant!!! 

Elephants have been known for not forgetting. A strong memory helps them survive. They are also highly intelligent, emotional, and social animals. Because of the observations of elephant behavior, they have become a symbol for mental health. They are known to experience joy and are playful. They also recognize emotional behaviors and offer comfort to those in need. Sadly, they also suffer from things like depression, grief, anxiety, and even PTSD. These experiences increase when placed in zoos or when used for entertainment in circuses and festivals. It is heartbreaking.

So, what does this have to do with the elephant on my arm? It's quite a tale.

About nine years ago, my psychiatrist of many years decided to retire. I knew this wasn't great, but little did I know just how bad things would get.

The person I started to see for my medication needs was a psychiatric nurse practitioner. I heard she was known for using the least amount of drugs possible to help her patients. At this point, I was on very few meds and wanted to keep it that way. I scheduled my first appointment and away we went. Shawn came with me to appointments because I felt it was helpful to have his point-of-view on my behaviors. The very first appointment should have been a bit of a red flag. She was technology averse, she had no computer so the thumb drive I brought with my records from my previous psychiatrist was of no use. She asked a bunch of questions to do an assessment. Next thing I know I'm being diagnosed as bipolar and being put on lithium in combination with the other meds I was taking. So, this brought me up to 4 psych meds.

Now, my first major depressive episode was when I was 28. That was 12 years before I started going to her. I had three psychiatrists in that time. The first doctor was when I lived in Cleveland. Then I found someone when I moved to Colorado. I wasn't with her long before changing to the guy who retired on me. None of these three ever brought up bipolar, EVER!

But, I needed help. Shawn and I both were like, okay, this is different, but she did her assessment, so what do we know. After a few months of taking lithium and changing other meds, she suggests electroconvulsive therapy (ECT). Well, shit. Things got really serious, really fast. I mean, the first image that comes to mind is Jack Nicholson's character R.P. McMurphy in One Flew Over the Cuckoo's Nest. Rest easy, my friends, it is not like that.

We went for a consult at the clinic where I would end up going. I went through assessments and tests. The idea was this could reboot my brain in a sense. It could help improve the efficacy of the drugs. The expectation was about 6-8 weeks of treatments, starting with 3 times a week and then reducing the number based on what progress was being made. My first treatment was April 18, 2016. My final treatment was December 23, 2016. Not quite the 6-8 weeks we were planning on.

While I was going through this, I was 100% dependent on Shawn, especially on treatment days. We were fortunate enough that Shawn had a company willing to let him work from home. The office was only three miles away, so if he needed to run in on a non-treatment day, it wouldn't be too big an issue. My life was quite restricted. I couldn't work. Driving was not allowed at all. Jarvis and I couldn't take walks by ourselves. I was pretty much required to have supervision if I were to leave the house, even on non-treatment days. All of this is because your memory gets FUUUUUUCKED! On treatment days, I was super useless. Shawn would bring me home and put me to bed. Then, I'd get up at some point and have dinner and watch something with Shawn. Seeing my therapist was kind of pointless because not much was going on with my brain being so messed up. I think I wasn't seeing the PsychNP, either. My ECT doc was my mental health provider for the course of the treatments. I didn't know it at the time, but Shawn was able to meet with the clinic's social worker as she was there to provide support to caregivers. I'm glad to know he had that. I did go down to a couple times a week to once a week at some point. When treatments became fewer and further between, some restrictions were lifted. I could drive, but had to have an adult with me. I could venture out for walks with Jarvis. Eventually, I was able to drive alone. But, come December, it was frustrating because things really weren't having the results we were hoping for. Shawn thought it was time to stop. I had no reason to disagree. So, we stopped.

Here's the thing, what I didn't realize was that I lost a year of memories. We've come to refer to 2016 as the "lost year" because I have almost no memory of that year. There are some flashes every so often. It even took away those few months of 2016 before treatment even started. When I see pictures from that time, they mean nothing. They look like I was having a good time. I hope I was. My dad had such a hard time understanding how this could be. He would talk to me about something and I would tell him I had know memory of it. Whatever it was, he thought it was so significant an event that surely it would have stuck out. At this time Captain America: Civil War came out. We saw it a couple of times, so I'm told. Shawn said that my chosen "side" changed with different viewings. When it came out on DVD, I think it was the fourth time watching, it was like the very first time seeing it and retaining it. So, yes, my memory was seriously FUUUUUUCKED by ECT.

I continued with my PsychNP after this. I stuck with her for far too long. But, the idea of starting over with someone else just stressed me out. The person who was known for prescribing the least amount of meds as possible, kept adding meds and/or changing my dosages. For sure I had gotten up to six medications, but I think it may even had gotten to seven. She checked my blood regularly because lithium is a real motherfucker. Side effects suck. I developed tremors, common for lithium users. One of the meds she added messed with my sleep. I also had one that gave me these weird jerky movements. We dropped those and moved to something else. 

She stopped taking my insurance so we decided to spread out appointments and pay out-of-pocket. Then COVID hit and in person visits were out. Like I mentioned, she has some weird issues with technology, so I bit the anxiety bullet and found someone else.

I really didn't think it possible to go from worse to worst. This guy, thankfully is now retired. But not soon enough for me. He decided to just go the bipolar route without really doing any kind of assessment. To him, lithium was the end all be all; an oldie but a goodie. I really should have stopped seeing him when he asked about my weight and said he may have to send his orc he found in a dumpster after me so that I would run to get more exercise. Again, I hate doc shopping, so I stuck with him. Also, he didn't have me get regular blood work. I didn't think much about it until my physical health started to get messed up. I was seeing my primary care doctor for something. He ordered blood work and was concerned, so he ordered more bloodwork for lithium levels. I was in lithium toxicity. 

I brought this to my psychiatrist who was like, it's just a tiny amount over the line. But, there is a line and it exists for a reason. Meanwhile, my tremors were so severe I couldn't do so many things like write; insert my debit card into the slot; use a pin pad or touch screen; turn pages; and, at times feed myself. I was dealing with incontinence, both bladder and bowel. There were times when, thankfully I was at home, I just surrendered and pissed myself and flooded the floor. My calcium levels were also getting out of control. My parathyroid glands, which I didn't even know were a thing, were not functioning correctly. If they suck, you have to have surgery. There isn't medication for it. So last September, I had surgery to remove the two funky glands, move the less funky one to my chest so that if it gets worse it'll be a simple outpatient procedure to remove it, and the good one was left in it's proper place. Thankfully, my thyroid is able to be controlled with medication. My kidney function and my liver are both being monitored on a regular basis. I had another surgery last year for a growth on my ovary that went through torsion. The ER was convinced I had cancer and within two days I was seeing an oncologist. So, that was it, all female reproductive organs were gone and I woke up in menopause. Not entirely sure if lithium can be ruled out for that, but it could be on the list. I also have curly hair. So many things. 

I got off of the lithium in September. It was my decision against the advice of the doc. He did a nine day taper. That is ridiculous! Then, October comes and I'm asking him for changes to be made. He swears by the lithium. He tells me I'm difficult patient who is beyond his skill set; that I refuse his recommendations; I care too much about side effects and therefore limit his medication options; tells me again to go to a certain depression clinic, which I already told him had a six month waiting list. This isn't my first rodeo when it comes to meds. I understand side effects are part of the game. But, when the side effects are severe and intolerable, I'm not going to take that medication. He then referred to treatment resistant depression instead of bipolar. So, what was I really being treated for? I laid into him. I raised my voice. He told me we should meet in person because the phone call had gone too long. I told him I was done and would no longer be using him for my care. He tried to talk me out of it. I stood my ground. He said something about enjoying having me as a patient. I hung up (not as satisfying with a cell phone, but still).  He was retiring, so I was going to need someone new anyway.  

So, I lost what little mind I had left. Once again, dependent on Shawn, he found someone new. Her take is:

Moderate recurrent major depressive disorder.

Panic disorder, also known as episodic paroxysmal anxiety.

Chronic post-traumatic stress disorder (PTSD).

This feels like we're getting back to Miller time (the name of the retired guy from years ago, not the beer). A little more like where I was before late 2015. I'm on a slow taper of one drug. The plan is to go through the dark to get to the light; to start fresh with medications. I'm down to only three medications. However, she's leaving the practice...so, in July, I will start seeing someone else in the practice. So, here's hoping for a better mental health journey.

Back to the elephant on the arm. I decided I need this tattoo to remind me where I've been. It's on my arm where I can look at it easily and often. The thought bubble is a play on elephants never forgetting, but for this one, 2016 is lost (not quite visible in the picture is a "?"). And the elephant itself is a symbol of mental health; of the good and the bad experienced in life; and, my simple love for elephants.

*Tattoo credit goes to the amazing Britton Dixon at Coven Tattoo.