Expert: Libby Bonner - 3/5/2010

Question
QUESTION: I have been diagnosed with Bipolar I with psychotic features ( I have been told that I am at the top of the bipolar spectrum).  I have gone back to college and I manage to hold a job for a while (right now I am drawing unemployment because my last employer fired me illegally)I also have generalized anxiety disorder, T3 and T4 hypothyroidism, and paranoia.  Could you please explain to my family that I am actually high functioning considering my diagnoses?  They truly think that I just pull my little stunts for the fun of it.  I have tried to explain that I do a very good job keeping it in check with meds, biofeedback, and cognitive behavioral therapy.  I had a psychotic episode (short duration thankfully) and did something out of character for me.  To add to this, my Father has lung cancer that has metastasized to his brain and so I am now also dealing with stimulus overload, lack of sleep, and a very sharp increase in anxiety.  I just want my family to be able to read a doctor's opinion on how good or bad I function.  Thank you, Selina

ANSWER: I can answer more fully if you will give me more info.

When diagnosed w/ bipolar?  With the other disorders?  Any/all being treated?  All/any being helped by treatment/s?

Did you get diagnosed while in college?  What year in school?  How long out of school before returning.  Will you complete this semester?

Who in family are we trying to explain this to, and have any been to any appts w/ you?  How many sibs?  Ages, and your age.

---------- FOLLOW-UP ----------

QUESTION: I was diagnosed at around 23 but after giving Dr personal history they are sure I have been Bipolar since I was 6.  All of my other disorders are generalized anxiety disorder, My T3 and T4 hormones for my thyroid are not working right (new diagnosis...Dr is thinking it is Hirosimoto's hypothyroidism which is a auto immune disorder).  I bounce between insomnia and extreme fatigue and sleep. I have degenerative disk disorder (auto immune)ulcerative colitis (auto immune)a esophageal ulcer, 2 stomach ulcers and a duodenal ulcer (auto immune)and a hietel hernia, I have several large ganglion cysts in my neck that puts pressure on the nerve bundle at the base of the skull, I am morbidly obese at the moment because of the thyroid but it is starting to come off now, I am very highly intelligent and at times I consider that to be a bad thing, severe edema of the lower legs, ankles, and feet.  I am on a good regimen for the bipolar and anxiety, Cymbalta, Serquel XR, Elavil, Xanax, and Phenagrin.  I am on a good regimen for the Thyroid, synthroid and cytomel.  i am chemically sensitive so it is hard finding things I can take (hence the xanax...tried everything else).  We can only treat the Ulcerative colitis for acute attacks steroids and I don't mix well.  I have had two suicide attempts resulting in hospitalization and two voluntary admits.  I have had enough pills stashed around to kill myself with since I was 12.  I refresh the stash about every two years.  I do have suicidal and homicidal ideations (and dreams) almost constantly.  I cannot force my self to clean house ( I have ALWAYS been that way about house work).  I am lucky if I can force myself into the shower once a week.  I have panic attacks so bad they make me vomit.  Too much sensory stimulation makes me really wiggy, I have to go find a quiet spot.  I am gay but I like looking like a girl so I get left alone unless I am seeing someone and then I hear all the judging.  I also see the dirty looks, snickers, and snide comments about how fat I am.  I feel like everybody is out to make my life harder than it is.  I spy out the windows to see what is going on.  I constantly pick at my body and face, I have been told that it is a form of self mutilation.  I have been in and out of college for 18 years.  I don't start back to school until April.  I want my family that I live around (Mother 56 Father 61 Aunt mid 60's Cousin mid 40's Cousins ex-wife 27, another cousin 34 and my sisters Tonya age 36 (Husband age 30) Crystall age 34 and Angie age 32 (husband age 33)  No one has ever gone to the doctor with me.  They think I am over medicated even though the stuff I could catch a buzz from lasts about 6 weeks instead of 4.  They really think that I could never have a psychotic episode again if I didn't want to. They just really don't get it.  I would be very grateful for an explanation that they can see that I am doing very well considering the Bipolar I with psychotic features.  They just don't believe me and won't go to the doctor to have it explained to them.

ANSWER: Your father's illness probably makes this not the optimal time to forge on w/ your wish for belief and respect from the family.

And since you have been very sick for many years without, apparently, much family interest or understanding, it may be that this will remain their permanent stance to you.

So - my new questions and/or advice are these.  Who is treating the disk disorder or the various autoimmune disorders?  You have Medicaid and Medicare and a way to get treatment?

But, more importantly for your emotional health and well-being, do you see any other providers besides doctors - social workers, therapists, etc.  I hope you do, and other consumers/patients as well, because I think this is your route to being less unhappy.  If you are not now receiving any services from a community mental health center, go to samhsa.gov, enter your zip code, and they will give you contact info for the two nearest to you.  Your psychiatrist can write an order for one/some/all of the non-doc services that they offer.

Pls make an intake appt as soon as you are able.  From her community mental health center, my daughter has a social worker who visits her at home once a week.  She goes to a morning class that meets 2x/mo, and goes most Thursdays to 2 1-hour groups that she feels are helpful.  Her center also has 4 afternoons a week when anyone who wants can just drop by for unstructured semi-social activities.

NAMI, nami.org, also has a new program for patients/consumers called Connections. It is only one-and-a-half hours a week, but I think consumers are invaluable contacts for other consumers.

I hope your doc knows about the homicidal ideation....and that you have a good plan of prevention.

When you can let go of wanting what your family doesn't get, or refuses to get, or doesn't want to ever know about....your life may feel better.  It certainly will if you can create involvement w/ others who do care and understand, other patients.    ---  Can you have a pet where you live?  Would you take care of it?  Thought about getting one?  Very therapeutic for many.    ----  If you can't do that, but like animals and could be a reliable volunteer, you could see if local shelters need help.  I ask because Molly [beagle] is such a huge part of my daughter's life.

Perhaps w/ some conversations and guidance from others, you could find some new ways to organize your thinking about yourself or your problems.  What do you do best, or with the least difficulty?  Make those your starting focus.  The pick one hard thing and make it a goal.....maybe showering on a schedule - try to do it weekly until that's easy, and then maybe move to every six day.  Or choose the house.  Instead of clean - who likes to clean - could you make de-cluttering a goal?  There are a lot of articals about this, and they usually start easy, w/ just one room a day.     -----  OR - get to a center where they have better ideas than mine!

Good luck.



---------- FOLLOW-UP ----------

QUESTION: There is no viable long term treatment for the Ulcerative colitis or for the degenerative disk diesese because I get freaked really quick on steroids.  I do have pets and have always had pets.  
I do not have medicare or medicaid although I am submitting the paperwork for it again.
I told my doctor about the homicidal ideations and he asked me why I haven't done it yet and I told him the truth.  I can't get everyone I would like to see dead in one spot at the same time and that if I am going to go down for one, I'm gonna go down for all of them.
My family is very smart.  They suffer from most of the same things I do they just aren't understanding it's a spectrum disorder and that I am at the top of the spectrum and since they can keep thiers under control they think I should be able to also.  Strangley enough, it is my Father that gets it better than the rest.  I am the only one that lives at home and that is at my mother's request (she is physically disabled).  We have always hidden things from my Dad and this would be no different.  What I am asking for is a explanaition for them about how my top of the bipoar I with psycotic features coupled with the added stress my Father dying, providing help for my disabled mother and sick father when asked (God help if I do something I wasn't asked to do), living with two hoarders, the icrease of anxiety from my father dying and trying to get all his third party insurance and social security and medicare started, and how the lack of a normal sleep pattern is making me symtomatic they are smart enough to understand the explanation and my dad will never see it.  I am not currently seeing any therapists for this because I have no insurance and I am not eligble for Tenncare because the rolls are closed.  I am pretty much looking for a doctor's assesment to show them that I am not acting out and that I am doing a good job keeping myself balanced. Thank you for taking the time to help me. Selina

Answer
I am probably of no help to you since I am not a doctor.  To the extent that s/he can, your own doc can write something?  Doubt s/he'll want to comment on their status relative to your own, if none is his pt but you, but perhaps s/he would write positively about those areas where legitimacy is doubted....or where the outcome that they see is the best achievable w/ meds at this time.

You do not receive SSI?  or SSDI?  Is there a Legal Aide office that can help you file again?

I wish I were in a position to help in the way that you wish.