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Dear Dr. Michael,
Are you a psychiatrist or psychologist and where did you train?
I came to work. I had a conversation outside of my office with a man I had known for a long time, Marvin. I was having a lot of difficulties..separation, lazy staff, my father died and left me in charge with handling financial matter. Sister and I in legal battle. Night before, man who works in my office lost his temper and was shouting at me. I calmed him down and went into my office and closed the door. This man just opened the door and started shouting again. There was a volunteer in my office. I left and took the volunteer out to dinner the night prior to admission. I could not sleep despite taking Ambien. I was upset. So, on the morning of admission, I started to cry. I felt sorry for myself as I told this story to Marvin. This man's staff and called the paramedic. Marvin thought this man hit me.
I was forced out of my office by the paramedics. They would not tell me what this was all about. Taken to ER. Escorted to bathroom for urine specimen. I walked out of the ER to cafeteria in order to get something to eat. I had a brief conversation with a RN who I know. Taken back to ER. Clothes taken off. Bare upper ches in glass cubical. I pulled the covers over my head and asked for my clothes back. The next thing I know, IV Ativan and Haldol were given. I was never interviewed by the ER MD until after I was medicated. ER MD reports confused, speaking with pressured speech with marked flight of ideas. I said that it was 1999; the year was 2009. Has difficulty staying on tract with questions. "She does not recall her address on initial recall. I could not recall my address. I was upset. I thought, what in hell am I doing in the ER. No one would explain this to me. The Ativan knocked me out.
Neurologist came in to evaluate me approx. 2 hours after Ativan and Haldol. Was able to state name, mo, date, yr, city, state , place and president. Naming and repetition were intact. 3/3 on registration with 3/3 recall. Her speech did not seem particularly pressured. She easily recognized me and recognized other familar staff. Neurolgist partner came in the morning. I was still groggy from meds. "Does not want to open eyes." Dxd as being depressed and manic. Woke up in the afternoon. Had lunch with friend. Never took meds given to me. Let go 72 hrs later.
Never depressed. Sad about separation, but still worked out, got my hair done, bought tickets to music concert and invited friends. Friend came to office to assist with work. Did not think anything was wrong with me. So, was I manic, then depressed for two days, the ok again then manic one month later for two days, then ok as per psycholotherapist/J.D. who spoke to me for 2 hours?
Medications I was taking prior to admission were due to my car accident. Peripheral neuropathy.
Do not want to take Lithium. Cannot go off it as a condition for working.
Doctors in and out of my room. Shrink told me that I need a mood stabilizer at 10:20 pm. No further discussion. Neurologist writes that I am depressed and manic on the second hospital day. I was at 2 holiday parties in December. I was at the movies on Christmas in the evening. My girlfriend came over and spent the night after the movie. I went out with friends 6 days prior to my first admission. She did not notice anything unusual. I was with my, friend again, 6 days prior to admissions. I was admitted on Jan 23rd, about one month later. 72 hour hold. As per first email, I was on Lyrica 50 mg hs, 1/2 - 1/3 Vicodin ER, Lidoderm Patches, Naproxen, Ambien. Opiates positive due to Vicodin. All other test were normal.
Do bipolars have flight of ideas, pressured speech, memory lapses? I clearly recall getting ready for work. I dressed up in a suit. I looked up the name of a pharmacy where I had purchased some Lidoderm Patches. This was not my regular pharmacy. I called up, I asked to pay with my credit card. I read off all of the digits. I drove to work 15 minutes from home. I walked into the buiding where I work. I came in at the same time as this man I had known for years. I told Marvin what had happened the night before. This man in my office shouting at me for a minor problem. I started to cry. I felt sorry for my self. A separation, my staff taking advantage of me, this man in my office who I had helped. Marvin knew how hard I worked. Marvin was afraid that this man had assulted me. He had a staff who was with a bastard husband.
I am not a shrinking violet, but I have gone through a lot to achieve what I did. Marvin knows this. I had moved my office 5 times. I built out an office and was sued. I did not know what an estopel was. I did not have an attorney. I had terrible staff, but did not want to fire them. I did not want a affirmative action law suit. I was changing my own spools of toilet paper and watering my own orchids. They had my credit cards and but did not buy stamps or supplies. I paid my staff $5.00 to $9.00 more per hour than others. Let them use my credit card for lunch. Let them take days off when they wanted. I finally had a heart to heart discussion with one of my staff. Both walked out. I was happy.
I was very sleepy after 2 mg of IV Ativan and 2.5 mg of IV Haldol. I so sedated, but after I woke up, I could not sleep for 1 1/2 days. I had a sitter by my side. It was 68 degrees. I could not leave the room. Diagnosed with mania and depression after 2 days!! I have never been depressed. I have been sad. I was not my chipper self.
At baseline, I cry at funerals, I cry at movies, I cry when I see other people crying. I cry when I see people on Dancing With The Stars doing really well when they didn't think they could. I cry when I am surprised with a beautiful gift; touched.
Do bipolars have marked flight of ideas, pressured speech, tangential thinking, memory lapses?
I have read many accounts of individuals with bipolar disorders. They have shared their experiences online. They wanted to stay up all night and do projects. I wanted to sleep. I took Ambien and Benadry.
What is your opinion? Do you think that I am bipolar?
Do not have delusions or hallucinations. I am not schizoaffective. I have never had any medical problems ever except for a car accident in 2006.
I am a pretty high-functioning person. Lived independently since age 16. 12 years of college.
I was placing ads for new staff. Calling around and trying to find a new office tenant. I paid out my payroll and all vendors. I had too many friends hearing about my hospitalization and trying to help. I filed 2 restraining orders. This required focused effort. Two trips to the court house. I needed to feel safe at home and at my office.
It's funny how the diagnosis shades the staff's observations. A woman was coughing on my dinner tray. I got up and left my tray for her to eat. There were other uneaten trays so I ate one of those instead. Staff thought that I was confused. Staff noted that I was anxious and walking around the room. I am not used to being confined in a small room. I am not used to laying in bed all day. I was on Premarin and I did not want clots in my legs. "patient is anxious" I was walking up and down the halls my first night in this psych facility. The informed me that I had a very high blood pressure. My blood pressure has always been very low, 95/60. I was forced to take a blood pressure medication. Was I going to pass out?
Am I bipolar at 55? Can a bipolar function well off meds, if he or she does not work?
How can a person be hospitalized and deemed incapable of self-care when I have credit card records demonstrating that I was taking care of myself. Massage, nails, hair, dinner out, concerts? No plan of action written over and over. I had 3 doctor visits scheduled for the week after my last admission.
Thank you for your thoughtful consult.
I personally believe that my symptoms were due to the medications I was on, in addition to mutiple stressors and lack of sleep. Still would like to hear your opinion about Lyrica and manic. Neurotin label now specifically mentions mania, agressive behavior and even insomnia.
History is important. Independent thinking is important not only in psychiatry, but also in all fields of medicine.
My internal medicine practice and reputation has been destroyed.
You mentioned that true mania begins slowly and persists for days or even weeks at a time. Please define what you mean by slowly. Slowly over the course of 6 months vs 1 month? What is the range? What is the range for the duration of mania? The shortest episode vs the longest and the average?
Optional Information: Person's Gender: Female Person's Age: 58 Already Tried: On Lithium. Levels 0.4. Have been on Lithium monotherapy for about 10 months.
I agree that stating that the year as 1999 vs 2009 and "not staying on tract", was not a big deal. In my opinion, Ativan was probably what caused my confusion. 2mg is a big dose. Ativan causes confusion,sedation and antegrade amnesia. Sometimes benzos can cause a paradoxical effect..hostility, aggression.
I have not completed my hx to you yet. I can see from some of the emails that I wrote that I communicated in a way that was not my norm. Long-winded. Jumping from topic to topic. Left out words in sentence. Ex, "I am going store." Typed some parts of emails in bolder larger font. Wrote and said things to people that I would have never said under normal circumstance. For ex, my friend, Janet, thought it took me too long to get ready to go out to eat. Janet, my former professor of med, dresses in jeans and t-shirts. I managed her stocks for years. She didn't want to learn how to do this. I emailed her to say that I cannot dress as "tacky" as she does..private practice, not county hospital..."Please get my name off her stock account immediately.""Stop emailing me"; Janet moved back to Hong Kong. Janet is my dear friend. I wear old gym clothes all the time at home. I blurt out to my friend/patient that he should not go to Dr. X in my absence because he could not pass the Boards afterXXXXX X and I worked together at our first job. I like him, but he is not well-trained. Does not answer page for hours. I introduced the pt/friend to this Dr. We socialized on several occ. Previously, I may have said, "Dr. X's office is so much further than Dr. Y next door to my office. I have worked alot with Dr. Y.and she is excellent.
Wrote 2 emails on night and at 5:00 am, on night prior to admissions. No sleep. Had taken Ambien, Neurontin or Lyrica, Lidoderm Patch, Vicodin, possibly Benadry. One email fairly well-written. 2nd, as described above.
Cannot go off meds as condition of lifting suspension. Have psychiatrist, small town. Have psychotherapist. Neither ask pertinent negatives or positives. No Lithium levels in 8 months!! No ques about compliance. Both know that I did not take meds given in the hospital. Put into food, trash, clothes. Previous psychiatrists affiliated with UCLA. Saw both on one day. Neither can recall I am on Lyrica after 2 visits. They both rx Lyrica. Great, I'll take Lyrica.
Have more hx, but would like your impression of above.
Would like Dr. Michael's impression regarding the emails that I wrote prior to admission. Also, his impression of my lack of tact with my friends.
Bipolar vs lack of sleep and under trmendous pressure.
I am only taking Lithium.. Levels 0.4 - 0.6 for at least 1 year. If I am not bipolar, I would like to go off Lithium. Do not think that 3 UCLA faculty with private practices can evaluate my record objectively.
I would like to ask you questions regarding bipolar disorder. Recall, no hx of depression. Dxd at age 55 yo.
Onset Jan 23rd.mania. Dxd with depression by Stanford-educated neurologist after the 2nd hospital day. "Flat affect" "Does not want to open her eyes." I could not open eyes due to sedation with Ativan given the day before. 72 hrs later, discharged. Readmitted by man who I called to give me a car ride home. My coat had been stolen with car key. This man probably knew about 1st admission. Retired MD. Bizzare man fired from Kaiser. Taken to same ER. Same hx came up on computer. Not evaluated by ER MD. so Feb 16th, adm 72 hrs at psych facility. Did not take any meds given. I "seemed better". Psychiatrist knew I was not taking any meds; friend reported this to him. Saw psychotherapist/lawyer. Spent 2 hours with her. Spent about 2 hours with friend. Both felt I was functioning at my baseline. So, manic/depressed. 3 weeks later, manic and not depressed. One week later at baseline as per woman who worked as a litigator, then became a psychotherapist. Approx 3 weeks later, grabbed out of my home by ex who hears about my hx and hospitalizations. Taken to same ER. He has not seen me in over 3 months. Reports that I am not taking care of self. Home a mess. Great. Same hx on EMR. Taken to another psychiatry facility one month later. GAF of 35.
Is time course consistent with bipolar. Is it consistent with GAF 35 to buy groceries, have nails done, hair done, pay 10 vendors for my office, buy concert tickets and invite friends?