[BeyondtheRainbow]

My therapist listened to everything that's been going on in the last week and looked at my mood charts and also the data on my phone for the days since I printed the charts and said he's concerned that this may require hospitalization because my symptoms are getting worse and he does not like the increased psychotic symptoms. He said he doesn't think that this has to happen now but that it may happen and that we can't let the psychotic stuff get worse. I already knew this of course; it's hard to not know that IP is a strong possibility when things keep getting worse. He says we have to get me some rest, more like what one would expect of someone taking what I am.

I'm supposed to email my psychiatrist and then call her secretary and ask her to tell my pdoc that she needs to find and read the email out of her daily pile of hundreds.

My big reasons for not wanting to go IP (besides not needing to yet although I know the day is coming that I do need to) is that it is a small space and very hard to handle when agitated (168 steps to walk the perimeter of the unit, including detouring into the little hallway where the laundry is and back out. Also I never sleep well there and if I go in not sleeping I could have a really, really tough time. I also am afraid that if I went in the only med that has gotten me some sleep, valium, would be taken away because the hospital dr on that unit doesn't like benzos and would be opposed to my being on 2. My pdoc can explain the reasoning to him and he listens to her but I'm afraid that if she forgot to mention it or something he'd pull the valium and make me go through ambien and lunesta again and those do not work. At most they give me 3 nights of some sleep.At least with the valium I get sleep every night, more than with the sleeping pills. I can't be on tricyclics for sleep because of being on an MAOI so that reduces what they usually use IP. And not sleeping there is horrible. The night nurse makes me feel like it's my own fault unless I lay awake in the dark for hours and then she questions whether I've been awake until I describe everything that has happened with room checks, doors being cracked open and my closing them AGAIN (I hate that they do that although I know they are trying to be quiet but the light is really hard to sleep with), etc. before she'll believe I was awake. Then I get in trouble for not pulling myself out of whatever degree of sleep I had achieved to tell them I was still awake. Whatever.

I just feel so tired and like the mixed episode is pulling me in 2 different directions so hard it is pulling me apart. I am so tired and cranky and it feels like this is never going to end. Last week I really thought it might be on the path to getting better but then that ended and it's just gotten worse. I can't even remember the last time I slept all night from a reasonable hour to a reasonable hour and didn't wake up over and over and over again.

And I knew I'd be talking about the hospital today yet it still makes me feel really sad. My therapist is always faster to go to the hospital discussions than my pdoc so as far as she's concerned it's probably farther off. But I have no idea how much farther off. Hopefully she'll have some good news for me, in whatever form that takes. I'm even considering asking about going up on the Seroquel dose one more notch. She said that has been done before. I just don't know if I could handle the side effects. TMI but this makes it very difficult to pee and it is painful because my bladder has to be full to pee without effort. This morning I just couldn't go and had to wait an hour until my bladder filled more and try again. So I don't know if the higher dose would even be an option with that; obviously I must urinate.

I'm just tired of this. I need a vacation from my own brain.

[~Christina]

Have you ever discussed going on a second AP for a very short term, Lots of Pdocs like to add a heavy hitter like Zyprexa to basically knock people out and stop the psychotic stuff.

Just a thought, hope you find a solution that will help you avoid an IP stay.

[BeyondtheRainbow]

Yeah, that's actually hopefully happening in 2 weeks. I go to a very large hospital that doesn't allow the staff drs to have samples unless they are for a specific patient with a specific situation. I can't afford the med we're planning to try (Latuda) so will get it from patient assistance but first I have to try it on samples. So my dr had to request the samples specifically for me and the Latuda rep had changed so first she had to find out who to contact then get the samples. I don't know if she has them yet or not; she's been out a lot lately. I think her daughter may have graduated from college and she has some health issues that require testing about this time every year. Anyway, normally she wouldn't ask me to stop by for the samples b/c I live 2.5 hours away. If she does have them now I may need to make a trip up to get them.

We have tried 2 APs before without any effect. I was on 800-900 mg of Seroquel and 10 mg of Zyprexa along with various sedatives (kind of like now) and it did absolutely nothing. I also tried Seroquel/Latuda once before but I was extremely sick and didn't stick with it long enough to have any idea if it worked. I was too suicidal then to continue a new med and trying to adjust. So I'm not sure how this will work.

If she doesn't have Latuda which is by far my best choice I'm going to ask about loxapine which she said once should be safer with my extra-pyramidal symptom risk or if we can do something like haldol and just start cogentin from day one to see if we can prevent EPS. I have no idea how she'll feel about that; avoiding neuoroleptics has always been higher on the list than if we could attempt one with pre-emptive EPS treatment. But the day that I ran out of safer options has been coming for a while so I'm sure she has ideas in her head that I don't know. Clozaril has come up a number of times but she's always said she doesn't want to put me through that. I don't know which comes first, avoiding EPS or all the Clozaril issues (which can cause EPS on its' own too). And I don't even know if my Med D pays for Clozaril at a level I can afford.

Sorry, thinking aloud. But yeah, that's the plan it just had to be delayed a month from making the plan to implement it. I even tried to get it from my family dr but he said that he'd had one set of it but it must have expired and been thrown out. (this makes me happy that my family dr isn't passing out APs but it was too bad it expired).

Thanks