2022: The Year in Review

Posted on by Astrid

Hi everyone. It’s the last day of the year, so in keeping with my tradition, I thought I’d do a review of the past year.

I started 2022 by reviewing the forms for my extra care funding application – my extra care had just been re-approved for two years at the end of 2021 – with the behavior specialist. “Extra care” is what I usually refer to as “one-on-one” here, but I’m told by several staff that it’s not technically one-on-one if it’s not full-time one-on-one. Whether that’s true, I don’t know. I made some suggestions for when the application had to be submitted again in two years’ time. With how much has changed over 2022, I doubt any of it will be relevant anymore.

I also started the year with a healthier food plan and by seeing a dietitian. Over the course of the next nine months, I lost about 4-5kg and, like I had hoped, got to a relatively stress-free food plan. I did, towards late summer, start overexercising a little, but I attribute that to the newness of my Apple Watch.

By April, things started to shift a little, as I officially voiced my wish to explore the possibility of my moving to the main institution or another care agency with an institutional setting. The behavior specialist and I created a housing profile with my needs and wants on it and the behavior specialist gave it to the care consultant.

As it turned out, he only got applications sent out to the main institution and to one other agency, an agency in elder care. The reason was the fact that said agency operates an assisted living facility for blind or visually impaired older adults. With the fact that my long-term care funding is blindness-based, it makes some sense, but the place isn’t suitable at all.

I did get to meet the behavior specialist and two support coordinators for the main institution. As it turned out, they did find a place they considered suitable, ie. my current care home. I moved in early October to what from the care agency’s website looked like my dream home. It quickly turned into a nightmare though.

Thankfully, during the timeframe of late November till late December, some things got settled. I’m still finding I feel very easily frustrated with some things in my home and I’m swinging between letting them go (which is very hard for me) and mentioning them (which may come across as me sweating the small stuff).

For one thing, I lost another 6kg during these three months that I’ve now been here. I know I am still overweight by a few kilograms, so in this sense it’s okay, but it does create some difficulties relating to my disordered eating habits. I’d really like to get in touch with the dietitian again.

In other health-related news, I got some med tweaks in 2022. First, I started pregabalin I think in February. Then, in April, I took my first step lowering my antipsychotic dosage.

I also found out during the summer that my kidney function was mildly decreased. I had it retested about two weeks ago and, though it decreased a tiny bit further, this could be because I have a UTI.

Let me also share about my creative endeavors of the year. I did a ton of polymer clay crafting and really loved it. When I moved to my current care home, I for a while had to let go of this hobby, but now I’m trying to slowly reinvent my creative self.

Lastly, faith-wise, I remain a struggling new believer. I am really hoping and praying that God will lead me further on the right path towards Him in 2023.

#WeekendCoffeeShare (August 6, 2022)

Posted on by Astrid

Hi everyone on this first Saturday of August. Okay, that starting phrase gets boring, but who cares? Well, me, but I can’t think of any better way to start my post. I’m joining #WeekendCoffeeShare today. I’ve had five cups of coffee already today and it’s mid-afternoon. Want one too? I hope I haven’t used up the whole pot. Well, it’s a virtual coffee share. Let’s have a coffee and let’s chat.

If we were having coffee, I’d ask about your weather as usual. Ours has been mostly warm, sometimes hot. On Wednesday in particular, the daytime temperature rose to 31°C. Today, it’s only about 21°C. I even wore long sleeves this morning when going out for a walk.

If we were having coffee, I would share that I discovered a function I hadn’t previously known about existed in JAWS, my computer’s screen reader. When you press INSERT+4, INSERT being the designated JAWS key, JAWS displays a menu with special characters to select from, such as the euro sign, the degrees sign I used above, etc. Before I knew about this function, I’d do a Google search for something that’d pop up the character I wanted, copy/paste it into a text document and copy/paste from that document to my blog. However, if I wanted a character that wasn’t yet in the document, I’d need to do a search all over again. Besides, it’d mean having to open a separate app, in this case Notepad, and copy/pasting from there rather than selecting the character from the menu.

If we were having coffee, I’d share that, today, I started on 25mg rather than 27.5mg of aripiprazole (Abilify), my antipsychotic. So far, so good, but I’m not expecting any effects as of yet, as aripiprazole has a half life of 72 hours and the dosage decrease is so small anyway. This is my second decrease out of possibly twelve, each taking three months. That’s an incredibly slow taper, but it’s this way so that any possible changes in my mood and/or behavior can be observed over time.

If we were having coffee, I would tell you that I’ve been busy crafting this past week. Someone from a neighboring care home has her birthday next week and a fellow resident from my care home has his birthday on the 25th. I asked the woman who has her birthday next week what her favorite color is and she immediately understood why. “Ah, you know when I have my birthday!” she exclaimed. Of course, I didn’t reveal anything else. I am creating a necklace with all polymer clay beads for her. I did this for someone else, who had her birthday at the end of January, and back then it’d taken me weeks to create all the beads. Now, I was able to do half of them in one day. The other half is a little harder, because that color of clay is more difficult to work with.

For the man who’s having his birthday on the 25th, I bought a canvas, which I painted black this week and am going to decorate with polymer clay cookie cutter shapes once I’ve finished the necklace. I am doing his name and a car. Since the challenge theme for this month in the Dutch polymer clay Facebook group is mixed media, I’m also thinking of including some other technique, but I’m not yet sure what.

If we were having coffee, lastly I’d share that today, my husband went to get his new-to-him car, a Fiat Panda. He’s coming for a visit tomorrow. We originally thought of driving to some town or city in the area, but neither of us can think of an interesting one, so we may just go to Subway to have lunch.

How have you been?

Gratitude List (July 31, 2022) #TToT

Posted on by Astrid

Hi all on this last day of July! Today I’m joining Ten Things of Thankful (#TToT) for a gratitude list. I’m rather late to the party, but better late than never, huh? Here goes.

1. I am grateful for some good phone talks with the care facility’s behavior specialist this week. She gave me some useful advice on how to handle my frustration with respect to my recent care review with her and my nurse practitioner from mental health.

2. I am grateful my nurse practitioner gave the get-go for me to lower my antipsychotic again. Next week, I’ll be starting with the slightly decreased dose.

3. I am grateful for a nice visit from my sister and her family. I am so grateful Janneke, my oldest niece, was really friendly with me. I tried to show her how to make a play-doh unicorn, but she may still be a bit young for that and/or I wasn’t engaging enough.

4. I am grateful I got to hold Wolke, my youngest niece, who is just two-months-old.

5. I am grateful for the belated birthday gifts my sister and her family brought me. I got four sets of cutters and a set of texture sheets to use with my polymer clay.

6. I am grateful for a delicious salami pizza with added olives and red peppers. Yum! We ordered pizza (and fries for Janneke) last Monday when my sister and her family were here.

7. I am grateful for a good visit from my mother-in-law on Friday too. We went out to have lunch, which was delicious.

8. I am grateful for no mosquitoes last night or the night before. This hopefully means my anti-mosquito device, that I’d bought last Friday when in town with my mother-in-law, is working. Either that or none had been in my room at all. I don’t really care which, as long as the critters aren’t bothering me.

9. I am grateful my pasta machine isn’t broken after all. I had experienced it’d crumble several colors of polymer clay. Even after a deep clean session, it still did this, so I thought it must be broken. Thankfully, one of the most knowledgeable people in the Dutch polymer clay Facebook group took a look at a picture I’d taken and said it wasn’t broken. Apparently it’s the clay.

10. I am grateful the new pasta machine I impulsively ordered online when thinking the current one was broken, can be returned. I will probably ask my staff to drive me to the PostNL pick-up point tomorrow. When I have my refund, I’m going to order supplies I really do need from that same store I now ordered the pasta machine from.

What are you grateful for?

#WeekendCoffeeShare (April 24, 2022)

Posted on by Astrid

Hi everyone on this last Sunday afternoon of April. Can you believe that we’ll be in May this time next week already? I certainly can’t. The weather’s okay: sunny and about 16°C. I can’t wait for higher temperatures though. Anyway, I’m joining #WeekendCoffeeShare today. I haven’t had my afternoon coffee yet, but am likely going to take a break while writing this post to have it. You can have a cup as well. The staff are also trying to get me to try some type of drink that sounds much like what Americans call Kool-Aid: a powdered substance (sugar-free or so I’m told) that you add to cold water and that then creates the flavor of juice. I’m pretty sure I’d prefer plain water though. Anyway, we have this stuff in the apple-flavored variety, so if you’d like a drink of that, get yourself one. Let’s have a drink and let’s catch up.

If we were having coffee, I’d tell you that this week, I’ve been experiencing quite the rollercoaster ride of emotions. Due to a number of triggers, I got to doubt once again whether I want to stay in my current care home forever and, on Thursday, I more or less decided that I at least want to discuss the possibility of looking for another place. I have no idea whether a voluntary move is even possible and it’s certainly not something I’m looking to decide on quickly. My assigned home staff E-mailed the behavior specialist and manager to see if they can discuss the possibilities and process with me.

If we were having coffee, I’d share that I also experienced quite a bit of emotional dysregulation recently. I am having some major flashbacks and identity confusion. It looks like a new factive alter (an alter based on a real, outside person) may have formed recently.

If we were having coffee, I’d tell you that tomorrow, I’ll finally be discussing lowering my antipsychotic dosage with my nurse practitioner. I’ll most likely take the first step sometime in early May. Even though I’m not feeling at my best right now, I want to move forward with it.

If we were having coffee, I would share that I did enjoy doing some polymer clay work recently. Mostly, I just mixed colors. Like I said before, last week, I got the Fimo Professional true colors six-pack, which comes with a mixing chart, from the day center. I love it! My mother has her birthday on Thursday and I’m fully intending on making her a tulip out of polymer clay with all colors I mixed myself.

If we were having coffee, lastly I’d share that I went to Lobith yesterday. It was good being with my husband once again. We got Domino’s pizza and had orange tompouces (a Dutch-specific pastry) in honor of King’s Day on Wednesday. This morning, my husband went out to the local bakery to buy us croissants. Yum!

How have you been?

An Unbelievably Good Psychiatrist’s Appt Yesterday

Posted on by Astrid

Yesterday, I didn’t blog, because I was overwhelmed and frustrated all evening. The frustration is a topic for another time. My overwhelm was mostly positive in a way, in that I’d had a psychiatrist’s appointment in the morning and was overcome with disbelief at how understanding she was. That in turn triggered feelings of disbelief at my current life situation in general, which triggered memories of trauma.

I’d seen this psychiatrist once before, last December. Then, she had switched my PRN medication from lorazepam to quetiapine. Now was the time to discuss whether this was the right medication for me. I wasn’t sure to begin with. I explained truthfully that, while the medication helps somewhat with my oversensitivity to stimuli like noise, it doesn’t help with the anxiety and PTSD symptoms. I didn’t mention PTSD as such, but I did mention that my basic level of arousal is already pretty high. She asked me to describe how I moved from my baseline, which I explained was already a five on a 1-10 scale, to a level ten. I explained that I move very quickly and, once I’m at a ten, I’m too overwhelmed and unable to process stuff to take a quetiapine. Then, when I recover slightly to, say, a level eight, I can take the medication and it helps me get back to my baseline level of five.

I can’t remember how we got talking about it, but I assume my nurse practitioner already told her some things about my anxiety. I mean, we got talking about my fear of going to sleep, which I up to that point had hardly realized was maybe an actual fear of going to sleep because of nightmares. Until this point, I’d always assumed it was some form of fear of abandonment, as the night staff isn’t in my home all the time.

The psychiatrist pretty quickly got to her suggestion, which is adding a low dose of topiramate (Topamax) to my daily medications. I had heard of this medication before and a person I know online, had gotten it at his own request to help with PTSD-related nightmares. This person got it only for a few nights when he had to endure a triggering situation though. Besides, I don’t have nightmares every night. So before I agreed to it, I asked the psychiatrist to explain what it would do. She said it’s normally prescribed for epilepsy or migraine, but low doses are also found to be effective for trauma-related symptoms. She explained that some people love this medication and some hate it due to its side effects. At first, I’ll get one 25mg tablet to be taken at night. I’ll notice any side effects I’m going to get within the first several days and can then stop right away if they’re too unpleasant. If I tolerate this medication, the dose can be upped, in which case I’ll need to take the medication twice daily. The highest dose she usually goes to for PTSD is 150mg a day. She said that it should help with nightmares, but also could be helpful in preventing me getting triggered and having flashbacks often during the day.

I loved how understanding she was of my symptoms. I can’t even remember having said that I experience flashbacks, but I quite often do indeed. She said that, though I can continue to take my PRN quetiapine, that one dulls me a bit, while the topiramate should actually make me less susceptible to flashbacks. It reminds me of an explanation of the different effects of antipsychotics vs. anticonvulsants in helping with sensory overreactivity that I once read. It said something like, imagine overload is hearing a hated radio channel at top volume in your head. Both antipsychotics and anticonvulsants change the channel, but while antipsychotics give you headphones, anticonvulsants actually lower the volume of the radio. Of course, I will continue to take my daily antipsychotic (aripiprazole) and antidepressant (citalopram).

A possibly not-so-undesirable side effect of topiramate is decreased appetite. Other than that, side effects include drowsiness, sleepiness, double vision and tingling in the hands or feet. That last one, particularly if it’s going to effect my fingers, sounds annoying, but I’ll get to experience that if it happens.

Since my nurse practitioner will have to talk to my care facility’s physician before the medication can actually be started, I don’t expect this to happen till sometime next week. It’s also been decided I will start this when a trusted staff is on shift.

Now this did get me into an excited yet overloaded state yesterday evening. I mean, seriously, how can it be that someone truly understands? It baffles me but I’m so relieved.

Another Appointment With My CPN

Posted on by Astrid

Today, I had an appt with my CPN again. I can’t remember all the details, but I did tell her that I had had a breakdown on Sunday. I was completely honest, sharing that I had seen and heard things that aren’t there. It was as if something was truly telling me I’m a monster and everyone will leave me. Then I saw some form of Heavenly light. I can’t describe it really and it wasn’t very vivid even then, but it was more than mere wishful thinking.

My CPN encouraged me to discuss this with the psychiatrist when I see her on the 22nd. I really hope she can help me. My husband later asked me whether it was truly psychosis or a panic attack. I don’t think I was full-on psychotic but my perceptions and thoughts were definitely headed that way. My CPN agreed.

I can’t remember whether I told my CPN, but I had these thoughts and perceptions once before. Well, a few weeks ago I had them too, back when this depressive stuff all started, but then it wasn’t that bad. Back in December of 2009, I think it was even on Christmas, it was. I had run off from the psych ward in the snow. I picked up snowballs and somehow was convinced they contained drug needles. I wasn’t depressed at the time, just batshit crazy. It lasted only for a few hours though, but came back several times within the next few months, only disappearing when I was put on Abilify.

Now I’m pretty pessimistic. After all, I’m already on the highest dose of both Abilify and the antidepressant Celexa. (I mention this because I’m pretty sure I’m depressed, whether clinically or not.) I’m hoping though that the psychiatrist can put me on some PRN medication other than lorazepam, which I can use if I fully break down again. I know I have had experience with Phenergan (promethazine, a low-potency neuroleptic) and that worked great when I was on no other medication but not at all once I was on my current regimen. Maybe the psychiatrist can prescribe me something similar but different.

I also talked to my CPN about the incessant crying. She told me this may be useful. After all, I learned from a young age on to hide all negative emotions except for frustration (because I couldn’t hide that). In fact, I was told that I was “too quick to anger”, but this was used as an excuse to force me to repress every emotion other than a smile. I hadn’t been able to cry unless I was angry first until only a few months ago. As such, my CPN reasoned that I might have a lot of catching up to do.

My Medication Musings: Abilify

Posted on by Astrid

It’s been a while since I last did a post on my medications. Today I’m writing about the medication I’ve been on the longest: aripiprazole (Abilify). I’ve been taking this second-generation antipsychotic for over ten years.

When I first got prescribed Abilify in 2010, I had been on no psychotropic medications except for PRN oxazepam for over two years. I was having a lot of meltdowns though and the staff at the psych hospital couldn’t adequately care for me. I was sent to the locked ward for a time-out shortly before starting on Abilify.

When my psychiatrist proposed this medication, he made a pun about the drug’s name by saying it makes things a little easier. I didn’t like that, but agreed to take a low dose of Abilify anyway. I started at 5mg a day.

Within half a year, I had had my dose upped to 15mg a day. I did pretty well on that moderate maintenance dose for several years, until I moved to another hospital. There, the staff/client ratio was lower and besides, staff weren’t as willing to accommodate for my needs. I quickly had to up my dose again to eventually 30mg a day.

I wasn’t so sure I wanted to go beyond 15mg, as most clinical guidelines recommend a higher dose for acute mania or psychosis only. My new psychiatrist disagreed and seemed to have no interest in lowering my dose once I had upped it. For this reason, I’m still on 30mg a day.

When I first came here, I expressed a wish to lower my dosage once I’d settled into the care facility. The intellectual disability physician for my facility as well as my psychiatric nurse practitioner recommended I wait at least six months. I’ve now been in the care facility for a year, but haven’t felt comfortable asking to be tapered yet.

Now I must say I don’t experience any of the more major side effects, such as akathisia (a form of physical restlessness). I however do feel slightly sedated.

I also feel that the medication’s effect has worn off over the years. I recently learned that your neurotransmitter receptors overgrow when you’ve been on psychotropic drugs for a long while. At least, that seems to be the case for the dopamine D2 receptor, the one Abilify mainly acts on. Recommended action is lowering the dosage or trying another medication. I will definitely raise this issue with my nurse practitioner.

As a side note, like I said, I had my dosage upped once I moved to a psych ward with a lower staff/client ratio and less willingness to accommodate my needs. This is not an appropriate reason for medication increases, but I didn’t know what else to do.

My Medication Musings: Risperdal

Posted on by Astrid

I started this should-have-been-series a long time ago, but never got beyond the first post. Today I’m not very inspired to write, but I want to write something anyway, so I am deciding to continue with my medication musings. The medication I’m covering today, is the first daily medication I was evver prescribed.

Risperdal, which is now sold under its generic name risperidone, is an atypical antipsychotic. It was approved by the U.S. FDA for use against irritability in autistic children in 2006. I was not a child when I was prescribed Risperdal in 2007, but I was definitely irritable and autistic.

I remember very clearly when I saw a psychiatrist I’d never met before and who may or may not have read up on my psychiatric history on July 25, 2007. She had a strong Flanders accent. My CPN had referred me to her after my staff at the independence training home called her because I had been very irritable of late. Looking back, it’s no wonder, since I was due to move out of the home and into independent living the next week. But my staff were desperate and so was I.

My CPN had suggested a sleeping medicationor tranquilizer, as I was also sleeping very poorly. Not that the psychiatrist agreed, since when I reported how many hours of sleep I got at a later phone consultation, she said that wasn’t worrysome. The psychiatrist listend to my symptoms and suggested Risperdal.

I agreed without much further questioning. That evening, I wrote a blog post saying antipsychotics in autistics are a matter of really well-informed consent. The post was a response to the general consensus at the time among vocal autistics that antipsychotics should never be considered.

Looking back, while I don’t feel that antipsychotics are completely off limits for autistics – I still take one -, I do agree with another notion from said vocal autistics: psychiatric medication is no substitute for proper support. And yet, at the time, there was no convincing my staff that I shouldn’t move into independent living, so I felt I had no other option if I wanted to have somewhat of a life worth living.

And yet, I was scared. When, after two days, I started experiencing palpitations, I was extremely anxious. It happened on a Friday night when my staff were already gone. Don’t ask me how I got through that night. The next morning, I rang the out-of-hours GP, who recommended I stop taking the medication for a few days and consult my psychiatrist on Monday. Said psychiatrist didn’t believe that this could be a Risperdal side effect or I’d have experienced the palpitations right from the start. So back I was on Risperdal.

I was on a low dose of 0.5mg twice a day. My psychiatrist was in the training home’s city, so when I moved the next week, I had no psychiatrist nearby. My GP ended up prescribing my medication. When I complained to both the training home city psychiatrist and my new GP about continuing palpitations, both dismissed me. The psychiatrist even suggested I up my dose. I refused.

Because of the abrupt change in my living situation soon after starting Risperdal, I had no idea whether it was working. I was still experiencing a lot of meltdowns.

After two months, I took myself off of the medication. I more or less informed my GP, because she was really against me going off of it. I probably lowered my dose way too quickly, going from 1mg a day to 0.5mg for a week and then stopping altogether.

We will never be sure whether Risperdal worked for me, as I never went back on it. However, three weeks after stopping the medication, I started to spiral down into crisis and had to be hospitalized four days later. The crisis service psychiatrist didn’t say a thing about me having discontinued Risperdal.

An interesting thing I need to note, is the fact that Risperdal is notorious for increased appetite and weight gain. However, I experienced the opposite if anything. This could’ve been due to stress though.

Working On Us Prompt: Psychiatric Medication

Posted on by Astrid

I’ve been thinking of doing some posts on the medications I’ve been prescribed so far, but didn’t get down to it till now. Today, Beckie’s topic for Working On Us is psychiatric medication. Beckie asks a few interesting questions I didn’t think of.

First, she asks whether, when you were first diagnosed with a mental illness/disorder, it took you a while to get used to the medication prescribed. Well, my first diagnosis from a psychiatrist was autism, for which there are no specific medications. It took four months after that diagnosis before I first got put on a daily psychiatric medication. That was Risperdal (risperidone). I didn’t like it at all, even though it took only a few days to kick in.

I remained on Risperdal for 2 1/2 months, and then took myself off. I felt that the medication was merely used to keep me just contained enough that I didn’t qualify for more care. Well, it is my firm belief that medication is not a substitute for proper care.

Going off Risperdal was a mixed bag. I felt okay the first few weeks, but three weeks after having stopped taking the medication altogether, I spiraled into crisis.

After taking myself off of the Risperdal, I was without daily medication for nearly 2 1/2 years. I was in a psych hospital, so I can tell you right away that the crisis service nurse was wrong to say hospitalization would mean being put straight back on meds. Apparently my psychiatrist agreed medication is no substitute for proper care. That was until, despite mostly adequate care, my irritability got so bad I just needed something. I was put on Abilify (aripiprazole) and remain on that ever since.

Beckie also asks about withdrawal. I have been on the same antipsychotic and antidepressant ever since 2010 and never lowered my dosage yet. However, I did for a while take Ativan (lorazepam) at a relatively high daily dosage. Then when I wanted to quit, my psychiatrist said he’d prescribe it as a PRN med. Well, I didn’t need it for the first few days, so I didn’t take it. That was until I started experiencing tremors a few days into withdrawal. I am lucky I got only those and didn’t get seizures or the like. Thankfully, I got put back on lorazepam and tapered safely.

Beckie’s last question is whether you work closely with your doctor in managing your meds. Well, I just had a meeting with the intellectual disability physician for my facility last Monday. She is making sure I get my medications and will also order yearly bloodwork to check for metabolic issues etc. I haven’t seen a psychiatrist with my new mental health team yet, but will soon enough. I want to eventually try to lower my Abilify dose. The intellectual disability physician advised me to wait at least six months to get used to living here though.