Perfect in all her Imperfections

I am officially on pregnancy watch at my doctor’s office.

Before you start to get to excited I should let you know that I’m not actually trying to get pregnant yet. We are far from removing the goalie.

But apparently when you are on lithium and say that you are maybe, thinking about, perhaps trying to get pregnant you get flagged. Lithium is that bad for a fetus, according to my doctors and my husband, who is pharmacist.

If I get pregnant while on lithium my baby could be born with a heart defect. And it would be all my fault. I’ve been told this for the past seven years.

Sure, some doctors say it’s okay to stay on lithium during pregnancy, but I’ve only read of these doctors on the internet. None of the doctors I’ve ever went to have said it would be okay to stay on my lithium during the first trimester.

If I do wean myself off of my medication and get pregnant it will be a risky pregnancy in that I could become depressed or manic (aka dead inside or detached from reality.)

Contemplating pregnancy when you are bipolar is very isolating. I don’t know anyone else in this situation and feel most people either don’t, or wouldn’t, understand the severity of my decision whether or not to pursue pregnancy.

Never the less I have done all the things you shouldn’t do when you are not sure if you can get pregnant.

I’ve picked out names and can picture the baby in my head. She has my curly hair and spunk and Logan's mischievous smile and knack for science.

I’ve imagined how we would decorate the nursery and can almost hear her little giggle.

Yes, I’ve done every thing you should NOT do if you aren’t sure you can get pregnant. This little girl in my mind is just a figment of my imagination.

In reality, I have a lot of choices to make before I can get pregnant.

1. Do I want to be off of my meds completely during the pregnancy or at least first trimester?
2. Do I want to get on medications that are less risky?
3. Am I willing to risk another major episode of depression or mania?
4. Even if I am willing to make take this risk is that the responsible thing to do?
5. Could we financially afford to adopt a child?
6. If adoption is an option why am spending so much time obsessing about getting pregnant?

I believe in a woman’s right to chose, but when it comes to my own reproduction I wish I didn’t have so many choices to make.

Adoption clearly makes the most sense. It is best for my health, it is best for the environment (hello population control) and it is best for the child we would take in as our own. Yet, there is a narcissistic part of me that wants to create a baby that is a little part Arley, a little part Logan, and 100 percent ours.

Do's and Don'ts for the Holiday Season

I enjoy Christmas lights and eggnog as much as the next gal, but let’s face it most of us experience more stress than good tidings during the holidays.

Over the years I’ve found ways to make the holidays, not just bearable, but actually enjoyable. I know this is is shocking, right? Unless is not shocking and you are one of those lucky people with fond memories of your childhood Christmases. If that’s the case you can go ahead and skip this blog and get back to browsing Pintrest for homemade Christmas decorations.

Here are some Do’s and Don’t’s for the holiday season for those of you who, like me, may experience anxiety during this time of holiday cheer.

Do set healthy boundaries. Remember you can’t be everything to everyone. And if you come from a split family and/or are in a relationship you likely have at least four places to attend each holiday. Find what works best for you and your household and stick to it. This may mean saying no to some invites, but remember your sanity is just as important as the feelings of your Great Aunt and third-cousin twice removed.

Don’t allow guilt trips from your family or in-laws to get to you. I’m not a mother yet, but it seems that somewhere during the labor and delivery process mothers receive these superpowers that allow them to give guilt trips like no other. I’m very lucky that my mother doesn’t use these during the holidays. But if I didn’t set healthy boundaries she might be tempted to. She is, after all, a mother.

Do reach out to your doctor if your anxiety and depression starts to get worse this time of year. An antidepressant or anti-anxiety medication can help regulate your moods in a safe and healthy way.

Don’t self medicate. There is a difference between having a glass or two (or three!) of wine at a Christmas party and turning to alcohol to drown your sorrows and numb your pain. The former is fun and festive the later is dysfunctional and self destructive.

Do create traditions that are meaningful for you. My husband and I try to go to the Christmas Eve service every year as our “tradition.” I say try because we’ve only actually went once. One year there was a blizzard so bad that churches actually cancelled their Christmas Eve services. Every other year he has worked and this year he’s on-call. So, maybe that tradition was a bad example, but you get what I mean.

Don’t set your expectations too high. Things happen and the holidays are never as picture-perfect as they are on TV. Unless they are for you, in which case why are you still reading this blog? Shouldn’t you be on Pintrest?

Do give yourself lots of grace. So you didn’t pick out the perfect gift for your mother-in-law? No biggie. So you burned the pre-made sugar cookies? Who cares. You forgot the date and time of your extended family gathering? Don’t worry, there’s always next year.

Don’t completely shut down. It’s not healthy to isolate yourself from your loved ones when feel depressed or anxious, but it’s what we tend to do. If you feel yourself shutting down, take a minute and reach out to your “safe” person. It could be your best friend, or your spouse, or you sister. Whoever it is for you, reach out. Don’t keep yourself in isolation.

Do feel free to leave comments if you found this blog helpful.

Don’t stop reading this blog if you are one of those people who have great holidays. I forgive you for continuing to read even after you were instructed to go to Pintrest.

Erring on the side of happiness

I generally try to put on a good face wherever I go, but especially when I have to go to my psychiatrists office.

I say “my psychiatrists office” as if I have I psychiatrists I see regularly. For now I go to KU Med and see which ever resident fits with my schedule.

In reality, I haven’t been able to find an attending psychiatrist who sees outpatients who is not a complete quack, but I’ll save my adventures in doctor hunting for another post.

This blog, is about saving face, a skill that I have mastered over the years. During my quarterly psychiatry visits my goal is to be the ideal patients. I have had doctors hug me at the end of my appointments before. Why? You might ask. Because I’m an extremely compliant patient. I take my lithium as directed (minus my the little experiment I had earlier this year), I get my labs checked, I exercise, eat healthy, and stay connected to my support systems.

I strive to be the perfect patient. If there is ever a hint of hypo-mania in my head, I call in. That’s what good patients do.

I’m like a teacher’s pet, only with my doctors. I don’t want to let them down, so much so that when I’m feeling depressed I don’t like to mention it. I mean really, an ideal patient shouldn’t get depressed, right?

This obsessive people pleasing may sound strange to you. Unless you are related to me or a part my inner-inner circle, in which case you already know this is the neurosis we call Arley.

A few weeks ago I had an appointment with a new resident. I scheduled the appointment with a female resident who came highly recommended from my therapist.

That morning I put on a super cute dress I just bought from White House Black Market, scrunched my curls in place and prepared for what I thought would be an awesome doctor’s visit. I planned to discuss the possibility of tapering off my medication so I can maybe, possibly, fingers-crossed, try to get pregnant next year. I was ready for the appointment. I was ready.

Before my doctor’s appointment I had a slightly stressful meeting at work, but I didn’t let that get me down. I listed to Fresh Air on KCUR on the way to KU Med and thought about all the questions I wanted to ask the doctor about bipolar pregnancy.

But when I arrived at the sixth-floor outpatient psych unit, the receptionists put glitch in my plans.

“Your appointment isn’t until tomorrow Miss Arkenberg,” she said politely.

“What?” I’m sure my voice was obnoxiously high. “My appointment is today. It says so on my phone.”

I held up my iPhone as proof.

She just gave me a look that said, “Seriously?”

Clearly I had typed the appointment into my phone wrong, but I knew there was no way I could take off two afternoons of work in a row. And I couldn’t let anyone at the office know that I had written down my doctor’s appointment wrong. I mean really, getting confused about when your psychiatry appointment is, how embarrassing is that?

“Well, what if Dr. Smith’s 2 o’clock doesn’t show up?” I asked. “Could you squeeze me in then?”

It was already 2 p.m . so I thought their might be a good chance that she wouldn’t show up.

I was wrong. Two minutes after I asked the questions the woman showed up, prompting me to call her swear words in her head. It wasn’t this woman’s fault that I entered the wrong day in my calendar but I needed someone who I could project my anger towards.

I sat down in the waiting area to collect my thoughts. As I did so tears began to fall down my cheeks.

“Come on Arley,” I thought to myself. “Be strong. Think of a plan. What’s your next move going to be?”

I decided to reschedule my appointment with Dr. Smith. I couldn’t come back tomorrow, but I would be able to come back in a couple of weeks. That seemed like the reasonable, responsible thing to do. That seemed like the thing a “good patient” would do.

But when I went up the receptionists desk to reschedule my appointment she wasn’t there.

I sat back down in the waiting room and succumbed to my tears.

Ten minutes later the receptionist came up to me to let me know that there was another doctor available to see me.

I wiped the tears from my eyes and followed the doctor into his office. Instead of giving him my pre-scripted overview about how well I was doing and how my husband and I would like to start having children, I broke down and told him how I really felt.

I felt overwhelmed.

I felt tired.

I felt paranoid.

I felt anxious.

I felt embarrassed.

I felt isolated.

I felt confused.

I felt depressed.

I realized that I hadn’t planned to tell the doctor and of these things when I left the house this morning. I’m always hesitant to tell anyone when I feel depressed. In some ways I’m still ashamed of my depression. As if I should know better. As if the chemicals in my brain should cooperate better.

The doctor asked me if their was a reason that I kept my SSRI (anti-depressant) at such a low dose.

“I’m scared of getting manic,” I confessed.

“It’s okay to err on the side of hypo-mania,” he said. “We can catch that and make adjustments. We want you to be happy. We want you to err on the side of being happy.”

His words, “err on the side of being happy,” struck me. I had never thought of it that way.

Part of me has always viewed happiness as frivolous or even reckless if there was any risk involved at all.

This doctor was telling me to go ahead and take the risk. My happiness was worth it. I was worth it.

When I left the doctor’s office that day, I didn’t feel like the ideal patient. But I did leave with a new outlook on life and a script for a higher dosage of Zoloft.

Take care of yourself

Saturday marks the end of Mental Health Awareness Week.

There so many different aspects you can touch on when it comes to mental health awareness. The area I want to highlight is the importance of taking care of ones self.

We live in a go, go, go society. I’ve heard people brag about getting by on less than five hours of sleep and working more than 60 hours in a week. Busyness has become a virtue in America.

But when comes to mental health, this virtue often becomes a vice.

One in four people experiences mental illness each year. Whether it’s a severe chronic condition, or an isolated episode of depression or anxiety, these mental health issues should not be ignored.

I don’t hear people brag in the office that they eat a Big Mac extra value meal every day for lunch and get by with no exercise. Granted I work for a wellness company, but you get the picture. We don’t brag about the ways we don’t take care of our bodies so we shouldn’t brag about the habits that our detrimental to our mental health.

The best advice I can give anyone is take care of yourself. That can mean different things for different people. Find out what it means for you and don’t feel guilty about taking care of yourself.

If you need nine hours of sleep to function at your optimal level don’t be ashamed. Go ahead and go to bed at 9:30. John Stewart’s feelings won’t be hurt if you DVR the Daily Show and watch it while you get ready for work.

If you need to take a lunch break to clear your mind, go for it. Enjoy your Panera and don’t feel guilty about coming back to the office with a yummy late.

Don’t feel guilty about the things that keep you sane. There is a difference between selfishness and self awareness. The former places ones own desires ahead of the needs of others. The later acknowledges ones own needs, which in turn enables them to help meet the needs of others.

When we take care of ourselves we are better equipped to take care of each other. Take care of yourself friends.

Battling my demons

I don’t know if I believe in demons, but I feel like I’ve been fighting three this week: mania, depression and rapid cycling.

I suspect my low levels of lithium combined with an increase in the amount of Zolft I take has caused a bit of rapid cycling. Within seven days I’ve experienced the high of hypo-mania and lows of depression. Technically, I don’t think I’ve met the DSM IV’s definition of rapid cycling because my hypo-mania didn’t last for at least four days.

For the purposes of this blog, lets just say in the last week my moods have changed more dramatically than Mitt Romney’s stance on political issues.

It all started a few months months ago when I decided to decrease my dose of Lithium from 1200 mg a day to 900 mg a day because I was afraid of dehydration during the ridiculous Kansas summer heat. I ran this past my primary care physician who was all, “Cool, whatever.”

Note to readers: Do not adjust your own doses without consulting an actual psychiatrist. Your primary care physician, pharmacist, or husband is no substitute for your actual psychiatrist. This is true even if your husband is a primary care physician or pharmacist.

When my lithium levels came back low I told my doctor’s nurse that I was comfortable with that and reminded her of the dehydration scare I had experienced the previous summer.

I was, and am, comfortable with 900 mg a day. So comfortable, in fact that four weeks ago I decided to decrease my dosage down to 600 mg a day. Why not? I eventually want to get off of lithium all together so what’s the worst that can happen by tapering down on my own?

Note to readers: DO NOT DO THIS!

For this tweak, I knew better than to tell my husband, who is in fact a pharmacist. I felt fine, better than ever. And that lasted for a couple of weeks. I noticed mood swings that spiraled toward depression two weeks ago. I bounced back from the mini-depressive episode and I as I did my energy increased and my thoughts grew faster.

I brushed off any signs that this could lead to hypo-mania. I am in the midst of a very busy season at my job, so of course I have a constant stream of thoughts, I told my self. If I didn’t things would fall through the cracks.

A week ago Sunday I realized that my rapid thoughts had crossed into the danger zone when I found myself doing dishes, practicing a standup comedy routine and going through my client’s wellness calenders. All of these tasks occurred simultaneously and later two occurred in my head.

“I should really try to get a stand up act going,” I thought. “I’m really funny.”

And that’s when I knew I needed to slow things down.

That night at dinner I asked Logan if I had seemed a bit flighty lately and confessed that I had reduced my dosage of Lithium.

He told me to get back on the dose my doctor had prescribed and I made an appointment with my psychiatrist and therapist the next day.

I have only had one full blown manic episode in my life, but it was in enough to scare me into compliance with my doctor. Anytime I experience anything that I think resembles hypomania or could cause me to become manic I go straight to my therapist and doctor. I can’t risk becoming crazy again, and that humbles me to get help.

Depression, on the other hand, is a demon all its own. And in the darkness of depression I don’t reach out for help as often. I fear that mania would cause me to lose everything I love. But when I’m depressed I don’t feel like I love anything at all. I feel like I have nothing to lose because it’s already gone.

My week that started off so high and full of my grand comedic ambitions ended with me crying my self to sleep, longing for something to numb my pain. This emotional roller coaster is the beast I call rapid cycling.

Sometimes depression reaches a level where you can’t pull yourself out of it, where you can’t even find the strength to get out of bed. I’m not at that level. So I woke up today, took a shower, went to church, and prayed for traveling mercies as I continue on my journey with this disease.

Dissecting my depression

Sitting in the parking lot of Dillion’s while my husband purchased groceries for our camping trip, I felt a hot steady stream of tears roll down my face.

Depression. When it occurs it causes me to write ridiculously long sentences like the one above and I don’t know how to stop it. 

I typically try to pinpoint the trigger of my depression.

Is the dose of Zoloft I’m taking causing me to rapid cycle? Some studies show anti-depressants can cause rapid cycling (i.e. frequent shifts from depression to hypomania).

Is it my always evolving job description at work? I tend to get anxiety when I don’t have a clearly defined role.

Is it the changes in the weather? A cloudy, rainy forecast can get me down in the dumps.

Or is the routine stresses of my life? I mean stress would be what would cause a normal person to be depressed, right?

Sometimes I think it’s the reality of constant change, rather than the change itself, that causes my depression.

But no doubt levels of my serotonin and other hormones that cause my depression once the triggers go off.

During these times of depression, I just want to break free. Break free from the reprimands for all the ways I’m falling short. Break free from my mind that’s trapped in this foggy haze. Break free from this moment where I can’t see things clear.

I mustered the strength to get out of the car to go inside to inside Dillion’s to get a drink from Starbuck’s.

I don’t know how to break free. But at Starbuck’s I have control to chose my own destiny, at least as far as beverages are concerned. That morning I ordered a chilled lime refresher instead of my normal latte. And just maybe breaking free from my morning routine was enough to get me through the morning.

Community- A gift everyone should embrace

“We should all exercise our gift to build community.” Jean Vanier

During college I took my junior year off to live in an intentional community through a volunteer program.

Along with living together and sharing a budget we also prayed together, broke bread together, and shared in each others struggles and strengths on a daily basis. We were five women who had never met learning what it meant to create community within our house and within the neighborhood in which we lived.

This experiment in communal living (or as I sometimes jokingly refer to it, ‘living in a commune) taught me the beauty of living life together. It also taught me that literally living in the same house with five, or rather any other roommates post-college, was not something I wanted to pursue. (I tried having roommates the first year after college and it didn’t end well. Cut to my happy life in midtown.)

I found an artsy one-bedroom apartment in midtown Kansas City and discovered a neighborhood in which I truly belonged. One of my close friends moved in a few blocks a way, I found an amazing progressive church, and other friendships naturally fell into place. I loved my midtown apartment. It was my safe oasis from any annoying drama I faced in my coverage of health and education in the suburbs.

Nothing, short of a marriage proposal, would be able to take me away from cozy, ridiculously low-priced home.

Well, on May 31, 2010, my boyfriend, now husband, hid a ring in a picnic basket and popped the question while we dinned on orange soda and pre-maid grocery store sandwiches. When it comes to romance that is how we role.

So, we bought a house in Lawrence, Kan., and I moved 40 miles west to the land of milk, honey, and national basketball championships.

My excitement for the wedding, my marriage and this new life Logan and I had started faded as depression started to sit in.

One thing I have noticed since my diagnosis with bipolar disorder is that major life changes are often a trigger for depression. Moments that should be the happiest of my life, wouldn’t be without the help of SSRIs.

As I tried to adapt to my new life in Lawrence, I realized that even months after the move I still didn’t feel at home.

Logan and I had recently started to attend Plymouth Congregational Church, conveniently located just a mile from our house. One Sunday, as I sat in the pew feeling, lost and lonely, the pastor preached a message about how God will protect us, sustain us, and lead us home.

When he got to that last line I could feel the tears welling in my eyes. God had led me home, this - this church, this town, this husband- this was my new community.

That same Sunday a woman lifted up a prayer for the mentally ill in our community. And even though I don’t like to think of myself as “ill” I knew in my heart that that prayer was for me.

Since that day, Logan and I have joined Plymouth as official members. And the void that existed in my heart for community has been filled. I feel truly blessed to attend a church where I can be open about my mental illness without the fear of stigma or judgement.

Everyone needs a safe place, where true community can thrive. I am lucky to have found mine.

Boundaries and other (forced) blessings of bipolar disorder

When the psychiatrist diagnosed me as bipolar in some ways it felt as though a load of bricks  has been taken off of my shoulders. Finally there was explanation to the craziness inside of me.

I wanted so desperately to get back to normal, or at least my version of normal. In the seven years since my diagnosis, I’ve come to look at my life and the world differently. I consider this new perspective a blessing (that is unless I’m in the midst of depression, in which case nothing seems like a blessing).

This new perspective has forced me to acknowledge my own boundaries and recognize my triggers.

I used to thrive on a busy workload. At one point during college I worked three jobs and had full course load. I started my first job after college as an education reporter for a suburban paper. I covered four school districts and stayed as busy as I could. I attended school board meetings, wrote stories, and brainstormed ideas for future stories.

I thrived on this energy. I always had. But my brain chemicals betrayed me the summer I started my first full-time job.

The normal energy I had enjoyed catapulted into mania. Those of you who are bipolar type 1 know the beauty and brutality that is mania. For those of you who don’t, imagine smoking crack and tripping acid at the same time. You have infinite energy, no inhibitions, and flights of ideas. This is all well and good, until the high energy and no inhibitions you gets into trouble. And your flights of ideas transition from creative to crazy.

I learned after my diagnosis that my days of 60-hour-work weeks had to be a thing of the past. I have maintained a full time job ever since my diagnosis, except for the 11-months of unemployment that I had after a newspaper layoff. I am capable of full-time work. I’ve heard of people who have bipolar who are not able to work full time and I feel very grateful that a 40-hour work week does not put me over the edge.

But I also know that a pattern of 10 and 12 hour days does. In the post-recession America a 40-hour work week seems to be a thing of the past, particularly for salaried employees.

Every employee has to find their own work/home life balance. My bipolar disorder forces me to be firm with mine. If I didn’t have this illness, I probably wouldn’t have such solid boundaries, but I honestly look at this as a blessing.

Everyone should strive to have a balance between their work an home life. Because I know that overwork and lack of sleep can trigger mania and/or depression, I don’t feel guilty about working only eight hours during the day and sleeping nine hours at night. I know myself, and I know I function best within these parameters.

I know myself, because managing this disorder requires that I do so. And perhaps that is the greatest blessing I have received from this beast we call bipolar.

Hello there blog reader

Welcome to my latest blog venture. I decided to launch this blog for several reasons, but the main reason is to encourage others who are diagnosed with bipolar disorder.

I have been diagnosed and on medication for seven years and I haven’t had a major relapse since my diagnosis and hospitalization. In fact, most people would never imagine that I was once institutionalized. That is unless they knew me during that brief period of psychosis, but I’ll save that story for another blog post.

My point is I am a healthy, happy, successful 29-year-old. And as I get ready to enter my 30s, I want to inspire anyone struggling with this beast we call bipolar because I know first hand that there is hope. And I also understand how much the process of finding the magic medical cocktail that works for you sucks. Even after find the magic doses part of you knows (or if you don’t you will soon find out) that those doses might not always work like magic. Living with bipolar is journey with no destination. You just keep moving with ebbs and flows of your moods. Dealing with depression when it hits and riding the waves of hypo-mania, praying the fun won’t spin out of control and turn into full blown mania.

When you have bipolar you live your life around these highs and lows. But the important thing I’ve learned to remember over the years is that you do indeed get to live your life. There was a time in the darkness of my depression where I thought I wouldn’t make it, that even if I lived it wouldn’t be my life. It would be a hallowed out shadow of what I use to be pre-depression.

Today, I see that there is life after depression. There is dignity after mania. And if you are lucky enough you will have a few close friends who stand by you through it all.

Thanks for letting me share my journey with you.