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You’re not depressed. You just need $250,000 in your bank account.

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Because I don't necessarily want my fb updates to be just health vents

MRIs provided some data. Not totally helpful but leading somewhere. Some areas of swelling improved but there's also new areas. I paid for the left as well because I feel it there, just lesser extent. It's nice to have imaging that proves it.

One interesting thing is radiology can tell the difference between swelling and inflammation. Sports Medicine is putting in for a rheumatology referral. Funny enough, I did just get labs done and while my GI is ignoring them because they're normal in his eyes, one inflammation marker is higher for me (still in the range though, just over 3 times my last result 6 months ago).

The other thing is there's still a chance it could be compartment syndrome though sports medicine remains so dubious that they had to put that commentary in the visit note. But they are okay with setting me up for testing. Basically if Spaulding doc said treat for compartment syndrome and radiology includes it as a possibility in their report... 2 out of 3 stakebolders. I'm not holding out hope for a clear result though knowing my body. It's just kinda data... That's incredibly expensive to collect.

Frustrating. A year of symptoms and almost 10 months of treatment and there are days I'm still in pain.

Also just did a bunch of labs I never do that the NP who's tracking my blood pressure ordered

Waiting for them to come in. I'm pretty terrified that my kidneys are damaged enough for a nephrology referral. It was only ~5 years of 900mg lithium.

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Buckets of paper cuts. The question is how many paper cuts is too many? And how many buckets can I carry?

Just multiple health issues going on. Gonna get another MRI on my legs and dealing with other things. New things like high blood pressure! (That has family history so I'm not sure how inevitable it was but also the attitude was "you're really young")

Meanwhile I'm trying to get off lithium completely. I'm *shocked* that I haven't had to add any replacement or increase my seroquel. Yeah I'm depressed but it's situational...

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If I had an issue with blue cross blue shield giving me conflicting info when I'm trying to get Lupron, should I believe them when I'm trying to figure more PT?

It doesn't help that these agents aren't in Massachusetts even though I'm chatting with them through my BCBS MA portal.

Save your chat transcripts.

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How do I make a fb post and know they throttled it? If I use the word privilege? Because I absolutely am.

I have 3 different options to address issues related to quality of life but not required for survival. The only problem is they're expensive.

PT the "correct" after seeing someone through Spaulding. I know it's more expensive but I've been at the substandard cheaper place for 6 months already so that's a lot of money.

Trying Lupron to see if it reduces my pelvic pain. I'm not even in constant pain so I'm struggling to justify the $450 injection and daily aygestin. But at least there's an option. And it'd be for a year maybe 2. So $3600 total at most.

Private pay individual therapy to explore gender identity/expression. I found a place that starts at $175. I'm not looking for anything long term maybe 4 or 5 visits depending on how it goes.

But I feel like I can't justify spending money on all of these at the same time because I'm not getting paid enough and I know prices are going up already. So... PT definitely has to happen. I can't run without it.

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8 years since my first break... first hospitalization in 2017.

But I'm not broken, I'm a bowl with gold filled cracks.

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I'm not sure if my therapist of 13 years is the best person to talk about gender stuff. I know I'm not trans I don't mind being AFAB but I know there's a lot besides cis/trans. I mentioned it today but wrapped in a new administration sandwich.

Who do I ask for that emotional labor? I can't post on fb.

Need to work on the fibroids. Spinning my wheels in gateway messages.

And while I still think relationships are a moot point, I am at least going to a Covid cautious speed dating event next month.

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I had about 5 years of 900mg lithium. They gave it to me in the hospital when I was first diagnosed. I was stable but we never adjusted the dose. I didn't think to ask, psych never offered. I think Covid happening a year into it may have been a factor. Also I didn't exactly get along with him.

I forget how long I was dealing with thirst issues and getting up to go to the bathroom but I didn't realize they were side effects. I must have reported it to my PCP but didn't think to bring it up with psych.

Psych retired and I went 9 months without one. (This has happened before but it was the longest without one!) My thyroid got messed up. I'm on synthroid now to adjust my TSH but thankfully I wasn't very symptomatic.

I saw a psych who was just a temp and he knew I was on too high of a lithium dose. I resisted for a while, I thought lithium (and seroquel) were heavy hitters, important to my stability.

I have to wean off lithium because one of my kidney labs definitely started trending south a lot sooner than expected. At least I like my permanent psych more than the last one. He doesn't challenge me as much as the temp.

I've said this ages ago, behold, the lithium post.

"Isn't that like a battery? Is it drinkable?"

Why don't we leave the science of it behind a bit, mostly because the majority is speculation.

1. Lithium is an element, one of the original elements if you'd like. It is found in nature and even in a class of stars (how poetic is that?)

Lithium salts have been used as long ago as ancient greece, in the form of baths, where they put manic patients. It's important to understand that the greeks sometimes had a funny (try googling Plato on mania) and sometimes quite accurate view of mental illness. Also, they were pretty tolerant and humane to those affected.

Around the 1950s, it was popular again and used in the treatment of melancholia and mania. It is still considered the best in terms of effectiveness.

2. The downside, although, is that lithium is most effective in patients with mania and especially classic type. For those with bipolar 2 or rapid cycling or even mixed episodes, another stabilazor or antidepressant is generally used.

The fact that lithium is monitored by blood plasma is a good thing and a bad thing. Doctors can easily tell its effectiveness, as your body and dose are adjusted to maintain the perfect level for you. Of course, the problem is lithium intoxication, which means that the concentration of lithium in your blood surpasses the optimal levels. Basically, it becomes toxic.

This can happen when you take too much, but not necessarily. When you build up lithium levels in your blood, even as little as exercise or slight dehydration cause the levels to rise. That's why the most important thing you can do is to stay hydrated and learn about the early signs of toxicity.

3. Side effects most people experience are excessive or pronounced thirst, which goes with frequent urination. This happens because your body is trying to "wash out" the foreign substance in your blood. Followed by tremors that have a range from mild to severe. It has to be noted that in some cases, additional medicine is prescribed if the person's job requires steady hands (for example, pianists).

(Some gain weight, there's evidence of acne connected with lithium, thyroid dysfunction or malfunction that usually happens after a long periods of time, coordination problems, night vision or vision in general problems, lower libido, and plenty plenty more...)

The modern form of lithium has reduced the majority of side effects. Lithium used to be notoriously bad for tolerating in terms of side effects. This is why people nowadays are still prejudiced. Ironically, it had the least side effects for me, none from the former paragraph.

4. The dose you are on matters and should be expected to change. For instance, when you have symptoms of mania, the doctor will up the dose, and once you are back to stability, they might lower it again to avoid depression.

Probably due to toxicity, lithium has a scary reputation. What helped me in the early days was trusting the history, because it was effective for not decades, but centuries. And the memoire An Unqiet Mind, where dr. Jamison tells her journey of how lithium saved her life.

It can also be a nuisance to have your blood levels checked, especially in the beginning, as it has to be more frequent.

Overall, I'd love if you could add your experiences with lithium, your own, or someone you know, to maybe help the narrative and those looking for answers.

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This revolutionary photo shall never dissappear

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I misread the gyn visit notes. Lupron/aygestin was meant to be paired not separate. I can't take Lupron without the estrogen (5mg daily tablet)

So I'm thinking I can't do meds. Even if my GI is okay with that daily dose (I asked his office) he wants me to avoid long term estrogen. And if he does say that's okay then do I even want to go through it?

Is this enough effort to justify ruling out meds and considering surgery? Mom and my therapist were surprised I was considering it.

I'm assuming I'm feeling my fibroids more because of stress. But if the pain is more than perhaps it'd help me not gaslight myself 🥲😅

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GI said no long term estrogen. Left psych a message if he had any insight on taking Lupron while on my meds. To be honest unless he flat out warns against it, I'm gonna have to try Lupron. I don't think people in my life would understand if I went straight to a surgery. They'd question my decision.

Even though I have a good job/insurance/PTO right now.

Even though I'm as scared of the mental health/mood swings impact of Lupron as I was with BC, probably even more.

Even though I can't shake the fear that somewhere out in the courts is another case like Dobbs (that took 4 years to go through) where this surgery option would be taken away. I know that's hyperbole and probably catastrophe but it's there.

I was worried about mental health issues when I first thought of getting an IUD. My psychiatrist at the time wasn't helpful. He first thought I should go to perinatal psychiatry. I think he just wanted to punt it. So I waited. My PCP walked me through BC options and I finally got a mirena IUD on October 2023. No regrets. No cycle.

Except

Pelvic pain that turned out to be fibroids. I have no idea when they showed up. Only started feeling them 6 months after my IUD.

Met with a gyn and she gave me med options, procedures, and surgical options which was nice to hear all at once but a fire hose of info. Technically an IUD is treatment for fibroids?

The meds are estrogen or oriahnn. Oriahnn has increased SI as a side effect so that's out. I haven't had SI in years but that's how my mental illness started. I checked Mayo Clinic's site and Lupron doesn't play well with seroquel so I think that's out. That just leaves agyestin. After doing research I sent the gyn a message. Lamictal could potentially increase certain side effects. I'm wary of the mood swings. In the last year I've been reducing my lithium so I was on a higher dose when I got the mirena.

Waiting to see what the gyn says before I send my psych a message. It's another old white dude but he seems to be better than Lorenzo was.

And I'm gaslighting myself. The pain isn't that bad. I never had a heavy bleeding issue so the IUD was purely for convenience/politics and a little bit of gender issues as well. I never want bio kids and have felt that way for at least 8 years if not longer. Why should I have to deal with a cycle?

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So I had a hysterectomy today (hooray!) and I brought along my stuffed orca, Shamu, as a comfort object. And everyone i interacted with during my pre-op was like "Oh! Who's this?" so I was telling them all about him, how he's been with me since I was 9 and gone on every single vacation and road trip, and they were telling me about their own stuffed buddies (one lady said she still has hers after 40 years!) and all of this while I was signing consent forms and providing a list of the things I'd brought with me, you know, small talk.

So then a nurse comes over and goes "Okay, I've got some stickers I'll put on your things so we know they're yours" and I'm like "OK cool" so she puts a sticker on my coat and stickers on my bags of clothes and then she turns to Shamu and I'm like "oh I guess he gets a sticker too"

But no. She pulls out a hospital bracelet that's an exact copy of mine and slaps it on his tail, like so:

And i was delighted by this, so I took a picture to send to my friends, who were equally delighted, and were cracking me up with their reactions (like so:)

Anyway, they take me back and put me under, and when I awake groggily a few hours later it takes me a minute to get my bearings, so I don't notice Shamu at first. But then I realize he's tucked up next to me in the gurney, so I grab him, and my hand touches gauze.

And I'm like "huh?" so I look at him and I realize

They gave my fucking orca a hysterectomy

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I picked a hell of a time to start questioning more gender stuff. I don't even think it's worth pursuing it.

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Hey here is your friendly reminder to not tell your nice boss stuff.

I’m at the executive management level for my very small company and I have 4 people who report directly to me. I am a nice boss. I’m friendly with my employees, I treat them like professional adults, I actively try to create a positive work environment, and I mentor them and make sure they’re advancing in their careers. I do my best to shield them from the rest of management doing stupid shit. My employees like working for me.

The other day one of my employees came to ask if she could change her hours on Mondays. I said yes immediately because it’s helpful for me to know when she’s here and when she’s not, but as long as she gets her work done I don’t care when and where she does it. She then proceeded to tell me that it was so she could attend therapy and like … I will never use this information but … as a general rule don’t fucking do that.

Do not tell your employer shit about your mental or physical health except for the bare minimum needed to request a reasonable accommodation. Even your nice boss can fire you, even your nice boss can unfairly change your working conditions, and even your nice boss at some point is probably going to face pressure from their superiors.

I’m not saying don’t trust your boss with anything ever. I’m just saying that anytime you are in the workplace you need to keep your private information private. You can still have a good relationship with your boss. Your workplace can still be pleasant. But if it ever feels like disclosing private information is required in order to have a good relationship with your boss, please see that as a red flag.

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I was worried about mental health issues when I first thought of getting an IUD. My psychiatrist at the time wasn't helpful. He first thought I should go to perinatal psychiatry. I think he just wanted to punt it. So I waited. My PCP walked me through BC options and I finally got a mirena IUD on October 2023. No regrets. No cycle.

Except

Pelvic pain that turned out to be fibroids. I have no idea when they showed up. Only started feeling them 6 months after my IUD.

Met with a gyn and she gave me med options, procedures, and surgical options which was nice to hear all at once but a fire hose of info. Technically an IUD is treatment for fibroids?

The meds are estrogen or oriahnn. Oriahnn has increased SI as a side effect so that's out. I haven't had SI in years but that's how my mental illness started. I checked Mayo Clinic's site and Lupron doesn't play well with seroquel so I think that's out. That just leaves agyestin. After doing research I sent the gyn a message. Lamictal could potentially increase certain side effects. I'm wary of the mood swings. In the last year I've been reducing my lithium so I was on a higher dose when I got the mirena.

Waiting to see what the gyn says before I send my psych a message. It's another old white dude but he seems to be better than Lorenzo was.

And I'm gaslighting myself. The pain isn't that bad. I never had a heavy bleeding issue so the IUD was purely for convenience/politics and a little bit of gender issues as well. I never want bio kids and have felt that way for at least 8 years if not longer. Why should I have to deal with a cycle?

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I didn't really know how to divide the categories but I tried my best.

Please recognize for larger sample size!!

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Disclosure

so easy to sit in shame

risk losing everything that you worked hard for It's only your own identity You feel frozen, forced to not share Fearing repercussion, retaliation readjustments as you know they will hold you at arm's length going forward always view you and your work through the lens of your diagnosis

Any little mood shift, behavior quirk don't you dare snap even if you do disclose You'd still have to mask for their comfort

they turn a label into a noun a stand in for you, shorthand for your name a stereotype that shadows you of course you have a temper and even if you don’t you know you need to behave like “A good little bipolar" your work is "pretty good for a bipolar” your personhood remains unsaid

better to remain silent, stilted, segmented static to change is a risk you can’t take a leap of faith and a trust fall where no one’s there to catch you

deep breath you can only hold it for so long it’s time to come out of the closet bust down the door

it’s time to be whole ditch the mask embrace your identity and wear it proud you’re bipolar and that’s not a dirty word