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Some Changes & Experiences With BPD Drugs

R

RonPrice

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Joined
Oct 10, 2009
Messages
94
Location
George Town Tasmania Australia
5. 2002-2009: “Sodium Valproate Arrives in 2007”

5.1 In April 2007 I switched from the mood stabilizer, lithium, to sodium valproate--an antipsychotic agent. It became my main medication due to the fact that the creatinine levels in my blood, tested every 3 months for the previous six years and periodically and irregularly every year for 21 years before that, had been too high for too long—for about a year. These creatinine levels were indicators that readers of this document can read about in the BPD literature to see just how the kidney function can be affected by lithium treatment. I am not a doctor and I make no attempt to go into the finer aspects, the more detailed anatomical and physiological aspects of this medical problem, this mental health illness. I have lived with it for years, but much of BPD as an illness is still beyond my level of analysis and the sophistication of my understanding—and it will remain so. My interest in the medical and scientific aspects of BPD, in spite of appearances to the contrary, are limited. After all these years, my interest in fine-tuning my understanding, in enlarging my scientific knowledge of this disorder is of a low order on my general scale of interests inspite, as I say, of any appearance to the contrary--as the evidence of writing this lengthy essay might indicate. Readers with a keen interest in the anatomical, the chemical and many physiological aspects of BPD can now read and study virtually any aspect of BPD on the internet if they have: (a) the computer skills and (b) the reading ability/level of competence.

5.2 Most of the people who ever read this document will not themselves be au fait with the relevant literature that relates to my problem, to BPD, although many may have a more than lingering interest in the disorder. Many readers here may have an interest in one or more of the many alternative medical treatments hypothesized by: (a) various health professionals and/or (b) the anti-psychiatry elements in society. Some specialized facilities, clinics and therapeutic centres under a variety of names, whose aims are to help BPD sufferers, combine a medical and an educational approach. Medicines and nutrients are often prescribed by physicians. To complement medical treatment, such programs often emphasize a wholesome diet, daily exercise and the development of habits that will assist recovery and support continued good health. Because of the strong learning orientation in such facilities, residents are often referred to as students rather than patients.

The staff in such specialized clinics often includes professionals with credentials in psychology, psychotherapy, social work, substance abuse counselling and biochemistry as well as teachers of nutrition, exercise, arts, crafts, dance, drama, writing, and literature. Orthomolecular physicians are often at the core of these alternative medicine homes, clinics or residential care places and they supervise the medical treatment of the students. A visiting nurse, a behavioural optometrist, a chiropractor and an acupuncturist are often and also available.

5.3 One of the typical responses to my ‘coming out’ as a person with BPD in recent years is an urging that I seek out some alternative medicine milieux. In the past I have often entered into some ensuing dialogue with my friends, family and associations, my listeners and readers, students and laymen: in letter, over the phone, in conversation and now in email form or on the internet—a dialogue about the use of some other treatment than drug therapy. But this statement, this essay, does not explore these alternatives, the ones I have investigated and not investigated, nor does it examine the details of the biological and physiological, medical and anatomical aspects of BPD. After all these years I have lost any desire to try alternatives and now rely solely on my psychiatrist, my medications and my wife to provide the core milieux for my current and prospective treatment regime. I take a general and somewhat detached interest in alternatives as they appear in the literature but, for the most part, I do not take them seriously as alternatives for my own path, for my own prescription for living. This is partly due to my lack of funds and partly due the fact that well-staffed alternative facilities do not exist anywhere near where I live in Australia, but it is mainly due to the fact that I am happy with my current treatment regime.

5.4 I leave the investigation of alternatives, of the finer aspects of the physiological and medical aspects of BPD and indeed the burgeoning literature on the subject to the keener students and readers here. I have been encouraged, found the courage, at least initially, in my coming-out due to several celebrities in the media who, since the 1990s, have made their BPD public. Stigmatization still exists, although it is not as strong as it was, say, nearly two decades ago in 1991 when I was stabilized on lithium and totally complaint, when I was working in professional employment, when I was active in local community life and kept my story under wraps, except on rare and exceptional occasions of ‘coming- out.’

5.5 The milieux of alternatives to mainstream chemotherapy for my psychiatric disorder, my BPD, in 2009 is a different milieux-of- alternatives than was available in 1963 when I first had significant manifestations of this problem even though my BPD was not diagnosed as such until 1968; but this is a tangential topic or issue. As I indicated above, I no longer seriously consider alternative treatments since I am happy with my medication regime. But let me return to the new medication regime I began in 2007 and the kidney difficulty which led to these new medications.

5.6 Had I continued on lithium in 2001 I would have had serious health problems associated with kidney damage and eventually had to go on a dialysis machine. As I write this revision of my story, this seventh edition, I have been on the sodium valproate for eight years. I have now found a new routine, a new normality, for my sleeping pattern, although it has not been as difficult as the regime change in Iraq has been for the USA. This change in sleeping routine has been difficult to establish. The process of establishing a new sleeping pattern has affected me much more than the nightly stories do on the TV and radio about that distant and war-torn country or, I might add, the many other crises, disasters and many community concerns both within and without the Baha'i community I have been a member of for more than fifty years.

5.7 I always have a short sleep in the afternoon or early evening for one to two hours after I have been awake from my nightly sleep for about eight to twelve hours. Now after two years on this new cocktail of drugs and its fine tuning in just the last ten months(1/09-10/09), this new sleeping pattern has assumed a regularity, a new normality. BPD is associated with irregular or pathological functioning of circadian rhythms. The circadian rhythms are the regular rhythmic changes in waking and sleeping, waxing and waning activity levels, even sensations of hunger or thirst and their satisfaction. These rhythms become disordered when a person suffers from BPD. Sleeping and waking as well as other patterns such as eating habits and activity levels are disturbed. This internal clock is difficult to reset when a new cocktail of medication is administered. After two years(5/07-5/09) this clock was reset. Teenagers have problems with sleep patterns and there are now techniques available to help them regularize their patterns. I could use these same techniques for they are useful for sufferers of BPD. But I am happy now with my sleep patterns and in August 2009 I began to take one panadol before going to bed to smooth out my sleep regime and it has helped. People tend to sleep more lightly and for shorter time spans as they get older. This is certainly the case with me, although I generally need about the same amount of total sleep as I needed in early adulthood.

5.8 Since I occupy the same bed and occupy, too, the same space, the same house, day after day, as my wife, routines and patterns are important. I like to maintain a regular sleeping pattern and sleep with my wife as much as possible. My interest in this important aspect of my life is not for the sake of sexual activity as some readers might be keen to read about and as I would be keen to read about as well--and thus provide, in the process, a sexual-spice in this account and in my personal and sexual proclivities. I’m sure by now some readers are finding the absence of some of the frequent absurdity of BPD behaviour, frequent stories of sexual and other behavioural abnormalities and/or any general eccentricity in my day to day life, which often characterizes BPD stories, is making this narrative far too clinical, indeed, overwhelmingly clinical and analytical for their liking.
---MORE TO SAY BUT ONLY IF READERS WANT MORE-----
 
R

RonPrice

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Joined
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Messages
94
Location
George Town Tasmania Australia
Some More For schiz01 and others

5.14 Routines are important when living with others, as I mentioned above, in different ways than when living alone. Much must be done for the sake of a more harmonious and general interaction due to the interdependence and interrelationship that exists. My sleeping patterns have varied in the last several years from two to four hours of total sleep at night in the first month, May-June 2007, to a regular six to eight now in October 2009--with a waking and getting up two or three times for urination and a sleep for 1 to 2 hours in the day/evening: (a) to make up for the loss of sleep at night, (b) to give into a tired feeling or (c) due to my new circadian rhythm.

5.15 My wife has helped me in this area of sleep monitoring, although she came to find it frustrating, the endless discussion of sleep and its patterns. I should add, somewhat parenthetically but very importantly, that since the late 1970s when the first episodes of this disorder appeared during this my second marriage, my second wife has been my main care-giver. I have been her main caregiver, but that is a separate story which I briefly refer to below. We have each been for each other the main care-givers over these many years. We have not, though, applied for care-giver status and its remunerative package from Centrelink a sector of the Human Services Department here in Australia for reasons explained above.

5.16 My preference and need for sleep seems to be from 7 to 8 hours on average per day. This has been the case since the early onset of this disorder back in the 1960s, although in my teens and twenties, as in my childhood before, sleeping patterns have had great variations. The whole question and story of sleeping patterns is a long and complex one and I don’t want to go into any more detail on this theme than I already have; indeed, concern for and obsession with sleep is a characteristic worry of those who suffer from BPD and over the years I have often written pages of analysis and gathered pages of data on my sleeping patterns, but I will limit my discussion of this subject in my life at this juncture in this essay.


6. April 2007 To October 2009 : Enter Venlafaxine

6.1 I have only just begun my story, my experience, with venlafaxine or effexor as it is known commercially. I will, therefore, leave this part of my account for now and return at a later date after more experience of this new medication has been acquired. After 2 and 1/2 years on this new medication, combined as it is with sodium valproate, the future on this medication package looks promising. A new sense of normality, of my old self, in an ironic sort of way, had already returned in the first two months(4/07-6/07) of my being on the final element of this new medication-cocktail, venlafaxine. The symptoms of my OCD have significantly dissipated, although they are still present in an abnormal way from my wife’s point of view—the person who observes me more than anyone and whose opinion is important in making this statement. I can feel what I can only describe as the ‘healing effects’ of this medication package. My wife calls this healing effect a sense of well-being and sees it as characterized essentially by less frenetic activity. It looks again like I am going to win the battle with BPD, although I had my doubts yet again, even as recently as April 2007. In the past the battle has periodically looked like a situation of utter defeat, a sense of defeat I first experienced as far back as those October evenings in 1962 when I first suffered a blackness I had never felt before and I had, at the time, no idea what was happening to me.

6.2 The affects of BPD on my day to day life seem to have been finally put into some niche, yet again, so that I can go on with the next chapter of my life. The negative affects may rear their ugly heads, yet again at some future time but, for now, I can put this account to bed. I have to thank my psychiatrist for his skills and expertise and the medications and consultations that are part of modern psychopharmacology and psychiatry for this progress—in the main. The profound advances in bio-medical knowledge and research so rapidly accruing today, although not being effectively transformed into meaningful advances in health care for literally billions of people in our global society, are being brought to my attention and applied to my BPD, as they are to other billions on this earth. The worse that can be said about the skills of my current psychiatrist--and some significant others in my life have indeed said the worse—is that at nearly 70 he offers to me a more traditional psycho-chemotherapeutic approach and he is not likely to experiment with: (a) other medications for BPD or (b) alternative treatments as younger/other psychiatrists might do.

7. Other Difficulties:

7.1 The Physical and Psychosocial:

7.1.1 Seven years ago in 2002 I was diagnosed with chronic obstructive pulmonary disease(COPD) or emphysema which gives me a shortage of breath when I exert myself even mildly. Many millions of people have died from this illness in the last several decades and by 2020 will be the third leading cause of death worldwide. There are a range of bleak statistics, but it is not my intention of discussing this medical problem in any detail, only insofar as it relates to my BPD. My form of COPD is mild as indicated on a spirometer test for COPD. My COPD probably originated in: (i) my smoking an average of one package of cigarettes every day from the age of 20 to 50, 1963/4 to 1993/4, (ii) growing-up in a household where both parents smoked and (iii) working and living in smoking environments for 30 years(1963-1993). The onset of this tobacco habit coincided, coincidentally, with the onset of my BPD symptoms. I did suffer from a mild RSI and various other maladies in addition to COPD, some of which I treated with exercise, thus lessening their overall effects. These several medical problems exacerbated my remaining BPD symptoms.

7.1.2 It has become by degrees from year to year more difficult for me to engage: (a) in any physical activity for more than short periods of time in excess of even a few minutes; or (b) in social interaction for more than about two hours. In the case of: (a) above I have been informed by my GP and by the relevant literature that with regular/daily aerobic exercise this few minutes could be increased and my COPD improved, although not eliminated. In the case of (b) above two hours of stimulation has been the maximum I can take on without my level of social efficiency decreasing, my social interaction skills degenerating and fatigue setting in. I have also kept a database of information on: (1) visits to GPs and psychiatrists since 1999 with the general medical problems and treatment regimes in the many aspects of my health as well as (b) aspects of my health since 1980 when I went on lithium, like weight gain(65 pounds from 1980 to 2009), but it is not my intention to discuss these problems here--only to the limited extent that there is a direct relationship with my BPD.

7.1.3 These two activities, the physical and the social, if taken in excess of the time limits I have indicated above and if necessity has dictated, impose a strain on either my physical or social capacities and sensibilities. I’m not sure how much of (a) and (b) in section 7.1.1 and 7.1.2 above is related to the BPD and how much is just the natural result of moving into the middle years(65-75) of late adulthood(60-80) in 2009. With forty years of a working life also behind me, 1961 to 2001; with PT and most volunteer work also behind me in the years 2003 to 2005; with no desire to take part in most of casual and voluntary work’s many forms any more; with decades of struggling with various features of SAD, P, D, MD and BPD and the occasional episode I have described briefly above, I feel as if the years from, say, 1959 to 2009, a half century, have slowly and insensibly removed many of life’s juices from my being. They did not remove all my juices, though, thankfully. I enjoy reading and writing, eating, drinking, socialising to a minimum, watching a little TV-about two hours each day on average—and, most importantly, I no longer suffer from the ravages of my disorder.
---MORE IF DESIRED---FROM RON IN TASMANIA----:cool:
 
R

RonPrice

Well-known member
Joined
Oct 10, 2009
Messages
94
Location
George Town Tasmania Australia
For schiz01 and Interested Others

7.1.4 For the most part in community life I rarely talk about my BPD and most people who know me have no idea of my medical history, the difficulties that I have lived under physically or psycho-socially. Most people have a domain of private experience which they keep to themselves for the most part and so this is not of itself unusual. We often, if not usually, have little idea of the inner battles that others go through in life. I have for many years regarded my difficulties as part of my own spiritual battles in life. They are difficulties that have largely slipped into a low gear in the last year or so, since being stabilized on my recent medication package. These symptoms do not trouble me significantly, at least not sufficiently for me to 'dump' on people as we used to say.
As I say, this seems especially the case with the new medication package I began in the last two and a half years(5/07 to 10/09).

7.1.5 I should mention that a certain spiritual attitude which has been part of my belief system since the 1950s has helped me more than I can myself really appreciate. This is especially true of the attitude to tests and difficulties in life which the Founder of my religion, Baha’u’llah, says are often “like fire and vengeance but inwardly light and mercy;” or as the old English proverb puts it more colloquially: “the gem cannot be polished without friction.” An attitude of fighting one’s own spiritual battles without giving vent to them verbally with others, an attitude of suffering in silence, stoicism or, what in Australia is often called the quiet battler mentality, has also been part of my way of looking at life. And it still is.

7.1.6 But even the wisest of advice, the finest of philosophy and the most practical of alternative and specialized treatments for BPD does not and will not remove all of our suffering, mine or humanity’s for a different set of reaons. Indeed, it is my view that suffering may just be part of the critical axis of our life, mine, others and society’s. If one can eliminate some of the suffering in one’s life it seems to me only natural to do so and this account is the story of the elimination of some, if not most, of that suffering, at least as it relates to BPD. But however one views suffering, it comes to us all. This account does not deal, as I say, with the philosophical and largely religious aspects of my struggle with BPD nor the wider psycho-social aspects of my tests and difficulties except in a few broad strokes.

7.2 Application of the Recovery Model:

7.2.1 In the last decade or two, perhaps as far back as the 1970s, there has developed in psychiatry and psychology what has been variously termed a self-regulatory, self-diagnostic, illness-identity-and-monitoring model aimed at one’s personal ongoing treatment, care and recovery. It is a program that involves the client, much more than programs of treatment ever did before, in developing and drawing on what are sometimes called the evidence-based skills of mental health consumers. These skills are applied to and in a manner consistent with, the particular disorder. The consumer, the client, becomes their own doctor but this, as one can appreciate, is no easy achievement and the literature on the subject is extensive.

7.2.2 It is argued that this Recovery Model is based on: (a) the evidence-based skills of mental health consumers; and (b) the provision of an integrative framework combining both a description and analysis of: (i) the evidence-based practice of these consumers and, in my case, the practice and skills of certain significant others in my life; (ii) manageable and modularized competencies relevant to case management and psychosocial rehabilitation contexts; and (iii) a greater recognition of the subjective experiences of consumers.

7.2.3 The summary I have just outlined above of this Recovery Model is itself a mouthful of words, to say the least. There are many verbal and written mouthfuls, jargon if you will, in this field of mental illness, as I have indicated before in this statement, and they keep the sufferers of this and other mental disorders as busy as little beavers trying to come to grips with the terminology and its mystique. The mystique involved in mental illness is a mystique in some ways not dissipated, but curiously reinforced, by all the new knowledge in this last half century or so. This recovery model puts the onus on the people with the disorder to work out what is their best way to cope and to survive, in society given the conditions of their illness. Such individuals must work out the techniques and strategies for day-to-day living. Sometimes knowing more helps but often, too, as the Danish proverb puts it: “a handful of patience is worth more than a bushel of brains.” Sufferers from BPD often lack that in-built patience due to their emotional imbalances. They often also lack that ‘bushel of brains.’

7.2.4 With each individual BPD is idiosyncratic; individual consumers of mental health services must work out the pattern of their BPD, if there is one: whether, for example, they have rapid cycling bipolar disorder, that is, four or more episodes in one year or whether they experience a bout of depression at one moment with extreme giddiness the next, with no lull in between. Such a switch is considered as a worse type of bipolar disorder. It is also known as biphasic cycling. I have never had either of these typicalities. Each BPD sufferer must work out what is best for them in terms of: (a) the mental health services and specialists they require and (b) what life activities and lifestyle are appropriate for them within their coping capacity in life’s day-to-day spectrum. This, too, is a complex question and I don’t want to dwell on it unduly here. It is my hope that my story may help others to work out their own particular regimen of treatment programs and their daily coping tools.

7.2.5 I have not developed, nor has it been my intention to do so, a comprehensive treatment plan for others to manage their BPD successfully. It hardly goes without saying. the internet has many a site with plenty of advice available. During my lifetime I have needed something that worked for me personally. I did not draw on a cookie-cutter idea used for all people with the illness, an idea that simply focused on medications. Some sufferers with BPD develop their own management system to deal with their disorder, to cut the number of their symptoms and to live a more stable life and other sufferers put their hands into the arms of professionals to work out their BPD treatment program. Research on the internet will reveal a number of systems that BPD sufferers use. Readers here will find no such system only the slow working out of regimes and changed packages of treatment over many deacdes. One can not remove a fly from a friend’s forehead, as an old English proverb says, with a hatchet, an axe or a hammer or, I might add necessarily, with more than 37,000 words on an internet site. Sometimes all one can do is let time take its course in one’s own dear life and the lives of others.

7.2.6 The view that one’s vulnerability to develop a major affective disorder is genetically transmitted and neurochemically expressed has been strengthened in the years since I have gone off lithium at the turn of the millennium in 2001. The development in this orientation to BPD has unfortunately been accompanied by a philosophy that drugs and various physical/body/somatic therapies offer the best and sometimes the only choice for treatment. This view of what comprises adequate treatment is sometimes short-sighted and, indeed, it may be in my case. There is currently no evidence to support strict adherence to a purely psychotherapeutic or purely pharmacological treatment strategy. Although there is some evidence to support the idea that pharmacological treatment alone is not sufficient to prevent relapse, I feel more secure on my new cocktail of medications. Relegating this disorder to the realm of a physiological disturbance that requires medical treatment alone is often considered a serious clinical oversight and a gross scientific presumption, similar to the earlier psychological oversimplifications and prejudices that compounded the difficulties that have inhibited the development of multi-dimensional treatment approaches. However true this is, though, I am hesitant to go off my medication and any movement in that direction that I take will only be done after further consultations with my psychiatrist in the years ahead, the middle years(65-75) of my late adulthood(60-80).

7.2.7 The most convincing scientific progress in psychiatry in the past decade, 1999 to 2009, the first decade of my retirement from FT work, has had little to do with the many talk therapies or the many different medications now available. There has been rigorous, scientific verification that certain forms of psychotherapy are effective and especially cognitive therapy which has received much popular press. This is perhaps not surprising. One of the major insights in the modern biology of learning and memory is that education, experience, and social interactions affect the brain. When you learn something and then remember it for a long time, it's because genes are being turned on and off in certain brain cells, leading to the growth of new synaptic contacts between the nerve cells of the brain. Insofar as psychotherapy works and produces stable, learned changes in behaviour, it can cause stable anatomical changes in the brain. We are now beginning to measure such changes with brain imaging. If a person with obsessive-compulsive neurosis or depression undergoes psychotherapy—and if the treatment is successful in changing behavior—the treatment will cause a reversal in the biological markers of these disorders.
----MORE AVAILABLE IF DESIRED BY READERS------:tea:
 
Q

quality factor

Guest
Without wishing to spoil your flow, I too have kidney disease following taking Lithium for fourteen years, my creatinine levels are too high and at the moment only have 40% kidney function, which is better than many I realise. I don't understand how I was allowed to reach this state having been monitored as required. Did the GP's get it wrong?...nobody will say, interestingly enough!

QF.
 
R

RonPrice

Well-known member
Joined
Oct 10, 2009
Messages
94
Location
George Town Tasmania Australia
Good Point QUALITY FACTOR

Good Point QUALITY FACTOR....my wife asks the same question and the answer, as best I can piece it together is:

(a) To know if the lithium I took was responsible for my increased creatinine levels would require that I be seen by a nephrologist and fully evaluated. At the time of my diagnosis I did not even know what a nephrologist was;
(b) my creatinine levels were high and as a long-term lithium therapy client I developed what some doctors now call a sort of creatinine creep syndrome over a period of several years. Regular monitoring of my creatinine levels in serum and medical consultation took place since the level rose above and remained above 1.6 mg/100 ml was recommended. The frequency of this monitoring should have been more frequent since I was beginning to show early signs of creatinine creep.

A creatinine clearance is indicated when serum creatinine increases significantly (say, from 1.4 to 1.6) and medical consultation obtained. But--that doesn't necessarily mean that lithium therapy should be discontinued!

The question is complex and I must come back to this later after dinner.-Ron in Tasmania
 
R

RonPrice

Well-known member
Joined
Oct 10, 2009
Messages
94
Location
George Town Tasmania Australia
More On Creatinine

Gitlin in the Journal of Clinical Psychopharmacology, 8/'93;13(4):276-9 reported that: "on a sample of 82 bipolar patients treated in an affective disorders clinic, 3, that is 3.7% were found to have developed serum creatinine levels greater than 2.0 mg/100 ml from baseline levels that were within normal limits. One of these patients progressed to chronic renal failure and hemodialysis, making him the second probable reported case of lithium-induced chronic renal failure. No common risk factor for renal disease among these patients was apparent."

But Gitlin goes on from his words in 1993: "As increasing numbers of patients are treated with lithium for a decade or more, previous conclusions as to the benign effects of long-term lithium treatment on renal function may need to be revised."
 
R

RonPrice

Well-known member
Joined
Oct 10, 2009
Messages
94
Location
George Town Tasmania Australia
My Bi-Polar Story: More

7. Other Difficulties:

7.1 The Physical and Psychosocial:

7.1.1 Seven years ago in 2002 I was diagnosed with chronic obstructive pulmonary disease(COPD) or emphysema which gives me a shortage of breath when I exert myself even mildly. Many millions of people have died from this illness in the last several decades and by 2020 will be the third leading cause of death worldwide. There are a range of bleak statistics, but it is not my intention of discussing this medical problem in any detail, only insofar as it relates to my BPD. My form of COPD is mild as indicated on a spirometer test for COPD. My COPD probably originated in: (i) my smoking an average of one package of cigarettes every day from the age of 20 to 50, 1963/4 to 1993/4, (ii) growing-up in a household where both parents smoked and (iii) working and living in smoking environments for 30 years(1963-1993). The onset of this tobacco habit coincided, coincidentally, with the onset of my BPD symptoms. I did suffer from a mild RSI and various other maladies in addition to COPD, some of which I treated with exercise, thus lessening their overall effects. These several medical problems exacerbated my remaining BPD symptoms.

7.1.2 It has become by degrees from year to year more difficult for me to engage: (a) in any physical activity for more than short periods of time in excess of even a few minutes; or (b) in social interaction for more than about two hours. In the case of: (a) above I have been informed by my GP and by the relevant literature that with regular/daily aerobic exercise this few minutes could be increased and my COPD improved, although not eliminated. In the case of (b) above two hours of stimulation has been the maximum I can take on without my level of social efficiency decreasing, my social interaction skills degenerating and fatigue setting in. I have also kept a database of information on: (1) visits to GPs and psychiatrists since 1999 with the general medical problems and treatment regimes in the many aspects of my health as well as (b) aspects of my health since 1980 when I went on lithium, like weight gain(65 pounds from 1980 to 2009), but it is not my intention to discuss these problems here--only to the limited extent that there is a direct relationship with my BPD.

7.1.3 These two activities, the physical and the social, if taken in excess of the time limits I have indicated above and if necessity has dictated, impose a strain on either my physical or social capacities and sensibilities. I’m not sure how much of (a) and (b) in section 7.1.1 and 7.1.2 above is related to the BPD and how much is just the natural result of moving into the middle years(65-75) of late adulthood(60-80) in 2009. With forty years of a working life also behind me, 1961 to 2001; with PT and most volunteer work also behind me in the years 2003 to 2005; with no desire to take part in most of casual and voluntary work’s many forms any more; with decades of struggling with various features of SAD, P, D, MD and BPD and the occasional episode I have described briefly above, I feel as if the years from, say, 1959 to 2009, a half century, have slowly and insensibly removed many of life’s juices from my being. They did not remove all my juices, though, thankfully. I enjoy reading and writing, eating, drinking, socialising to a minimum, watching a little TV-about two hours each day on average—and, most importantly, I no longer suffer from the ravages of my disorder.

7.1.4 For the most part in community life I rarely talk about my BPD and most people who know me have no idea of my medical history, the difficulties that I have lived under physically or psycho-socially. Most people have a domain of private experience which they keep to themselves for the most part and so this is not of itself unusual. We often, if not usually, have little idea of the inner battles that others go through in life. I have for many years regarded my difficulties as part of my own spiritual battles in life. They are difficulties that have largely slipped into a low gear in the last year or so, since being stabilized on my recent medication package. These symptoms do not trouble me significantly. As I say, this seems especially the case with the new medication package I began in the last two and a half years(5/07 to 10/09).

7.1.5 I should mention that a certain spiritual attitude which has been part of my belief system since the 1950s has helped me more than I can myself really appreciate. This is especially true of the attitude to tests and difficulties in life which the Founder of my religion, Baha’u’llah, says are often “like fire and vengeance but inwardly light and mercy;” or as the old English proverb puts it more colloquially: “the gem cannot be polished without friction.” An attitude of fighting one’s own spiritual battles without giving vent to them verbally, an attitude of suffering in silence, or what in Australia is often called the quiet battler mentality, has also been part of my way of looking at life. And it still is.

7.1.6 But even the wisest of advice, the finest of philosophy and the most practical of alternative and specialized treatments does not and will not remove all of our suffering, mine or humanity’s. Indeed, it is my view that suffering may just be part of the critical axis of our life, mine, others and society’s. If one can eliminate some of the suffering in one’s life it seems to me only natural to do so and this account is the story of the elimination of some, if not most, of that suffering, at least as it relates to BPD. But however one views suffering, it comes to us all. This account does not deal, as I say, with the philosophical and largely religious aspects of my struggle with BPD nor the wider psycho-social aspects of my tests and difficulties except in a few broad strokes.

7.2 Application of the Recovery Model:

7.2.1 In the last decade or two, perhaps as far back as the 1970s, there has developed in psychiatry and psychology what has been variously termed a self-regulatory, self-diagnostic, illness-identity-and-monitoring model aimed at one’s personal ongoing treatment, care and recovery. It is a program that involves the client, much more than programs of treatment ever did before, in developing and drawing on what are sometimes called the evidence-based skills of mental health consumers. These skills are applied to and in a manner consistent with, the particular disorder. The consumer, the client, becomes their own doctor but this, as one can appreciate, is no easy achievement and the literature on the subject is extensive.

7.2.2 It is argued that this Recovery Model is based on: (a) the evidence-based skills of mental health consumers; and (b) the provision of an integrative framework combining both a description and analysis of: (i) the evidence-based practice of these consumers and, in my case, the practice and skills of certain significant others in my life; (ii) manageable and modularized competencies relevant to case management and psychosocial rehabilitation contexts; and (iii) a greater recognition of the subjective experiences of consumers.

7.2.3 The summary I have just outlined above of this Recovery Model is itself a mouthful of words, to say the least. There are many verbal and written mouthfuls, jargon if you will, in this field of mental illness, as I have indicated before in this statement, and they keep the sufferers of this and other mental disorders as busy as little beavers trying to come to grips with the terminology and its mystique. The mystique involved in mental illness is a mystique in some ways not dissipated, but curiously reinforced, by all the new knowledge in this last half century or so. This recovery model puts the onus on the people with the disorder to work out what is their best way to cope and to survive, in society given the conditions of their illness. Such individuals must work out the techniques and strategies for day-to-day living. Sometimes knowing more helps but often, too, as the Danish proverb puts it: “a handful of patience is worth more than a bushel of brains.” Sufferers from BPD often lack that in-built patience due to their emotional imbalances. They often also lack that ‘bushel of brains.’

7.2.4 With each individual BPD is idiosyncratic; individual consumers of mental health services must work out the pattern of their BPD, if there is one: whether, for example, they have rapid cycling bipolar disorder, that is, four or more episodes in one year or whether they experience a bout of depression at one moment with extreme giddiness the next, with no lull in between. Such a switch is considered as a worse type of bipolar disorder. It is also known as biphasic cycling. I have never had either of these typicalities. Each BPD sufferer must work out what is best for them in terms of: (a) the mental health services and specialists they require and (b) what life activities and lifestyle are appropriate for them within their coping capacity in life’s day-to-day spectrum. This, too, is a complex question and I don’t want to dwell on it unduly here. It is my hope that my story may help others to work out their own particular regimen of treatment programs and their daily coping tools.

----------------more story if desired-------------------
 
Q

quality factor

Guest
Hi again, an interesting read...thanks.
As an aside, my father died of COPD last year at the age of 81, interestingly he never smoked a cigarette in his life. His father smoked throughout his adult life until he died at the age of 72.
I haven't gone into the factors causing dad's death in any detail but do wonder how he contracted Emphysema in the first place.

QF.
 
R

RonPrice

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George Town Tasmania Australia
COPD

A lady in Australia was charged/fined for smoking in a car with a child present. COPD is acquired from smokers even if one does not smoke oneself.-Ron
 
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