Things just got tougher

[waverider]

My wife had stage 3c breast cancer couple of years ago and had a mastectomy and lymph nodes removed. She has had to deal with painkiller addictions, and ended up on methadone. Took a while before she was well enough to even consider a reconstruction, and as it is via public system took a lot of effort to get on a list.

Last november finally had a reduction on her remaining breast in preparation for reconstruction on the other. Recovery from that surgery incurred a lot of the drama that surrounds any pwBPD surgery. Anyhow that was healing nicely and she was looking forward to the final step when the pathology results came back from the tissue removed. These showed early signs of cancer markers, and so it was suggested that instead this breast should also be removed and a double reconstruction done. As you can image this caused immense distress.

This was set up and at preadmission 2 weeks before operation, they discovered she has been abusing prednisole (steroid used for helping a previous chest infection). Rather than tapering off it she had been doctor shopping to high levels. As a consequence they cancelled the operation until such time as she is off it. As it interferes with healing. This will take maybe a year, even by complying.

Shortly after this she suffered arterial fibrillations(irregular heartbeats), and went of to hospital in ambulance, where they find not only was prednisole levels still increasing but she is now diagnosed with type 2 diabetes possibly brought on by the prednisole abuse.

So going from looking up a month ago its just gone rapidly downhill. BPD +diabetes +prednisole addiction is a toxic mix as diabetes takes structure, self care and responsible behavior to manage. My wife has non of these. I cannot see how she is going to balanced meals nor avoid over or under dosing on insulin.

She also self discharged from hospital before they had the predinsole stabalized and fully arranged diabetes care regime

If anyone else has a pwBPD with diabetes any words of advise would be helpful. At the moment it is absolute chaos

A relevent link
Borderline Personality Disorder and Diabetes: A Potentially Ominous Mix

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[Sunfl0wer]

Hi waverider, I'm sorry I have no useful info to share.  Just wanted to hear what others say as my son's surrogate dad has just been diagnosed with diabetes and we both figure, with his (HPD) lack of self care and attention to long term affects of putting sugar etc in his mouth, he likely has 5 yrs left in him.  We are at a loss.  Will read the link, hopefully someone has words of wisdom for you, sorry.

Other than supportive words to take care of your self and such... .
Wish I knew a way to make one compliant with doc recommendations.

[Naughty Nibbler]

Hey Waverider:   

I'm so sorry about all the health problems with your wife.  That's a frustrating set of circumstances.

Do your local laws allow for you to discuss you wife's health care with her physicians, without her permission?  Is there such a thing as a prescription monitoring database, where you live?  Just wondering if there is some method to prevent your wife from doing more doctor shopping for prednisole. Any way to clue in the local pharmacies to not fill prescriptions for that type of med?

If your wife is taking injectable insulin, perhaps you can be the person to administer it?

Is it possible to develop some system for administering her meds that are in pill form?  i.e. Set up a daily pill box (a.m., p.m., etc.)  Only have daily doses of the abused meds available (lock up/hide the rest of the meds somewhere). Even Setting out a daily allotment of all meds can serve to track all pill med usage.  I know there is a pill box available that has compartments for 7 days, with am and pm compartments for each day.

My mom took the blood thinner, coumadin.  Her dosage changed, in accordance with her frequent blood test results.  At one point, we assisted her in setting up her weekly pill box.  Her total coumadin daily dosage was generally a combination of different dosages of coumadin. 

Is there an issue with her NOT taking the meds for blood sugar level?

I'm thinking you probably have some device to use to sample your wife's blood sugar levels at home.  You could start a chart of some sort.  It could be as simple as a piece of paper with hand-written columns, a spreadsheet or a phone app.  If your wife won't participate, then perhaps you can both agree on you assisting with a least one check a day (a.m. & p.m would be better).  That would give you the opportunity to observe the reading and document it and track it.

If you need some info. on dietary restrictions for diabetics, there should be plenty of data online.  Probably the best you can do is try to keep certain foods out of the house.  If there is something you like to eat, and it is forbidden for your wife, you might consider not eating it in front of her.  If your wife has some favorite foods or snacks that aren't good for someone with diabetes, help find some alternative food that she will like.  If she has enjoyable food (that is diabetic friendly) available at home, then she is more apt to stay on a diabetic diet.

The steroid use is interesting.  I did a little Googling, after I read your post.  I was aware of the many side effects of steroid use, and most people who take it for medical conditions, can't wait to get off of it (if possible).  I did read that some people get a high and euphoric when they are on steroids.  Now that you are aware of your wife's steroid abuse, have you noticed a positive mood change while she has been on the steroids (versus more moodiness and rages)?

[waverider]

Sticking to her meds and not going off overdosing on one or the other has always been an issue, it hasn't always been the obvious restricted ones, its often quite benign ones, but taken to toxic levels.

Thats just par for the course and been through all the avenues of locking them up, limited dispensation etc. Typically that causes it to be an even bigger problem which is common when you try total prohibition with an obsessive person. A balance of co operation works best.

The steroid is an upper which combats the downer of the more sedative ones. She does want to be off it but has a huge fear of withdrawal, it is almost like you are trying to take her breath away... This constantly cycles through many issues, and this wont be the last.

My real concern is how to moderate/regulate herself to deal with the diabetes. As opposed to just starting a new health food fad, which will pass. Hopefully as the steroid is reduced the severity of the diabetes reduces, as that is probably the biggest trigger for it at the moment

[isilme]

I'm assuming "doctor shopping" is something my BPD mother would do - go to a lot of different MDs to get a prescription from each for her favorite drug of the month.  To top it off, she's write hot check for the pills and MD visits.  She liked barbituates.  I did not know this was still possible in this day and age, I'd assumed pharmacies kept tabs on controlled items via a database, so even if you pharmacy hop you'd get caught.  

H is not diagnosed diabetic, but I am afraid that might come in a few years. It runs strongly in his family.  He is sensitive to sugar highs and lows, and can get sick from having a donut and orange juice or a soda at the wrong time of day, and rages seem tied to low blood sugar, and can sometimes be avoided simply by eating every 4 hours.  I try to monitor that he eats "on time" as best as I can, and provide a rounded meal.  It sounds strange, but a plain cold cut sandwich seems to be the best for his body to process.  

I can't really think of ways to cope with a person with an obsessive personality and a dependency on medications, other than to say take it a day at a time, one "battle" at a time.  

Maybe as a "safety blanket" for tapering off the steroids you can put some homeopathic placebos in place - like an aroma therapy diffuser or humidifier that can pump out Vick's or peppermint oil/eucalyptus.  I use those at home for my chronic allergies and tendency to get sinus infections from congestion.  Our local grocery store even had some relatively inexpensive diffusers and oils.  

You may need to look into such things to give her a less harmful kind of "crutch", and it would show you ARE thinking of her and not trying to make her unable to breathe.  It's just an idea.  

[Cat Familiar]

Wow, Waverider, you've certainly been through hell and back with her so many times. I'm so sorry that you're having to deal with such life threatening circumstances and with so little cooperation or self-regulation from her.

It seems that she's been pursuing a slow moving path to suicide for most of your relationship and that you've had to intervene to save her time and time again.

I wish I had something helpful to offer, but the only thing that occurs to me is to see whether she can qualify for a diabetes pump, since she has proven not to be capable of self monitoring.

[waverider]

Would you believe during her one week stay to wean down substantially off prednisone, turns out she was topping herself back up whilst there from her own supply. So net change after her stay has been minimal. What chance of doing it at home if she can't even as an inpatient

I wish I had something helpful to offer, but the only thing that occurs to me is to see whether she can qualify for a diabetes pump, since she has proven not to be capable of self monitoring.

Interesting thought, we are going to see Endocrinilogists this morning, may bring this idea up

[isilme]

turns out she was topping herself back up whilst there from her own supply

She had some hidden away?  Have you gone through the house to check likely and unlikely hiding places?  Have you discussed the possibility of admitting her if she puts up a fuss about it?

[waverider]

She had some hidden away?  Have you gone through the house to check likely and unlikely hiding places? 

Dont really get hooked into that anymore, they are easy to obtain. You can drive yourself nuts chasing shadows. Though I did find a large stash of endone tablets so they got thrown out before they became the next problem. Who knows what the next one will be, but there will be one for sure.

Have you discussed the possibility of admitting her if she puts up a fuss about it?

There are no facilities or grounds for doing that.

Blood sugers are in the range 20-30mmol/L (375-540mg/dl) which is 3-4 times the normal range

[Cat Familiar]

Stating the obvious:
1. She has a history of overdosing and drug abuse.
2. She hasn't had a "wake up" call from previous overdoses and continues that reckless behavior.
3. With cancer and now diabetes, her body is in a weakened condition and improper drug protocol is likely to lead to irreversible harm.
4. She refuses to follow directions given to her by medical professionals.
5. You've tried to monitor her medications in the past, but she has repeatedly thwarted your attempts.
6. Through her irresponsible behavior, she has made you the intermediary between organ failure and death.

I'm sorry to say but it seems like it's just a matter of time before that final fatal overdose, no matter how carefully she is monitored. My questions to you are what are you getting out of this relationship? And does she have any idea of how her behavior is impacting your life?

[waverider]

Stating the obvious:
1. She has a history of overdosing and drug abuse.
2. She hasn't had a "wake up" call from previous overdoses and continues that reckless behavior.
3. With cancer and now diabetes, her body is in a weakened condition and improper drug protocol is likely to lead to irreversible harm.
4. She refuses to follow directions given to her by medical professionals.
5. You've tried to monitor her medications in the past, but she has repeatedly thwarted your attempts.
6. Through her irresponsible behavior, she has made you the intermediary between organ failure and death.

I'm sorry to say but it seems like it's just a matter of time before that final fatal overdose, no matter how carefully she is monitored. My questions to you are what are you getting out of this relationship? And does she have any idea of how her behavior is impacting your life?

All true and i am under no illusions as to her having a long and healthy life. Hence it is sad to see this happening, but is also one reason i am not going to drive myself nuts getting too entrenched between her and her poor health choices.

I get plenty out of it as long as i dont stand in the tracks of her runaway train of obsessions. That is her train wreck

[waverider]

prednisone was initally prescribed for a chest infection/pneumonia, she is always getting these. Byproduct was that it was an "awakener" offsetting other sedative meds. That caused the initial motivation for upping it. After that an ingrained fear of withdrawing off anything kicked in, whether physically addictive or not, escalating this. It is the same pattern that repeats with anything, even food fads.

She wants to quit, but fears the process.

One issue is that she confuses the affect wearing off with actual withdrawal. So claims withdrawal symptoms even when doses are not reduced, rather it is just increased tolerance levels.

She is currently being given hydrocortisone to deal with a chest infection she currently has, maybe they are using this as a detox aide, not sure.

Any insight in regards to long term thinking is only superficial, she knows the words but the motivations of the emotional now always override everything.

At least with the blood sugar monitoring she has to do now it will help override the delusions in regards to bad diet.

[sweetheart]

Hi waverider,

I'm in the UK so I don't know much about your health/mental health care system. My dBPDh has lots of the same issues around px and OTC meds. I have learnt to now like you keep out of the way.
What I was thinking given your wife's dx, she has v poor insight, she is demonstrating fluctuating if any capacity to make informed decisions about her care, physical or mental, combined with deteriorating physical issues etc means that she should qualify for an inpatient treatment plan to withdraw her off the steroids. An experienced clinician should assess the above as risks to herself exacerbated by the current increase in emotional stress she is under.
If you can get her mental health team to approach her reduction from the steroid with the above in mind, would your w consider an in-patient reducing regime treatment plan? Is it something that might be offered where you live, it would be possible here in the UK?
I completely understand your wife's fear of reducing off the meds of her own volition, even though she of course would be ok to her it must feel like dying. My h has only ever been successful in reducing off meds he has abused and become dependent on as an in-patient, or in prison. Only to just repeat the same again over time once home with a variety of easily accessible meds including the truckloads he is px.