Part 4: At the hospital now

[stolencrumbs]

This is a continuation of a previous thread: https://bpdfamily.com/message_board/index.php?topic=337088.0

Talking together is  a WONDERFUL idea.

Let her say her truth. YOU say yours.  Don't hold back at all.  She won't.

No more secrets.  Remember that mantra.  No more secrets.

Flip it about the doctor.  Be glad he told her.  You should own it.  He should own it.  Your wife should KNOW it.

No more secrets...(keep the mantra going!)

Best,

FF

I feel like that's a really good mantra. I'm trying.

She just called again. She really doesn't want the injection. But she feels (probably correctly) that she doesn't really have a choice if she wants to come home as soon as possible. I got more of how things have been on the phone tonight. It's my fault. This is what I wanted. I'm going to get what I wanted. I hope you're happy. etc. What she wants me to do is talk to the doctor again and, though these aren't her words, minimize everything that's happened and convince him she doesn't need this long-acting anti-psychotic and it's fine to send her home. That seems inconsistent with "no more secrets."

But I can't say I'm board with what he is recommending. It's a pretty scary drug that is normally prescribed for schizophrenia and bipolar 1, neither of which applies to her, imo. And if she gets the shot, there's no stopping whatever it does to her for thirty days.

And sure, she can have her truth and I can have mine, but she is the patient in the mental hospital and I'm not. If I say my truth, they're going to believe me. I'm tired of pretending that she knows what is best for her mental health, and tired of going along with that. But I don't really trust what they're doing here. So I could try to make a case for her to not get the shot, and then implement "no more secrets" once she is back home and we are seeing someone in an outpatient setting. I don't know. I hate this.

Sorry for all the posts, and thanks for all the responses. People in my real life are very supportive, but also have no real idea about what this is like.

[stolencrumbs]

Empath,

Do you think the doctor seeing the dramtic contrast would be a good thing?  That's where I was going with it.

Best,

FF

I don't think he would see it. I don't think she would "show" that.

I have years of texts and emails and photographs and recordings that would demonstrate the contrast.

I didn't use the word, but both the doctor's description and the police statement said I described her as violent. That really upset her. But that's also true, right? I mean, I didn't use the word, but if you listened to the description, that seems like a reasonable summary.

[Gemsforeyes]

Yes, SC.  I agree that her outbursts and behavior can be accurately characterized as violent.  Also destructive and dangerous to you, herself, your pets and neighbors.

What she WANTS and expects and what is best may not match up; especially as it relates to YOUR wellbeing.

No more secrets.  Is it out of line to play a few recordings for them?

Gems

[formflier]

No...I don't think you should "get on the triangle" with her and the doctor.

Remember the Notwendy story about "terrible providers"...it appears she is trying to convince you this is a "terrible doctor" and you have found something that might indicate she is right.

However, neither you or she are practicing physicians.  Not all approved drug uses or side effects can be found with a google search.  I have personal experience with that

I'll try to make this story quick.  I'm 100% disabled from VA..also on social security.  So my medical file is pretty thick and I have drugs I'm likely on for life.  It is what it is.  

A new drug was introduced last year that "everyone tolerates well".  I also take my BP several times a day and record it in an app to help monitor things.

Well...my resting heart rate went from 70...to 110.  And I felt weird.

There were lots of side effects listed for the drug...but that one wasn't.  Well..I finally get with my provider and they confirmed it is a rare (but known) side effect.  Congratulations...I have my first drug allergy.

I just so happen to be friends with a Pharmacy Doctor (pharmacist with PhD..)  He can't diagnose..but can "treat" patients with drugs.

Anyway...I asked him what was up with drug information on the internet and he warned me against relying on it.  Said it was very incomplete.

So...DO NOT rely on internet for medical information.  Ask the provider for more information if you have concerns.  Stay away from using internet to evaluate doctors choices.

My best guess is he believes she will be "non-compliant" with a drug regimen...so he wants to give her the shot to give her 30 days of "compliance".  (again..that's my best guess)

No more secrets!  

I know this is hard...keep up the good work.  You are walking a different and VERY uncomfortable path for you.  Self care is key!  Expect it to feel weird!

You can do it!

Best,

FF

[boatingwoman]

Really, the minimizing is lying. So she is violent, a danger to herself and others, a liar and possibly an addict, all with pyromaniac tendencies.  Don’t feel afraid to name the behaviors.

[I Am Redeemed]

Aripiprazole, aka Abilify, can be used for purposes other than just the psychosis associated with schizophrenia and bipolar. It can be used in some dementia patients, and it can be used in combination with an SSRI (selective seratonin reuptake inhibitor) to treat such conditions as Major Depressive Disorder (which I have) if the anti-depressant alone is not working sufficiently.

The psychiatrist has a reason for prescribing this, and it may be best that she gets the drug now while she is still in the hospital so they can observe how she reacts to it.

Another thing to think about is that if she is detoxing from years of taking an amphetamine-based drug such as Adderall, the Abilify may be to aid with that. Dependence on amphetamines can exacerbate mental health issues, including suicidal thoughts, hostility, psychosis, and impulsivity. The withdrawal from amphetamines can produce such symptoms, as well. The antipsychotic may, in part, be prescribed to aid with the Adderall dependency.

[empath]

SC, there are a couple of versions of Abilify injections. One is the longer acting version, then there is a short term one. Sometimes, it can help with major depression in addition to bipolar and schizophrenia. Major depression can manifest with psychosis, too. Do you know which version of the injection the doctor was recommending? From what I read, the longer acting version is used after stabilization on the oral version for a few weeks.

[GaGrl]

Remember that Borderline Personality Disorder was described in that way because it describes a person functioning between Neurosis and Psychosis. Don't underestimate the tendency toward psychosis. If this medication is intended to help stabilize, you need to be in alignment with the doctor.

Your wife's behaviors are closer to psychosis than neurosis ( my opinion). She is not functional in day-to-day life and activities.

[stolencrumbs]

SC, there are a couple of versions of Abilify injections. One is the longer acting version, then there is a short term one. Sometimes, it can help with major depression in addition to bipolar and schizophrenia. Major depression can manifest with psychosis, too. Do you know which version of the injection the doctor was recommending? From what I read, the longer acting version is used after stabilization on the oral version for a few weeks.

It is the longer acting version. It is supposed to last 30 days. She has only been on the oral for two days. She has been on a 10mg dose of the oral, and will be getting two different shots. One is a 400 mg shot and one is 675 mg. One of those is what they are calling a "loading dose." This seems to be to get her to a therapeutic level more quickly.

I've read the same thing from the manufacturer. It sure doesn't seem like a good idea to put someone on that after only two days on the oral version.

[babyducks]

Hi Stolencrumbs,

You are doing a good getting through this.   I know it's tough.   Hang in there.

But I can't say I'm board with what he is recommending. It's a pretty scary drug that is normally prescribed for schizophrenia and bipolar 1, neither of which applies to her, imo.

Can I ask,  what's your thinking about the bipolar 1?   why do you believe this doesn't apply to her?   if your wife doesn't fit the ~Hollywood picture of bipolar, do you think it's possible that bipolar kindling is at work here?   My ex was Bipolar 1, very rapid cycling,  it's a small subset of the bipolar disorder.    It's also more severe.

Being committed involuntarily, after a dangerous incident and spending 6 (or so) days in a hospital means there is a lot for your wife to process.    It also means there is a lot for you to process.     a lot for you to examine and come to terms with. I know that this is very uncomfortable for you.     You describe a system that is over taxed and with limited resources, but they are keeping your wife.    I think there is a clue there.    An emergency psychiatric intake is a triage,  a quick attempt to stabilize the person, quiet the raging brain and develop a treatment plan outside of the crisis center.    Long term psychiatric hospitals or care centers operate differently,   they don't usually take patients directly from an ER because the patient isn't stable enough to work with.   that's been my experience.

I know you hate this.   I would too.   Not every medication they try will be effective,  or something your wife can tolerate.   (if she takes the medication as prescribed.)   there is some trial and error with getting medication choices and levels optimal.    that's how it works.   stupid example,  it's taken 4 attempts to find a blood pressure medication I can tolerate.   even then it has side effects.     bottom line is I can work to find a blood pressure medication or I can live with the effects of very high blood pressure.    those are the choices.    that's it.    try the medication or live with the disease.     

Yes your wife is violent.    Trying to reopen a break by hitting herself in the head where the fractures occurred is violent.

I got more of how things have been on the phone tonight. It's my fault. This is what I wanted. I'm going to get what I wanted. I hope you're happy. etc. What she wants me to do is talk to the doctor again and, though these aren't her words, minimize everything that's happened and convince him she doesn't need this long-acting anti-psychotic and it's fine to send her home.

She seems very convincing.    She seems very persuasive.     she's also mistaken.   I agree with Gagrl that there is an amount of psychosis that your wife displays.   No one is psychotic 100% of the time.   

What concerns me is you.    and the idea of 'minimize everything'.      To me this seems like a dangerous dangerous slippery slope.    To me it seems like she is conditioning you to adopt her way of thinking.    and it is strangely effective.    always was for me.    when some one we care for us pushing us to adopt a dysfunctional maladaptive coping strategy it's hard to say,  "I'm sorry I can't do that, I am going to let the medical professionals make the decisions they are trained for."     It's especially hard when our own doubts are played on.    there are no perfect solutions here.     there are the lesser of two evils.   

my two cents
'ducks

[formflier]

You are doing a good getting through this.   I know it's tough.   Hang in there.

This is my biggest "message" as well.  Keep it up.  Watch out for the pitfalls...especially any effort to minimize.
 

   bottom line is I can work to find a blood pressure medication or I can live with the effects of very high blood pressure. 

   those are the choices.    that's it.   

 try the medication or live with the disease.     

Then when you get "comorbid" things it really complicates things.  (Is there any doubt your wife has several things going on?)  Some BP drugs are also used for prostate issues, so when trying to get the right combination...it's very complicated.  (this is what I'm dealing with..BP and prostate stuff)

I'm undeniably making progress, yet I've been keeping careful records and measurements for a year now.  Probably (hopefully) one more adjustment this fall, then I might be stable for a while.

Along the way I've had some really frustrating experiences and came close to quitting several times.  I'm glad I've stuck with it.

 
  "I'm sorry I can't do that, I am going to let the medical professionals make the decisions they are trained for."    

And variations of this when questions/ideas come at you that you have not anticipated.

I find that I'm really good at dealing with repetitive things or variations on a theme of "blather" coming from my pwBPD.

What gets me is when it's something I've never heard before, yet I get that odd feeling that I'm walking into a trap...but can't quite put my finger on it.

Perhaps "Well..that seems important and is certainly something to think about.  Let's discuss with your care team."

Best,

FF

[Notwendy]

All the nurses tell her she's wonderful and shouldn't be there, and that's the main input the doctor gets on how she's doing. She is smart, and warm, and kind, and all the things she is when she's not talking to me after dark

My BPD mother is like this too.

It is very hard for medical providers to help my mother. She lies to them, tells them what she wants to hear. She likes certain medications, and will tell her symptoms the way she thinks they need to hear. If she doesn't like one, she won't take it.

From my own experience, I think it is important for you, stolencrumbs- to decide just how much you want to be involved with these issues. Are you willing and able to be a caregiver for a person with serious psychiatric issues who may not cooperate with the health care team or with you?

Your wife has a serious mental health need- and it isn't going to change instantly. She needs to cooperate with her health care providers and attend the outpatient sessions. Is her motivation to get better or to get out of there- where her issues are known and she isn't in control? Can you manage this at home?

[babyducks]

It sure doesn't seem like a good idea to put someone on that after only two days on the oral version.

SC,   it's been your role to protect and caretake your wife for some time now.    For sure some of that protecting and caretaking has been reasonable and necessary.   the question is, I think,   where is the line?   where are the boundaries?

FWIW,  I completely agree with you.   It's very difficult to get quality and effective medical care.     Psychiatry is as much guess work and trial and error as anything else.   Until there is a way to examine the brain in situ without killing the patient, it's probably going to remain that way.

I wonder if perhaps there are additional under lying issues also at work here.    separate from the complexity of the medical condition(s), there is a long established history of you going to every length to respond to your wife's distress.  you've listed some of them in this thread,   giving up your home, sleeping in your office,   not using certain chairs in the house,   doing this rather than that with the dogs.   

what's the goal of these shots?  upstream you said "But she feels (probably correctly) that she doesn't really have a choice if she wants to come home as soon as possible."   if the goal of these shots is to help with the transition off her existing medication and assist with the transition from the hospital to home, isn't that a good thing?     

My Ex told me once that she struggled to take her medication for a long time because she felt like it robbed her of her personality.    That there was nothing wrong with her and trying to change her was punitive.    Yikes.

NotWendy raises a good point, if the shot is intended to help her come home with out another outburst (and yes this is still a question)  is that worth it?    and whose decision is it?    where is your boundary around decision making in your wife's mental health care?

'ducks

[sweetheart]

Aripiprazole and Olanzepine are newer style antipsychotic medications. They are currently being used to help with the symptoms of impulsive behaviour and emotional instabilty associated with BPD.


There is still no one medication that is used specifically to treat BPD, so in cases like your wife’s, clinicians treat the presenting symptoms.
 Similar symptoms are also present in schizophrenia and bi-polar.

Your wife is prescribed Adderall for ‘weight maintenance,’ which is seriously worrying for someone with poor impulse control and emotional instability, so your wife being prescribed Aripiprazole for symptoms she actually presents with makes sound clinical sense IMHO.

If your wife can not tolerate the medication her clinicians will not keep her on it.

From the person you have talked about in your threads, your wife is a very unwell woman with complex mental health needs, sometimes when this is confirmed by mental health professionals it can be very hard to hear.

[stolencrumbs]

Lots to think about here, and lots to process overall.

I’m not going to get involved in trying to manage what the doctor wants to do. I am happy to talk with him again, but I’m not pushing it. And it isn’t my decision. My wife can refuse. That might mean she has to stay longer, but that is her choice. Right?

And yes, this all feels very uncomfortable for me. I did patch the newest holes in the drywall. I might have a second career if things go south in higher ed. It’s really hard to sit around and do nothing.

‘ducks, to answer just one question, when I read about bipolar, it just doesn’t seem to fit. Maybe I’m not good at identifying hypomania. Descriptions of it I read don’t seem to fit, either, but maybe I’m just mistaking hypomania for a normal, good mood. Anyway, I’d be interested in learning more if there are some resources that you think are good about atypical presentations of bipolar. She does have a family history of bipolar and schizophrenia.

[formflier]

I’m not going to get involved in trying to manage what the doctor wants to do. I am happy to talk with him again, but I’m not pushing it. And it isn’t my decision. My wife can refuse. That might mean she has to stay longer, but that is her choice. Right?

Right!

The way you wrote this out seems very thoughtful.  Well done!

I'm going to introduce some nuance, I'm interested in your thoughts if it works for you.  

Is there a difference in getting involved with the doctor to get YOUR questions answered (even if you don't agree...) versus getting involved with the doctor as an "advocate" for what your wife wants (demands) to happen?

It would seem to me a thoughtful, wise and informed person being appropriately involved in your wife's care would exponentially increase her chances of a better and more healthy life.

Does that nuance seem appropriate?

And yes, this all feels very uncomfortable for me.

I'm glad you can share this here.  How can we better support you working through these uncomfortable feelings?

I did patch the newest holes in the drywall.

I find drywall work calming.  There are times it serves as "self care" because I get to focus on "fixing" something and can see a good outcome.  Very satisfying.

Especially when there are other things I would like to "fix"...that seem resistant to my efforts.

Am I on the right track here?

 It’s really hard to sit around and do nothing.

Right there with you on this!  However, I am deliberate about finding alone and quiet time.  Just me and my thoughts.  It was weird at first.  Now I "crave" it.  

‘ducks, to answer just one question, when I read about bipolar, it just doesn’t seem to fit.


 She does have a family history of bipolar and schizophrenia.

Making caregivers aware of family history is an important piece of the puzzle.  I know your list of things to talk with docs about is a mile long.  Written lists are good!  

Hang in there...  I'm really proud of the hard work you are doing!

Best,

FF

[formflier]

    For sure some of that protecting and caretaking has been reasonable and necessary.   the question is, I think,   where is the line?   where are the boundaries?

Some big questions here Stolencrumbs.

Where do you see the line?  Is that a comfortable line?  Should it be comfortable?  Perhaps picking a line with some discomfort is where you should be to "calibrate" things.

Best,

FF

[sweetheart]

https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

[stolencrumbs]

Right!

The way you wrote this out seems very thoughtful.  Well done!

I'm going to introduce some nuance, I'm interested in your thoughts if it works for you.  

Is there a difference in getting involved with the doctor to get YOUR questions answered (even if you don't agree...) versus getting involved with the doctor as an "advocate" for what your wife wants (demands) to happen?

It would seem to me a thoughtful, wise and informed person being appropriately involved in your wife's care would exponentially increase her chances of a better and more healthy life.

Does that nuance seem appropriate?

Yeah, I think that seems appropriate, and it is part of what I thought about last night and this morning. If I got involved in the way my wife wants me to, why am I doing that? Honestly, the biggest motivator is fear of how she reacts to what I do or don't do. She is going to be infuriated that I "let" them give her that shot. That's how she'll frame it, guaranteed. And that'll be another thing on the list of ways I've betrayed her and hurt her. Anyway, fear would be my motivation for doing what she wants me to do. I've had enough of that.

I do have questions and concerns and things I'd like to talk to the doctor about, and I will be involved in her care, but not as blanket support for whatever she decides she wants.

[formflier]

Honestly, the biggest motivator is fear of how she reacts to what I do or don't do.

 She is going to be infuriated that I "let" them give her that shot.


 That's how she'll frame it, guaranteed.
 
 Anyway, fear would be my motivation for doing what she wants me to do. I've had enough of that.

Stolencrumbs

Whatever you are doing to bring about this level of self reflection...keep it up!.  Remember it.

 

FF 

[Cat Familiar]

I worked in a mental hospital when I was in college and the biggest problem for staff was patient compliance. Much of my time was spent picking up pills on the floor that patients had pretended to swallow.

What makes you think your wife would be medication-compliant should she return home?

[stolencrumbs]

I worked in a mental hospital when I was in college and the biggest problem for staff was patient compliance. Much of my time was spent picking up pills on the floor that patients had pretended to swallow.

What makes you think your wife would be medication-compliant should she return home?

Good question. And honestly, I don't think she would be. There is no history of that. She is a voracious researcher, and if she is taking a drug that she doesn't want to take, she will find justifications for not taking it. I honestly have no idea how many of the side effects of other drugs she's taken were real. She seems to manifest lots of side effects. Maybe she really is sensitive to lots of drugs, or maybe it's psychosomatic. I don't know.

And as I said somewhere, she is hyper-concerned about her weight. She's prescribed adderall for ADHD, but I think her main motivation for taking it is her weight. And weight gain seems to be a pretty common side effect of abilify. There's very little chance, imo, that she would continue taking it if she starts gaining weight. So I don't actually think a long-acting shot is a bad thing. I do worry about the dose, and I worry about her reaction to it, whether real or imagined.

[Cat Familiar]

My thought is that if she doesn't get something to interrupt her pattern, she will act out in even worse ways once she returns home.

She has crossed the Rubicon and she's angry with you for holding her accountable. This seems like a very dangerous situation.

[stolencrumbs]

Another question, and I guess this is something I should ask the doctor. Do I take all of her pills away? Put them somewhere safe? I've gotten rid of all the alcohol in the house (not that she can't go buy more, but at least it's not sitting here). Not sure what to do about all the prescription drugs. From what I can find, there's adderall, ativan, ambien, and a beta blocker (used for anxiety, not blood pressure.)  

[Cat Familiar]

Yes.

[boatingwoman]

There is a saying, “don’t borrow trouble or trouble will borrow you.”

Not everyone gains weight on abilify.

It’s also possible you wife isn’t “fixable” because she is psychotic (IMO she isn’t hypomanic) and doesn’t believe she has a problem.  This is my sister. My sister will never get better because she can’t/won’t accept she needs extensive mental health care.

I’m being nosey here.  About her parents— would it be wise to bring them to care for her? Are they part of the problem? They have two self-destructive, mentally ill daughters who are trying to kill themselves directly or indirectly.

What happened to these women? What kind of abuse were they subjected to and by whom? Are her parents part of her issues?

Bottom line is to just keep remembering that your wife is severely mentally ill with no coping skills and she is also about as low functioning as a person can be.  She is not equipped to make decisions in her best interest. Anything she says about her treatment IMO should automatically be disregarded. Would you ask a toddler for her input on treatment plans?

Of course she is going to be non compliant when she gets home. It is part of her disease. At least if she gets the shot, she gets a month’s chance at changing something.

[stolencrumbs]

There is a saying, “don’t borrow trouble or trouble will borrow you.”

Not everyone gains weight on abilify.

It’s also possibly you wife isn’t “fixable” because she is psychotic (IMO she isn’t hypomanic) and doesn’t believe she has a problem.  This is my sister. My sister will never get better because she can’t/won’t accept she needs extensive mental health care.

I’m being nosey here.  About her parents— would it be wise to bring them to care for her? Are they part of the problem? They have two self-destructive, mentally ill daughters who are trying to kill themselves directly or indirectly.

What happened to these women? What kind of abuse were they subjected to and by whom? Are her parents part of her issues?

Bottom line is to just keep remembering that your wife is severely mentally ill with no coping skills and she is also about as low functioning as a person can be.  She is not equipped to make decisions in her best interest. Anything she says about her treatment IMO should automatically be disregarded. Would you ask a toddler for her input on treatment plans?

Of course she is going to be non compliant when she gets home. It is part of her disease. At least if she gets the shot, she gets a month’s chance at changing something.

The short version of the family is that this is her dad and his third wife. My wife was first born from wife #1. Her half-sister is third born from wife #2. Second born from #2 overdosed/killed himself about 15 years ago. All of the kids were raised by their mothers in very bad environments with various forms of abuse and neglect. The only good memories my wife has of childhood are spending summers with her dad and grandparents. Her father was/is very passive (not unlike me, surprise surprise) and I'm pretty sure she blames him for not getting her out of horrible situations as a child. My wife forged documents and got herself into boarding school when she was in 8th grade. Since I have known her, she has had a pretty good relationship with her dad and stepmom, and she still has a great relationship with her grandmother. I don't know how much help they will be, but I don't think they are the problem or will cause more problems. They're good people and they do love and care about her.

[formflier]

I think you were wise to take away the booze and I heartily agree with the YES to take away all pills (and only allow what is CURRENTLY prescribed by the doctors.

That means you will need to get an affirmative answer (vice silence) on the docs about each drug.  (I don't think this is overfunctioning on your part..it seems wise).

Also likely wise to get an affirmative answer (one way or another) on what is wise for you to do (according to her docs) should she bring alcohol back to the house.

Lastly...how is her diet?  I think it wise for YOU to make sure healthy foods are available and that YOU don't have anything to do with bringing twinkies and such into the house.  Although I can't bring myself to suggest you should clean out the twinkies (and such) if she somehow brings more to the house.


Best,

FF

[boatingwoman]

Ok, if she loves her dad it might be good for them to get together. Maybe they will resolve some things that need to be said? Maybe that is wishful thinking, but if her brain goes back to normal speed and she has some moments of clarity, maybe some positive things will happen as a result.  I’m not talking earth shattering things, but maybe some seeds can be planted.

[formflier]

  I don't know how much help they will be, but I don't think they are the problem or will cause more problems. They're good people and they do love and care about her.

OK..from your story I would tentatively agree.

1 thing to watch for.  If she tries to triangulate with them against you/doctors.  If you can't be persuaded to be on "her side", perhaps they can.  You know she will try.

From what you know of them..will they be susceptible to her charms in this area?

Best,

FF