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health

How a Nurse Practitioner Living With Bipolar Disorder Takes Control In the Workplace

I first came across Ann Roselle, an acute care nurse practitioner, via Twitter after reading the extremely personal and brave post that she wrote for the online magazine, Ravishly, which poignantly highlights the humiliation she experienced during one of her numerous psychiatric hospitalizations. Given the stigma that surrounds mental illness, many may feel ashamed to disclose their diagnoses (especially as a professional in the medical field). However, Ann writes so openly about living with postpartum onset bipolar disorder as a guest contributor on several websites and in her blog, Bipolar&Me. She dispels the misconception that people diagnosed with bipolar disorder can’t live fulfilling lives, have a successful career, balance numerous roles and responsibilities (wife, mom of 3 boys, mental health advocate, blogger, to name a few), AND cope with the fluctuations in mood characteristic of bipolar disorder. I am a huge fan of Ann’s writing and am honored to have her contribute to my blog as she discusses her commitment to maintaining stability in her personal and professional life.

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“It’s stylish to talk about mental health, especially how we maintain our own.” As a nurse practitioner who lives with a serious mental illness, bipolar I disorder to be exact, how could I not fall in love with a blog with a psychiatrist who talks so frankly about mental health and her practice?

I am a surgical nurse practitioner, specializing in cardiac surgery. I am fortunate enough to be able to be open about my disorder in the workplace. I had fears initially about being open, however with time I believe it has proven to be a positive experience. In my case, living with bipolar disorder never proved troublesome with my training as I was diagnosed after I had been in active practice for six years. So, the questions that beg to be asked are — How does my illness impact my patients or influence my interactions with them? And how do I maintain stability with full-time employment in a stressful environment?

First, it starts with the moment you accept that you have an illness. That you have an illness you are going to need to learn to manage as one manages any chronic illness. And, I won’t lie — accepting the diagnosis is hard. I didn’t want to accept my diagnosis for a long time. I cried and mourned the vision of the life that I thought I was going to have, that I was supposed to have, thinking everything changed in the moment I received my diagnosis. It took a long time for me to realize nothing had actually changed and that the life I wanted and envisioned was still there waiting for me to seize it.

Part of my seizing the day, so to speak, was to commit myself to doing what I needed to do and stop fighting with my treatment team. Stop fighting the need for medication. To stop being the non-compliant patient I would roll my very eyes about as a practitioner. I showed up for appointments, attended groups faithfully in the early days, and took my medications. I played with my diet trying to find a proper nutritional balance. I quit drinking on a regular basis. I became fanatical about ensuring proper sleep hygiene and getting rest. I fully admit that I am not great about the exercise piece as my work hours limit my ability to get to a gym on workdays and I am so busy with my family on days off. I’ll get there, though. Exercise helps mood and I feel infinitely better on the days I’m physically active.

Now, what about nursing practice you ask? What about those patients? Ultimately, if you are in treatment (on meds, working with a therapist, a prescriber, or even have a support group to fall back on) and stable, the disorder has no bearing on your practice. None. I hold the view my bipolar disorder is a chronic manageable condition no different than diabetes or hypertension. I learned (and am still learning) to manage my moods in the same vein that a diabetic learns to count carbohydrates and manage their blood sugar.

Emotionally, I have always had the ability to hold myself together for the hours I am at work and dealing with patients. My patients will never know I carry this diagnosis. I may fall apart once I get home and feel safe to do so, but never within the walls of my employment. I also make it a rule that no matter what happens, no matter the co-morbid psychiatric diagnosis my cardiac patients may carry, I never reveal myself to them. They come for cardiac care and not to hear my story. I do find I have become more empathetic to those who carry psychiatric diagnoses. I discourage staff from saying inappropriate and stigmatizing things both in and out of earshot of patients. There is a huge difference in a patient who is emotionally labile because of a mood disorder and a patient who is emotionally labile trying to cope with their physical illness. I view it as my responsibility to help staff understand such a critical difference. Emotional lability in and of itself does not a bipolar make. I make sure my patients’ home medication regimens are adhered to as closely as possible. And when a patient is acutely decompensating in terms of their mood or mental status, I make sure that medically we have dotted our I’s and crossed our T’s before calling the psychiatry consult service.

I’m not perfect. I have days I need to take a time out and walk away. This is beyond the usual code blue that may have been upsetting for staff or seeing a patient I really cared about suffer from a devastating complication. I have colleagues who respect that need and allow me the moments I need to compose myself and come back calm and ready to do my job.

I am fortunate to do what I do. And I am fortunate to be able to practice with both the patient and provider perspective.

While I am only human, at the end of the day, I think all those I encounter are better for it.

For more of Ann Roselle’s writings, check out her blog, Bipolar&Me. You can also find her on Twitter and Facebook.

October 27, 2015 7 comments

Psychiatry therapy

Termination Point

written by freudandfashion

Saying “goodbye” can stir a variety of emotions including sadness, anger, and relief. The whole experience can feel quite uncomfortable, so is it better to say “goodbye” or to say nothing at all? Clearly, the more thoughtful and courteous action would be to leave with at least some type of acknowledgement (a wave, a handshake, the verbalization of “goodbye,” etc), though it might be less anxiety-provoking to slip away unnoticed.

In the context of terminating treatment in Psychiatry, there are various reasons why treatment between the psychiatrist and a patient may end:

a patient wishes/chooses to end treatment
the psychiatrist gets a new job, retires, or leaves the practice
the patient changes insurance plans
the patient moves
the psychiatrist passes away

For the sake of this post, I will focus on what I’m currently experiencing — saying goodbye to patients due to a new job. In this situation, the ending of treatment is not the patient’s choice, which can stir a combination of emotions such as abandonment, sadness, loss, betrayal, anger. Though some psychiatrists may feel that sending a letter or written notice informing of their leave will suffice (I won’t get into the complex legal aspects here), effort should be made to ensure that the patient does not feel at fault for the termination of treatment (ie, a patient may feel that the doctor is ending treatment because the doctor doesn’t like them, etc). Which is exactly the reason a termination phase (or at the very least, a final session) is crucial to help process emotions that may come up, allot a decent amount of time to coordinate transfer/continuity of care, and most importantly, to provide closure (for both the patient and psychiatrist).

In the last few days, I’ve experienced random moments of feeling sad and numb. Some of my followers on Snapchat may have noticed my absence of posts for over one week (I usually post on a daily basis). My videos are generally motivated by something exciting from my day or a psychiatric tidbit of knowledge that I wish to share, however I haven’t been as inspired lately. Even while writing this post, I’m interrupted by moments of abruptly staring into space and my mind wandering to more superficial thoughts such as shopping, what to make for dinner, and celebrity gossip.

With only a few weeks left until my final day in clinic, I fight the urge to flee and avoid the discussion of termination. But then I refocus and put my psychiatrist hat on and consider the potential impact that avoidance of the topic may have on my patient. However, the professional aspect of fulfilling my duty and ensuring proper transition to another provider for continuation of care is the easier part. The more difficult aspect is letting go of the strong connections that I’ve built with my patients, especially those who watched me grow from a newbie psychiatrist straight out of residency to one they grew to depend on and trust.

Despite the complex mixture of emotions, I know that I’m doing what’s best for me personally and professionally by taking this next step in my career. Yet, if I’m having a tough time, imagine how my patients must feel.

September 10, 2015 10 comments

Personal Psychiatry

Look You In The Eye

written by freudandfashion

Several friends have pointed out to me their observations of my interactions when in public places: that people strike up random conversations with me, ask for directions, of if I could take a couple’s picture at a touristy hot spot, etc. These types of interactions are becoming less awkward to me in the last few years, and I initially attributed my approachability to giving off a “psychiatrist” vibe, as if people can sense that I’m trained to listen to people’s issues. Or, perhaps, as one friend pointed out, I appear to be the antithesis of “bitchy resting face” syndrome.

Flashback to around twenty years ago when I was a loner preteen in the girls’ locker room, where my locker was located in the same aisle as the most popular girls at my school. As I stared at the floor too shy to make eye contact, I recall trying to muster the courage to say something to them…anything…in hope of some kind of acknowledgement, a wave, even a “hi” — anything to feel slightly less invisible than I already was. When I looked up directly towards them, words never left my mouth. All I had the courage to do was smile. A forced, awkward, and uncomfortable smile that caused my cheeks to fatigue.

And all that effort and energy exerted for the end result of coming off as creepy: “That girl is smiling too much,” was all they said. From then on and for quite some time, I became known as “that weird smiley girl.” As if smiling was a negative thing. And, as one could imagine, I didn’t smile for months thereafter. Little did they know how much of a hit to my self-esteem that one incident would have. Putting yourself out there only to get rejected sucks and may hinder further attempts to connect with others in the future.

One may perceive me as a highly sensitive, socially anxious person, and I don’t deny possessing those traits. However, rather than being identified with a label or descriptor (ie, “That weird, smiley girl” or “Vania is anxious and highly sensitive”), I prefer that people acknowledge the different facets of my personality that make up who I am as an individual (ie, “Vania has social anxiety and can be sensitive”). The general tone changes depending on the wording and language used. In the former statement, being “anxious” and “highly sensitive” are inferred to be words that define me, whereas the latter refers to “anxious” and “highly sensitive” as traits.

For many years, I viewed myself as abnormal. That is, until the last few years where I grew to appreciate the qualities that make me who I am as a unique individual, which I attribute to surrounding myself with an amazing support system, including my therapist, who helped me realize it. As a result, I no longer stare downward nor feel afraid to smile and chat with others.

An issue that I have with how Psychiatry is perceived is the tendency to create labels. Many people have enough anxiety about seeking psychiatric help in the first place, and the fear of being labeled and stigmatized might sit at the top of one’s list of concerns. I’ve encountered several patients who told me they were diagnosed with a specific mental illness after one brief, initial 30-minute interview. “The doctor told me I’m Bipolar without barely getting to know me” is a statement of different variations that I’ve heard several times in my practice. I try to maintain an open mind about my colleagues, especially those who are only allotted 20-30 minutes to meet with a new patient (which is ridiculous in medicine, especially in psychiatry) because the ability to see a high volume of patients within a short time frame AND fully get to know each patient seems unrealistic and virtually impossible to maintain.

However, the last thing any person, including any medical provider, should do is make you feel like another label and essentially invisible or judged. Often when people muster up the courage to reach out and seek help are in times of desperation and in highly vulnerable states. The most therapeutic thing any person (or provider) can do is look you in the eye (even if you might be too afraid to look directly at them) and acknowledge you for who you are.

September 2, 2015 8 comments

Medicine Psychiatry

Why Am I So Tired?

written by freudandfashion

{Rancho Cucamonga, California}

As I struggled to get up this morning and hit the snooze button multiple times then proceeded to turn off my alarm clock on accident (thus waking up several hours later), I contemplated reasons why I’m feeling so tired today. I’m sure several of us try to diagnose ourselves, and sometimes jump to the worst conclusions as to the causes of our tiredness. But before you start self-diagnosing, here are a few potential causes that I generally explore with my patients before resorting to lab tests and referring back to their primary care doctors:

1. Are you getting enough sleep? Lack of sleep is an obvious cause, but you’d have no idea how many people actually believe they’re inhuman and should be able to get by on less sleep without crashing.

2. Is your schedule constantly changing? Our circadian rhythm acts as an internal clock that guides our sleep-wake cycle. Any disruption as a result of a change in schedule or activity (ie, I have several patients whose job schedules constantly change, such as firemen, dispatchers, etc; or college students studying late night for exams; or recent travel to a different time zone) can disrupt your cycle, thus causing you to feel more tired than normal during the day.

3. What type of food do you eat? If you start your day with a meal chock full of refined carbs (bagel, doughnuts, croissants, etc), your insulin levels skyrocket, thus feeling sluggish. Also, not eating enough food is an obvious reason for low energy levels.

4. Do you rarely exercise? Just turning up your current level of activity up a notch (ie, if you’re sedentary, start walking, etc) has been shown to increase your energy levels.

5. Do your workouts involve exercises that your body’s not quite yet conditioned to? I, myself have tried various types of workouts programs and generally struggled to adjust when I first started, which is to be expected. In the past, I’ve done boot camps and Crossfit, which I truly enjoyed, yet my recovery times were quite long (in addition, I also had to change my nutrition to adequately fuel my body). Thus, I had several days where I’d want to nap or veg on the couch all day (leg days tend to be the worst!). I have several patients who feel abnormal because they’re making great efforts to drastically increase their physical activity, yet don’t realize that feeling tired during the recovery phase is normal.

6. Did you forget to take your medication? Thyroid medications (such as levothyroxine), stimulant medications (such as those used to treat ADHD), antidepressants (such as buproprion) can drop your energy levels if not taken regularly.

7. Is it a medication side effect? If you were recently started on new medications and notice that you’re feeling more tired lately, then check with your doc (or search online as most people do) to check if lethargy is a possible side effect.

8. Did you cut back on your regular caffeine intake? Somnolence is a common symptom of caffeine withdrawal (in addition to headache, irritability, decreased concentration, etc).

9. Did you overexert yourself with activity recently? Work, running errands, planning a big upcoming event, etc — it’s normal to feel exhausted and need time to regroup after a busy day (or days) of activity. Know your limits as to how much activity you can handle, or go easy on yourself if you’re not as productive on subsequent days.

10. Are you working on some difficult material in psychotherapy? Since I am a psychiatrist, I usually explore this possibility. Processing difficult emotions can be draining. I’ve experienced this firsthand and used to take naps after my Saturday sessions with my therapist.

11. Is tiredness a sign of depression? If tiredness is also accompanied with symptoms such as loss of interest in activities you normally enjoy, isolation, sadness, etc, then lack of energy might be a sign of depression. Reach out to your doctor, especially if symptoms don’t improve and start impacting your ability to carry out your daily activities.

If the cause of tiredness is not apparent, then make sure to contact your medical doctor to discuss your symptoms. However, more often the cause of tiredness is not a major medical issue. In my practice, I find that the most common cause of lethargy is related to schedule and unrealistic expectations that we place on ourselves to be superhuman (I’m definitely guilty of this) and accomplish so much in one day without allowing adequate time to rest and refuel, thus leading to excessive stress, insomnia, poor eating habits, subsequent depression, etc. Listen to your body — if rest is needed, allow yourself enough time to reset, relax, and gain your energy back.

Photo by Marlon Santos

June 3, 2015 5 comments

Personal therapy

Let Go

written by freudandfashion

{Ventura, California}

Several of my readers know how much I struggle with self-care and criticize myself on days that I feel less productive (I wrote about the subject here, here, and here). I’m starting to let go of the guilty, judgmental thoughts, which I’m sure are ingrained in the minds of many others like myself who’ve spent most of their lives incessantly working towards a degree and busy career. Last month, I disclosed to one of my patients that I sometimes sit on the couch and watch tv for hours on days I feel exhausted and overwhelmed. I regretted telling her the information because I realized my attempt to make her feel less guilty about doing a similar “lazy” regimen was really an attempt to validate my own actions of simply resting on my days off. I realized how much I still need to work on letting go. I need to let go of the pressures, demands, guilt, and self-criticism.

Well, I’m happy to report that I went to the beach this week, strolled, and stared out at the water as the surfers rode the waves. The thought of rushing home to answer emails popped up in my head a few times, but I surprisingly allowed myself to let the thoughts go. I’ve been working on this process of self-care for years, but I’m making progress. And that’s all that matters (no self-criticism involved).

What activities of self-care did you incorporate this week? I hope you all have a wonderful, relaxing weekend!

April 10, 2015 12 comments

Lifestyle Personal

Thankful Thursdays – Time Off

written by freudandfashion

{Fairfield, California}

Time off from work couldn’t have arrived at a better time. It has been awhile since I wrote my last “Thankful Thursdays” post (see previous ones here and here), so I think it’s appropriate to write one given my current state of mind (which is more relaxed and centered). My vacation started off with a quick, last minute trip to visit my family in northern California, which is usually my preferred travel destination each time I get the urge to feel more rooted and have the need to reset. During a stroll with my sister, I realized the grassy hilltops are gorgeous landscapes that I’ve taken for granted ever since my family first moved to the area when I was in junior high. For some reason, the lush hills appeared immaculate and majestic this time around. I enjoyed reuniting with family visiting from the Philippines, tasting my mom’s traditional filipino dishes, and playing card games with my cousins and siblings. I truly savored my brief stay.

Currently, I am sitting in a hotel lobby located in the flourishing city of Scottsdale, Arizona. I stare outside at the backdrop of pristine mountains, pale blue skies streaked with thinly layered clouds, and adobe fountains and fixtures at the forefront. Everything seems extremely tangible – from the texture of the furniture to the warmth of the sun hitting my face. While attending a conference, I am also aware of the numerous psychiatry and neurology residents here preparing to take their board exams tomorrow, as they lay out by the pool with heads buried in flashcards and exam prep books.

“I remember being in your same position two years ago,” I said to one of the girls who studied while lounging on the chair next to me. All I could remember from that day two years ago was memorizing the diagnostic criteria for various psychiatric diagnoses, the treatment for alcohol and drug withdrawal, etc. I never would have imagined noticing the simplistic, yet characteristic details of the locale like I am able to observe now. Fortunately, I passed the horrific test, yet I reflect on the past and a part of me wishes I was more mindful of the details from that experience. However, as the saying goes, “better late than never.”

Photo by Marlon Santos

March 12, 2015 6 comments

Personal

Weekend Reflection

written by freudandfashion

{Ventura Pier, CA}

In order to take charge of my life after a stressful week, I made the decision to temporarily cut back on certain responsibilities. In the past, I rarely said “no” to projects or other opportunities, however, as I mentioned in my last post, I’ve been extremely overwhelmed and need some time to regroup. Though it’s difficult, especially if you’re someone who people rely on (especially if you’re the caregiver type), setting boundaries with people and activities is a healthy way to cope and manage your life. I’ve never met anyone who devotes a huge percentage of their energies on work and everyone else BUT themselves without getting burned out. However, if you have mastered the art of life balance, please message me. I’d love to know your secret.

Hope you’re having a wonderful weekend filled with relaxation and self-care!

March 8, 2015 19 comments

Personal therapy

Sticking To It

written by freudandfashion

{midweek hike in Malibu Creek State Park}

My “Monday Motivation” consists of posting my continued efforts to maintain my New Year’s goals for 2015. I truly appreciate all of you because you’re part of my support system — you’re helping me hold myself accountable to stick with these goals! I can’t emphasize enough how important self-care is to maintain a sense of well-being, which is the reason my last few posts have been dedicated to the topic. Most of my patients struggle with the same issue, which leads to burnout, increased stress, uncontrolled anxiety, worsened health, and much more. The photos in my post are proof of my activities from last week, and serve as my motivation to continue this week. If you’d like to join me in my efforts to prioritize self-care, would love for you to share how you’ve been doing so thus far!

{Took a REAL lunch break & caught up with celeb gossip and world news}/ {went to two amazing yoga classes, even though I was initially too lazy to go and wanted to back out (pic taken before class)}

{Took a stroll on the beach of Playa Del Rey after my weekend therapy session}

January 27, 2015 11 comments

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