Laying Down the Law

I have been going around and around in my head, fighting with myself trying to determine where the fine line is between 'enabling' Josh and offering appropriate help and support.

I find myself often worried about him, but worse, I find myself doing things for him that I'm pretty sure I shouldn't be doing, like waking him up to get to class on time.

I struggle because all my 'normal' reactions to any situation with Josh, are followed up with the thought, "BUT, he's Bipolar!" I find myself excusing his behavior simply because he's Bipolar.

Other areas of my personal life have put me in front of my therapist a couple of times lately. She asked me how Josh was doing and I told her about my concerns.

He's back in school, but not functioning as well as he should be. While his general mood is good, his sleep schedule is still upside down and he often goes out with a friend late in the evening and doesn't return until 5AM. This is not conducive to getting up at 10:30 and getting to class. He's also struggled with the basic workload, missing the due date for his first written assignment.

I told my therapist that Josh and I had an agreement; he is to clean the house each Friday in lieu of paying me $50 a week in 'rent'. I established that agreement at the suggestion of Josh's therapist as a way to begin making him more responsible for himself.

Slowly over the last several weeks, the house hasn't gotten cleaned.

My therapist encouraged me to take a hard line with Josh about this issue. "If you allow him to just blow this off, THAT is enabling him, don't do that."

So that day (which was a Friday) I went home and told Josh that I would be going out of town on Saturday, returning late in the evening. "When I get home tomorrow night, one of three things better have happened. Either this house is cleaned as we agreed to, OR you leave $50 on the kitchen counter for me, OR your bags are packed. I don't care which one you chose, that's up to you, but one of those three things better happen."

He argued with me that he had to work Friday night and Saturday night and he had that past due paper to complete.

"Not MY problem Josh, figure it out."

I came home that Saturday night and the house was spotless.

That was encouraging. "Hmmm, there's something to this being assertive thing!"

The week progressed with lots of things going on in both our lives. I found myself worried about the paper Josh was working on, but instead of asking him if he was working on it, I'd ask him if he was still struggling with it so badly.

When he had starting writing it, he had complained about his inability to focus and gather his thoughts enough to write it. He had done the research, he just couldn't get the information out of his brain, onto the page.

He thought maybe he needed ADD medicine, I encouraged him to explore that and if THAT didn't help, perhaps he should explore a Bipolar medication.

But of course, he has been unwilling to actually call the doctor and make an appointment.

He was up all night working on the paper Monday night, so he could turn it in Tuesday. When I got up Tuesday morning he asked for my advice for his conclusion paragraph. I went to work and when I came home mid afternoon, he was gone to class. I was very curious about the paper he had written, wondering if the end product was disjointed and unorganized. I pulled it up on my computer and read it, and it was, without a doubt, the best paper he's ever written.

That was encouraging. That even though he struggled so badly with it, he WAS able to produce it in the end in a well thought out, cogent fashion.

When I met with my therapist this Friday, I asked her if we could discuss Josh for a few moments. I told her that her advice about the house cleaning had worked very well and having that work so well, it made me realize that I need to stop enabling Josh in other ways, but that I was always hesitant to totally 'let go and let Josh' because, after all, he's Bipolar.

"Well, doing things like waking him up for class and stuff IS enabling him. In the end HE has got to run his own life. And that includes learning to manage his Bipolar."

So last night I told Josh I had a couple things I wanted to discuss with him.

"Josh, you have been very vocal about wanting to 'live your own life' and that is exactly what I want you to do too, but I find myself doing things for you so you don't suffer negative consequences; like making sure you get up to go to class. I'm going to stop doing those things. That means that this is ALL on you, which is the way it SHOULD be. I hope you do whatever it takes to be successful in school this term. I want to see you succeed, but whether you do or not is entirely up to you. The ONLY thing I'm going to be monitoring from now on is your general mood. If I see you sliding one way or the other (depression or mania), I will sit down and discuss my concerns with you and we'll figure out what to do, but I'm not spending one more second of my time worrying about the rest of your life.

But listen to me Josh, if you fail out of this term, you will then be working full time and living in your own place, because if you're not a student, then you will become completely independent of me.

It's important for you to not just manage your work schedule and school responsibilities, but you also need to be very aware of how you're doing overall and get medication if you need it.

And one more thing, it's Friday at 5 PM and this house isn't cleaned yet. Because you have class on Thursday and Friday, I'm going to change our arrangement a little bit to make it more manageable for you. From now on, this house needs to be cleaned by Sunday evening, OR you can pay me $50. So manage your time to make sure that gets done."

So we'll see. But I feel very good about taking this position and realize that it's a stance I should have taken long ago. The thing about having a child with Bipolar is that it's all so terribly frightening. You've seen your child at both ends of the spectrum, and that's not pretty, and you live in fear of having to live through one of the poles again.

The reality here though is that Josh is very stable right now. No, he's not functioning the way he should, but he's not depressed or manic. While it would be hard to set him out on his own if he were in a bad state, the fact of the matter is that he's NOT in a bad state right now and so I've told myself that now is the perfect time to turn it ALL over to him.

I'm not terribly hopeful about the outcome, I'm pretty sure that Josh is not going to be able to get it together. I hope he surprises me, but more than anything I hope he remains stable because in THIS state, it would be very easy to push him out of the nest if he fails out of school.

And if he becomes unstable, we'll deal with it and then pick up the pieces and move forward.

I do feel that he WILL get it eventually, but it might take failing out of college and getting out in the real world to do it, and I'm finally OK with that scenario.

The Struggles Begin

Josh had a paper due yesterday that he's known about for several weeks. He got ONE paragraph of it written after working on it all night. He didn't go to classes yesterday either.

So I talked to Josh last night about missing classes yesterday and not getting his paper finished. I told him, "First of all, I'm not mad at you, so don't get all defensive, I'm concerned. You have a golden opportunity here and I hate to think you're not gonna be able to take advantage of it."

He said the paper was impossible.

"OK, but the key here is that it was impossible for YOU. I doubt any other student saw the project as anything more than another paper, just like a zillion papers they've written before, right?"

"Yea."

"OK, so really think about this...why did it seem impossible to YOU?"

"I don't know Mom, I just couldn't even get past the very beginning. I did all the research and everything and I just couldn't pull it together, like my thoughts were a jumbled mess."

"OK, why do you think that happened? I mean, was it a function of having put it off till the last minute and the pressure you put yourself under caused you to not be able to form a coherent thought OR are your thoughts just jumbled? I know that with my work, I KNOW how to approach a certain job, I'm good at what I do and I step through a job very methodically; I do THIS, then I check THAT, etc. But if I'm under pressure, whether I've procrastinated or something unexpected has landed in my lap that I have to get done NOW, I can get all disorganized with it and I find myself attacking the job from all angles, and I can't seem to get myself to FOCUS and step thru it logically."

"Yea, it was kinda like that. Maybe I need to get back on my adderall?"

"Then you should make an appointment and go see the doctor, and maybe while you're there you could discuss a sleep aid with her. Do you feel depressed at all?"

"No."

"Well one thing to think about, and I know you don't want to believe you really have Bipolar, but you need to really consider that it's possible that the trouble you had with this paper could be the 'disordered thinking' that is part of Bipolar."

"I don't know how Bipolar could make me not be able to write a paper, it seems more likely it's my ADD. There are tons of people with Bipolar who can write a paper mom."

"Yep, tons of Bipolar people ON BIPOLAR MEDICATION can write a paper. But with Bipolar your brain doesn't process information properly and I think you owe it to yourself to really think about the possibility that the problem you had with this paper may NOT be ADD, but just a part of Bipolar. I know you wanna think you're not Bipolar, but things like this...this disordered thinking, are a part of it. If you think back to last fall semester, you had this same problem writing one of your fiction stories, something you used to be able to just sit down and pound out. I don't know Josh, if you want to REALLY be successful in school this year, you've got to take a hard look at what's happening and be willing to explore all the possibilities and do whatever it takes to make it better. Maybe see the doctor and try adderall, cause that will work IMMEDIATELY, if the problem is ADD, but if you find yourself still struggling, I think you need to consider a bipolar medication maybe."

He didn't make a decision, but I'm going to ask him to make an appointment with his doctor tomorrow. I've learned that *I* have to stay right on top of these things, cause he'll just let it slide and not address it. That's not gonna work, so I'm gonna have to push him to ACT.

Something I've been doing for the last year, with mixed results. The problem is he'll finally act after he's gotten himself SO FAR DOWN, I have to really keep pushing him to ACT NOW.

I did remind him that HE will have to repay the grant money if he fails a class, that I'M not going to repay it, the grant is in HIS name, they will look to HIM for repayment.

"Something else to consider is dropping all your classes now, before the grant funds, and getting a full time job and see what the next year or so brings in terms of this Bipolar stuff. You can go back to school at anytime."

"So you think I should drop out of school?!!!"

"No, *I* think you should address what's happening right now and realize you need help. Josh, something has shifted for you. In High School and your first year of college, you didn't have these issues and you can stay in denial and NOT look at the reality here, but if you're gonna be in denial, you might as well be there in a full time job MAKING money instead of at an institution of higher learning WASTING money."

I Never Knew how Scary NORMAL can be.

Things around here couldn't be more normal, so normal that there are entire afternoons or mornings when thoughts of Bipolar don't even enter my head.

And then, out of the blue, I'm suddenly gripped by a deep fear when my thoughts turn that direction.

Josh starts classes Tuesday and he is very excited.

On very rare occasions, he will make mention of this 'creature' lurking in the dark, but for the most part, he prefers not to talk about and gets a bit snippy with me if I do.

For now, I am enjoying this calm before the next possible storm and I pray every night that things just stay as they are.

Schmadrian would say I have my head in the sand, that I should be DOING something to prepare for any eventuality. But this is Josh's journey and he is in charge of the road map, I'm just here to act when and if action becomes necessary.

But you can bet that I monitor Josh closely and will be contacting Peter, his therapist, for guidance at the first sign of trouble.

Still Playing the Waiting Game

Not much new to report where Josh is concerned. He continues to be 'fine'.

He got all of his student aid issues resolved and has enrolled for fall classes. His grant money and student aid is conditional on him not failing any classes or getting any withdrawls or incompletes.

He is only taking three classes and his classes will be on Tuesdays, Thursdays and Fridays, they all begin at 12:30. This schedule should work well for him since he won't have to drive either direction during rush hour traffic and he can sleep in which is the schedule he prefers.

Right now his sleep schedule is completely topsy turvy. He goes to bed between 4-6 AM and sleeps until 3 PM or so. I pointed out that not only is his schedule upside down (which won't work once school starts), but he is also sleeping 12 hours some days.

"You know Josh, people who are depressed tend to sleep too much, you need to check yourself to make sure you don't feel like you're slipping into a depression."

"I think I'm fine, I'm not sad or having any dark thoughts or anything."

"OK, but you need to monitor that because now would be the time to address it so that you will be ready when school starts."

He has been very slow to address his job situation. He has typically been working less than ten hours a week and this week, they didn't schedule him at all. In light of that, he has submitted some applications online, but his money situation has now become dire. Last week his car battery died and instead of giving him or loaning him the money to buy a new battery, I let him figure it out on his own, my thinking being that a new battery would take most of his available cash and he would FINALLY feel a need to act on the job thing. That seems to have had the desired effect.

He went without a car most of the week until he got his paycheck. He jumped his car and drove and bought a new battery.

In general he has been very pleasant. Often he'll do dishes or other household tasks before I can even mention them to him. Now, don't get me wrong, it's not like he's tearin' it up around here, but I see improvement in that area.

He also agreed to clean the house every Friday in lieu of paying me rent and he has done a pretty good job with that. Sometimes he won't get everything finished on Friday, so he finishes up on Saturday, but he's at least doing it with a smile on his face.

He still spends too much time alone, but also sees his 'good' friends fairly often. They will all be returning to college soon, but so will he AND I hope he has a new job as well. School and work will fill a lot of his time and force him to get on a more normal schedule.

I feel pretty comfortable about his return to school. There is no way to know what might happen as the school year progresses. It's quite possible that Bipolar symptoms will appear and I can only pray that if they do, he will address them properly. I think not moving forward with school plans would be detrimental to him at this point, he needs the routine that school provides and to feel like his life is moving forward after having it all derail so badly during the last year.

He would like to think he's not Bipolar, but I'm not convinced he isn't. I expect there to be further issues down the road and it is impossible to say that if he's in a Bipolar state of mind will he still 'see' the need for medication. I guess we'll cross that bridge when we get to it.

It's very hard feeling like we are sitting on a time bomb, just waiting for it to explode, but that's what we're doing. There is very little that we can do to prepare for that eventuality. Josh isn't willing to discuss the possibilities very much, about the only thing we've agreed upon is to seek his therapists help if things go tits up.

I have missed the last several DBSA meetings due to other obligations, and I won't be able to attend tonight either, but hope to go back next week. It is very hard to sit in those meetings and listen to other people's horror stories when Josh is doing so well. It feels a bit like what survivor guilt must feel like. It's nice to know that the group is there though because I have a feeling I'll be needing their support again in the future.

Josh is doing well, but that doesn't mean he's 100% where he needs to be. I'm watching him closely, there is no part of me that feels like we're out of the woods or anything. I'm just trying very hard to enjoy this respite; I'm getting a lot done around the house and enjoying time with my friends etc.

Basically, I'm waiting for the other shoe to fall.

Why do they have to make it so hard?

Josh was referred to an Endocrinologist by our Primary Care Physician.

No one mentioned how difficult it is to get an appointment with an Endocrinologist.

I was given three names and checked with Josh's insurance company to determine which doctors were in his network. I then called to schedule an appointment.

Sheesh!

You can't make an appointment with any of these doctors without first having a years worth of medical records sent to them so they can determine the urgency of care needed, but the real kicker is that once they receive the records, the first available appointment isn't until mid to late September.

This was the case with all three doctors I called.

It seems to me that they're going to need not only Josh's records from his Primary Care Physician, but also records from his IOP at the Stress Center back in January, AND his records from the Psych Hospital.

By the time they receive all that information, I imagine the September appointments will be filled and we'll be looking closer to October.

And in all of this, there is an issue with Josh's Student Aid for the Fall Term. We have to present documentation from a physician stating that Josh is OK to attend school in the Fall. The problem is that Josh isn't really under any doctor's care right now. The student aid office doesn't know that he has been diagnosed as Bipolar, they are concerned with the depression that caused him to fail out of last Fall's classes. This documentation needs to be to the Student Aid office by the 14th of July. We were hoping that Josh's Thyroid tests would come back and indicate an underlying Thyroid condition that we could state we were treating.

Josh and me have an appointment with his therapist, Peter, this Wednesday. Peter is willing to compose a letter that explains the situation; that Josh recovered fully from the depression, became sleep deprived that resulted in a manic episode, whereby he was diagnosed with Bipolar. But then it gets a little tricky. We are not treating Josh's Bipolar at the moment, so Peter is going to have to dance around a bit, stating that Josh is functioning well right now and will treat any further episodes, if they occur, as needed.

Josh has FREE money available this year, for the first time, and I hate the thought of him losing out on that. He has decided to start back to school in a very cautious manner, taking only three classes. While he hates taking such a light class load, he understands that he needs to avoid stress. I told him that he could catch up during the summer session, but that since we really don't KNOW what might happen; he could experience more Bipolar issues, that a cautious approach would be best.

Worse case scenario, I will have to pay for his classes this year and I hate to do that since I have spent so much money on his medical bills this year. I don't think it is in Josh's best interest to sit out the Fall Term. I feel strongly that he needs to 'get his life back' because it has spiraled horribly out of control over the last year. Some normalcy would be good for him and he needs to be working towards a goal and school would force him to get on a healthier schedule.

In addition to the medical issues he is facing, his employer (a national chain) is close to bankruptcy. He may not have a job for long and they have cut back every one's schedules to the point that Josh is working only about 10 hours a week. Jobs are hard to come by though, especially with the college kids home for the summer. Josh's older brother has been unemployed now for a year and a half and his unemployment benefits ended three weeks ago. His brother is in that first wave pool of people who were laid off, so there will be a glut of those people whose unemployment benefits have ended, who are aggressively seeking any available opportunities. Which means it will be even more difficult for Josh to find employment.

Added to my financial woes is the fact that for the first time EVER, Josh's brother has had to ask me for money, and I'm sure his needs will continue.

Right now everything, every aspect of our lives, is in flux and that's a very uncomfortable position to be in. Josh could experience Bipolar symptoms at any moment, or he could be fine for years. It's hard to know WHAT to do because nothing is a given, so we'll just have to take things as they come, deal with the issues in front of us each day and be frugal as hell because everybody is in my pocket right now.

Sigh.

Not Good News

Josh's thyroid blood work and ultra sound all came back normal.

Sigh.

The doctor has asked that Josh see an Endocrinologist anyway. She is still concerned about his elevated levels upon admittance to the hospital.

Josh is NOT a happy camper.

Neither is his Mom.

Fingers Crossed

Josh had his physical today. We both love our doctor, he actually delivered Josh, so he's been in our lives a long time. We didn't see him today though, our appointment was with our favorite Nurse Practitioner. She also has cared for us both for years and she has a very holistic approach to medicine, always more apt to suggest a supplement over a pharmaceutical.

Anyway, I went in with Josh because I wanted to be sure the NP understood Josh's recent history. She was pretty shocked that Josh's thyroid levels were as high as they were upon admittance to the Psych Hospital, and yet nothing further was done in an attempt to ascertain if there was an underlying Thyroid problem.

She ordered further blood work, and because she felt Josh's thyroid was enlarged, she ordered an Ultra Sound on it.

As we talked with her, I became a bit more hopeful that Josh may not be Bipolar at all, that perhaps a hyperactive thyroid created a vicious cycle of sleep deprivation that led to the mania he experienced.

I feel like Josh having a thyroid problem and NOT Bipolar is kinda like winning the lottery. Not likely, yet.......if you read the symptoms of hyperactive thyroid and then read the symptoms of sleep deprivation (Josh had had only two hours sleep in a three day period when he became manic), it's very easy to get your hopes up. I mean, after all, SOMEBODY wins the lottery, right?

So we'll wait and see.

Josh right now has been totally himself, right down to being a bit short with me sometimes, bordering on rude. (No screaming and yelling, let alone pounding his fist or slamming a door)

He's still having trouble sleeping, but he's getting a solid 8 hours, unfortunately he often isn't asleep before 4 am, this morning when I got up at 6 am, he was still up. For now, his schedule allows this strange sleep pattern, but eventually he's going to need to get back on a more normal routine.

I look over the last year of Josh's life and can see how everything that has happened could be explained by a hyperactive thyroid. The thyroid controls so many functions and the hormones it produces are very powerful. I've said before that his eyes have bothered me for some time, his eyeballs seem to 'bulge'. This is a symptom of Grave's Disease and if you read the following link, under the heading of "How is the Diagnosis of Grave's Disease Made?", the second paragraph talks about 'clues' that might lead to such a diagnosis. The very last line talks about family members with related autoimmune disorders, such as I have....vitiligo.

My sister had a hyperactive thyroid, so there is family history, but the biggest factor to me is MY autoimmune disorder (vitiligo) that is known to cause blood relatives to be more prone to ALL autoimmune disorders.

And if you don't think sleep deprivation plays a part in all this, read this.

I may be grasping at straws, but I just keep coming back to Josh's thyroid problem not being addressed in the hospital.

So, we'll address it now if there is a problem, and then we'll wait and see if Josh shows anymore symptoms of Bipolar or not.