By Natalia A. Beiser
These are Natalia’s experiences with Lithium and Dialysis. Not every patient will share the same experiences.
I have now been on dialysis for one year and two months. The psychiatrist and I have had the Lithium dosage at a level that I can tolerate, which is 150mg. on non-treatment days (Tuesday, Thursday, Saturday and Sunday) and 300mg. on treatment days (on Monday, Wednesday, Friday).
The 300mg. is given on treatment days because dialysis washes all of the Lithium out of the system and the medication must be built back up again to treat the mood disorder. Mentally, I am feeling well.
My psychiatrist sent an initial benchmark of 0.5 for the Lithium level bloodwork, which we figured out early on would not be met. I have observed that the physical side effects (namely excess Parkinsonism) became evident and intolerable at a Lithium level of 0.5. I feel well and have the typical Lithium tremor at a bloodwork level of a 0.3, but no other symptoms are problematic. Now my blood level is simply gauged by how I am feeling. The newer benchmark was determined by the least amount of physical symptoms and my displayed amount mental clarity.
My psychiatrist has expressed that she knows that if I begin to display problems that I will contact her quickly and a tweak of the Lithium dosage will be made.
There is a newer antipsychotic drug on the market that I have not tried in place of Lithium. Initially, the doctor knew because of my health insurance that I would not be able to receive it. My doctor then thought she had found a loophole where she could get it dispensed in my case. She also wanted to get genetic testing done.
I was not initially opposed to trying the new medication or getting genetic testing. However, I learned several key notes about doing so. First, with trying the new medication, I learned that it does not hit any of the biological markers that Lithium does, which is critical because Lithium is the only medication that has consistently worked for me. Because the medication would not hit any of the biological markers, there would be a greater chance that I would suffer a significant mental setback. I have not had any psychiatric hospitalizations since 2011.
Secondly, it has been displayed that persons with end stage renal disease do not bounce back from psychotic or depressive episodes as well as those without them, if they ever recover at all. I did not want to take the chance of spending the rest of my life trying to recover from depressive or manic symptoms, so I chose not to go that route.
Initially, I thought that genetic testing was a fantastic idea. My psychiatrist could not tell me how much the testing company would charge me with government based insurance. She told me that she thought it would be small.
My experience with my psychiatrist is that she does not understand the poverty of someone living on less than $1500 per month and that her version of “small” could be much different than mine. This topic has presented itself before and I did not want to have the experience of having a medical bill landing in my mailbox that I could not readily pay.
Initially I fought excessively hard not to go on dialysis. I have learned a few things now that I have experienced it a while. I never knew how loved I was by others until I began dialysis. The outpouring of love has been evident by those around me and even in those that I do not see on a regular basis.
I have also found a small amount of my life where I can still work at a job that is not too physically enduring. My energy level is low, so I have a job where my performance is based on using more of my brain than using my body.
I have OCD, and one of my obsessions is cleaning. However, I do not have enough energy to keep the house as clean as I would like. I had much anxiety because the house was never completely “done.” I am very frugal and never imagined that I would ever drop the money on a housekeeper, but my housemate and I determined that it was necessary and we are splitting the charges on a once a month cleaning. It has helped my anxiety tremendously to have a housekeeper.
I have found that only one person in my life has been verbally negative about my going on dialysis. She commented in a roundabout way that I would be going on welfare, with an edge in her voice. I have gone on “more welfare,” which initially was a very difficult concept to accept on multiple levels. However, now when I receive what I think of as welfare, instead of calling it welfare, I get out my cognitive behavioral tool bag and think of it as a scholarship.
The amount of love that I have experienced from people in my life is what has kept me going. They have made my life as it is now more worthwhile. I have also let people know that I have bipolar disorder and most have accepted it without as much stigma as I would have anticipated. I also pray every day that God would keep me here as long as my life is a benefit to others.