Too Late

His words rang in her head.  “Whom do you think they’re going to believe?  You, an African refugee or me, an upstanding citizen of the community?”

He was right.  No one would believe that the District Attorney was sexually abusing her.  It would be her word against his.

She walked past the quail and went into the house.  It was time to give Mrs. Foster her medication.

Ten minutes later, she went to the kitchen.  He was there, leaning against the counter, holding the empty glass of lemonade.   I should have emptied it in the sink.  Now it’s too late.

100 words

Written as part of the Friday Fictioneers challenge hosted by Rochelle Wisoff-Fields.  For more details, click Here.

To read more based on this week’s prompt, visit Here.

 

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World Mental Health Day

“The deepest pain I ever felt was denying my own feelings to make everyone else comfortable.”

Today is World Mental Health Day and the theme for this year is Mental health in the workplace.

It is so important for those who are living with mental illness work in environments that are supportive and conducive to their well being and productivity.  We spent more time with our co-workers during the week than we do with our families so it helps when employers and managers put initiatives in place that would promote mental health.  A negative working environment can lead to physical and mental health problems, drive people to abuse substances, alcohol, skip work or perform their jobs poorly.

A friend of mine was working in a negative environment which may have contributed to her relapse.  The last time I saw her, it was obvious that she was not taking her medication.  She suffered from bipolar disorder.  She had personal issues as well which could have also been a contributing factor.  Another woman who used to work in the same department also suffered from mental illness.

You can look at people and not know that they have mental illness until something happens and they have a breakdown.  We can’t tell who is living with depression, anxiety disorders or other mental issues.  There is still a stigma attached to mental health and those suffering with it may not feel comfortable disclosing their struggles.  The platform for them to do so may not be there.  This is why World Health Day is observed on October 10 every year to raise awareness and mobilize efforts in support of better mental health.

What can you do to support mental health in your workplace?  The Mental Health Foundation offers helpful tips for those who have mental illness and for those who work with them.

1. Talk about your feelings

2. Keep active

3. Eat well

4. Drink sensibly

5. Keep in touch

6. Ask for help

7. Take a break

8. Do something you’re good at

9. Accept who you are

10. Care for others

 

You can support a colleague by:

• Asking the person how they are doing.  Be warm and sincere.
• Setting a time and place that is most comfortable for the person.
• Active listening.  Give your undivided attention.
• Managing your own feelings.  You want the person to feel that they can talk to you about anything without fear of judgment.

If your co-worker says that he or she is having suicidal thoughts or you suspect that they are thinking of committing suicide, it is very important that you encourage the person to get help.

You can keep in touch with co-worker who has been away from work by calling or sending cards.  When they return, you could help them to get back into their work routine.  For the co-worker who you see on a day to day basis, you can check up on them informally and find out how they are doing.  You can offer to help them as a mentor or coach or friendly support on an ongoing basis.  You could ask them if there is any way you can support them as they manage their condition such as spotting signs that they may have missed which indicate that they are becoming unwell.

My sister suffers from bipolar disorder.  I will never forget the time when she was having a breakdown and she just clung to me.  I held onto her.  It was heartbreaking. Mental illness affects not only those who have it but those around them.  We have to be there to offer them our love, support and whatever they may need.  We have to be sensitive to what they are going through.

 “We feel alone because due to the illness we have lost loved ones, families, friends, jobs, and it has created broken hearts & shattered dreams. We feel extremely unwanted for something we didn’t ask for and trying so hard to cope with. Believe us, if we could snap our fingers and make it disappear, it would be a wish come true. But that only happens in fairy tales.”

“Those who suffer from mental illness are stronger than you think. We must fight to go work, care for our families, be there for our friends, and act ‘normal’ while battling unimaginable pain.”

“Ignore those who say just get over it. Healing is a process.”

“The only thing more exhausting than having a mental illness is pretending like you don’t.”

“You keep a lot to yourself because it’s difficult to find people who understand.”

“This disease comes with a package: shame. When any other part of your body gets sick, you get sympathy.”

“The strongest people are not those who show strength in front of the world but those who fight and win battles that others do not know anything about.”

Quotes on Mental Health Stigma by Healthy Place

 

Sources:  World Mental Health Organization; Mental Health Foundation; Healthy Place;

Women and Mental Health

May 1-7 has been Mental Health awareness week.

One in three Americans struggles with mental illness but the rate is much higher in women.  Research shows that women are 40% more likely to develop depression than men.  It is not clear why mental illness is more common among women but doctors have come up with a number of possibilities.

Discrimination, Trauma and stressful life experiences

Trauma is common among women with half of them experiencing some form of trauma in their lifetime.  One in four women have faced an attempted or a completed sexual assault.  Reportedly, one in three are abused by a domestic partner.  Gender discrimination, violence and mistreatment undermine a woman’s mental health.  Stress is a predictor of mental illness.  Women juggle housework, kids even while working fulltime.  They report that they have to work harder to get the same credit as men and worry about the gender wage gap.  They have to deal with sexual harassment and discrimination in workplaces where these are commonplace.  These challenges can significantly affect a woman’s ability to cope and her self-esteem.

Hormonal Issues

Women produce lower quantities of serotonin than men due to differences in hormone levels and this deficiency can lead to mental health issues such as depression and anxiety.

Pregnancy, Birth and Parenting

41% or women suffer from some form of postpartum depression.  Some of them are overwhelmed by the demands of parenting, especially in the early days.  I remember that there were times when I felt that I was drowning–in over my head.  Once I even cried out while I was holding my toddler.  Thankfully I had God and a very supportive partner.  It helped when he came home and I had an adult to talk to. Not all women are as blessed.  Research shows that women who don’t have supportive partners, experience traumatic births, live in poverty or a highly stressed will most likely develop postpartum depression.  

Gender bias is another problem women face.  Some research suggests that doctors tend to label women’s symptoms as emotional while taking the men’s symptoms more seriously.  So, a woman who reports that she is experiencing chronic pain to her doctor might be labeled as depressed.  This happens because we live in a world where gender discrimination exists and women are seen as more emotional and less rational.  

In many countries, the way health workers spoke to the women made it difficult for them to disclose their psychological and emotional distress.  And when they worked up the courage to disclose their problems, they were either over-treated or under treated by many of the health workers.

I read in an article in The Globe And Mail that women are getting the prescription that is available more often than the treatment they need.  They are getting medication to solve their problems even when science finds that treatments such as psychotherapy is equally or in some cases more effective without the side effects.  Bias in mental health care is a hindrance to women, preventing them from getting the proper help they need.  Not much effort goes into researching how drugs affect female patients.  While drug companies like to bombard women with their pills, most of their clinical trials have been dominated by men.  And the ironic thing is that the disorders most commonly diagnosed in women such as depression, anxiety and insomnia are the ones most likely to respond to therapy.  Most women are likely to prefer therapy over drugs.  

According to Dr. Marina Morrow, a Simon Fraser University psychologist who studies gender and mental health, “Women aren’t getting access to the range of care they need.”  She believes that an effective approach to this would be to include medication when necessary but in also offer therapy, peer support and pinpoint what social circumstances lead to the illness.

It has been argued that therapy is the safer, more effective and cheaper choice.  The authors of a 2015 study by Canadian and U.S. researchers concluded that, “There remains no sound justification to prescribe drugs without first trying therapy.  Dr. Cara Tannenbaum, scientific director of the CIHR Institute of Gender and Health, believes that “the way we fund therapies in Canada does not make sense right now.”  She wrote a letter to Quebec’s health minister to make the point that even if 20 per cent of seniors with insomnia received Cognitive Behavioral Therapy (CBT) with is used to treat insomnia, the cost-savings to the system could be in the hundreds of millions, based on the potential falls that would be avoided.  Therapy saves on costly and debilitating falls and hip fractures.  

We live in a country where medication is favored over psychotherapy and women are more likely than men to be prescribed antidepressants and sedatives as seniors and as a result they are at a higher risk of suffering from adverse effects.  Hopefully more women and those in the medical profession will speak out against the bias that is prevalent in the mental health care.  Doctors and those in the health care system need to give women more choices when it comes to treatment.  It’s their health so they should have the right to determine how they want to proceed once they have been diagnosed.

Administering Medication to Parkinson Patients on Time

Lately, *Wendy is plagued with the fear of losing her mother.  Granted her mother *Marian had lived a long and happy life but Wendy was not ready to lose her.  Marian was in her seventies.  She celebrated her 75th birthday a couple of months ago.  Wendy and her sister *Lauren had taken her out for lunch to celebrate.  In the past, Marian celebrated birthdays, Christmases and every Mother’s Day at her home or at one of her daughter’s home.  However, everything changed when she was diagnosed with Parkinson’s.  She couldn’t remain in her home after she fell.  She was a widow and had been living on her own.  She had to sell her home and move into a nursing home.  It took time for her to adjust to living in a room and having to depend on nurses to change and bathe her and do the things she used to do for herself.  It was hard to give up her independence.

She was still able to go and spend time with her children and grandchildren but lately, it was becoming increasingly difficult for her to move around without the wheelchair.  She had gone from using a cane to a walker and now to a wheelchair.  She had fallen several times.  Once Wendy went to visit her and was horrified to see the ugly bruises on her arms.  Marian fell because she tried to do things on her own when she should have called for help.  The nurse would go into her room and find her on the floor.  Thankfully, she hadn’t had any serious falls but Wendy worried about her.  She had heard stories of elderly women breaking their hips and suffering other serious injuries from falls.

Just recently, Wendy received distressing news.  Her sister Lauren informed her that their mother was not responding well because she hadn’t been given her medication that morning.  The last dosage was the night before so she was supposed to get the next one around 7 in the morning but the nurse hadn’t given her.  When Marian’s regular nurse found out two hours later, she decided to wait until 11 to give her her medication.  Lauren was livid.  She demanded to know why the nurse waited instead of giving her mother the medication right away.  As Wendy listened to her sister, she felt sick in the stomach.  Their mother had been without her medication for 15 hours.  She was lying in her bed, with her eyes closed.  She was aware that her nurse was in the room and was responsive but she couldn’t do anything except lie there.  Her nurse kept checking on her to make sure she was okay.  She was relieved when Marian woke up.  Marian’s doctor told the nurse to try to get the medication into Marian which she kept trying to do until she succeeded. The doctor said that it could take 24 hours for Marian to recover as a result of not getting her first dosage that morning.

The Administration at the nursing home acknowledged that two gross mistakes had been made.  The first nurse should have given Marian her 7:00 a.m. meds and her regular nurse should have immediately given her the meds at 9:00 when she realized that she hadn’t been given her first set of meds instead of simply waiting for the next set.  The director assured Lauren that they were taking measures to make sure that this never happened again.  They plan to follow up with the first nurse who neglected to give Marian her morning medication.

Wendy was thankful to God for watching over her mother who is okay.  Tears came to her eyes as she imagined her mother lying there with her eyes closed, unable to do much else and how it could have been much worse…

How many other Parkinson’s patients like Marian do not receive their medication on time?  According to an article written on the National Parkinson Foundation website, hospitals can be danger zones for people with Parkinson’s.

Hospitals are usually a safe haven for people with serious illnesses, but for people with Parkinson’s disease (PD) going to the emergency room or being hospitalized can be a nightmare, because their condition is more likely to deteriorate due to inappropriate care and the anxiety of being in an unfamiliar environment.

Parkinson’s patients are often afraid to challenge a hospital’s medical staff, because they assume that they know what they are doing, but many may have little or no knowledge about how to care for someone with Parkinson’s, said Dr. John Morgan, assistant professor at Georgia Health Sciences University.

Three out of four people with Parkinson’s do not get their medication on time when they go to the hospital, which can cause serious complications even death, said NPF’s National Medical Director Dr. Michael Okun. Even more alarming is that research shows that the majority of hospital staff do not know which drugs are unsafe for Parkinson’s patients, and they do not understand Parkinson’s disease.

People with Parkinson’s must take their medication on time, especially those with moderate and advanced Parkinson’s who are taking frequent doses of levodopa, a common Parkinson’s medication, Dr. Morgan said. “If medication is not taken on time, they can become stiff, rigid, tremulous and unable to move and prone to falls, etc. Even one hour off of a scheduled time can make a big difference,” Dr. Morgan explained.

There is no cure for Parkinson’s, but medication helps control symptoms by increasing the levels of dopamine in the brain. Dr. Morgan emphasized that medications should be taken 30 minutes to an hour before meals or an hour or more after meals, because the protein in food can inhibit the absorption of the medication into the body. If a person eats too close to their scheduled medication time, Dr. Morgan said it is better to eat a low-protein meal rather than delay taking medication.

The article mentions that one hour off of a scheduled time can make a big difference.  Wendy’s mother had been 15 hours off her scheduled time.  Another article states, “Medications must be administered on time to promote consistent therapeutic blood levels and prevent disabling symptoms. A delay of even 5 minutes can cause the patient to suddenly lose the ability to move, walk, and speak^.”  If Wendy and Lauren wanted to, they could sue the nursing home for gross negligence and failing to administer the proper help.  Marian should not have gone through what she did.  She was in a facility that was supposed to take care of her.  Their negligence could have cost Marian her life.  For now, Wendy and Lauren are hoping that this doesn’t happen again.

Want to get involved in raising awareness for Parkinson’s?  Here’s how.

*These are not their real names.

Source:  http://www.parkinson.org/About-Us/Press-Room/NPF-In-The-News/2012/November/Hospitals-can-be-a-danger-zone-for-people-with-Par; http://journals.lww.com/nursing/Fulltext/2011/03000/Administering_medications_for_Parkinson_disease_on.24.aspx

Women and Heart Disease

Believe it or not, the number one killer of women is heart disease, formerly thought to be a “man’s disease”.

What is heart disease? 

Your heart is a muscle that gets energy from blood carrying oxygen and nutrients. Having a constant supply of blood keeps your heart working properly. Most people think of heart disease as one condition. But in fact, heart disease is a group of conditions affecting the structure and functions of the heart and has many root causes. Coronary artery disease, for example, develops when a combination of fatty materials, calcium and scar tissue (called plaque) builds up in the arteries that supply blood to your heart (coronary arteries). The plaque buildup narrows the arteries and prevents the heart from getting enough blood (Heart & Stroke Foundation).

Why does heart disease affect women?  Women are more likely than men to have coronary MVD. Many researchers think that a drop in estrogen levels during menopause combined with other heart disease risk factors causes coronary MVD.  The disease affects women differently than it does men.  This can cause many women to be misdiagnosed.  Here are the differences:

• For women, heart disease symptoms may be subtle – but when a heart attack
  strikes, women are more likely to die than men. Women are also at twice the risk
  of death following open heart surgery, compared to men
• Heart damage is more likely to occur in women when the small blood vessels become obstructed from plaque.
• Women are also more likely to maintain heart function after a heart attack, unlike men whose heart muscle becomes weaker; 38 percent of women die from heart attack, making heart attack more lethal for women than men.
• Women are also more likely to have a second heart attack within six years of their first one, unlike men.
• Women are also less likely than men to have obstructive coronary artery disease.

Women are also more likely than men to have a condition called broken heart syndrome. In this recently recognized heart problem, extreme emotional stress can lead to severe (but often short-term) heart muscle failure.  Broken heart syndrome is also called stress-induced cardiomyopathy (KAR-de-o-mi-OP-ah-thee) or takotsubo cardiomyopathy.

Doctors may misdiagnose broken heart syndrome as a heart attack because it has similar symptoms and test results. However, there’s no evidence of blocked heart arteries in broken heart syndrome, and most people have a full and quick recovery.  Researchers are just starting to explore what causes this disorder and how to diagnose and treat it. Often, patients who have broken heart syndrome have previously been healthy.

Women’s College Hospital in Canada where I go offered the following differences between the sexes and the effects of heart disease:

Women Tend to Develop Heart Disease at a Later Age

Women tend to develop heart disease later in life because they are often (though not always) protected by high levels of estrogen until after menopause. Men’s risk of developing heart disease increases in their 40s. A woman’s risk of heart disease becomes similar to a man’s risk about 10 years after menopause.

Women Experience More Silent Heart Attacks

Women experience more silent heart attacks than men. That is, a woman may not know she has had a heart attack. Women are also more likely to have a single artery narrow whereas men tend to have multiple arteries narrow.

Women Are More Likely to Be Suffering from Other Health Problems

Women are more likely to be suffering from other health problems, such as diabetes and high blood pressure, when they have heart problems.

Women Do Not Always Get the Health Care They Need

Heart disease is under-detected in women. Once women do seek treatment, doctors do not always recognize their symptoms as the symptoms of heart disease. Women are also less likely to be referred to a heart specialist, to be hospitalized, to be prescribed medication or other treatment, or to be referred for exercise testing. As a result, women do not always get the health care they need.

I find it unsettling that women are not always getting the health care they need when they seek treatment for heart disease.  They should receive the same considered as men.  They should be referred to a heart specialist or hospitalized or given whatever care they should be entitled to.  It’s time for women to stop being under served and under treated.  In the mean time, educating women about their risk of the disease and how to take control of their health so that they can reduce that risk.  Whenever I go for my annual checkup, my doctor always orders an ECG for me.  Although I just read that ECG tests are not recommended by a government backed panel.  Read article.  Heart for Life has information on screening and heart tests on their website.  Check them out here.

I read that young women can have heart disease too.  Even though heart disease among women becomes more common after menopause, it affects younger women.  Every year in the U.S., heart disease kills about 16,000 young women and accounts for 40,000 hospitalizations in young women, according to the American Heart Association.  Young women may experience symptoms of a heart attack and fail to recognize them as such for the following reasons:

• They thought they were too young to be having a heart attack.
• They had atypical symptoms that lasted for more than a day.
• They chalked up their symptoms to other conditions, not to a heart attack.

African American women are more at risk for heart disease than Caucasian women. And, if an African  American woman has a heart attack, she is 69 percent more likely to die of that  heart attack than a Caucasian woman.

Don’t be discouraged.  The Heart & Stroke Foundation assures us that heart disease is preventable and manageable.  They say that our defense is controlling the risk factors that could lead to coronary artery disease, such as high blood pressure, high cholesterol, diabetes, smoking, stress, excessive alcohol consumption, physical inactivity and being overweight.  Here are healthy heart steps we need to follow:

• Be smoke-free.
• Be physically active.
• Know and control your blood pressure.
• Eat a healthy diet that is lower in fat, especially saturated and trans fat.
• Achieve and maintain a healthy weight.
• Manage your diabetes.
• Limit alcohol use.
• Reduce stress.
• Visit your doctor regularly and follow your doctor’s advice.

Let us take action today.  Let us keep our hearts healthy.

Women tend to think that breast cancer is their biggest health threat. And while it’s important, heart disease remains the No. 1 killer of women, even young women. But that message just hasn’t been fully recognized – cardiologist Nicea Goldberg, MD, director of the Women’s Heart Program at NYU Medical Center and author of the new book Complete Woman’s Guide to Women’s Health.

Sources:  http://www.womensheart.org/content/heartdisease/heart_disease_facts.asp; http://www.webmd.com/heart-disease/features/women-and-heart-disease-key-facts-you-need-to-know; http://womenshealth.gov/publications/our-publications/fact-sheet/heart-disease.cfm; http://www.oprah.com/health/Facts-About-Heart-Disease-for-Women; http://www.reuters.com/article/2012/07/30/us-ecg-heart-idUSBRE86T1EE20120730; http://www.nhlbi.nih.gov/health/health-topics/topics/hdw/; http://www.emaxhealth.com/1020/heart-disease-affects-women-differently-men; http://www.womenshealthmatters.ca/health-resources/heart-health; http://www.modernmom.com/article/women-and-heart-disease-getting-the-right-health-care;  http://www.webmd.com/heart-disease/news/20080502/younger-women-miss-heart-attack-signs; http://www.heartandstroke.on.ca/site/c.pvI3IeNWJwE/b.4007287/k.4ACF/Heart_Disease__What_is_heart_disease.htm

Women and Bipolar Disorder

The first time I was aware of bipolar disorder was years ago in New York.  It was there that I learned that my sister was manic depressive.  She had suffered from a nervous breakdown.  I never knew that she was manic depressive.   It was not evident to me.  She seemed fine to me.

While living in New York, she only had one episode where she had to stay in the hospital overnight but after that she was fine.  She had a good doctor who was diligent in her care.  I have other relatives who suffer from bipolar disorder.  And a co-worker of mine is no longer working because she had a relapse.  The last time I saw her I couldn’t believe it was the same person.  She called me on the phone and she was saying things that didn’t make sense and using language I never expected to hear coming out of her mouth.  I realize that when a person has bipolar disorder, he or she is different.  The illness changes the person.  Things from the past are dredged up, there are resentments and the belief that there is a conspiracy against him or her.

It’s hard to see someone you love suffering from a mental illness.  It’s harder when the person comes off of the medication and winds up back in hospital.  Each time he or she comes off the medication, it becomes harder to get back on track.  And the scary thing is they get into debt or in some cases trouble.  It’s hard for family members to know just how to cope, especially if during these episodes harsh and hurtful things are said.  It’s so disappointing when the person is doing well for a long time and then there is a relapse.  Each time he or she gets better, you are wary, wondering how long it would last.  Each time he or she promises not to come of the medication and vows to stay out of the hospital but something happens and there is an episode.

Even though I am aware of bipolar disorder, I still don’t know much about it.  I thought that I would search the web and gather all the information I could find just to get a better understanding of the illness.

What is Bipolar Disorder?
Bipolar disorder, formerly known as manic-depressive illness, is a brain and behavior disorder characterized by severe shifts in a person’s mood and energy, making it difficult for the person to function. More than 5.7 million American adults or 2.6 percent of the population age 18 or older in any given year have bipolar disorder. The condition typically starts in late adolescence or early adulthood, although it can show up in children and in older adults. People often live with the disorder without having it properly diagnosed and treated.

What are the symptoms of Bipolar Disorder?
Bipolar disorder causes repeated mood swings, or episodes, that can make someone feel very high (mania) or very low (depressive). The cyclic episodes are punctuated by normal moods.

Mania Episode Signs and Symptoms:

• Increased energy, activity, restlessness
• Euphoric mood
• Extreme irritability
• Poor concentration
• Racing thoughts, fast talking, jumping between ideas
• Sleeplessness
• Heightened sense of self-importance
• Spending sprees
• Increased sexual behavior
• Abuse of drugs, such as cocaine, alcohol and sleeping medications
• Provocative, intrusive or aggressive behavior
• Denial that anything is wrong

Depressive Episode Signs:

• Sad, anxious or empty-feeling mood
• Feelings of hopelessness and pessimism
• Feelings of guilt, worthlessness and helplessness
• Loss of interest or pleasure in activities once enjoyed, including sex
• Decreased energy, fatigue
• Difficulty concentrating, remembering or making decisions
• Restlessness and irritability
• Sleeplessness or sleeping too much
• Change in appetite, unintended weight loss or gain
• Bodily symptoms not caused by physical illness or injury
• Thoughts of death or suicide

Apparently there are several types of bipolar disorder but the two main ones are bipolar I and II.  Bipolar type I disorder is the “classic” form, and patients often experience at least one full or mixed episodes with major depressive episodes. Bipolar type II disorder is where patients have at least one milder form of mania and one major depressive episode.  However, they never get a full manic or mixed episode.  Bipolar II is harder to diagnose because some symptoms of hypomania may not be as apparent. Hypomania is described as a milder form of mania with less severe symptoms.  I believe that my sister displays more symptoms of mania.

All the people I know who have bipolar disorder are women.  Although it is prevalent among men as well, it seems that it is approximately three times more common in women than in men.  For women it is rapid cycling.  Rapid cycling describes incidences where a bipolar patient experiences four or more episodes of mania, hypomania, or depression within a time period of a year (Leibenluft, 1997).

The article explains why rapid cycling bipolar disorder more common in women than in men. Three potential hypotheses to explain the higher prevalence of rapid cycling in women are hypothyroidism incidence, specific gonadal steroid effects, and the use of anti-depressant medications. First, more women encounter hypothyroidism than men do; however, there is not a general consensus on it being a primary cause of increased rapid cycling. Second, gonadal steroids, such as estrogen and progesterone, fluctuate throughout the menstrual cycle. Sixty-six percent of bipolar type I women had regular mood changes during either their menstrual or premenstrual phase of their cycle. They were more irritable and had increased anger outbursts (Blehar et al., 1998). These may set up women to frequent mood changes (especially prior to the menstrual cycle, as noted in the term “premenstrual syndrome”). Increased estrogen may cause women to develop hypercortisolism, which may increase the risk of depression. Stress levels are associated with cortisol level, so this may possibly be the reason for increased risk for depression.

There are risks involved in pregnant women who suffer from bipolar disorder.  Manic episodes and cycling seemed to occur exclusively during pregnancy.  For reasons still unclear, apparent pregnancy poses a question of relapse, which has an important effect on women and the fetus that they are carrying. The fetus can be at risk due to lack of attention to prenatal care, if the woman is not treated for the psychiatric illness. Precipitated episodes in the absence of treatment may be very detrimental to both parties involved. Secondly, the woman would be at risk because with each successive episode, the length of time to following episodes gets smaller. That is, the woman could have manic and depressive episodes more often. This would neither be beneficial to the woman or her child. The effect on the fetus due to many mood episodes is unclear (Viguera et al., 1998). “During pregnancy, a woman’s glomerular filtration rate increases” (Llewellyn et al., 1998). This means that any medication that she takes, such as lithium (discussed below), will be excreted more rapidly. This is very dangerous because if she does not have enough medication in her system, she can fall into relapse.

A dilemma arises in that if she increases her medication amount, she may be exposing her fetus to grave side effects and even danger (discussed below). Moreover, during labor, it is important that women remain fully hydrated. Since the period of time for delivery varies with each individual, a pregnant woman can become very dehydrated. When a woman gets dehydrated, the serum medication concentrations will increase (Llewellyn et al., 1998). This is the opposite effect of the increase in glomerulus filtration. Nonetheless, both situations are dangerous and can be very toxic to the woman and indirectly to the fetus.  As varying as the symptoms of bipolar disorder, per individual, so are the treatments. It is very important that bipolar pregnant women get the appropriate care and treatment that they need, in order to properly care for themselves as well as for the child that they are carrying.

It is disturbing to know that women with bipolar disorder are more susceptible to misdiagnosis.   recent study estimated that the odds that a woman with bipolar disorder will fail to be correctly diagnosed are roughly three times the odds for a man. This disparity may be explained in part by the fact that bipolar disorder tends to look different in women than it does in men—in the same way that physicians sometimes fail to catch heart disease in women because they are effectively looking for the male version of the disease, mental health professionals may not always be aware of the distinctive signs of bipolar disorder in women.  According to Vivien Burt, MD, PhD, director of the Women’s Life Center at UCLA’s Resnick Neuropsychiatric Hospital, “Women are more demonstrative—they have more of what’s known as ‘affective loading’—so it’s not surprising that bipolar disorder might be underdiagnosed in women compared to men.”

Another article stated that a woman is likely to have more symptoms of depression than mania.  And female hormones and reproductive factors may influence the condition and its treatment.  Research suggests that in women, hormones may play a role in the development and severity of bipolar disorder. One study suggests that late-onset bipolar disorder may be associated with menopause. Among women who have the disorder, almost one in five reported severe emotional disturbances during the transition into menopause.  Studies have looked at the association between bipolar disorder and premenstrual symptoms. These studies suggest that women with mood disorders, including bipolar disorder, experience more severe symptoms of premenstrual syndrome (PMS).

My sister had the disorder since she was in her thirties.  She is unmarried and doesn’t have any children.  If she had children would they be at risk?  Bipolar disorder is more likely to affect the children of parents who have the disorder. When one parent has bipolar disorder, the risk to each child is estimated to be 15-30%.  Bipolar symptoms may appear in a variety of behaviors. According to the American Academy of Child and Adolescent Psychiatry, up to one-third of the 3.4 million children with depression in the United States may actually be experiencing the early onset of bipolar disorder.

If you notice mood swings in yourself or someone else, don’t write them off as hormonal changes.  Seek medical help.  And if you are diagnosed with bipolar disorder, consult a psychiatrist or a general practitioner with experience in treating this illness.

My sister is currently on disability.  A bipolar diagnosis can have a great effect on your job and career.  In a survey of people with depression and bipolar disorder conducted by the Depression and Bipolar Support Alliance, 88% said their condition affected their ability to work.  Don’t be discouraged, though.  Being diagnosed with bipolar disorder doesn’t necessarily mean that you can’t keep your job. Plenty of people with bipolar disorder work and live normal lives.  If you are currently unemployed and are seeking employment, find a job that is a good fit for you–one that is not stressful and has a flexible schedule.  If you are currently in a job that is not working for you–is affecting your health, not letting you get enough sleep, maybe it’s time to make some changes.  Here are some things you should consider:

• Decide what you really need from your job. Do you need to reduce your responsibilities? Do you need extra breaks during the day to reduce stress? Would you rather work independently or in a group? Do you need to work shorter hours or take time off? Or do you need a different job altogether?
• Make decisions carefully. People with bipolar disorder are prone to acting impulsively. Think through the effects of quitting your job — both for yourself and possibly for your family. Talk over your feelings with your family, therapist, or health care provider.
• Look into financial assistance. If you do need to take time off because of your bipolar disorder, see if your employer has disability insurance, or look into Social Security Disability Insurance, which will provide some income while you recover. You can also look into the Family and Medical Leave Act. Ask your doctor or therapist for advice.
• Go slowly. Returning to work after you’ve taken time off can be stressful. Think about starting in a part-time position, at least until you’re confident that your bipolar disorder has stabilized. Some people find that volunteer work is a good way to get back into the swing of things.

Unfortunately you may encounter stigma at work.  Some people might treat you unfairly because of your disorder.  If you feel that you are being passed over for promotion or are being treated unfairly, there are things you can do.  Find out what policies are in place at your company that will protect you from this kind of discrimination which is illegal.    The Americans with Disabilities Act can protect some people who are discriminated against because of a health condition.  Before you do anything, research the law and talk things over with family, friends and therapist.  Mitzi Waltz, author of “Adult Bipolar Disorders,” advises bipolar employees to call a counselor or local support group to help them with workplace problems.

Bipolar disorder is tough on families and spouses.  They have to cope with behavioral problems.  Family members often experience feelings of extreme guilt after the individual is diagnosed. They are concerned about having had angry or hateful thoughts, and many wonder whether they somehow caused the illness by being un-supportive or short-tempered, although this is not the case.  There are times when I feel guilty because I didn’t touch base with my sister as often as I should have.  There are times when I am frustrated with her for coming off her medication because she is aware of what happens when she does.  I feel that she should take more responsibility for keeping the disease under control by taking her medication.  I see how her relapses affect my mother who has Parkinson’s.

I realize that although it is difficult to cope, families of patients with bipolar disorder need to be more supportive.  It is in the best interest of the person to be hospitalized for his or her own protection and for much needed treatment if he or she is in the middle of a severe episode.  And it is important for the patient to  to understand that bipolar disorder will not go away, and that continued treatment is needed to keep the disease under control. It is important that they understand that proper therapy will enable them to have a good quality of life and enable them to have a productive life.

The following tips are for families who want to help their loved ones to cope with the illness:

1. Educate Yourself
2. Learn How–and When–to Talk
3. Make Some Rules
4. Plan Even More
5. Listen
6. Go Gentle
7. Laugh Together
8. Support Yourself

I encourage families of people with bipolar disorder to educate themselves and then see how they can help their loved ones to cope.

Sources:  http://bbrfoundation.org/frequently-asked-questions-about-bipolar-disorder; http://psychcentral.com/lib/2007/women-and-bipolar-disorder/all/1/; http://www.health.com/health/condition-article/0,,20274376,00.html; http://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-women; http://www.bphope.com/BipolarIndepth.aspx; http://www.ehow.com/about_5032842_signs-bipolar-disorder-women.html; http://www.webmd.com/bipolar-disorder/going-to-work-bipolar; http://www.livestrong.com/article/23014-good-career-those-bipolar-disorder/; http://www.psychiatry24x7.com/bgdisplay.jhtml?itemname=bipolar_family; http://www.beliefnet.com/Health/Emotional-Health/Bipolar/8-Ways-to-Help-Your-Bipolar-Loved-One-Cope.aspx