Spouses of Bipolar in Active Relationships

I have told my story in another thread so I don’t want to bore everyone. But I do have a question in general.

My wife is in a hospital for the last 4 weeks since her mania. The hospital she is in is ‘rough’ cause we had no choice as it was Easter weekend. The ER could not keep her so they had to move her out. The only available place was this hospital or another one a couple or hrs away. The social worker said this place is ‘rough’. But we had no choice cause we don’t want her too far away. The social worker said the patients there are not just mentally ill but they are also there for their other abuses like drugs or are off the streets. How bad can a hospital be?

Well anyways, she tells me every day I visit her that she needs to get out and she does not belong there. So I told her, she can only get out if she is healthy based on pdocs review. Well, she was put on lithium just this past Monday while prior; she was on other meds which did not work.

So my question is, Lithium can’t work that quickly, can it?. The last 2 days I have visited her, she is not even at 70%(in my opinion when I test her). Can she trick or stay calm enough in front of the nurses and pdocs that she can convince them she has improved? I just hope it is not a smokescreen when she is still unstable. Her family and I thinks it might take at least 1 more week till the meds kicks in 100%.

So can this happen? Can she trick the pdocs? Or am I over thinking and worrying myself to death?

Lithium does take time to become effective and I believe therapeutic levels can be (and are) measured by a blood test.

My husband felt much better and it was evident to those around him when his Depakote reached a therapeutic level (after about three weeks) they started him on a low dose, increased it, then decreased it.

I'm sorry that she is in a "rough" place. I hope she starts feeling better and can come home.

I forgot to add that she is scheduled to go home on thursday by the hospital. They said they saw an imporovement (with 2 days of lithium?). But when I or her family sees her, we think it is too early.

I see. Tell them your concerns. Be emphatic about it.

Does she have any alcohol or substance abuse issues? Because if she leaves hospital and does any of that it can be very destabilizing.

(just letting you know since I wish I had known this and the hospital didn't tell me)

Lithium levels are monitored using a blood test. There is some 'debate' over whether to have someone at the lower end of the therapeutic range to lessen the side effects. I also believe that the therapeutic range is lower than what it used to be...anyway they should be monitoring her levels via a blood test not only to determine if she is in the therapeuticl range but also to avoid lithium toxicity. I agree with Kitkat, you should share your concerns (and I would try to state very specific examples) as you know her the best.

If you think that they are discharging her because she can't pay their fees? Contact your local NAMI chapter as soon as 8 am rolls around in your section of the world.

http://www.nami.org/template.cfm?section=your_local_nami

Lithium is a GOOD med for bipolar people. What do you most need to know about it? I think I would say 1) Lithium dehydrates. So she needs to drink lots of water or green tea (check the caffeine content as it varies) or juice---noncaffeinated or very low caffeine beverages and she needs to be deliberate about hydrating. Sodas won't do. Also....alcohol and Lithium are a BAD and potentially TOXIC combo because alcohol is dehydrating too.

This is serious because longterm lithium use can cause kidney damage. This is why...well, see number 2. 2) She HAS to have the regular routine blood tests to make sure her lithium levels don't reach chronic or acute toxicity.

Post edited by: marriedtoit, at: 04/24/2012 09:55 PM

My wife does not drink nor has any abuse with any substances. She was just entered to this hospital cause of convenience for us family members to visit and lack of space in other hospitals.

Insurance is covered by my wife’s company medical so she can stay longer if needed. All covered after deductibles are met.

Prior to her mania, she was taking lithium along with other antidepressants. She was off them cause we were planning to have a baby and she did not tell me she was bipolar and taking those kinds of meds. She stopped cause her pdoc said so but I doubt it. I think he meant her to lower the meds instead of cutting it cold turkey.

So prior to her mania, she was taking 300 mg of lithium regularly. Now they are giving her 450 mg since Monday. But she was taking Trileptol 3 weeks prior. The only thing that has been constant since her hospitalization is Zyprexa at 10 mg.

I will voice my concerns with the hospital staff tomorrow.

That's reassuring, libob. You don't have to really have concerns about Lithium--but just be on top of "when will her next blood test be to make sure her lithium levels are okay"--? Lithium is the oldest BP med and it has saved more lives than any BP med over the years.

Zyprexa is a great med for stopping mania in its tracks.

No pdoc (psychiatrist) would recommend she quit meds cold turkey. Another clue that this was NOT the pdoc's idea is that YOU were not consulted. ANY pdoc worth his or her salt would hear this from a BP woman and want to talk to her partner SOON...

As a matter of financial solvency, most hospitals in the US accept Medicare and Medicaid insurance. In order to accept that insurance, they need to meet the "Conditions of Participation for Hospitals," which are regulations promulgated and enforced by the Centers for Medicare and Medicaid Services (CMS). One of those conditions of participation is "Discharge Planning." The hospital MUST have a discharge plan in place prior to discharging a patient. They MUST include the patient and family members in the development of the discharge plan. A majority, if not all, patients admitted for psychiatric reasons are going to need some type of after care - partial hospitalization (PHP), intensive outpatient (IOP) or at the very least an appointment in place with their pdoc (and the insurance authorization in place to cover that appointment. The URL for the discharge planning regulations is:

http://cfr.vlex.com/vid/482-condition-participation- discharge-19811453

Knowledge is power. As one of our other group members discovered, if you start quoting state (some states have state regulations covering this sort of thing as well) and federal regulations to a facilty, they figure you aren't someone to mess with and become MUCH more cooperative.

If the issue is insurance related - ie, your insurance company is denying additional days of treatment as "not medically necessary," you have the right under federal law (Patient Protection and Affordable Care Act) to appeal that determination. If a member is currently receiving services, that appeal must be processed on an EXPEDITED basis. If the hospital in which you loved one is receiving treatment participates with your insurance plan (note: accept is NOT the same as participate) their provider contract with the insurance company most likely requires that they file appeals on the member's behalf and/or assist the member (or a family member) in filing the appeal.

Just so y'all know, I sent a PM to libodog early this morning so he had the "ammunition" he needed to address his particular situation.

Post edited by: WornOut2, at: 04/25/2012 09:32 AM

Post edited by: WornOut2, at: 04/25/2012 09:39 AM

Post edited by: WornOut2, at: 04/25/2012 09:39 AM

Post edited by: WornOut2, at: 04/25/2012 09:40 AM

Its wonderful to have an expert in this field Wornout, I am sure he appreciates it a lot! We all can use all of the help we can get!