by: David Oliver
What if you are away from home and:
• You can't get to your regular doctor?
• You feel like you're going into an episode?
• You need to see a psychiatrist?
• You need to go to the hospital?
• You forgot or lost your medication?
• Your sleep schedule is "off?"
• Your diet is "off?"
• You're not sure about your insurance coverage? (Will it cover you out of town? Out of the country?)
• You are feeling "confused?"
• You feel as if you are "off-track?"
• You are out of the country and don't know what to do?
• You are in a different time zone?
• You come back from your trip/vacation and feel "let-down?"
Let's approach these issues one at a time. You are away from home and:
• You can't get to your regular doctor.
If you have followed the advice given in the previous section, you should have already made arrangements to have a doctor in the area to which you are visiting. If not, call the hospital where you are now visiting, explain your situation, and ask for a referral to a local physician who has experience with Bipolar Disorder patients.
• You feel like you're going into an episode.
You know how it feels when you think you may be going into an episode. Many times an episode can be averted simply by lowering your stress level, increasing your relaxation exercises, using your affirmations, writing about it in your journal, keeping up with your mood diary, taking your PRN medications (such as anti-anxiety medications, medications for insomnia, extra mood stabilizers, etc.). Talk to your supporter, if they are with you. Watch your diet, exercise, and definitely make sure you are getting enough sleep. Rest as often as possible; take catnaps. Use positive self-talk. Read inspiring books. Do everything you know of that is within your power to do to keep from going into an episode. You may not have access to a doctor, therapist, or psychiatrist. But there are still many things you can do on your own.
If you are feeling as if you are going into a manic episode, make sure your supporter is in charge of your money. Watch yourself and make sure you are not talking too much – try to keep as quiet as you can. Relax your mind (try yoga, ti chi, meditation, relaxation tapes, etc.). Especially be aware of impulsive activities, and if you have to, consciously force yourself NOT to do them.
If you are feeling as if you are going into a depressive episode, try to keep yourself and your thoughts as positive as possible. Positive self-talk and affirmations work well in this situation. Stay realistic. Tell yourself, "This is normal," or "This too shall pass," or "This is not as serious as I'm making it out to be." These are examples of positive self-talk. Talk to your supporter, and be honest about how you are feeling – that is what they are there for.
Tell whomever you are visiting about how you are feeling – they will help you, because you wouldn't be visiting them if they didn't care about you, would you? Also, again, exercise will help you, because it excites endorphins in your body which help you to feel better naturally. Don't increase your sleep, which you will naturally want to do. Choose activities which will make you feel better. Do fun things! Stay busy (but not so busy that you flip into a manic episode). Enjoy your trip (vacation).
• You feel like you need to see a psychiatrist.
This is much like the first point, like seeking out a doctor. Follow the same instructions as above. Most hospitals now have a psychiatric unit (behavioral unit). They should be able to refer you to someone who can help you. If not, the phone book in the city you are visiting should have listings of mental health clinics and/or professionals.
• You need to go to the hospital.
Most importantly, see my point about insurance (below). However, most hospitals these days will NOT turn away anyone who is in a true emergency and needs hospital care. They will probably call in their psychiatric team who will evaluate you to see if you are in a bipolar episode. Either way, they will get you the help you need – whether it is to get you the medicine you need, to refer you to a psychiatric facility (in-patient or out-patient), or to admit you to their hospital.
• You forgot or lost your medication.
If you have followed the instructions I gave you about getting your medication ahead of time and prepared it according to those instructions, you should not be facing this problem. But, if worse comes to worse, and you are facing this problem, according to a pharmacist I consulted, here is what you need to do:
If you lose your medications and IF refills are available, your prescription can be transferred, BUT insurance will probably not cover it and you will have to pay for it yourself, because they only pay every so many days (usually every 30 days – some every 27 days, and some—if you're lucky—will pay a week early).
NOTE: Unfortunately, prescriptions can only be transferred ONE TIME, per federal law. If you cannot do a transfer, you will need a new prescription, called in by your own doctor, or the new doctor where you are visiting (see below).
Most bipolar medications are not controlled substances, so you shouldn't have a problem. Unfortunately, you can't do this with controlled substances, medications such as anti-anxiety medications (such as Xanax, Klonopin, and Ativan). If you are not sure if your medication is a controlled substance, follow this rule: In general, any habit-forming medication is a controlled substance, like: Restoril, Ambien, Lunesta, and Sonata; i.e., Hypnotics.
Other specific medications used by people with Bipolar Disorder that are controlled substances or are habit-forming and might present a problem for you are pain killers (Oxycontin, Hydrocodone, etc.), and medications for side effects of your Bipolar Disorder.
If your medication is a controlled substance, call your own doctor, who would call the pharmacist where you are visiting. Have your doctor call in a new prescription and give the pharmacist permission to fill your medication early. Some pharmacists may want to do this even if it's not a controlled substance. And some pharmacists will even call your doctor for you. Every pharmacist is different, and it comes down to a pharmacist decision. Pharmacists are licensed by their state, and state laws vary, so you will need to ask the pharmacist which rules apply there. However, federal law is uniform. If you want to find out this information ahead of time (which I recommend), there is a website for [your state] Board of Pharmacy, and also the National association of Boards of Pharmacy. You can also ask your local pharmacist ahead of time.
• Your sleep schedule and diet are off?
Keep your sleep schedule as close to normal as possible. Being out of town, visiting relatives, on a cruise ship, or anywhere where your activities are disrupted and/or different from home, it is easy for your normal sleep schedule to be disrupted. However, for many people with Bipolar Disorder, disruption in sleep schedule is a trigger to a bipolar episode, so you need to be aware of this, and stick to as normal a sleep schedule as possible for you. This means sleeping 8-9 hours, and going to bed as close to your normal bedtime schedule as possible as well.
Keep your meals as close to normal as possible. Being out of town is not a free pass to high-fat/high-cholesterol eating, nor an excuse to go off your diet or deviate from your usual healthy way of eating.
• You're not sure about your insurance coverage. (Will it cover you out of town? Out of the country?)
Only you can get the answers to these questions, because only you have the insurance coverage that you have. There are hundreds and hundreds of different insurance companies, and you will have to contact yours ahead of time to find out what your coverage is: in and out of the U.S., and out of town (especially in the state and town to which you are visiting). Find out about deductibles. They may cover you completely, partially, or not at all. But you MUST know this information before you go out of town, because you may have to make arrangements to be able to pay for medical care, should you need it. This is a very important point.
• You are feeling confused.
First of all, make sure you have taken all of your medication, and that you have not skipped any – also that you have taken all the right dosages. Also, that you have not been taking any supplements that have not been cleared by your doctor. In addition, make sure you have not been drinking too much water! Believe it or not, this happened to someone I know. She ended up in the hospital in a bipolar episode that began with becoming very confused, because her body had become depleted of sodium and potassium, all because she drank almost a gallon of water a day for a diet she had been on! And all because she had not checked with her doctor beforehand!
• You feel as if you are "off-track."
Before you do anything, make sure there is no physical cause for how you feel. (See last point above). Then, make sure you have taken all your medications and in the right dosages. Make sure you haven't forgotten to eat (I know someone who regularly "forgets" to eat and has this problem all the time!). Make sure you are getting enough sleep (and not too much, either), exercising, eating right, etc. You know, all the normal things you do to stay stable. Then go over all the points mentioned already and make sure you are "on-point" on all those things.
• You are out of the country and don't know what to do.
The best way to handle this is "better safe than sorry." If you are going to be out of the country, go over every point in this section ahead of time, and find out the information based on the country you will be visiting. The best example of this (and the one that most people miss all the time) is if you are going on a cruise. Most people don't realize that you will still be out of the United States, even though you are "just" going to the Bahamas or Mexico! You MUST find out what the protocols (rules) are in each country, as every country is different. In addition, if you are going on a cruise, every cruise has an infirmary staffed by a "ship's doctor." This doctor may be an M.D., or may just be a military medic. You will need to find this out in advance. Also find out, if going on a cruise, what the limits of the infirmary and ship's doctor are – can they set a broken leg? Or only hand out sea-sickness pills? And, especially, check out what the charges are for any infirmary care, because on a cruise, there is usually some payment (although minimum) for doctor's care.
• You are in a different time zone?
I learned this from someone I met. If you have to fly in different time zones,
keep your watch time the same and operate like you were in your original time
zone. This way your body clock will not get "confused," and it will be easier to stay on your normal sleep schedule, which will help you avert a bipolar episode.
For example, if you are from New York, and you fly to California, there is a three-hour time difference. This person recommended keeping your clock on New York time and slowly changing over so that you (and your body) can adjust. This especially works well when you are going out of the country (i.e., Mexico is one-hour behind us, and England is two hours behind us – based on EST). Time differences can get very confusing.
• You come back from your trip or vacation and feel "let down."
This is very normal. Have you ever heard the expression, "I need a vacation from my vacation"? Sometimes when we are away from home, we try to pack a month's worth of activities into just a week. We are constantly on the move, with a flurry of activity. We may skip meals, sleep much less than we would normally, etc. By the time we come home, we are exhausted! Especially if there was a difference in time zones. And if we had to drive to and from our destination, there is an added stress factor. In addition, there is an emotional element I call the "return let-down," and what a friend of mine calls the "Vacation Depression" (I think they're the same thing). Give yourself a chance for your body clock to return to normal, to get used to being back at work (if you do work), for your household routine to return to normal, for everything to return to normal. Do not confuse the Vacation Depression with a bipolar depressive episode. It is not! You will return quickly to yourself once you get enough rest and your life settles back into its normal routine. Welcome Home!
