Spinning Plates: Managing my Physical and Mental Health
- Angela Merriott
- 4 hours ago
- 5 min read
I am 66 years old. I have had bipolar since the age of 21. (Bipolar is a condition where a person’s mood may go high or low). I have written three times before on this platform: about diagnostic overshadowing, about mixed affective states, and about living with a serious mental health condition. As well as bipolar, I have developed several physical health conditions.
I have ulcerative colitis (an inflammatory bowel disease). I have also experienced two lymphomas (a lymphoma is a type of blood cancer). I had a low-grade lymphoma in 2015, which was treatable but not curable. In 2019, I developed a high-grade aggressive lymphoma, which was treated and cured with heavy-duty chemotherapy. Shortly after this, I was diagnosed with Inclusion Body Myositis (IBM), which is a rare inflammatory and degenerative muscle condition for which there is no treatment. The most well-known person who has IBM is Peter Frampton, an English rock musician who was most successful in the 1970s.
Having several conditions often feels as though I am spinning plates. I am trying to keep any one condition from spinning out of control. Medications used to treat one condition can also have devastating effects on another. I am having to balance and monitor and shift attention constantly. In this piece, I wanted to share some of my experience with this, looking at the difficulties and challenges of trying to keep these conditions under control over decades.
I will specifically focus on two experiences which have gone badly for me, as examples of the possibly disastrous interplay between health conditions and their treatments. I have often wondered whether anything more could have been done to support me through these medical and psychiatric crises.
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In the summer of 2003, when I was 43 years old, I caught a stomach bug. The diarrhoea carried on for two weeks. I then started passing blood in the early mornings. My GP treated me with antibiotics, which didn’t help. Eventually, I took myself to A&E.
I was admitted to hospital and put on a side ward, getting a lot more unwell. I was there for three days before I was seen by a gastroenterologist. He immediately diagnosed fulminant (end stage) ulcerative colitis. The inflammatory markers in my blood were sky high.
By the next day, I had developed a toxic megacolon (a serious complication where the colon becomes very dilated and stops working). It is a dangerous state to be in because of the high risk of the colon perforating. The doctors managed to save my colon. I was receiving high-dose steroids intravenously. Slowly but surely, my colon started working again, and I was discharged from hospital nine days later. I was desperately weak – I could barely walk. I had lost a stone in weight and was anaemic.
I had a follow-up appointment with a gastroenterologist two months later. My colon was definitely recovering but I had crashed into a major depression, which I really didn’t understand. Prior to this, my mood had been stable for thirteen years.
I have often wondered why my bipolar had destabilised so catastrophically after the serious physical illness.
Was it because the wall of my colon had been so damaged, letting toxins into my bloodstream?
Had the neurotransmitter balance in my body and brain been seriously disrupted by the illness?
Could it have been the high dose of steroids which destabilised my mood?
Were the very high levels of inflammation to blame?
Had my gut microbiome been wiped out by all the antibiotics?
Perhaps there were psychosocial factors involved? I had suspected that these may have contributed to the ulcerative colitis, but were they also responsible for the mental health relapse?
Had I internalised the psychological and physical trauma of the prolonged episode of ill-health into my whole being: body, mind and spirit?
Or maybe it was a combination of all these factors which led to the depression.
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The major depression, which started in October 2003, carried on for six months. I felt suicidal a lot of the time. I came out of the depression in the spring of 2004.
I then experienced sleeplessness and agitation through the summer, entering into another major depression that autumn. These mood shifts carried on for another two years.
It wasn’t until I started taking a mood stabiliser in 2006 that the seasonally linked mood cycles stopped completely. I had accessed an assessment at the Psychopharmacology Unit at the Bristol Royal Infirmary (sadly no longer in existence). They said that I had bipolar, and they recommended the mood stabiliser medication which helped me enormously.
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The next notable incident occurred in 2016 when I was 56. My low-grade lymphoma was causing me severe fatigue. My haematologist decided to treat the lymphoma because my fatigue was so bad. I received six cycles of immunotherapy, each three weeks apart. After the fourth infusion, I knew that my mood was destabilising. I was slipping into hypomania (high mood).
The hypomania progressed quickly into a mixed state (a toxic mix of high and low mood). It was a terrible time. I was very unwell. Some seven months later, I was seen at the National Affective Disorders Service at the Maudsley Hospital in London for an expert opinion. They diagnosed bipolar and a mixed state. They said that the immunotherapy that I had received for the lymphoma had most probably destabilised my mood.
Why had the lymphoma treatment triggered the hypomania, which progressed to the mixed state? I really have no idea. I had only previously experienced one prolonged spell of high mood when I was 25 years old.
My mood is currently stable, but I have to be aware of my health conditions, their treatments, and the ways in which they can affect each other.
My main challenge is with the IBM. The muscles in my legs are very weak, as are the muscles in my hands. I can only walk short distances. I am unable to manage many of my former hobbies and pastimes, particularly hill walking, gardening, swimming and camping. I have worked through a lot of grief because of the loss of these activities. If I get too exhausted, I have to rest at home for a day or two, which isn’t good for my mental health. My mood definitely dips when I spend too much time on my own.
There are activities which I can manage, such as seated Shibashi (a form of Tai Chi), and I sing in a choir. I enjoy spending time with friends and family, as well as reading and cross stitch. I can still go to nice places, with careful planning and the right support.
I try not to let my muscle condition define me. I know that I will need to be in a wheelchair full-time at some stage in the future. Depending on how long I live, I may end up hardly being able to move at all, but I don’t dwell on this.
I am currently in discussion with a psychiatrist, talking about the mood stabiliser medication which I have now been taking for twenty years. It has definitely helped with my bipolar, but it has caused me to put on a fair bit of weight, which is detrimental to my mobility and my general health. I should probably change over to a different mood stabiliser which doesn’t affect my weight, but I cannot risk any further destabilisation of my mood. I need to keep the plates spinning.
