Personal Blogs

I have just blogged about my recent depression but now I want to tell you about mania, as I guess most people don’t really understand what it is like.

I consider hypo-mania, that is, low grade mania, a normal part of my every day life. When I am hypomanic, I have constant racing thoughts in my head, like a dialogue with myself (just to be clear, I’m not hearing voices; I’ve never had auditory hallucinations). I have a heightened awareness of my surroundings, of colour and noise, and it is often an enjoyable experience, though the discourse can cause anxiety when you replay conversations and mistakes from 30 years ago.

It is hard to say when hypomania tips into mania, I think it is when I start feeling tipsy and my thoughts become more grandiose. My internal discourse contains grand speeches where I share my words of wisdom with the world and everyone hangs on my every word. I see myself as charming and engaging, with my eyes twinkling like diamonds (and I can understand how someone with psychosis might be deluded enough to imagine they are diamonds). I am excitable, wanting to engage with the world, to run down paths with my arms outstretched. I am lucky that I have a lot of insight and control when in a manic state so I don’t do anything to embarrass myself in public; this is how I manage to continue as high functioning within society. I’m also lucky to have seldom experienced psychosis, though I understand and appreciate the thin line between reality and delusion in mental illness.

I can tell my moods from my shopping habits; I told my GP when my depression started by looking at my PayPal account. When I am manic, I shop more and buy frivolous items or several pairs of identical shoes in different colours. This morning I started browsing for colourful tops for my summer holiday, yellows and corals. My Mad March Mania is very late this year.

If you want to read a book about experiencing bipolar disorder, I recommend Kay Redfield Jamison’s An Unquiet Mind, an autobiography of a manic depressive written by an academic expert on manic depression. I don’t agree with everything she says from a medical perspective but her descriptions of her emotional states and behaviour were very recognisable to me, as well as the vulnerability of academics/medical professionals declaring their mental illness.

Annie

I had a bout of depression for a week or so after Christmas. This is not unusual, in fact, it is a feature of the Christmas holiday for me. But I thought I would unpack it a little.

The most obvious reason for depression during December is seasonal affective disorder (SAD). Like many manic depressive, I do have SAD. As well as the lack of happy inducing sunlight, with the resultant low vitamin D levels, I am very responsive to changes in mood and routine and the changes in the seasons are a cycle of this. Mania will come in Mad March, as it always does. But it is more than SAD, over Christmas my routine is altered in many ways and this impacts on my moods.

I really like the excitement of Christmas. I love buying people presents, planning and making the food, decorating the tree and making people happy. And I start my Christmas planning early as my anxiety does not like last minute rushes. But, of course, after Christmas this winds down and it is then the depression comes. This mirrors my normal bipolar cycle; after a period of mania I have a short period of depression. It reminds me how important a regular routine is to maintain my mental equilibrium.

This week my depression has lifted. I am back into my work routine and, despite my husband having been away on business in the US for 10 days from New Year, I have managed to keep everything at home running like clockwork. Today I went for my morning walk in the cold frosty morning with a clear blue sky and saw buds appearing on some trees. Spring will soon be with us.

Annie

Last week I was accepted to present at the OU’s Mental Health and Wellbeing Conference and this led me to reflect on how much my confidence in presenting my ideas has increased over the last 2 years. Presenting at conferences was part of my development plan in year 1 and was quite apprehensive as I have social anxiety as part of my bipolar disorder.

Some people misunderstand how social anxiety can present and assume that I am a confident speaker because they think I am an extrovert, when I am actually a sociable introvert with hypomania. I don’t like being the focus of attention; during my nursing training I actually failed practical assignments because of anxiety with being watched.

Unusually, the pandemic has played to my advantage here as conferences were moved online. I’ve been teaching in online rooms for almost a decade so this is a comfortable environment for me and the screen interface means I feel less in the spotlight. Consequently, I have presented my research  at internal post-graduate research conferences and at the annual AdvanceHE Teaching and Learning Conference in 2021, where I also did a Q and A. So, although I still have anxiety at presenting at the conference, I am now much more confident in my voice when speaking about the subject I am passionate about; supporting students with mental health challenges. I look forward to the conference in December.

Annie

This week I transcribed my first research interview and I found it quite a profound experience. Obviously, I was apprehensive about starting the process, that’s normal for me, but once I began I found it fascinating and I felt like I really got to know my participant. Listening again to the conversation highlighted things I hadn’t registered during our discussion and I began to understand the student experience in more depth. Listening to the participant talk and recording their words made me reflect on my current practice and prompted me to make changes in some of my communications this week. I can see why Braun and Clarke (2006) recommend that researchers immerse themselves in the data by listening to each audio recording before manually transcribing the data, giving a verbatim account, including all verbal and non-verbal utterances with appropriate punctuation and pauses. The process is very active and I’m glad I took this route rather than using an automated transcription service. It was time consuming (10 minutes typing for every 1 minute of speech, plus reviewing and editing) but very much worth it for the intensity of experience and understanding.

Annie

I decided this week to take a step back from the research and wait and watch patiently. Doing research can overwhelm you and start to invade your every thought, and this is especially so when it overlaps with your practice. The first few weeks of the data collection was intensive, with sampling and invitation emails, planning and testing interview procedures and doing my first data collection, alongside my usual work commitments which included online tutorials, so I needed to make some space to reflect on what was happening. Besides which, my regular students need my help to settle into their modules and they are my priority. So I spent the week absorbed in forum discussions and communicating with students in tutorials and via email.

I'm happy about this. I am up to date with my teaching workload and feel that I am beginning to establish good relationships with my students. I have a clear and achievable plan of what needs to be done over the next few weeks, both from a work and research perspective. Next week I will review my recruitment approach and look at how I can make my research as flexible and inclusive as possible for my students with mental health challenges.

Annie

A couple of students have enquired about my research so I thought I would share what it is about and what it will mean for my students.

I am currently doing a Professional Doctorate in Education, exploring how students with mental health challenges can be empowered to be independent learners in the online learning environment. My choice of investigation was prompted by reading the research of Richardson (2015) which found that distance learning students with mental health challenges were significantly less likely to complete and pass their modules than other students. This concerned me as an Associate Lecturer who wanted all her students to reach their full potential, but also as someone who has bipolar disorder; I, too, dropped out of my first degree when I had a mental health crisis 25 years ago. I want to understand the barriers these students face and how they might be overcome so that I can support my students in their learning journeys.

Whilst there is some research into the barriers faced by these students, there is also an assumption that it is up to academics to decide how to overcome the challenges. But my knowledge of health and social care tells me that we need to go to the service user for their expertise on their needs. I am doing emancipatory action research study with an emphasis on student voice to explore the lived experience of students with mental health challenges, using case study interviews to plan, implement, evaluate and reflect on the support needs of these students, alongside data analytics to identify students at risk and intervene as necesary. It uses the affirmative model of disability, an inclusive and collective approach emphasising positive social identities, to develop relationships and deliver individual and proactive support. Participants are offered an initial telephone interview to discuss their experiences of studying with mental health challenges, the barriers they face, the resilience they bring and to negotiate the support they would like to receive from their tutor. The follow up interview happens at the end of the module when we evaluate and reflect on the experience of studying and being supported.

Doing research with my own students brings up ethical dilemmas that needed addressing. For instance, my research needs to be fair to all my students so I am careful to reassure that any student can have an interview about their support needs; they don’t have to take part in my research to be supported in their studies and whether they take part or not will not influence their assessment. My sample of students also needed approving by the Student Research Project Panel to ensure that students who have opted out of research invitations or have recently been invited to take part in research were removed from the sample. This means that not all my students will have received an invitation to take part. Taking part is voluntary and all students who participate are provided with information about the study and are required to sign a consent form detailing the purpose of the research and the use of data. The issue of consent is revisited throughout the research.

What I hope to achieve from my research is a greater understanding of the experiences of students with mental health challenges and the support they would like in achieving their learning goals. This is an exciting opportunity to influence how student support is provided and I look forward to working with my participants in developing new knowledge.

Annie

Today’s reflection is on how I welcome students. I’ve always sent out fairly lengthy welcome letters which include a biography, details on tutorials and forums, and how to stay in contact. These are necessarily sent addressed to ‘student’ not individually named students as I use the university group mail system to send emails to nearly 100 students. I also send out individually named emails to disabled students, enquiring about their needs and offering support. This can be time consuming as up to a third of my students might have a disability but I think it is worthwhile as establishing early positive contact is good for relationship building and addressing any challenges early is beneficial. I wanted to build on my general welcome messaging this year and decided a welcome message in Adobe Connect might be the way to go so that students might be able to hear and see me at the beginning of the module. So I planned and delivered 10 minute welcome videos for my K219 and K220 groups (KE322 have a welcome tutorial already timetabled in). The videos included an overview of the module and website, staying mentally healthy during studies and study skills tips.

I found the process strangely anxiety-inducing, considering I am an experienced online lecturer, but I guess that is my bipolar talking as it dislikes new experiences. I needed 2 takes of my first video due to not enabling my mic (a hazard of presenting by yourself without an audience). What I did discover in that first take is that I hated the webcam and found it distracting; I am an animated speaker and my head bobbing around was not helpful. But once I got rid of the webcam all went well, though I stumbled over a few words at the beginning. I think it was a worthwhile addition to my ‘welcome’ -  and I have already had some positive feedback. It also won’t be too time consuming to repeat in future presentations. I really didn’t like the webcam though and didn’t find it helpful.

Going forward, I will be repeating the video on future presentations as I think it is an easy thing to incorporate into my ‘welcome’ and beneficial for relationship building. I now have a greater idea of what works for me and that means no webcam. On some of my tutorials I have a photo of me on one of my introductory slides and in future presentations I will add this to my 'welcome' slides.

Annie

I always find it exciting when new academic year beckons, and not just because of the interesting students I will be meeting and the new challenges ahead. I also look forward to getting back into a routine again.

I have high functioning bipolar disorder and hypo-mania is pretty much part of my daily life experience. I manage my bipolar disorder and the inevitable ups and downs using cognitive behavioural techniques and an organised routine is very important to me as it helps to manage expectations and brings much needed structure to the day. Like most associate lecturers I am not employed by the university over the summer, at least not until the new contract comes in, and my teaching responsibilities are mainly in term-time. My doctorate also has term-based deadlines, though there is plenty of reading to do over the summer. As much as I love having a nice long break from the day job from mid-June to mid-September, I can sometimes feel unsettled and disorientated with the lack of structure to my day. Obviously, my doctorate is helpful at the moment for giving me something to focus on but I decided that I needed to establish a firm routine early before the new term starts to help the transition back to work.

So, on the first of September I got back at my desk and organised myself. As I have some tight deadlines this year (it’s my research data collection this year, alongside my usual teaching, and I also have draft chapters of my thesis to write) I gave myself writing deadlines and planned ahead with my studies. This has really paid off; I am back to my regular routine of a walk in the morning then at my desk at 9.30 to check the emails before setting into the day’s work. It’s been very productive due to the lack of interruptions; I’ve re-drafted two thesis chapters, done my annual admin and research planning, as well as some mentoring work and writing teaching resources. Getting all this done early has made me feel more confident and relaxed about the new term starting and I’ve also been able to reflect on what I want to achieve in the year ahead. It’s going to be a great year.

Annie

Yesterday it hit me after several intense days of writing; I guess it comes to all doctoral students at some point and those of us doing professional doctorates alongside our day jobs probably experience it more than most. I'm talking about the desperate question of 'Why am I doing this to myself?'.

It's a natural question to ask, after all, I work 32 hours a week as an Associate Lecturer (AL) and the professional doctorate is a four year programme so little different to a more conventional full time doctorate schedule in terms of deadlines and completion. It is very much full on and has to be done alongside my other commitments which also have firm deadlines (I marked nearly 100 assignments in November at approximately 20-25 hours a week).

I don't need to study for a doctorate. I've been an Associate Lecture for 13 years and have no immediate plans to change that as working flexibly from home suits me and I enjoy the contact with students that such a role has. There has never been any pressure from the university for me to study for a doctorate either; it was all my own idea. I've never been one enamoured of status so that is not a consideration. So why bother?

Three of the modules I teach start with an assignment which relates to goal setting or reflective learning, and with very good reason. Having a goal in mind helps to build our resilience when times are hard and gives us a focus for the future, motivating us to overcome the obstacles that occur on the way. I am doing my doctorate because it is a subject that I am passionate about and a story that needs to be told. My research into supporting students with mental health challenges has the power to change lives for the better and that is what spurs me to strive towards the goal.

So how did I overcome yesterday's mental obstacle? Well, I took a break from study for the day. I went for a nice long walk, had a cup of tea and did some AL work instead. Today I'm coming back for a couple of hours work with a clearer, less stressed, mind and some new ideas for my assignment. Every day is a new day.

Have a good weekend.

Annie

Well, I'm now 15 weeks post-covid and I still have the post-viral symptoms of Postural Orthostatic Tachycardia Syndrome (POTS). But my pulse is noticably improving, I am regularly walking two miles in the morning with a normal walking pulse. A brisk walking pulse should be around 110 and I am generally below that; if it creeps higher I stand still and it immediately goes down again which seems to me a healthy response (POTS symptoms tend towards pulse rates being stubborn at returning to normal). My standing pulse is also much better and I can go whole days with a normal pulse.

Absurdly, as my pulse has got better the lightheadedness has got worse. I am no longer having to take gasps of breath when seated as I was a few weeks ago but I definitely lightheaded more often and have 'brain fog', and more prone to morning headaches than before. Ironically, lightheadedness in POTS occurs mainly in a seated position and it is presumed to be due to pooling of blood in the lower legs at rest. The solution is to get up regularly and keep the legs moving while sitting. Good job my standing pulse has improved! I actually find it helpful to work while feeling like this as it distracts me, even if I am not as productive as usual.

I'm hoping all this is just a lag in my system as it gets used to me no longer having as much tachycardia. I'm going to increase the cardio exercise to see if this will stimulate my venous return more. I've also started on low dose rehydration tablets. When I developed POTS I increased my fluids dramatically as per the recommended regime but did not increase my salt intake alongside this as I appear to have a slightly raised blood pressure (BP) post-covid. But my GP is unconcerned about my BP and I'm wondering if my electrolytes are now out of kilter and if I would feel better with extra salt and minerals, as well as retain fluids better.

Anyway, the improvement in pulse rate seems like a positive step forward in recovery.

Annie

Today I walked for 2 miles with a normal walking pulse of below 110. Admittedly I had to slow down in the second half to maintain my pulse but I’m really pleased as this gives me hope that I can manage, or possibly even overcome, the postural tachycardia I developed post-covid. My missing sweating function is returning too (sorry if too much information).

But I have had tachycardia this morning as when I got dressed my pulse went over 120. And this is why postural tachycardia is such a debilitating illness for many people; it is at it’s worse when performing activities of daily living. I fully understand why some people struggle to get out of bed with it.

I first noticed my tachycardia in the second week of my covid symptoms when I had palpitations carrying the laundry downstairs - my pulse was 125. I get the same when hanging out the laundry or chopping vegetables (even in a seated position). Even difficult crochet raises my pulse! My 2 worse episodes of tachycardia have occurred when gardening, that magical combination of heat, exercise and lifting your arms up. The second episode resulted in a subconjunctival haemorrhage so my blood pressure is clearly shooting up too.

Now I’m conquering my venous return in my legs I’m tackling my arms with some Iyengar yoga; cobra and downward dog should be helpful as well as standing poses. My lungs are hating seated twists though.

My tachycardia is postural, my resting pulse is around 65 and it goes up to 90 when I stand up - when I first noticed it was up to 128 just walking around the house. It is exacerbated by exercise (walking upstairs can raise it to 110, going for a walk to 125, once 150), raising my arms (carrying laundry downstairs or sitting to chop vegetables raises it to 125, even brushing my teeth raises it), heat (gardening on a warm day made it 140), and eating (rise to 90 when seated). Alcohol sometimes exacerbates it, caffeine doesn’t and might well improve it.

The paramedic on my second trip to casualty did a seated and standing pulse and BP and suggested Postural Orthostatic Tachycardia Syndome. I have since researched this (I am an ex-nurse) and it fits my symptoms and circumstances, especially as a post-viral autonomic response. I have instigated suggested lifestyle changes including increased fluid intake, slow transition on rising, wearing light compression running leggings, gentle yoga and taking a daily morning walk with regular rests and water. 

I think water intake has had an enormous effect. Taking water 20 minutes before getting up in the morning has resulted in a normal pulse on rising. I can now, most days, walk around the house without tachycardia as long as I keep my fluid intake up. My morning walk pulse is gradually improving too. Arm raising is still an issue but I am aiming to increase my upper body strength with seated and supine yoga.

I have to avoid fatigue, though. If I push myself too far I can get fatigue for the next few hours or even the next day. The best solution for the tachycardia is to sit on the floor cross legged, that results in an immediate drop in pulse. If I am outside I stand with legs crossed.

Obviously I am in a better state than many people recovering from covid as I was not hospitalised and did not spend my symptomatic two weeks on bed rest so my body is not very deconditioned. I am well enough to do my usual online teaching job and carry out activities of daily living despite my tachycardia. But I thought I would share my experience of dealing with post-covid tachycardia in the hope that it might be useful for other people.

(Hopefully once I’ve beaten the tachycardia I can find a solution to my strange lung pressure issue! I can’t bear high air pressure and get air hunger, especially at rest. I’m hoping increased exercise will lead to greater lung expansion)

This morning I stood up and did not have tachycardia. I even managed to walk to the bathroom with a normal pulse. Admittedly it did increase when I brushed my teeth (and more so when I got dressed). But this is quite a development. Let me explain.

On the 17th March 2020, a couple of days before lockdown, my 15 year old developed a cough. Just a mild occasional one, not a hacking cough, but the warning signs were there and we went into isolation. He never developed more than this mild cough, though it went on for at least 6 weeks. Several of his friends also had it and apparently a parent of a fellow pupil had a positive covid diagnosis.

The next day I had a cough and sore throat so called in sick. I had mild fatigue but never developed a fever. I felt better after a few days and told my manager I would be back after a week and I duly returned to work. Later that evening I developed shortness of breath and chest tightness. This later developed into a central chest pressure where it felt I might stop breathing, exacerbated by exercise. But on day 16 I felt better. On day 17 I even phoned a student and a work colleague, with just mild shortness of breath.

On day 18 it all changed. I was overcome with extreme fatigue and shortness of breath on exertion. Over the next few days I developed anxiety and panic attacks. Then the fog lifted and I realised that what I really had was tachycardia. I had tachycardia when standing up and moving around and it seemed to be getting worse. It appeared to be autonomic, as I also developed a severe aversion to food which was clearly not gastric; I had to do breathing exercises in order to eat. Eventually I could stand it no more and went to casualty.

After a thorough check up all they could find was sinus tachycardia with a mild rise in blood pressure. The doctor suggested maybe a mild myocarditis which would improve on bed rest. As one of my bloods was slightly raised I was started on anti-coagulants and would have a lung scan to check for a clot on Monday.

The next day I felt awful, presumable due to the anti-coagulants. I spent the day in bed (where, incidentally, my pulse stayed in the 60s) but got up in the evening. I had a massive surge in pulse with chest pain and resultant panic attack and ended up in casualty again. Here an x-ray was taken and the doctor reassured me that he did not think there was anything wrong with my heart or lungs (I think he thought I was just an anxious patient, a common problem for tachycardia patients but I am also bipolar which colours perceptions). 

The lung scan was normal and the doctor in the acute admissions clinic sympathetic and interested. I’m on a waiting list for a 24 hour ECG and echocardiogram.

The paramedic earlier had told me he thought I had Postural Orthostatic Tachycardia Syndrome (POTS) and I looked it up; it fitted everything I was experiencing. The tachycardia on standing and moving around, exacerbated by lifting my arms (chopping vegetables gives me a pulse of 125!), the shortness of breath and chest pain, even the panic attacks. Over the next few weeks I recognised other symptoms such as tachycardia after eating, heat intolerance (my record tachycardia was 140 on the VE bank holiday due to gardening in the sun) and air hunger when sitting and concentrating. It is now 8 1/2 weeks since I developed my assumed covid symptoms yet I’m still recovering from the experience. The prognosis for POTS due to a post-viral Dysautonomia is generally good and I instigated rehabilitative techniques early, an advantage of being an ex-nurse who uses cognitive behavioural therapy daily to manage mental health. But I’ll discuss that in another thread.

Annie