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Dizziness, nausea, grogginess, and twitching may signal lithium toxicity.

Travel, saunas, hot springs, and heat waves require a lithium safety plan.

Protecting stability means listening to your body, not pushing through.

I recently traveled to Italy in the middle of a record heat wave. It was beautiful, memorable, and physically much harder than I expected.

Part of that was the heat itself. Part of it was the way travel quietly changes the body’s usual operating conditions. Air conditioning is not as prevalent in Italy as it is in much of the United States. Days that look reasonable on an itinerary can become a long chain of sun, walking, crowds, standing, sweating, and trying to keep up.

Our trip included hot springs and saunas. We went on a boat excursion. We toured the Vatican. These were extraordinary experiences. They were also, I now realize, exactly the kinds of conditions that can be risky for someone taking lithium.

At first, I did what many people do when they travel: I explained away the warning signs.

I was dizzy. I felt nauseated. I was extremely tired and groggy, not just “vacation tired,” but heavy and slowed down in a way that felt different. I noticed muscle twitches in my hands. Still, I blamed jet lag. I blamed the time change. I blamed disrupted sleep, changes in my schedule, different meals, too much walking, and the ordinary stress of being far from home.

Those explanations were not irrational. They were just incomplete.

Eventually, I realized what was happening: I was on lithium, and my body was struggling in the heat.

Lithium has been incredibly important in helping me manage bipolar........

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