Wednesday, October 15, 2014

At Least I Know I Have a Heart

So when we left the story hanging last month, I was just getting my shit together after scraping a new low of depression: I was seeing a psychiatrist for my meds, a therapist for my head, and a social-worker to coordinate it all.  I was still depressed but I felt really hopeful about everything, which was new and quite pleasant.

Then I had a heart attack.  It wasn't a bad one, but on the other hand there's no such thing as a pleasant heart attack, so the fact that it could have been worse doesn't really make you feel better. And it was really the last thing I expected, heart disease doesn't run in my family and I'd never been diagnosed with high blood pressure or exceptionally high cholesterol.

Nevertheless, that's what happened.  All that day I was feeling short of breath and kind of dizzy, very weak, and kind of sickish; but I often feel that way and didn't think much of it.  But when I was at the grocery store I sat down to rest at the little blood-pressure machine and took my blood pressure since I was there.  It registered really high, which alarmed me a bit, but then those machines are famously inaccurate so I didn't get too terribly alarmed.  I finished my shopping and went home, where I hit the couch and rested a while.

Around 6 o'clock I started feeling a pain in my chest... not where my heart is, but where my diaphragm is, and it felt a lot like a pulled muscle or ligament.  No big deal, I took some Advil and got in bed.  But the pain increased as the evening wore on, in the center of my solar-plexus, feeling more and more like a pulled muscle and getting more and more sore.  By 10 o'clock it hurt so much I couldn't sleep.  I put a heating-pad on it and waited for it to pass.

But then finally the pain moved into my left arm, which I knew was a warning sign of a heart attack, and the pain in my chest settled very distinctly in the spot where I knew my heart to be.  I didn't really think I was having a heart attack, it was all too vague and floaty, but I knew something was wrong.  A little after 11 I got up and got dressed and drove myself over to Highland Hospital.

Now, last time I went to Highland Hospital's emergency room was over twenty years ago, 1992 when Ariel was a newborn and we lived across the street.  It was grungy, then, though not as grungy as my first experience of the place when Grandpa was taken there after choking on a hunk of sweet-and-sour pork back in 1986.  So my expectations were pretty low going in.

But golly, it was nice in there!  I didn't even get sat down in the waiting-room, I was seen by a triage nurse immediately (though I know I caught them at a dull moment, midnight on a Wednesday, so they weren't overrun), then was ushered into a private waiting-room to wait for a bed, then into the bed within the next half hour.  Before 1 a.m. I was laid up in a room by myself, pumped full of morphine, and being tended by the cutest young man imaginable... not a nurse, I don't think, but a physician's assistant or intern or something of the sort.  Anyway, a pretty pleasant setup.

Of course that's when things slowed down.  I had to wait for a doctor, only one of which species seemed to exist in the whole trauma center, and have a lot of blood tests done, and a few EKGs, and get rolled off for a bunch of x-rays and rolled back again, then wait for the doctor to come back, then diagnosed with a heart attack and slated to be transferred upstairs for treatment.  But I was high on morphine, which is really the nicest drug, and I had my tablet to keep me entertained with card games and Kindle books.  I got upstairs a little before dawn, plopped into a bed in a very noisy ward (everyone was asleep but all the staff were moving around and talking as they worked), and was enjoined to get some sleep.  I got about half an hour, I couldn't turn over off my back because of all the wires and nodes attached to my front.  Then The Robert Show started.

First it was the hospitalist, the general-practice sort of doctor in charge of hospital patients, who led a flock of twenty-somethings in white coats into my cubicle and started asking me a hell of a lot of questions; Highland is a teaching hospital you see, and during daylight hours every doctor is accompanied by such a flock.  Then the cardiologist came with her own flock and asked a lot more questions, and the flock asked questions, and Caroline had turned up in the meantime and she asked lots of questions of the cardiologist, and it was quite a little kaffeeklatsch but without any coffee or pastries.

Speaking of which, I was ravenous by then, they hadn't let me eat or drink anything since I arrived a little before midnight and it was now getting on for 9 a.m.  Caroline kept me company anyway, and I lay there watching the comings and goings of the ward and the little flocks of doctors-in-training as they learned at their masters' knees.  About ten or eleven it was decided that I was going to get an angioplasty, and then things started moving fast again―less than an hour between decision-making and being wheeled down the hallway.

Odd to say, the angioplasty was almost the highlight of my stay.  The guy who was stationed at my head and kept an eye on my vitals and prepped my groin (more embarrassing than titillating) was really funny, gay as a paper hat and full of jokes and good nature; and I was given even better drugs (something called Twilight or like that... dreamy) and told what was going to happen in reassuring detail.  Best of all I was allowed to watch the procedure on the x-ray screen.  Utterly fascinating!

So I watched on the screen as this object was inserted in at my groin and run up through my arteries like a drain-snake, slowly slowly slowly but I felt every centimeter of movement (pressure but no pain, the weirdest sensation) until it reached the clogged artery on my heart that was causing all the trouble.  Then a leeeetle balloon inflated and left behind a teeeeny piece of medicine-treated metal (or "stent") to keep the artery from closing again.  Then they slowly pulled the apparatus out and I was done.  Unfortunately the local anesthetic wore off while they were pulling out and the last few minutes of the procedure was excruciatingly painful, alleviated only by the euphoric drug, but it was only a few minutes.

Afterward I was wheeled into my own room in the ICU... not because I was in any danger but because it's standard procedure to put all post-op cardiac patients there, from major open-hearts to minor angioplasties.  People were very nice to me, though I still wasn't allowed to eat or drink for a long time, for fear of something going amiss and my needing further surgery.  But Caroline was still there, had been waiting while I was in the procedure, and she kept me company for the rest of the afternoon.  About the time she had to go home, they finally brought me a tray of food, and I was so hungry it was the most delicious fish filet I'd ever eaten in my entire life.

Then began one of the longest and most unpleasant nights of my life.  As before I was unable to turn over (I always sleep on my side) because of all the nodes pasted to my torso and the tubes of saline and oxygen; and then being the ICU it was full of people dying and their relatives being really dramatically unhappy about it, and the noise was extraordinarily disturbing; and then when I did manage to doze off, a nurse would come in and take my vitals and ask me questions and poke me here and there.  And when I had to pee, I was made to go in a bottle, which I found incredibly disgusting.  Really, a hospital is no fit place to be sick in.

But the night passed eventually, and my morning began with a visit from three different fledgling cardiologists from the previous day's flock, who asked me a lot of questions, often the same questions; then the cardiologist came with the rest of the flock and asked those questions again and quite a few more, displayed my shaved and punctured groin, then decided that I was good to go and would be discharged.

Then I was moved to another room in the same ward for reasons that were never made clear to me, where the nurse was stationed right outside my door and kept me company when she wasn't busy tending to one of my neighbors.  I got fed again (OMG the eggs and sausage were sooooooo good and the one cup of coffee was utter heavenly ichor) and then settled in for the wait to be discharged.  A wait that lasted most of a day, but which was meant to end any minute now so I couldn't just settle down and rest.  I watched a lot of really bad daytime television (the TV only got one station) including my first-ever experience of the new Price is Right with Drew Carey (not too bad, but not what it was), had lovely chats with the nurse, had another meal (an unimpressive tuna sandwich and chicken soup), all while listening to people sob in the hallways and someone with dementia yelling "help me!" at five-minute intervals.

But finally, finally it was all over with, I was given bags of pills and sheet after sheet of instructions (including and especially what my new diet was going to be like: 1400mg maximum sodium, 1800 calories, and 20 grams of fat per day), a plastic basin full of toiletries and an extra pair of slipper-socks that would have been most welcome if I was staying in the hospital but were quite useless to me at home, and finally allowed to get dressed and go to an actual bathroom to eliminate.

My uncle came and picked me up at around 4pm, then went back later for my car, and I hit my bed at a run.  I slept for ten hours solid, then napped and dozed and slept off and on for the next twelve hours, and spent the rest of the day watching television before going back to sleep at midnight.  After another refreshing night's sleep I finally got out of bed and faced my new life bright and early Sunday morning.

The first order of business was to arrange all the new pills.  I was on metaprolol, clopidogrel, atorvastatin, and aspirin daily as well as my regular medications and OTCs, so I had to get my pill-boxes out and refill them, making a handy little list to keep in my now-full medications shoebox.  Then I had to organize my diet.  First the sodium: I went around the house reading the nutrition information on all of the foods I ordinarily eat, and discovered that each of them contained more than my whole day's allowance of sodium―a Cup O' Noodles, one of my favorite staples, contained double that amount, and a chicken pot pie was practically poisonous with salt―as well as more fat than you would have credited (one begins to see why I had a heart attack in the first place, the way I was eating).

So I went online and bought a low-sodium recipe book to keep on my tablet and study, and did a lot of research about the minimum amounts of sodium, fat, carbohydrates, and protein a body requires (so I know I don't go too low and malnourish myself), and a lot of research into prepared low-sodium and low-fat foods (none of which were low enough... prepared foods are shockingly unhealthy).

It was pretty quick and easy, developing the new diet.  I was going to have to cook more, but the diet book I bought featured a lot of energy-saving shortcuts for prepping your food on Sunday and then arranging it into meals as you go during the week.  You roast up a couple pounds of chicken breast or beef chuck or pork loin one day, and then cook steambag veggies and stuff like that for each meal.  I organized small meals, five three-hundred-twenty-calorie meals each day, eaten at regular clockwork intervals, and reduced my sodium to practically nothing.

Well, that went extraordinarily well, and I lost twenty pounds in the next six weeks, so that when I had my follow-up appointment with the cardiologist in September, I was in the very pink of health.  And during the rest of September I continued eating healthy, and lost another ten pounds, so I was finally back to the weight I'd been when I left work the year before (250lbs).  Sadly, my work pants still didn't fit, but that's another gripe (damn you, gravity!)

But then the depression came back.  I had been feeling pretty damned great all this time, meeting with my therapist and my psychiatrist and eating well and getting exercise, but then like a gopher-hole in a racetrack the first week of October threw me flat on my face, groaning and crying.  I managed to hang on to a lot of my healthy eating habits, but I lost my grip on the eating schedule and the neatly arranged meals, going back to snacking when I felt hungry―but still snacking on very healthy low-sodium low-fat foods.  So it wasn't as bad as it could be.  I felt like my depression was stable, at any rate, not the bottom-scraping terrors I was feeling in July, so I felt like I had at least made some progress.

So all in all, the heart attack was a good thing.  It was the short sharp shock I needed to get me out of that rut of depression I was in and make me take an active part in my life again, even if only for a little while, and to end a lot of the behaviors and conditions that were keeping me down.  It also gave me a really good argument for when I am feeling suicidal: considering the amount of money and effort that had been invested in keeping me alive, it would be a disgusting waste to kill myself now.  I mean, my little trip to Highland ended up costing Medi-Cal a whopping seventy thousand dollars... if nothing else, I am worth that much!

So though I am wallowing at the moment, I am feeling kind of hopeful about the future.  I'm thinking about what I want to do for NaNoWriMo next month, working on my anxieties and fears and interpersonal relationship issues in therapy, and thinking about ways to make my life better.  I really feel like the sadness I'm in now will pass and that though it will also come back I will be better prepared for it.

Anyway, that's what's going on in RobertWorld these days.  I'll check back in next time something happens, hopefully before some months have passed.  Cheers!

Saturday, September 27, 2014

OK... Let's Try Again

Longtime readers will not be surprised to learn that all of those grandiose plans for June, outlined in my last post, were a total bust.  Well, maybe not a total bust, but like most of my grandiose plans they certainly did not come off as intended—they lasted OK through June, but then they all fell apart at the beginning of July.

To start with, the painting class: it went very well at first, I really enjoyed going and learning and buying supplies, and got a huge kick out of this new art form; but I overestimated my physical abilities, and soon discovered that simply being upright for four hours solid, four days a week, along with the walk to and from the parking-lot on the far other end of the campus, was absolutely exhausting.

I soldiered on through the first three weeks, buoyed by the excitement of learning and by the fun of buying peripheral supplies that I didn't really need (a folding easel and folding chair, dozens of different brushes, etc.) but eventually the fibromyalgia pain got to be too much and I had to take a week off; after another week in class, the depression got so bad that I couldn't handle going anywhere at all, and so I dropped out.

Still, I kept on painting at home, with my "unneeded" extra equipment, and while I haven't progressed as quickly on my own as I did in a classroom setting, I am pleased with what progress I have made.  I finished the final project around the end of August, and intend to keep on going with some other projects I've dreamed up since.  So in the end, the painting class was only a partial bust, and not only did I gain a new hobby, but I've gained a little better understanding of what I'm capable of doing as far as outside activities.

Then there was the intention to wear my dentures all the time... that only lasted a couple of weeks. They're comfortable enough, I guess, but I can't eat with them in.  Perhaps the fit is off a bit, but I think a lot of it has to do with the way my mouth is constructed: I have too much soft palate, and the back end of the denture digs into it when I chew, being both a little bit painful and also making the dentures come loose when I bite into something.  In order to keep them in, I have to wear denture adhesive, which makes it gross when I take them out and also pulls on the lining of my hard palate and makes it sore.

I look better with them, and I talk more clearly, but I just don't feel like it's worth the effort.  I might try some more different approaches, like a soft-liner (a kind of acrylic goo that firms up into a comfortable gel-like pad in the denture) or different kinds of adhesive, but the bottom line is that it's too much trouble for too negligible a benefit.

And then there was the daily writing regimen, which simply did't happen.  Writing anything at all has been a trial and a chore, and even that little bit needs a crapload of energy and inspiration to get started.  It's been two months since I first tried to write this very post, and what little work I've done on Lord Foxbridge comes at a rate of about two paragraphs per day-long attempt, one day-long attempt per week.  And it's not that I don't have anything to say, nor that the stories are unworkable, it's just that I can't concentrate enough to type anything on most days, and on days when I can concentrate I just can't make the words come out.  It's been incredibly frustrating.

So that's what didn't happen.  Here's what did happen:

At the beginning of July, I slipped into a level of depression I've never been in before.  I shared before about how I was having these strong urges to cut myself, but that calmed down after I stopped taking the Lexapro; however, it came back in force in July.  I also had a much harder time controlling my impulses, and on one occasion I punched the screen of my laptop so hard that it broke, just because I was frustrated with how slowly IE was behaving.  And then alongside the cutting urge was a lot of suicidal thinking, feeling worthless and pointless and more trouble than benefit to those around me.

The combination was terrifying: when I've had suicidal thoughts before, I relied on my rather iron-bound impulse control to keep me safe; but with my impulse control breaking down, there wouldn't be much to stop me hurting myself or others.  I was a lot more afraid of hurting Grandmother than I was of hurting myself (which on most days didn't seem such a bad idea after all), and I spent most of a week tied up in knots of anxiety and anger, crying off and on and afraid to leave my room.

I got so bad that I alarmed Caroline, and she called Crisis Support Services on my behalf; and this was on a Sunday, when calling Crisis Support takes you directly to an emergency service that is essentially a suicide hotline.  I, of course, was loath to see myself as being really suicidal or "in crisis," which sounds far too dramatic and perhaps a bit foolish; but after Caroline made me talk to the crisis counselor and explain how I was feeling and what I was afraid of, I felt a lot better.

That phone call was, furthermore, the key I required to get plugged into the mental health services that I had been needing and had not been able to navigate into.  Way back when I stopped taking the Lexapro, my doctor didn't feel comfortable prescribing a new antidepressant and wanted me to start seeing a psychiatrist to get my psych meds straightened out; but getting in touch with mental health services turned out to be rather difficult for me, with my fear of making phone calls and my low frustration threshold when it comes to phone trees and referrals from other agencies.

The Crisis Support people, however, were able to line all that sort of thing up for me, and within a few days I had appointments with a social worker and a psychiatrist for crisis evaluation and medication management, respectively.  I also got a referral to a therapist, who I started seeing a week later.


I can't write any more, I'll come back to this later.

Sunday, August 31, 2014

Timeline of Bipolar Symptoms & Medications

I compiled this for my psychiatrist, since it was long and complicated and my brain no longer maintains oral history like it once did.  I reproduce it here for future reference and your infotainment.

August 2004 - Begin to notice pattern of depression (almost euphoric manic episodes in September and March sandwiched with three or four weeks of being really down), considering symptoms, discussing possibility with friends.

April 2005 - left job after 7 years, largely due (in retrospect) to increasing mood swings.

July 2005 - Diagnosis of Type II Bipolar Disorder at Kaiser Oakland BHC

August 2005 - met with Dr T, begin medication: Prozac 20mg + Depakote 100mg(?).  Gained a lot of weight (initially 210, up to 230) in the first month, began experiencing social anxiety, found it difficult to write, occasionally had difficulty sleeping; continued gaining weight, up to 255lbs in six months and 270 in a year.  Symptoms muted and sometimes improved but not relieved.  At the same time was working as a temp in a variety of situations.

March 2007 - switch Depakote for Lamictal (50mg?) Felt better, more social, in the first few weeks but went right back to how I felt before within couple of months. Lost ten pounds.

April 2007 - New job forced me into new health plan (Blue Cross), and I put off getting new doctors until my prescriptions would run out.

August 2007 - Depression symptoms intensify noticeably while work situation becomes stressful.  Crying a lot, sleeping a lot, having difficulty with my work.

September 2007 - Found new psychiatrist on plan (can’t remember his name) and met with him for medication management only: switch Lamictal for Abilify, continue Prozac at higher dose.  Major side-effects include akathisia, constipation, urethral resistance and interrupted sleep; reduced social anxiety, increased creativity; diet and exercise helped lose some weight but not much.

November 2007 - Depression symptoms returned, fatigue and sadness in particular, poor sleep increased waking up every two hours. Dr increased Prozac but only became grouchy and anxious; stopped Abilify end of month since side-effects were unpleasant and no benefits were noticeable, did not replace mood-stabilizer.

June 2008 -  Changed jobs and returned to former medical plan (Kaiser).  Depression and short manic spurts showed up at expected times during following year, but nothing serious or severe.

February 2009 - Began to notice increasing fatigue in autumn.  Depression intensified slowly over previous few months and got bad enough by January that I thought I should change meds and made an appointment to see Dr T.  Started Lithium 300mg and discontinued Prozac.

March 2009 - Felt much better and started a diet and exercise regimen that resulted in losing 50 pounds (down to 210, weight I was before starting meds) in a few months.  Mood swings were more frequent and intense but shorter, noticed significant cognitive dulling after a couple of months.

April 2009 - Had a long (2 week) severe mood period, mostly depressed but interspersed with manic, Dr T increased Lithium to 600mg and added Wellbutrin 300mg.

May 2009 - Weight loss and new meds result in a period of positive attitude and sense of happy normalcy.  Have periods of feeling down, and still tended to feel anxious in some social situations, but maintained a reasonably healthy social life.

October 2009 - Over the few months noticed spurts of intense anxiety, sorrow, fatigue, or euphoria instead of the extended periods of sadness.  Missed work because of depression for the first time.  Began to feel that sanity was slipping, bouts of irrational anger or anxiety.  Maintained some social life but experienced social anxiety on occasion; at work could not be around groups of people for too long without getting anxious and tired.

April 2010 - After four months of intense life-traumas/dramas, had a sort of breakdown, crying uncontrollably one morning and unable to work or function for several days.  Made appointment with psychiatrist but couldn't get seen until June.  Got a bit better but was down and fatigued most of the time.

June 2010 - met with Dr, switched out Lithium for Seroquel 75mg. Side effect of irritability and increased appetite.  Started Depression Group and instituted some positive habits (especially the gym; weight had gone up to 235 in previous months, then lost ten pounds in next two months) which helped a lot. Noticed a tendency to ‘overreact’ to situations, really happy or really sad or really angry when the situation didn’t call for it.

August 2010 - Dr changed 300mg Wellbutrin to 200mg Wellbutrin + 50mg Zoloft to combat short fuse issue.  Side effects of Zoloft were noticeable, groggy in the daytime and difficulty getting to sleep and staying asleep at night, urethral resistance again (though not as bad as with Abilify).  Felt more social and creative, reported feeling normal/good for next few months.

March 2011 - Noted long depressive period starting in January, caught lots of colds, surge in suicidal ideation; returned to normal by end of month.

June 2011 - Death in the family, found myself unable to grieve or even take much interest.

September 2011 - reported feeling normal/happy for last few months, felt social and creative.  Started new Depression Workshop, instituted some positive lifestyle changes (particularly taking better care of my person w/ dress and grooming), felt fairly happy though still tired most of the time.

November 2011 - Series of medical problems: kidney stone in beginning of month, viral labyrinthitis in the middle of the month that led to a strained sacroiliac ligament (took Vicodin and stayed in bed for a week), Hepatitis A at end of month.  Depression flared noticeably during drugged bedrest with strained ligament and got a lot worse with hep symptoms the rest of the winter.  Started using a walking-stick for balance problem after reinjuring ligament.

February 2012 - Remained depressed and severely fatigued last three months, frequent colds, increased joint pain, weight returned to 255; Diagnosed with moderate sleep apnea, given CPAP machine but it didn’t work.  Tried to make some positive changes to diet and exercise, but was moderately to severely depressed most of the time.  Noticed that joint pain increased when I was sad/down rather than when I had been exerting myself; spoke to medical and psychiatric doctors about issue, GP had me tested for arthritis and lupus and some other things but they came up negative.

May 2012 - had most of my teeth extracted at once, which took a long time to heal (two weeks taking Vicodin) and was followed in two weeks by a severe sinus infection; diet changed due to lack of teeth and nutrition suffered. Fatigue increased, mood plummeted.

September 2012 - Started weekly therapy group and new writing project; teeth problems sorted out, felt pretty good about life in general, though still felt sad and tired much of the time, just not “as bad” as it had been.

December 2012 - severely depressed, missing a lot of work; tweaked doses of Wellbutrin and Zoloft with no apparent effect.

April 2013 - changed Zoloft for Lexapro (dose?), dramatic difference noticeable in a few weeks, went over a month without feeling depressed at all, though was very grouchy (short fuse) again.  Also started taking Nabumetone for joint pain, which seemed to help for a while, though it only reduced the pain rather than alleviating it.

May 2013 - Work situation changed and stress increased, did not cope at all well with increased stress, exhausted and sad and angry all the time, suicidal ideation frequent, joint pain surged in July.

August 2013 - Work became impossible to continue, resigned at the beginning of the month.  Came to believe that I wasn’t able to work full-time anymore, examining the last few years I saw that I’d been pushing myself very hard just to make it to work, and my life outside of work had dwindled to little more than recovering from the effort of working.  Lost medical coverage at the end of the month, but refilled all my prescriptions before coverage ended.

October 2013 - after initial flurry of activity surrounding leaving job (applying for UI, State Disability, and SSDI, as well as looking for part-time employment), severe lethargy set in, I went weeks without being able to do much of anything at all.  I gained fifteen pounds in a couple of months due to reduced exercise (to 270), and joint pain intensified.  Ran out of Seroquel and didn’t notice any difference after I stopped taking it.  Without the stimulus of work routine, found it increasingly difficult to follow through on anything, dropped the thread of my search for new health care coverage.

December 2013 - stopped taking all meds (had forgotten to take them for four days straight and felt better so was curious to see what would happen if I stopped altogether) and didn’t see much difference in mood, it was essentially the same as before.  Signed up for MediCal with NAHC and made appointment to see doctor in January.

January (mid) 2014 - met with new Dr. Z at NAHC, did a bunch of tests, prescribed 25mg Zoloft (can’t remember why, exactly; I had forgotten when I was telling him about my previous meds that the Zoloft had been replaced by Lexapro), made follow-up appointment for March and recommended going to Sausal Creek for a psych evaluation.  Had difficulty remembering to take meds, and didn’t notice any change either good or bad in mood or health.

February (early) 2014 - fell into a deep depression, sadness and lethargy and increased joint pain; best friend helped me follow through on going to Sausal Creek for help, came with me and helped me with forms and remembering information.  Dr B (psychiatrist) prescribed increased Zoloft (50mg-100), on the principle that perhaps it would have better effect by itself instead of mixed with another antidepressant and mood stabilizer.  Was given info sheets for longer-term care providers and a chronic pain clinic; did not follow through on either.

March (late) 2014 - Stopped taking Zoloft, didn’t notice any benefit but some side effects (constipation, urethral resistance...was spending a lot of time on the toilet not managing to do anything), so didn’t refill when it ran out.

April (early) 2014 - Dr Z diagnoses fibromyalgia and prescribes Desipramine 100mg, as well as Lexapro 20mg for depression.  Desipramine worked great for pain but side-effects were too severe, stopped taking after four weeks.

June 2014 - noted intensified suicidal/cutting urges, difficulty getting to sleep, irritability and anxiety, and no relief of depression.  When meeting with Dr Z mid-month to follow up on fibromyalgia meds (prescribed Gabapentin 300mg in place of Desipramine), discussed whether the Lexapro was doing more harm than good; Dr OK’d stopping Lexapro but referred me to Pathways for medication management.  Discouraged too easily and did not follow through after getting bounced into ACCESS phone system.  Felt much better after starting Gabapentin and stopping Lexapro, slept well and more even-tempered for a while.  Started a class and was having a good time with it.

July 2014 - Joint pain flared up first week of July, missed a week of class, fell into a deep depression, and experienced frightening loss of impulse control, breaking my laptop in a fit of exasperation; over the weekend got worse, terrified of lashing out and hurting someone, even more afraid of hurting myself; best friend called Crisis Support Services for me on Sunday and conference-called with me and worker (TJ?)  Talked about safety plan and gave me phone numbers to call, and put in a referral for someone from ACCESS to call me on Monday.

Medication Summary

August 2005 - March 2007: Prozac (25mg?) & Depakote (100mg?)
March 2007 - August 2007: Prozac (50) & Lamictal (?)
August 2007 - November 2007: Prozac (75) & Abilify (?)
November 2007 - February 2009: Prozac (75) only
February 2009 - April 2009: Lithium (300) only
April 2009 - June 2010: Lithium (900) & Wellbutrin (100)
June 2010 - August 2010: Seroquel (75) & Wellbutrin (300)
August 2010 - April 2013: Seroquel (75) & Wellbutrin (200) & Zoloft (50)
April 2013 - October 2013: Seroquel (75) & Wellbutrin (200) & Lexapro (?)
October 2013 - December 2013: Wellbutrin & Lexapro
December 2013 - January 2014: no medication
January 7 2014 - Zoloft 20mg
February 2 2014 - Zoloft 100mg
April 2 2014 - Desipramine 100mg & Lexapro 20mg
May 5 2014 - Lexapro only
June 18 2014 - Gabapentin 300mg only
July 20ish - Gabapentin & Wellbutrin (300)

Friday, June 13, 2014

June Is Bustin' Out...

I decided last month that June is going to be a Start Over Month, and so far (nearly halfway through the month), I've managed to start all sorts of things, and have other projects in train. 

I met with my doctor this week and am having another change of medication.  When last I saw him, in early April, he put me on Desipramine for fibromyalgia and doubled the dose of Lexapro he already had me on for depression. 

I was very excited about the fibromyalgia diagnosis, it gave a name to something I've been talking to my Kaiser doctors about for years without getting any positive answers: they tested me for rheumatoid arthritis, osteoarthritis, lupus, low testosterone, half a dozen other things I can't remember, and everything came up negative; there is a test for fibromyalgia, but it's not widely used and is not conclusive, so I guess Kaiser doesn't keep it on the roster. 

Anyway, my new doctor listened to the symptoms, ran pretty much the same tests as I'd had before, and said it was most likely fibromyalgia... we might as well treat it as such, and if the treatment doesn't work, we'll know it wasn't that.  Why my Kaiser doctors couldn't think of something so simple... well, whatever.

So I started the Desipramine and doubled the Lexapro, but in retrospect I think I should have done them separately so I could see which side-effect went with which drug.  And boy, howdy, were there side-effects!  There were main-effects, as well, which made the question of whether or not I could stand the side-effects something of a quandary.

At first it went really well, within three days the pain was almost completely gone, I felt more energetic, and I was able to exercise every day without falling down half-dead at the end of a half-mile walk.  Also in those first three days, I slept really well, but for only five or six hours, and woke up refreshed and alert. 

On the negative side, I was sweating all the time, and my body temperature was permanently set one degree higher than usual.  And then the sexual side-effects started, I had trouble maintaining an erection, and when I did manage to get through to the end, the ejaculation stung a little bit, not too painfully but enough to kind of spoil the pleasure of orgasm.  But I figured I could live with that instead of the pain and exhaustion I've been living with.

After the first week, though, it got worse.  The first flush of sleep was still very deep, but much too short, I'd wake up after two or three hours and couldn't get back to sleep for another three or four hours; I was sleeping about five hours in twenty-four, in sets of two or three hours several hours apart, and spent a lot of time just lying awake in bed; and though I felt energetic, I also felt that sort of glassy, jittery feeling of sleep deprivation that I remember from my university days, like I'd stayed up two nights in a row writing papers at the last minute and taking final exams in between.  I tried taking the pills in the morning instead of at night, but then I was just groggy all day long; then I tried upping my melatonin, then resorting to Advil PM to sleep, but again no results except being groggy all day.

The sexual dysfunction got worse, too.  It wouldn't be so bad that I couldn't get off, since I only have myself to please and could do without frequent orgasms if necessary; but I was also completely obsessed with sexual thoughts and needed so badly to get off that I couldn't stand it, and then couldn't get off every time, but kept thinking about it and hunting for porn.  I was even having sexual thoughts and feelings of a most inappropriate nature, so inappropriate that I can't even admit to them in print.

Nevertheless, I gave the Desipramine a full four weeks to see if it worked itself out; then I finally just gave up and stopped taking it.  Another three days and the pain and exhaustion were back, but I could think about things other than sex, as well as come without pain, and I slept hours at a time, it was great!  I was still sweating profusely, soaking through my pillows every night and having to change my shirt all the time.  And I had a really hard time getting to sleep at night, though once I got to sleep I stayed asleep unless someone woke me up (which happens a lot nowadays, but that's a different story).

I did my best to continue the exercise regimen that is the key to fibromyalgia relief: you have to exercise a lot.  I was taking walks around the neighborhood, or taking extra walks when I was out running errands, but with the pain and exhaustion it was nothing like the daily practice I needed.  And I made a lot of plans, plans that I hoped would get me out of the house more often, give myself a bit of a schedule to stick to, and perhaps broaden my interest in life (more on that later).

Despite all this, I remained depressed more days than not; worse, I was dealing with a new degree of suicidal ideation that was very disturbing and painful: I had this incredible urge to cut myself, to make myself bleed.  It was like my blood itched, like my blood wanted to get out.  I have had urges to cut myself before, but these were so much stronger, so much more persistent, and lasted days on end instead of just a few minutes. And I was irritable, anxious, and angry quite a lot more than usual. 

It took me a while to realize that these things might be coming to me with the Lexapro, since I didn't experience these things when I started taking the stuff way back in January.  In the drama of the Desipramine, I actually forgot that I'd doubled my dose of Lexapro, and therefore needed to be aware of changes in my mood and thinking.  When I finally realized this, I examined what I could of my thinking and feelings and when they started, and came to believe that the doubled-up Lexapro was doing more harm than good.  Actually, aside from being more alert than before, it wasn't doing any good at all.

So when I talked to the good doctor this week, I shared this with him and he agreed that I should stop the Lexapro, and to try something else for the fibromyalgia: a gamma-Aminobutyric acid (GABA) analog called gabapentin (brand name Neurontin, by Pfizer).  The downside to this medication, in my doctor's opinion, is that it has to be taken on a schedule, three times a day at the same three times every day.  He knew I had a problem with remembering to take my pills every day, so really stressed how important this aspect of the treatment is.

Well, this was actually pretty fortuitous, I think: I was already looking at ways of structuring my life better.  I realized that a lot of my depressive symptoms have to do with not wanting to get out of bed, not wanting to do anything, and being bored out of my mind.  My life has become so small that's it's not comfortable to live in anymore.  And a lot of that is because I don't have anything much I have to do.  Having to take a pill at precise intervals, and having to get up at the same time every day to do it, is actually a blessing and dovetails perfectly with my other plans for the month.

The first plan that I made (last month) for this month was to take a class of some sort.  Grandmother recommended this to me when we got a flyer for Piedmont Adult School's community courses; I looked over the catalog but didn't find anything in there I wanted to learn, so I let the idea go.  Then I was talking to Caroline about some jewelry-making classes that she was thinking of taking at The Crucible, and the idea took root again; one day I was driving past College of Alameda, and decided I was going to take a class over the summer.

While I was reading through the Peralta Colleges Summer Schedules, however, I realized that I'd already taken most of the classes available.  I mean, I have a BA degree already, as well as three AA degrees, and spent a couple years farting around in community college after high school, years before I decided to pursue a degree.  Art classes, creative writing classes, language classes, history classes, I'd done it all.  Except oil painting!

I've never been even remotely interested in painting with oils or acrylics, I've always been a sketcher, using pencils and pen, sometimes pastels and charcoal.  I once took a class in watercolors, but I found it difficult to control the medium, and gave up on it pretty quickly; and of course I had extensive experience with tempera in high school, but it was the bright premixed colors one gets in school rather than the powder you mix yourself with water and egg-yolk, and I didn't think much of the stuff. 

I haven't drawn in ages, though, I've lost the knack as well as my interest in it, and haven't done more than doodle since I-can't-remember-when.  And last time I tried to draw a real picture, and more recently when I tried to hand-draw a floor plan, I realized that I've lost a lot of fine motor skill in my hands since the joint pain took over.  It simply hurt too much, and my hands shake a little, making the whole thing rather pointlessly difficult.

Oil paints, however, are so different a medium from pencils that I will be learning a brand-new skill rather than refining an existing skill, and brushes are a bit less fiddly and require less manual precision.  It might well be fun to learn to paint, and mix colors, and do different brush strokes, and all that jazz... and if I find out I'm no good at it, it might still be entertaining to dabble in.  I've never really pursued an activity that I wasn't naturally good at, so it'll be something of an experience.

Just signing up for the class, I felt a rush of interest in life, something exciting to look forward to, that made me feel better right away.  Not dancing-in-the-streets better, but a noticeable (if minor) improvement.  And hopefully, having somewhere to go four mornings a week for six weeks will make an even more notable improvement.  And if that works out, I might consider more classes in the fall, or maybe volunteering, or even a part-time job if it won't interfere with my eligibility for SSDI. 

The thing is to get up and out of the house regularly, rather than just when I have the strength for it... but not to take on too much at once, nor to take on something that I can't skip if I'm not feeling well.  An art class seems just the right thing.

Another plan is to finally accustom myself to wearing my dentures.  I haven't been wearing them for the last several months, I got so accustomed to not having them after my old set got lost and I had to go months without any teeth.  And eating with them in takes a lot of practice...and practice takes patience, and patience isn't one of my long suits these days.  I'd rather just get the food into my gullet without any fuss and fiddle.  They're also not very comfortable... not uncomfortable, either, just sort of annoying... like wearing a necktie, it doesn't hurt or anything, but I'd just rather wear a t-shirt.

Nevertheless, I have them, and I look better with them in, and I speak more clearly with them, so I need to wear them, at least when I go out.  All this month I've been wearing them for a couple of hours every few days, especially when I go out, and practicing eating when I come home so I can take them off and wash them.  The thing is that if the upper plate comes loose while I'm eating, which it often does, the food gets in between the plate and the palate so I can't get the denture back in place, and have to spit it out.  Not something you want to do in public.

I figure that if I can get used to putting them in and taking them out, and find some way of chewing without the upper plate coming loose, I can start wearing them every day like a normal person.  And maybe I'll even learn to smile with my lips apart, which I've never done in my whole life.

And finally, as I sit here writing all this after six months of non-blogging, I am participating in another bit of scheduling that I just decided to institute: I need to write every day.  When I was working, I always wrote something, even if only work-related emails, every single day; and at the same time I wrote a whole novel in less than a year.  The sequel has been coming in slower and slower increments since I quit working, and I think a lot of it is because I have simply not been forced to write, and so I get lazy about it and don't write, and then when I want to write it's difficult and slow. 

All established authors will tell you that the most important thing for a writer to do is to write every day, preferably on a more-or-less sacrosanct schedule of one to eight hours a day.  I'm not so ambitious to take on a big commitment of time, but I can commit to at least one hour of writing every day, be it a piece of the novel I'm working on, or notes for future novels and stories, or a blog post, or even just transcribing quotations or thoughts from books I'm reading.  I just have to write.

So now I'll get up every morning at seven, take a pill, go to class at ten, get home at three to take another pill and a nap, write for an hour or two, go about whatever business presents itself after that, take a last pill at eleven and so to bed. 

If all goes as planned, you'll be hearing more from me here in the near future.  Until then, here's some honey:

Sunday, January 5, 2014

Picture Post: Unexpected Content

I was looking for an ebook that I thought I'd downloaded, and found a bunch of images stored in My Kindle Content subdirectory, with no idea how they got there, and in some cases not sure why I downloaded them in the first place; it was kind of like finding a bag of new clothes in your closet.  Here they are (the 'sans peen' ones, anyway, 'cuz Swellegant ain't that kind of joint) for your viewing pleasure:


Now I'm going to go read that book I found.  Toodles!