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:

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