I tried. I really did. I took the various pills in the various ways prescribed and tried six ways of taking them to minimize side effects, but in the end the Wet Grey Blanket of Blah got to me anyhow.
Chef Boy looked concerned enough about my staring, unsmiling, out the window that I finally gave up and called the brain doc today. Normally I prefer to tough side effects out, but this time...so, anyway. I called.
And the response was not what I'd expected. The response I'd expected was "Stay on the meds for a few days more and see if you feel better." What I got was "Woh. Gah! Um, best start back on your original dosage, okay? And call me back in a week."
So I'm back to taking lotsa Effexor. Which is okay; as I said before, I can deal with the hunger and sleepiness side effects so long as I'm sane. This past two weeks, I've been neither hungry nor sleepy, but it's because I've been totally unenergized and not willing to move.
Brain Guy says it'll be a few days before my mood is back up to speed, though my memory and coordination should improve faster. Which will be a relief; I've felt like an early-stage Alzheimer's patient for the last four days, unable to remember what I had for breakfast. And don't even talk to me about the coordination problems.
So. The saga will continue, I'm sure. For now, though, it'll be nice just to approach within spitting distance of normal again.
Monday, January 29, 2007
Sunday, January 28, 2007
What I do on my day off...*
I must read up on legal issues in neuroscience nursing. The article's been sittng on my computer, bookmarked, for three weeks. I wonder if it covers the legal ramifications of bonking stupid family members in the head.
Gotta make a cake for work. I make a mean pie, too, but they only want cake. Cue Madame Antoinette.
When I opened the kitchen cabinet today to get the cat food out, about a gazillion plastic containers landed on the cat. Gotta clean that out, too.
While I'm at it, I suppose I ought to sort out Books I'm Done Reading from Books I'm Still Working On. They're all piled together on a table.
Speaking of which, I need a decent chairside table for the living room.
And my sock drawer is a mess.
And the cat needs to be Furminated.
Maybe I ought just to suck it up and go to Target rather than to my usual grocery store.
I wonder what size filters my air conditioner takes.
Oh, and I need to drop off that lease agreement at the apartment office.
What's in the dryer?
*These ruminations and plans to catch up with life brought to you by Wellbutrin XR, 150 mg.
Gotta make a cake for work. I make a mean pie, too, but they only want cake. Cue Madame Antoinette.
When I opened the kitchen cabinet today to get the cat food out, about a gazillion plastic containers landed on the cat. Gotta clean that out, too.
While I'm at it, I suppose I ought to sort out Books I'm Done Reading from Books I'm Still Working On. They're all piled together on a table.
Speaking of which, I need a decent chairside table for the living room.
And my sock drawer is a mess.
And the cat needs to be Furminated.
Maybe I ought just to suck it up and go to Target rather than to my usual grocery store.
I wonder what size filters my air conditioner takes.
Oh, and I need to drop off that lease agreement at the apartment office.
What's in the dryer?
*These ruminations and plans to catch up with life brought to you by Wellbutrin XR, 150 mg.
Saturday, January 27, 2007
Local Shopper Nearly Dies At Health Food Store. Details At Eleven.
Holeeee shit.
Take a medium-sized town. Sprinkle a couple of universities in it, then imbue it with a thriving art and music scene. Populate it with hippies young and old, the sort who know who Aldo Leopold was and work summers at Sprout Farm. And, like, live in ferrocement domes. Dude.
Then put it thirty miles away over dangerous highways from the nearest Whole Foods Market.
You can then imagine what my time today at the health food store was like.
Worse, the HFS was having its annual customer-wonderfulness weekend, with 15 to 50 percent off everything in the store. I thought Wal-Mart was bad the day before Christmas; this was miles beyond that.
I got out of there with the blocks of Callebaut I'd gone for, a bottle of vitamins, some Pellegrino, and my sanity. Just barely. A few steps out of the store, I turned wide-eyed and speechless to a man wearing a Vietnam Veterans cap. "My wife was acting like we shoulda got here at four a.m. and stood on line" he said. "Maybe we shoulda."
Take a medium-sized town. Sprinkle a couple of universities in it, then imbue it with a thriving art and music scene. Populate it with hippies young and old, the sort who know who Aldo Leopold was and work summers at Sprout Farm. And, like, live in ferrocement domes. Dude.
Then put it thirty miles away over dangerous highways from the nearest Whole Foods Market.
You can then imagine what my time today at the health food store was like.
Worse, the HFS was having its annual customer-wonderfulness weekend, with 15 to 50 percent off everything in the store. I thought Wal-Mart was bad the day before Christmas; this was miles beyond that.
I got out of there with the blocks of Callebaut I'd gone for, a bottle of vitamins, some Pellegrino, and my sanity. Just barely. A few steps out of the store, I turned wide-eyed and speechless to a man wearing a Vietnam Veterans cap. "My wife was acting like we shoulda got here at four a.m. and stood on line" he said. "Maybe we shoulda."
Friday, January 26, 2007
Things Not To Ask The Nurse, Volume One Gazillion
....but first things first. Change of Shift is up here.
So. Mama's been in the hospital now for months with something nobody can identify, and it's not looking good. Right now we're betting on either some sort of wasting disease like CJD or a particularly rare diffuse glioma.
I knew I'd have problems when, weeks ago, I met Sonny for the first time and he said, "If you should happen to make a mistake mixing medicines, I'm not going to mind."
Er.
Okay.
This is the fourth hospital Mama's been in. She's had various bits and pieces taken out and put in in an attempt to fix whatever the hell is wrong; she finally ended up with us when it became apparent that the taking-out and putting-in wasn't working. That's how it always goes: months after you might expect a diagnosis, or at least a stinkin' brain biopsy, a very sick person lands in one of our beds, a testament to other people's inability to know when to say "stop".
Well, Sonny wants to say "stop." Papa, not so much--he's convinced that a little full-brain radiation and a few drugs and hey, presto! Mama will sit up and ask for a Coke. That's not gonna happen, barring the sort of miracle that seems only to have happened a few thousand years ago.
So Sonny's been dropping little hints here and there. "How long would Mama live if we unplugged everything?" Days to weeks. "What's the most likely thing to kill her?" Pneumonia, but we're treating that.
Finally, Sonny asked me point-blank yesterday how much morphine, exactly, I would have to give Mama to slow her breathing down to the point that it got the job done.
"More than I could ever manage to get or to give" I replied. Then I pointed out to him that putting the metaphorical pillow over Mama's face wouldn't do him any good anyhow; she's a full code, so even if she stopped breathing, we'd bring her back and it'd just be more of the same.
The ironic thing is this: over two months ago, when Mama landed on our doorstep, she and I had a conversation. (This was when she was still able to talk and make sense.) She was strongly pro-euthanasia for herself, should she ever get to the point where (and here she was explicit) she was fed through a tube, was in danger of developing bedsores, and couldn't speak.
Check, check, and check. Unfortunately, Mama discussed these issues with the nurse and not with her family.
Our hospital's in a really, really bad neighborhood. Pretty much anything you want can be found within a few blocks of the parking lot, be it whores or crack or opiates. I'm wondering how dedicated Sonny actually is.
In the meantime, I've talked to both attendings and the DON on the quiet. Papa knows nothing of this. I've referred the problem off to the ethics committee and to the chaplains. Then I requested that I not be assigned to that patient again for at least a week. Then I went back and made double-damn sure *everything* was charted. Including my refusal to give morphine or other sedatives to Mama because Papa refused them.
If Mama died peacefully in the night some night after Papa went home--Sonny stays every night on a rollaway bed--I would not be surprised. Nor would I be surprised if she were dead long enough before discovery that she couldn't be coded. Nor would I be surprised if, on autopsy, opiates were found in her bloodstream.
They won't be *my* opiates, is all I can say.
So. Mama's been in the hospital now for months with something nobody can identify, and it's not looking good. Right now we're betting on either some sort of wasting disease like CJD or a particularly rare diffuse glioma.
I knew I'd have problems when, weeks ago, I met Sonny for the first time and he said, "If you should happen to make a mistake mixing medicines, I'm not going to mind."
Er.
Okay.
This is the fourth hospital Mama's been in. She's had various bits and pieces taken out and put in in an attempt to fix whatever the hell is wrong; she finally ended up with us when it became apparent that the taking-out and putting-in wasn't working. That's how it always goes: months after you might expect a diagnosis, or at least a stinkin' brain biopsy, a very sick person lands in one of our beds, a testament to other people's inability to know when to say "stop".
Well, Sonny wants to say "stop." Papa, not so much--he's convinced that a little full-brain radiation and a few drugs and hey, presto! Mama will sit up and ask for a Coke. That's not gonna happen, barring the sort of miracle that seems only to have happened a few thousand years ago.
So Sonny's been dropping little hints here and there. "How long would Mama live if we unplugged everything?" Days to weeks. "What's the most likely thing to kill her?" Pneumonia, but we're treating that.
Finally, Sonny asked me point-blank yesterday how much morphine, exactly, I would have to give Mama to slow her breathing down to the point that it got the job done.
"More than I could ever manage to get or to give" I replied. Then I pointed out to him that putting the metaphorical pillow over Mama's face wouldn't do him any good anyhow; she's a full code, so even if she stopped breathing, we'd bring her back and it'd just be more of the same.
The ironic thing is this: over two months ago, when Mama landed on our doorstep, she and I had a conversation. (This was when she was still able to talk and make sense.) She was strongly pro-euthanasia for herself, should she ever get to the point where (and here she was explicit) she was fed through a tube, was in danger of developing bedsores, and couldn't speak.
Check, check, and check. Unfortunately, Mama discussed these issues with the nurse and not with her family.
Our hospital's in a really, really bad neighborhood. Pretty much anything you want can be found within a few blocks of the parking lot, be it whores or crack or opiates. I'm wondering how dedicated Sonny actually is.
In the meantime, I've talked to both attendings and the DON on the quiet. Papa knows nothing of this. I've referred the problem off to the ethics committee and to the chaplains. Then I requested that I not be assigned to that patient again for at least a week. Then I went back and made double-damn sure *everything* was charted. Including my refusal to give morphine or other sedatives to Mama because Papa refused them.
If Mama died peacefully in the night some night after Papa went home--Sonny stays every night on a rollaway bed--I would not be surprised. Nor would I be surprised if she were dead long enough before discovery that she couldn't be coded. Nor would I be surprised if, on autopsy, opiates were found in her bloodstream.
They won't be *my* opiates, is all I can say.
Thursday, January 25, 2007
So, this sloth in Germany.
You know, Mats. The sloth that was part of a study on how animals move? Yeah, that one. He was supposed to climb up a pole and then back his way down the pole so that researchers could figure out how sloths back down things.
Well, he refused to comply. For three years.
So the researchers sent him off to a zoo, where he can live in slothful glory for the rest of his days.
That's not the point, though. The point is this: every story I read about Mats said that he refused to climb backward down the pole *even when tempted with spaghetti, his favorite treat.*
Who the hell figured out that sloths (or at least this sloth) like spaghetti? Does Mats like a light tomato-based sauce with plenty of basil, or does he prefer a creamy sauce with clams and capers? How does Mats feel about anchovies? Can sloths tell the difference between hand-grated Parmesan and the stuff out of the can? Where do they stand on green peppers in the sauce? Do they like linguine better than cappellini?
The mind reels.
Well, he refused to comply. For three years.
So the researchers sent him off to a zoo, where he can live in slothful glory for the rest of his days.
That's not the point, though. The point is this: every story I read about Mats said that he refused to climb backward down the pole *even when tempted with spaghetti, his favorite treat.*
Who the hell figured out that sloths (or at least this sloth) like spaghetti? Does Mats like a light tomato-based sauce with plenty of basil, or does he prefer a creamy sauce with clams and capers? How does Mats feel about anchovies? Can sloths tell the difference between hand-grated Parmesan and the stuff out of the can? Where do they stand on green peppers in the sauce? Do they like linguine better than cappellini?
The mind reels.
Wednesday, January 24, 2007
I am a miserable ovoid creature.
Well, not really. Not so much.
Tomorrow I start the 75 milligram-Effexor-plus-Wellbutrin thing. The taper has been bearable so far, though I went a bit faster than was probably necessary (or advisable) just because I fucking hate counting out little bitty pellets and scraping the remainder into a gel capsule. I've had a few shocks here and there--the parasthesias that are so common with tapers and discontinuation--but aside from one hour yesterday, they've been okay.
Barely.
Working out helps. Lots and lots of carbs, in the form of everything from potatoes to beer to broccoli, helps. Bach and Lyle Lovett and Cute Overload help. Chef Boy's baffled but open-minded sympathy is invaluable.
And my boss, when I said, "Look, I'm temporarily nuts right now" said, "You go ahead and be nuts; if you have to call in, it's not going to be a problem." First sign of humanity I've seen in six months.
All in all, this has been...okay. I mean, the parasthesias and the sleepiness and confusion are better than the constant hunger I had on 150 mg. of Effexor. The vaguely blah mood has been harder to deal with, but it's still better than the best day I had when I was depressed. I'm partly cloudy, with occasional periods of What The Fuck, but it's still workable.
Y'know, the hardest thing to deal with when you're a freshly-diagnosed or freshly-re-medicated depressive is this: You will have to do this for The Rest Of Your Life. Santa ain't gonna put normal brain chemistry into your stocking some Christmas. We are all stuck with the brains we have; some require more tweaking than others, and it's the thought of tweaking at intervals until I'm dead that daunts me.
But tweaking is better than depressed. Depressed is boring as hell; tweaking at least is interesting.
Side effects suck, too. I mean, I'm 40 pounds heavier than when I started this whole shebang; just tapering from 150 to 137.5 mg of Effexor showed me that the antidepressant is mostly to blame. My appetite is gone.
But side effects suck less than being depressed. Having no interest in anything outside your bed is much, much worse than having no interest in food.
The hardest thing to handle on a social level is other people's reaction to the news that yes, I'm a little off-balance, but that's because I have my fingers in my own brain just now. My trainer has been baffled but sympathetic, the two coworkers I really trust have been fantastic. Still, it's something I feel I *ought* to be ashamed of, being depressed.
But feeling antsy about revealing why I'm weirder than usual is so, so, *so* much better than working hard to not lose it in normal social situations.
In sum, I would say this: I was terrified of losing my security blanket, that blanket being Effexor in the dose I was taking, with all its attendant problems. (The hunger was not so bad when compared to the sudden spikes in blood pressure that could've caused me to stroke.) My shrink (God, that's a weird thing to say, "my shrink") pointed out that fear of a known pain is totally rational, and that he didn't blame me for not wanting to go back.
That terror was unfounded. I may be unusual, but I am not doing so badly, cutting down on antidepressants. I have great hope for the future, in that I will be a normal, happyish person who will not get barred from all-you-can-eat buffets.
I am going to be okay. Despite having brain chemistry that's whacked out right now, I really believe that. And that's a nice adjunct to four years of antidepressant therapy.
Tomorrow I start the 75 milligram-Effexor-plus-Wellbutrin thing. The taper has been bearable so far, though I went a bit faster than was probably necessary (or advisable) just because I fucking hate counting out little bitty pellets and scraping the remainder into a gel capsule. I've had a few shocks here and there--the parasthesias that are so common with tapers and discontinuation--but aside from one hour yesterday, they've been okay.
Barely.
Working out helps. Lots and lots of carbs, in the form of everything from potatoes to beer to broccoli, helps. Bach and Lyle Lovett and Cute Overload help. Chef Boy's baffled but open-minded sympathy is invaluable.
And my boss, when I said, "Look, I'm temporarily nuts right now" said, "You go ahead and be nuts; if you have to call in, it's not going to be a problem." First sign of humanity I've seen in six months.
All in all, this has been...okay. I mean, the parasthesias and the sleepiness and confusion are better than the constant hunger I had on 150 mg. of Effexor. The vaguely blah mood has been harder to deal with, but it's still better than the best day I had when I was depressed. I'm partly cloudy, with occasional periods of What The Fuck, but it's still workable.
Y'know, the hardest thing to deal with when you're a freshly-diagnosed or freshly-re-medicated depressive is this: You will have to do this for The Rest Of Your Life. Santa ain't gonna put normal brain chemistry into your stocking some Christmas. We are all stuck with the brains we have; some require more tweaking than others, and it's the thought of tweaking at intervals until I'm dead that daunts me.
But tweaking is better than depressed. Depressed is boring as hell; tweaking at least is interesting.
Side effects suck, too. I mean, I'm 40 pounds heavier than when I started this whole shebang; just tapering from 150 to 137.5 mg of Effexor showed me that the antidepressant is mostly to blame. My appetite is gone.
But side effects suck less than being depressed. Having no interest in anything outside your bed is much, much worse than having no interest in food.
The hardest thing to handle on a social level is other people's reaction to the news that yes, I'm a little off-balance, but that's because I have my fingers in my own brain just now. My trainer has been baffled but sympathetic, the two coworkers I really trust have been fantastic. Still, it's something I feel I *ought* to be ashamed of, being depressed.
But feeling antsy about revealing why I'm weirder than usual is so, so, *so* much better than working hard to not lose it in normal social situations.
In sum, I would say this: I was terrified of losing my security blanket, that blanket being Effexor in the dose I was taking, with all its attendant problems. (The hunger was not so bad when compared to the sudden spikes in blood pressure that could've caused me to stroke.) My shrink (God, that's a weird thing to say, "my shrink") pointed out that fear of a known pain is totally rational, and that he didn't blame me for not wanting to go back.
That terror was unfounded. I may be unusual, but I am not doing so badly, cutting down on antidepressants. I have great hope for the future, in that I will be a normal, happyish person who will not get barred from all-you-can-eat buffets.
I am going to be okay. Despite having brain chemistry that's whacked out right now, I really believe that. And that's a nice adjunct to four years of antidepressant therapy.
Monday, January 22, 2007
Trust me to get a bizarre side effect.
My brain's map of my body has gone totally cattywampus.
I'm on day four of my slow, careful taper.
Last night I went to bed my usual self; in other words, I was five-two and about 175 pounds.
This morning I am at least five-seven and skinny. And flat-chested.
Oh, and my arms are each about eight feet long. And my joints have been oiled with WD-40, so they're very loose.
It's weird, but not unpleasant. And having eight-foot-long arms sure makes it easier to get a fresh cup of coffee without leaving the couch.
I'm on day four of my slow, careful taper.
Last night I went to bed my usual self; in other words, I was five-two and about 175 pounds.
This morning I am at least five-seven and skinny. And flat-chested.
Oh, and my arms are each about eight feet long. And my joints have been oiled with WD-40, so they're very loose.
It's weird, but not unpleasant. And having eight-foot-long arms sure makes it easier to get a fresh cup of coffee without leaving the couch.
Sunday, January 21, 2007
In The Room
(An excerpt from a poem by James Thomson)
And while the black night nothing saw,
And till the cold morn came at last,
The old bed held the room in awe
With tales of its experience vast.
It thrilled the gloom; it told such tales
Of human sorrows and delights
Of fever moans and infant wails,
Of births and deaths and bridal nights.
Of Births
She was young--25--and female--and pregnant. Statistically, the last person you'd expect to be diagnosed with a glioblastoma. She was six months pregnant when the diagnosis came.
Gamma knife radiation was very carefully undertaken, with lead shields for both the operators and the fetus. Chemo and other standard treatments were out of the question; we had a baby to protect.
She held her daughter and breastfed her a few times before she became unresponsive and started seizing. Her daughter came to see us today, along with her father. She's a beautiful baby; barely two months old with a head of dark, curly hair and the biggest, roundest brown eyes you'd ever want to see.
And Deaths
Before that was the woman with inoperable metastatic cancer. We all expected her to live a week; after all, her family had asked that fluids be provided via an intravenous line, and the oxygen was going full-blast.
And Bridal Nights
This happened a few years ago. She had been planning their wedding when she had a horrible bleed, a class IV, just a few weeks before the day.
We kept her for two months. She had a stomach tube and a tracheostomy tube and other tubes running here and there to maintain some semblance of dignity.
Eventually she got transferred to the neuro rehab unit. Nobody could understand why she couldn't speak or respond until one bright nurse realized that her bleed had destroyed her hearing.
So she got hearing aids. And one of our nurses who's handy with a sewing machine altered her wedding gown to fit her thinner frame. And another nurse who's good with flowers brought armloads she'd grown herself. And the chaplain volunteered her services.
So, six months after her original wedding date, our patient walked down an aisle in the tiny chapel in the basement, wearing a gown tailored to disguise her feeding tube. Sure, she walked with a walker, but her groom had tears in his eyes all the same. We were all there. The patient and her family were kind enough to invite us, and to hold the ceremony during our working hours.
"I know what is and what has been;
Not anything to me comes strange,
Who in so many years have seen
And lived through every kind of change.
I know when men are good or bad,
When well or ill," he slowly said;
"When sad or glad, when sane or mad,
And when they sleep alive or dead."
And while the black night nothing saw,
And till the cold morn came at last,
The old bed held the room in awe
With tales of its experience vast.
It thrilled the gloom; it told such tales
Of human sorrows and delights
Of fever moans and infant wails,
Of births and deaths and bridal nights.
Of Births
She was young--25--and female--and pregnant. Statistically, the last person you'd expect to be diagnosed with a glioblastoma. She was six months pregnant when the diagnosis came.
Gamma knife radiation was very carefully undertaken, with lead shields for both the operators and the fetus. Chemo and other standard treatments were out of the question; we had a baby to protect.
She held her daughter and breastfed her a few times before she became unresponsive and started seizing. Her daughter came to see us today, along with her father. She's a beautiful baby; barely two months old with a head of dark, curly hair and the biggest, roundest brown eyes you'd ever want to see.
And Deaths
Before that was the woman with inoperable metastatic cancer. We all expected her to live a week; after all, her family had asked that fluids be provided via an intravenous line, and the oxygen was going full-blast.
And Bridal Nights
This happened a few years ago. She had been planning their wedding when she had a horrible bleed, a class IV, just a few weeks before the day.
We kept her for two months. She had a stomach tube and a tracheostomy tube and other tubes running here and there to maintain some semblance of dignity.
Eventually she got transferred to the neuro rehab unit. Nobody could understand why she couldn't speak or respond until one bright nurse realized that her bleed had destroyed her hearing.
So she got hearing aids. And one of our nurses who's handy with a sewing machine altered her wedding gown to fit her thinner frame. And another nurse who's good with flowers brought armloads she'd grown herself. And the chaplain volunteered her services.
So, six months after her original wedding date, our patient walked down an aisle in the tiny chapel in the basement, wearing a gown tailored to disguise her feeding tube. Sure, she walked with a walker, but her groom had tears in his eyes all the same. We were all there. The patient and her family were kind enough to invite us, and to hold the ceremony during our working hours.
"I know what is and what has been;
Not anything to me comes strange,
Who in so many years have seen
And lived through every kind of change.
I know when men are good or bad,
When well or ill," he slowly said;
"When sad or glad, when sane or mad,
And when they sleep alive or dead."
Saturday, January 20, 2007
People, relax.
I'm tapering the Effexor dose very slowly. As in, I'll probably be off of it by about 2018 or thereabouts. Or at least, that's how it feels right now.
Nobody panic. I promise I won't lose it.
Just had to reiterate that point. Seems a lot of folks misread, or I mistyped and gave the impression that I was dropping my dose in half immediately.
I'm going to go nurse this incipient head cold now.
Nobody panic. I promise I won't lose it.
Just had to reiterate that point. Seems a lot of folks misread, or I mistyped and gave the impression that I was dropping my dose in half immediately.
I'm going to go nurse this incipient head cold now.
Thursday, January 18, 2007
Who am us? Us am PAPOON!
Because Us Am NOT INSANE!*
I saw the Brain Doctor today. He was youngish and rumpled and bespectacled and goateed, like he'd come from Central Casting. He listened to my two main reasons for visiting him (1. My Other Doctor Is A Noodlehead; 2. J'ai faim toujours) and asked a few careful questions.
When he'd established that My Other Doctor had upped the dosage of my antidepressants without first checking six other things, and that MOD had decided I was bipolar on the basis of a misread chart, his polite and careful questioning gave way to an enormous eyeroll. The hunger side effect of Effexor was one he hadn't seen before personally, but one he wouldn't be surprised by. The sleepiness thing made him nod and jot a couple of notes down on a pad. Then he made the following recommendations:
1. I am not bipolar. I think I said something like "Well, *duh*" at that point.
2. That I taper the dose of Effexor I'm taking very, very slowly and carefully (the story of the missed-dose side-effects made him sit up and say "Woh." Just like that.) and supplement if necessary with Wellbutrin.
3. That I get various levels of various things tested, like my thyroid level. I suspect I'm not hypothyroid, but he wants to rule it out anyhow. If it turns out I'm not hypothyroid but I still want to try augmenting the Effexor with thyroid hormone, we can give it a shot. He assures me there's precedent for this. Um, okay. I'm more inclined to trust him than Mister Doctor You're Bipolar.
4. That if I hate the Effexor taper or the Wellbutrin augmentation or anything else about the process, I call him right away and let him know so he can do some hand-waving and dose-adjusting and we'll go from there.
I'm inclined to be optomistic. First off, the guy may be a brain doctor with a schwanky office in a nice part of town, but he's a bit off-kilter. He broke off in the middle of an explanation of something-or-other to do a double-take at the window and then say, "It's *raining*" in a disappointed voice, as though I'd turned down a plate of his own home-made cookies. "It wasn't supposed to do *that*," he persisted. I liked that immediately.
Second, he's more than willing to entertain the idea that I might be super-duper sensitive to the brain chemicals I'm ingesting and therefore ought to be able to taper them the way I feel is fit.
Third, The Eyeroll. I knew there was some eye-roll-deserving stuff going on with Other Doctor, but I didn't realize how eye-rolly it really was.
Fourth, his reaction to my description of my family was, "So...you're all a little weird, right?" Right.
So I begin tapering Effexor from 150 to 75 tonight. (Cue suspenseful music.) (Note: I will be doing this very, very, very slowly and carefully. Don't anybody fret.)
I can't thank you guys enough. The first time I posted about being a nutcase, more people than I thought read the blog came out of the woodwork to offer support and advice. The second time, when I asked specifically for help and ideas, you guys burned up the email and the comment boxes helping me out.
It's touching and heartening to know that people are so open to advising even poor-to-middlin' writers. I'll keep updates coming.
*These obscure references brought to you by Jo's Obscure Reference and Piano-Tuning Service.
I saw the Brain Doctor today. He was youngish and rumpled and bespectacled and goateed, like he'd come from Central Casting. He listened to my two main reasons for visiting him (1. My Other Doctor Is A Noodlehead; 2. J'ai faim toujours) and asked a few careful questions.
When he'd established that My Other Doctor had upped the dosage of my antidepressants without first checking six other things, and that MOD had decided I was bipolar on the basis of a misread chart, his polite and careful questioning gave way to an enormous eyeroll. The hunger side effect of Effexor was one he hadn't seen before personally, but one he wouldn't be surprised by. The sleepiness thing made him nod and jot a couple of notes down on a pad. Then he made the following recommendations:
1. I am not bipolar. I think I said something like "Well, *duh*" at that point.
2. That I taper the dose of Effexor I'm taking very, very slowly and carefully (the story of the missed-dose side-effects made him sit up and say "Woh." Just like that.) and supplement if necessary with Wellbutrin.
3. That I get various levels of various things tested, like my thyroid level. I suspect I'm not hypothyroid, but he wants to rule it out anyhow. If it turns out I'm not hypothyroid but I still want to try augmenting the Effexor with thyroid hormone, we can give it a shot. He assures me there's precedent for this. Um, okay. I'm more inclined to trust him than Mister Doctor You're Bipolar.
4. That if I hate the Effexor taper or the Wellbutrin augmentation or anything else about the process, I call him right away and let him know so he can do some hand-waving and dose-adjusting and we'll go from there.
I'm inclined to be optomistic. First off, the guy may be a brain doctor with a schwanky office in a nice part of town, but he's a bit off-kilter. He broke off in the middle of an explanation of something-or-other to do a double-take at the window and then say, "It's *raining*" in a disappointed voice, as though I'd turned down a plate of his own home-made cookies. "It wasn't supposed to do *that*," he persisted. I liked that immediately.
Second, he's more than willing to entertain the idea that I might be super-duper sensitive to the brain chemicals I'm ingesting and therefore ought to be able to taper them the way I feel is fit.
Third, The Eyeroll. I knew there was some eye-roll-deserving stuff going on with Other Doctor, but I didn't realize how eye-rolly it really was.
Fourth, his reaction to my description of my family was, "So...you're all a little weird, right?" Right.
So I begin tapering Effexor from 150 to 75 tonight. (Cue suspenseful music.) (Note: I will be doing this very, very, very slowly and carefully. Don't anybody fret.)
I can't thank you guys enough. The first time I posted about being a nutcase, more people than I thought read the blog came out of the woodwork to offer support and advice. The second time, when I asked specifically for help and ideas, you guys burned up the email and the comment boxes helping me out.
It's touching and heartening to know that people are so open to advising even poor-to-middlin' writers. I'll keep updates coming.
*These obscure references brought to you by Jo's Obscure Reference and Piano-Tuning Service.
Sunday, January 14, 2007
Whoops. That'll take some 'splaining.
The latest issue of the Journal of Neuroscience Nursing reminded me of something.
There's an article in this issue about the possibility that Al Capone, who suffered from some interesting psychological pathologies (putting it gently), may have had neurosyphilis. The authors cite his bed-making habits and megalomania, among other things I don't recall because I haven't read the article carefully yet; only skimmed it.
Anyway, we had a little situation some time ago at the hospital.
A very nice couple had come in. They'd been married for donkey's years, had kids all in their forties, and had had a pretty good life...until the husband started manifesting some signs of dementia. His memory had gotten poor, his gait ataxic, and he was beginning to be incontinent. His primary care doc had sent him to us, thinking that there was a chance he had normal pressure hydrocephalus that could be controlled with a shunt.
So neurosurgery put in a lumbar drain (for the non-medical types, it's a drain that goes into the small of your back through which we can drain off cerebrospinal fluid and reduce the pressure in the brain) and drained it religiously for a few days, every four hours. Physical therapy and neuropsych came in and administered a battery of tests, both before and after, to see if there was any improvement after draining.
No go. As it is in the majority of cases we see, the dementia is due to something else. So neurology came in and started running a battery of tests to determine what, exactly that something else was.
It's basic practice to run a test for syphilis early on, just as it is to run tests for HIV and a number of other, less common things. We'd only had one syphilis serology come back positive before, so nobody was expecting that.
Especially not the patient or his wife.
Sammy the neurosurgery resident wandered into the nurses' station, looking for me. I'd had care of the patient for two weeks, off and on, and Sammy was wanting some moral support when he went into the room to tell the patient and his wife that the cause of his dementia was a bad decision he'd made probably twenty or thirty years prior.
Syphilis, you see, is a tricky little bug. It's a bacterium that can be easily cured with high doses of antibiotics administered in a certain way over a certain time frame, but if it's not cured, it tends to hide out in the body. Over time, it can cause things like weird lumps in joints, strange rashes that come and go, and eventually (if you're one of the roughly thirty percent of people who's unlucky) neurological complications. Or cardiac complications. Or bits of your face--though this is increasingly rare--can begin to fall off. Most people catch it and get treatment fairly early, though Oliver Sacks recorded a case of a woman who developed neurosyphilis seventy years after her infection.
Apparently our man had had a little fling, or had visited a prostitute, or had somehow otherwise put himself in a position to catch this particular spirochete. And he'd done it long enough ago that he'd probably thought he'd gotten away cold. His wife's reaction was such that it was unlikely he'd ever confessed to his indiscretion.
Poor resident Sammy had to break the news. I went in as multiple moral support person, and afterwards we had a cup of coffee. There are some things you just would rather not remember much of after the fact; that half-hour in the patient's room was one of them.
I don't remember what happened to that couple. I know he was treated, but there was no way we could reverse the damage that had been done. I know she was referred to the state health department for treatment. I know there was icy silence from that room from the time Sammy and I walked out until the time they were discharged. But after that? He probably had some 'splaining to do.
There's an article in this issue about the possibility that Al Capone, who suffered from some interesting psychological pathologies (putting it gently), may have had neurosyphilis. The authors cite his bed-making habits and megalomania, among other things I don't recall because I haven't read the article carefully yet; only skimmed it.
Anyway, we had a little situation some time ago at the hospital.
A very nice couple had come in. They'd been married for donkey's years, had kids all in their forties, and had had a pretty good life...until the husband started manifesting some signs of dementia. His memory had gotten poor, his gait ataxic, and he was beginning to be incontinent. His primary care doc had sent him to us, thinking that there was a chance he had normal pressure hydrocephalus that could be controlled with a shunt.
So neurosurgery put in a lumbar drain (for the non-medical types, it's a drain that goes into the small of your back through which we can drain off cerebrospinal fluid and reduce the pressure in the brain) and drained it religiously for a few days, every four hours. Physical therapy and neuropsych came in and administered a battery of tests, both before and after, to see if there was any improvement after draining.
No go. As it is in the majority of cases we see, the dementia is due to something else. So neurology came in and started running a battery of tests to determine what, exactly that something else was.
It's basic practice to run a test for syphilis early on, just as it is to run tests for HIV and a number of other, less common things. We'd only had one syphilis serology come back positive before, so nobody was expecting that.
Especially not the patient or his wife.
Sammy the neurosurgery resident wandered into the nurses' station, looking for me. I'd had care of the patient for two weeks, off and on, and Sammy was wanting some moral support when he went into the room to tell the patient and his wife that the cause of his dementia was a bad decision he'd made probably twenty or thirty years prior.
Syphilis, you see, is a tricky little bug. It's a bacterium that can be easily cured with high doses of antibiotics administered in a certain way over a certain time frame, but if it's not cured, it tends to hide out in the body. Over time, it can cause things like weird lumps in joints, strange rashes that come and go, and eventually (if you're one of the roughly thirty percent of people who's unlucky) neurological complications. Or cardiac complications. Or bits of your face--though this is increasingly rare--can begin to fall off. Most people catch it and get treatment fairly early, though Oliver Sacks recorded a case of a woman who developed neurosyphilis seventy years after her infection.
Apparently our man had had a little fling, or had visited a prostitute, or had somehow otherwise put himself in a position to catch this particular spirochete. And he'd done it long enough ago that he'd probably thought he'd gotten away cold. His wife's reaction was such that it was unlikely he'd ever confessed to his indiscretion.
Poor resident Sammy had to break the news. I went in as multiple moral support person, and afterwards we had a cup of coffee. There are some things you just would rather not remember much of after the fact; that half-hour in the patient's room was one of them.
I don't remember what happened to that couple. I know he was treated, but there was no way we could reverse the damage that had been done. I know she was referred to the state health department for treatment. I know there was icy silence from that room from the time Sammy and I walked out until the time they were discharged. But after that? He probably had some 'splaining to do.
Thursday, January 11, 2007
Unrestrained Cat.
My mom and dad planned to drive thirty-five-hundred-some-odd miles from Seattle to Mexico with their cat. They planned to do so with the cat not in a carrier or behind some sort of grille, but unrestrained in the vehicle.
"Dad", I said, "Do you think that's a good idea? Because I think it's spectacularly bad."
"Some cats like to ride in cars*" was his reply.
Never mind what universe Dad hails from; the phrase "Unrestrained Cat" has come to signify, for Chef Boy and me, a wheels-off moment that lingers or a day so bad that no amount of Knob Creek will take the taste out of your mouth.
I yelled at my Big Boss.
More to the point, I carved her an entirely new alimentary canal, from tonsils to asshole.
We all know That Nurse. You would recognize That Nurse if you saw her; she's busy either talking incessantly about her latest date or surfing the Web on the hospital computers while her patients call repeatedly on the intercom. She's the one who doesn't open charts until fifteen minutes before the end of shift and who holds up report because, even after ten years on the job, she still hasn't learned to report concisely.
I had to charge a few weeks ago with That Nurse on staff. I redirected her as best I could and kept her busy the best way I knew how. It didn't sit well with her, so she complained to my boss.
Who called me in to gripe at me for being mean to That Nurse.
I'm not ashamed to say that I completely lost it for a good two and a half minutes. "You mean to say, " I began, "that I get here early, get out of report first, stay late, routinely take one or two more patients than the staffing sheet calls for, and do half of your managers' jobs for them," and here I paused for breath, "only to be called on the carpet for making sure somebody else does the minimum required for her job?"
Whereupon The Big Boss told me that she herself had not noticed any problems with That Nurse and hadn't heard any complaints about That Nurse.
The Big Boss hasn't even been on the unit for going on six months. Her sub-bosses are either concerned with getting out early (in one case) or sleeping with the other nurses (in the other) and so aren't really worried about what gets done or what doesn't.
So we went round and round.
Finally, I told her that telling her everything that went on was not my job. If she or her minions couldn't keep an eye on what was happening on the floor, or if they were just too unobservant, something needed to change from the top down. Further, if there were six nurses on the floor and five of 'em had a problem with the remaining nurse (That Nurse), the problem could probably be traced to That Nurse rather than the folks who were busting butt to keep call bells covered and doctors happy.
Then I told her this: since my annual employee review in July, the only feedback I'd gotten from anybody in Manglement about my work was *this one meeting*.
This whole situation makes me very sad. For one thing, it's not like we haven't been communicating with Manglement about problems on the floor. For another, Big Boss was a good small boss before she got promoted; she used to keep her eyes and ears open and know what was going on.
Worst of all, though, is the general feeling that anything can happen on the floor, up to and including management snogging employees in the stairwells, and nobody gives a damn.
It's not just me. It's really, truly not just me.
I feel like a big baby in one sense: I'm ashamed that I want positive reinforcement for being a good worker. In every job I've ever had before this one, it's been forthcoming, even when I worked for a Giant Soulless Corporation in a bookstore. I miss hearing a "thank you" when I, say, sign off sixteen charts or take an extra patient or two.
On the other hand, I'm angry. I'm deeply angry in a steely, awful way. I used to be proud to work for this hospital. I'm not any more; since we got acquired by A Larger Soulless Corporation, things have just gone to hell. Manglement's attitude and absence are symptoms of a larger problem.
I love my coworkers. Nine of ten of 'em would walk through fire for me, and I'd do the same for them...except for That Nurse. And That Nurse has, in the last week, become the focus of everything on the floor, thanks to our Big Boss's inability to tell a bullshitter from a handsaw.
I'm staying in my job for now. I'm staying for my other coworkers and for the patients...but I don't know how long that will last. I need to know that I have the ability and freedom to do my job. I need to know that I can depend on the people around me. And neither is looking likely at the moment.
*Apparently Dad was right, for only the nine-millionth time. They all got to Mexico with no trouble at all. Dammit. I hate it when he's right.
"Dad", I said, "Do you think that's a good idea? Because I think it's spectacularly bad."
"Some cats like to ride in cars*" was his reply.
Never mind what universe Dad hails from; the phrase "Unrestrained Cat" has come to signify, for Chef Boy and me, a wheels-off moment that lingers or a day so bad that no amount of Knob Creek will take the taste out of your mouth.
I yelled at my Big Boss.
More to the point, I carved her an entirely new alimentary canal, from tonsils to asshole.
We all know That Nurse. You would recognize That Nurse if you saw her; she's busy either talking incessantly about her latest date or surfing the Web on the hospital computers while her patients call repeatedly on the intercom. She's the one who doesn't open charts until fifteen minutes before the end of shift and who holds up report because, even after ten years on the job, she still hasn't learned to report concisely.
I had to charge a few weeks ago with That Nurse on staff. I redirected her as best I could and kept her busy the best way I knew how. It didn't sit well with her, so she complained to my boss.
Who called me in to gripe at me for being mean to That Nurse.
I'm not ashamed to say that I completely lost it for a good two and a half minutes. "You mean to say, " I began, "that I get here early, get out of report first, stay late, routinely take one or two more patients than the staffing sheet calls for, and do half of your managers' jobs for them," and here I paused for breath, "only to be called on the carpet for making sure somebody else does the minimum required for her job?"
Whereupon The Big Boss told me that she herself had not noticed any problems with That Nurse and hadn't heard any complaints about That Nurse.
The Big Boss hasn't even been on the unit for going on six months. Her sub-bosses are either concerned with getting out early (in one case) or sleeping with the other nurses (in the other) and so aren't really worried about what gets done or what doesn't.
So we went round and round.
Finally, I told her that telling her everything that went on was not my job. If she or her minions couldn't keep an eye on what was happening on the floor, or if they were just too unobservant, something needed to change from the top down. Further, if there were six nurses on the floor and five of 'em had a problem with the remaining nurse (That Nurse), the problem could probably be traced to That Nurse rather than the folks who were busting butt to keep call bells covered and doctors happy.
Then I told her this: since my annual employee review in July, the only feedback I'd gotten from anybody in Manglement about my work was *this one meeting*.
This whole situation makes me very sad. For one thing, it's not like we haven't been communicating with Manglement about problems on the floor. For another, Big Boss was a good small boss before she got promoted; she used to keep her eyes and ears open and know what was going on.
Worst of all, though, is the general feeling that anything can happen on the floor, up to and including management snogging employees in the stairwells, and nobody gives a damn.
It's not just me. It's really, truly not just me.
I feel like a big baby in one sense: I'm ashamed that I want positive reinforcement for being a good worker. In every job I've ever had before this one, it's been forthcoming, even when I worked for a Giant Soulless Corporation in a bookstore. I miss hearing a "thank you" when I, say, sign off sixteen charts or take an extra patient or two.
On the other hand, I'm angry. I'm deeply angry in a steely, awful way. I used to be proud to work for this hospital. I'm not any more; since we got acquired by A Larger Soulless Corporation, things have just gone to hell. Manglement's attitude and absence are symptoms of a larger problem.
I love my coworkers. Nine of ten of 'em would walk through fire for me, and I'd do the same for them...except for That Nurse. And That Nurse has, in the last week, become the focus of everything on the floor, thanks to our Big Boss's inability to tell a bullshitter from a handsaw.
I'm staying in my job for now. I'm staying for my other coworkers and for the patients...but I don't know how long that will last. I need to know that I have the ability and freedom to do my job. I need to know that I can depend on the people around me. And neither is looking likely at the moment.
*Apparently Dad was right, for only the nine-millionth time. They all got to Mexico with no trouble at all. Dammit. I hate it when he's right.
Sunday, January 07, 2007
A plea for anecdotal evidence...
And yes, I know the plural of "anecdote" is not "data." Let me explain:
Those of you who've read this blog for a while know that I've been dealing with changes in my brain chemistry. This is known technically as Being a Nutjob, of which I am proud. It's a long tradition in my family.
Trouble is that I'm experiencing some pain-in-the-arse side effects from Effexor. I'm not taking a huge dose of it, as doses go--150 milligrams of the extended-release stuff a day--but I'm still bugged by what's been happening.
What's been happening is, to wit:
1. Excessive daytime sleepiness. I've taken two three-hour naps today and could easily lie down again. I'll probably go to bed at about 8 tonight.
2. Body fat that will not go away, no matter how carefully I eat or how much I exercise. Note that I don't say weight gain; this is body fat distributed in places where it's never been before.
3. Massive, horrible side effects if I miss a dose by even a few hours.
4. Being posessed by the Hunger Monster at odd times of day. Like all day long, basically. I am never not hungry. Since I read that Effexor has an off-label use for treating eating disorders, this begins to make sense.
I have to visit the Brain Doctor sooner rather than later, so I figured I'd talk to him about making the change. Wellbutrin seems like a pretty good choice, even though the discontinuation syndrome is just as bad as it is with Effexor. At least the stuff I've read doesn't talk about increased appetite and trouble waking up, which are my two big bugaboos.
Or perhaps Lexapro, I dunno. From what I understand it's not all that different from Celexa, which again seems to have a side-effect profile I could deal with, except for those darn "sexual side effects".
So, people, what are you taking, if you're a nutjob like me? What have you tried in the past, and what did you like or not like about it? How was switching from one crazy med to another for you?
Just for reference, I was dealing with anxiety and moderate depression as well as some weird obsessive stuff before I started Effexor. All those symptoms are going away...but I'm going to get depressed again if I end up sleeping my life away.
Those of you who've read this blog for a while know that I've been dealing with changes in my brain chemistry. This is known technically as Being a Nutjob, of which I am proud. It's a long tradition in my family.
Trouble is that I'm experiencing some pain-in-the-arse side effects from Effexor. I'm not taking a huge dose of it, as doses go--150 milligrams of the extended-release stuff a day--but I'm still bugged by what's been happening.
What's been happening is, to wit:
1. Excessive daytime sleepiness. I've taken two three-hour naps today and could easily lie down again. I'll probably go to bed at about 8 tonight.
2. Body fat that will not go away, no matter how carefully I eat or how much I exercise. Note that I don't say weight gain; this is body fat distributed in places where it's never been before.
3. Massive, horrible side effects if I miss a dose by even a few hours.
4. Being posessed by the Hunger Monster at odd times of day. Like all day long, basically. I am never not hungry. Since I read that Effexor has an off-label use for treating eating disorders, this begins to make sense.
I have to visit the Brain Doctor sooner rather than later, so I figured I'd talk to him about making the change. Wellbutrin seems like a pretty good choice, even though the discontinuation syndrome is just as bad as it is with Effexor. At least the stuff I've read doesn't talk about increased appetite and trouble waking up, which are my two big bugaboos.
Or perhaps Lexapro, I dunno. From what I understand it's not all that different from Celexa, which again seems to have a side-effect profile I could deal with, except for those darn "sexual side effects".
So, people, what are you taking, if you're a nutjob like me? What have you tried in the past, and what did you like or not like about it? How was switching from one crazy med to another for you?
Just for reference, I was dealing with anxiety and moderate depression as well as some weird obsessive stuff before I started Effexor. All those symptoms are going away...but I'm going to get depressed again if I end up sleeping my life away.
Monday, January 01, 2007
New Year's Resolutions for the world
Things we need more of:
Laughter. No matter how hackneyed the joke.
Good dinners with people you'd normally never eat with.
Sandalwood soap.
Guys who smell good. (Whatever it was you scrubbed with yesterday, keep scrubbing with it. I'm talking to you.)
Acts of kindness undertaken without thought of reward.
Fuzzy sweaters.
Happy dogs to pet.
Purring cats or hedgehogs, take your pick.
Home cooking. (The blackeye peas I made for dinner made people say, "These are just like Gramma used to make!")
Vegetables.
Rain. (I remember sitting on the banks of the St. Lawrence River with a charming Francophone and raving about how much water there was there. "But what would you do with more water?" he asked, proving he'd never lived in a desert.)
Crusty bread.
Decent olives.
Happy endings.
The occasional Cinderella moment.
Smart teenagers.
Scotch.
Cheerful pink-cheeked people like my friend Scott, who looks like the baker he is.
Things we need less, or alternately, fewer of, this year:
War.
Asshole leaders, be they of party, sect, or nation.
Abusing groups because of their color, creed, or orientation.
Industrial farming.
Traffic jams.
Undeserved snark.
Britney Spears, the Lohans, and the Hiltons.
Fast food.
Clear-cutting.
Diamonds.
Mean people.
Impossible handwriting that doesn't go through triplicate copies on orders.
Women who are more focused on the size of their hips than the size of their brains and men who are more focused on the size of their dicks than the size of their hearts.
Laughter. No matter how hackneyed the joke.
Good dinners with people you'd normally never eat with.
Sandalwood soap.
Guys who smell good. (Whatever it was you scrubbed with yesterday, keep scrubbing with it. I'm talking to you.)
Acts of kindness undertaken without thought of reward.
Fuzzy sweaters.
Happy dogs to pet.
Purring cats or hedgehogs, take your pick.
Home cooking. (The blackeye peas I made for dinner made people say, "These are just like Gramma used to make!")
Vegetables.
Rain. (I remember sitting on the banks of the St. Lawrence River with a charming Francophone and raving about how much water there was there. "But what would you do with more water?" he asked, proving he'd never lived in a desert.)
Crusty bread.
Decent olives.
Happy endings.
The occasional Cinderella moment.
Smart teenagers.
Scotch.
Cheerful pink-cheeked people like my friend Scott, who looks like the baker he is.
Things we need less, or alternately, fewer of, this year:
War.
Asshole leaders, be they of party, sect, or nation.
Abusing groups because of their color, creed, or orientation.
Industrial farming.
Traffic jams.
Undeserved snark.
Britney Spears, the Lohans, and the Hiltons.
Fast food.
Clear-cutting.
Diamonds.
Mean people.
Impossible handwriting that doesn't go through triplicate copies on orders.
Women who are more focused on the size of their hips than the size of their brains and men who are more focused on the size of their dicks than the size of their hearts.