Imbalance

Well, the last time we spoke, I'd just made a big med switch and wasn't feeling well.

That was due to a few things, not least of which was that I was in the beginning stages of a pretty epic case of the flu.

Ugh!

Or whatever the hell that was. I wasn't very congested, actually. Extremely light, which is weird for me, but super, super achy and exhausted for days, and the worst migraine I've had in a while that just wouldn't let up. So that sucked.

That, paired with all the new meds, made for a pretty awful week.

But then I rallied as much as I could and went to Park City, Utah for the weekend to celebrate with my sisters and a few friends in honor of my youngest sister's upcoming wedding, and that was wonderful.

Everyone was really mellow and lovely and well-matched-- there were eight of us, and we basically spent the entire weekend in one giant conversation, all together. We were all on the same wavelength. What a fantastic group of people. I love every one of them!

So now I'm back, and I'm continuing with these meds, and they continue to make me tired and slow, but at the same time, I notice little bursts of... something different.

It's hard to explain. I still feel a bit lighter than I did on the Wellbutrin, and I think it was the right choice to move away from that. But I do think I still have a lot of anxiety, and I am aware of it now-- I think it's of the free-form variety, not the drug-induced variety at this point-- and now that I know what it feels like I'm attuned to its presence in my body and it's bothering me.

I am becoming aware of precisely where the imbalances are. This doesn't sit well with me at all.

But anyway, back to the meds. Since I started both at once (Cymbalta and Topomax), it's hard to know what is causing what. I mean, obviously these drugs have different effects, but many of the side effects overlap and I can't tell which ones come from where.

I am up to the full dose now on both drugs. 100mg of Topomax and 60mg of Cymbalta. The migraines have leveled out to the point of disappearing in their typical form, which sounds amazing, but I do have some kind of annoying headache/nausea something most days, it's just at a very, very low level. A very low, nagging ache.

It's not quite classifiable as migraine pain. It's different/ I haven't really had anything like it before. It's clearly part of this whole thing, and it's still annoying, but it's miles better than what was happening before, so I'm just observing it and seeing what it does next.

Before I move on, I'm just going to reiterate what I said a few sentences ago: my migraines have all but disappeared. 

Like, I got a new prescription of migraine meds a week and a half ago and I haven't even opened it yet.

Sure, there's an asterisk (or seven), but this is progress, people! We're figuring this out. And figuring it out without a migraine is a LOT more fun than figuring it out with one, I will tell you that for sure!

Something else I've noticed is that my back feels better. Like, a LOT better. Cymbalta is supposed to help with that, and by god, it DOES. Who knew?!

Another thing: I lose my balance occasionally (that culprit I know: Topomax). Nothing major. Mostly I just over-balance when I bend over or try to stand on one foot or something. There was one memorable one-footed sideways shimmy in the Salt Lake City International Airport that I'm pretty sure made me look like a drunk in front of a room full of disgruntled passengers waiting on delayed flights, but they were feeling bitter and judgmental anyway so there wasn't much I could do about that.

There are some other things going on, too. I think I'll switch to bullet points now, rather than explain everything individually.

So, in the pro column:

• NO MIGRAINES!
• Back feeling better!
• Feeling lighter!
• Less anxiety!
• Better sleep!
• Lighter appetite!
• Losing weight (4 lbs so far)!
• Feeling more motivated!

And in the con column:

• Incredibly tired!
• Cottonmouth!
• Terrible diarrhea (sorry, but it had to be said. This is real life, people)!
• Carbonated drinks taste gross (an incredibly bizarre side effect of Topomax)!
• Sometimes shaky!
• Lose my balance (which is a little bit funny but still)!
• Still with the mild headaches!
• Still with the anxiety!
• Still not motivated enough!
• Still not enough energy!

Overall, I'd say I'm riding at a C+. Those pros are really good. But the cons are nothing to sneeze at, either. I've only just reached full dosage, and I'll give it 3 months total (unless my doc recommends longer) before I make a decision to try something else or not.

_____

Another plan I had was to see the psychologist at the Northern California Headache Clinic to learn the  bio-feedback technique (it takes 5-7 sessions to learn it), and then I can be a free agent as far as the medical side, and try to find a doctor closer to me with whom I have better chemistry, and who I feel takes my whole situation more into account when prescribing my medication.

The doc at this clinic was  very good, don't get me wrong, it's just really, really far away and I don't have the freedom to get to know him really well, and I want someone who is more on the cutting edge of PTSD science as well if I'm going to be working with them. There are so many great doctors in my area, there's got to be someone who's working with both PTSD patients and migraine patients. 

I will find that doctor.

I'm realizing that anxiety is playing a MUCH bigger role here than I'd realized, and I need to address that more  directly than I have. And I've been so dissociated from my body that I'm only now learning what all of these things feel like. Who knows what else I'll discover?

So, that's what's happening. I have to admit, it's terrifying to be doing this while trying to raise two small children. I don't like feeling medicated. Even though I've taken anti-depressants before, I've never felt medicated before, like I do now. I feel it all the  time, and it's disheartening and exhausting and frustrating. Sometimes I just want to sleep until this phase has passed, and wake up healthy and alert and ready to bounce into the next one.

I'm too tired to be this tired!

But I am unbelievably fortunate to be able to do it now-- I don't forget for a moment that I have unthinkably amazing resources and support and time to do this work at this point in my life, and as hard as it is, it's also most important to do it now. 

Those girls and my dear, heroic husband are the reason.

So I will keep going. And I'll figure it out. And if I'm a little muddled and sleepy and stumbly in the meantime, well.

In the long run, is that such a bad price to pay?

Cloudy

All right, I've made the switch.

Dropped the Wellbutrin (which I discovered quite unpleasantly has been causing me anxiety at a low and constant rate for the past year and messing with everything), have started the ramp-up with Cymbalta, and am continuing the ramp-up with Topomax (my first-ever preventative migraine med).

Update, 9/14 2:30pm: In migraine news, since I began the Topomax 2 weeks and 5 days ago, I have had 7 migraines, one of which lasted 10 hours, the rest of which lasted 2-5 hours, and only one of which "broke through" with full-fledged migraine pain. As ridiculous as what I am about to say may sound now that I've written all that down, this, my friends, is HUGE PROGRESS! 

I'm not even up the the full therapeutic dose yet and I've already dropped from an average of 75% migraine days over the past few months to 36% migraine days in the past 19 days. (!!)

Anyway, back to Cymbalta and Topomax:

Both of these are expected to make me excessively tired during the ramp-up phase.

BOY, IS THAT EVER TRUE.

I feel like I've been hit by a bus. A really, really tired bus. After I had collapsed from exhaustion in the middle of the road.

This level of tired is seriously uncool. I've already been operating at a ridiculous level of sleep deprivation with this over-active amygdala of mine-- according to the sleep sensor bracelet I wear, I never have more than 4.5 hours of non-consecutive sleep in a night, no matter how long I'm in bed. So I'm sort of stumbling around trying not to fall asleep in my soup.

But believe it or not, I already feel... better. Lighter. Easier. Just... a bit... better.

The biggest difference, and the most welcome one: I am enjoying my children more.

I have more patience with them. I am not constantly just trying to get a moment of peace and physical distance from them. I am able to look into their shining little faces and enjoy moments with them without reservation.

It's been a while. I shudder to think how much longer it might have been.

That anxiety, that agitation, had wormed its way into my personality and was really starting to make its mark. My husband keeps beaming at me and saying, "It's so nice to have you back!"

I guess I'm back. :)

Or at least, I'm on my way.

I didn't know I was so far gone, which is ABSOLUTELY TERRIFYING JESUS CHRIST. But I'm on my way back now, and I'm grateful for that. I don't know if what i'm doing will be enough, or if it will be the right combination of chemical magic, and let me just say that I am more than a little horrified by this whole chemical clusterfuck, yes I am indeed, but today, I feel remarkably better than I did last week, more than I believed possible.

So that is something. No small something.

I want to get out of this state of chemical dependency as soon as bloody possible-- I've never had an experience like I had with that Wellbutrin a couple of weeks ago, and realizing what it's been doing to me for the past year is terrifying and frustrating and confusing and infuriating.

How could I not know?

I knew I was uncomfortable, but I figured it was just the price of playing poker, you know? I thought I was just pushing myself to uncomfortable places. But I think also that I just have a really, really high bar for what I'm willing to put up with. In fact, I think there's probably an incredibly high threshold before I'll even notice the discomfort in the first place, so dissociated have I been all these years, and so used to dealing with chronic pain.

I've been told that before, that people with migraines have ridiculously high pain thresholds, and I've seen that in myself. So I think that's played a part in my lack of awareness. I know that when I cash it in-- when I reach a breaking point and have to go lay down or stay home or whatever-- it's because I am BEYOND jacked up. Discomfort is de rigeur for me, so it takes something fairly catastrophic to take me out.

Thanks, Wellbutrin. You jerk.

Anyway, I'm not feeling great today, although I did get a bit of a nap yesterday and might get to bed early tonight, too, in my ongoing efforts to mitigate this hit-by-a-bus feeling. So I will leave you with this song by Simon and Garfunkel, which seems quite apropos.

Enjoy. And Happy Fall. I hope the leaves are beginning to change where you are. To me, that always feels like the real New Year season, when the slates get cleaned and the world gears up for a fresh start.

I'm ready. Are you?

Cloudy
The sky is gray and white and cloudy,
Sometimes I think it's hanging down on me.
And it's a hitchhike a hundred miles.
I'm a rag-a-muffin child.
Pointed finger-painted smile.
I left my shadow waiting down the road for me a while.

Cloudy
My thoughts are scattered and they're cloudy,
They have no borders, no boundaries.
They echo and they swell
From Tolstoy to Tinker Bell.
Down from Berkeley to Carmel.
Got some pictures in my pocket and a lot of time to kill.

Hey sunshine
I haven't seen you in a long time.
Why don't you show your face and bend my mind?
These clouds stick to the sky
Like floating questions, why?
And they linger there to die.
They don't know where they are going, and, my friend, neither do I.

Cloudy,
Cloudy.

STRIKE ONE

Well, THAT was a bit of a fiasco.

I went to the Northern California Headache Clinic last week and met with Dr. Kenneth Peters, who, I learned, was on the team that developed the first triptan medication, Imitrex, back in the '80s. 

This is significant because Imitrex was the first game-changer in the treatment of migraines and triptans remain the most effective migraine medications to this day, so that is no small thing.

Anyway, we crammed a lot of information into a single conversation, so it's always hard to know exactly how much is landing on both sides. But he did hear that I was uncertain about my current course of antidepressants and that my migraine meds were unreliable and that I'd never tried a preventative med before.

"Really?" he said to me, looking down at the file in front of him. "Sixteen years of chronic migraines, you're up to 20 or 25 days a month now, and no one has given you a preventative?" He leaned forward. coming up on the desk on his elbows. "REALLY?!"

I gave him a grim smile. "Nope," I said. "And that is why I'm here."

He offered to take over both my migraine and antidepressant prescriptions, and I let him. He agreed to bump up my Wellbutrin to 450mg, but warned me that Wellbutrin can cause anxiety and if I was already concerned about anxiety, I should watch out for it. He wanted to give that a try, and if it wasn't right, try another type before looking at "the addictive drugs." 

Meaning: the benzos. The anti-anxiety meds. Xanax, Ativan, Klonopin, etc.

Which is fine. I have no desire to form any sort of habit. Lord knows I've got enough to do.

So I took the prescription for the increased Wellbutrin. Check.

Next, he prescribed me a preventative med called Topiramate, a form of Topomax, which I'd heard called "Dope-o-max" on the migraine forums because it supposedly makes you slow and stupid and fuzzy.

Which, hello, is JUST WHAT I NEED RIGHT NOW. :/

When he saw my eyebrows shoot to my hairline, Dr. Peters said, "You've probably heard this drug referred to as "Dope-o-max. Let me tell you about that. We'll spend the next several weeks ramping you up slowly to a full therapeutic dose. During that ramp-up time you may find yourself feeling a bit cognitively impaired. I call them 'senior moments.' You might find yourself having a few more "senior moments' than you're used to having."

Being used to having quite a lot of "senior moments," especially when my depression and anxiety are on the rise and my medication is inadequate for the task, this caused me a bit of concern. How many more senior moments can I take before I become a danger to myself and others?

I told him that. He said, "Really, it shouldn't be that bad. And it should only be for the next month or so. After that, things should even out and go back to normal. For most people, it does. And if it doesn't, we'll try something else."

I figured it was worth a few weeks of discomfort if the end result was fewer migraines. And the real end goal of this clinic's work is to have me off drugs all together, or at least as much as possible, and as soon as possible, once I learn the bio-feedback techniques and identify triggers and make the lifestyle changes that will prevent migraines even better than medications can.

Worth it, in the long run. At this point, I'll try anything.

At least, that was my thinking last Monday.

So I started off with my increased dosage of Wellbutrin and my Topiramate. I take the Topiramate at bedtime, which is good, because even the tiny, 1/4 dose I'm taking now makes me markedly sleepy. It might help me to sleep better, which might ease up one of the triggers for migraines, depression, and PTSD all at once, so that seems like a win, right?

The Wellbutrin was a harder thing to gauge, anti-depressants having a cumulative rather than an immediate effect, but I did notice, that first morning, a bit of a zip in my step when it hit my system, mid-morning. As I can always use a zip in my step, I counted that as a win, too.

Skip ahead to Saturday.

I flew down to LA Saturday morning to attend two major events over the weekend: my youngest sister's bridal shower and my dear cousin's wedding. I was feeling a little antsy and exhausted, but as this is not too far from my normal state, I wasn't alarmed.

I went straight from the airport to the shower, already in progress, and walked into a room full of people. Not my favorite thing, but as the people in the room were most of my favorite people, it was best-case scenario in that regard. I was feeling a bit shaky and off, but chalked it up to my usual self-consciousness and to the New Orleans-like LA weather (90+ degrees, 90%+ humidity?! WTF, global warming?! DO YOU NOT REALIZE THIS IS A DESERT?!).

And then, right in the middle of the shower, a strange feeling descended over me. I can't describe it. A sort of raw-skinned, fogged-out, paranoid ickiness. I was freaking out. I couldn't wait for the room to clear. I don't remember being that uncomfortable before. I didn't know what to call it, what I was feeling, but I felt incapable of tracking conversations and didn't trust myself to communicate clearly. I attached myself to my best friend of 33 years, who was there (thank god), and who kept me entertained the whole time, and I think I managed to get through the event without anyone noticing much was off about me.

After everyone was gone, I was able to tell my sisters about the new meds and that something had kicked in and was making me uncomfortable, but at that point I didn't know what to call it and didn't know what to do. Over the course of the day, it slowly wore off, and by evening I was feeling exhausted but a lot better.

The next day, the same thing happened, but with fewer people around to exacerbate the weird part. We drove up to Hollywood to check into a hotel near my cousin's house to get ready for the wedding, and it became clear then that the uncomfortable part seemed to happen when the Wellbutrin hit my system. That was when it struck me that what I was feeling was anxiety.

It's funny to me to think that it was so hard to figure out what it was that I was feeling. And even funnier (ha ha. Ha. No really. Ha. :/) when I realized I'd been feeling a very low form of that feeling for a very, very, verrrry long time. But anyway, it struck me like a lightning bolt that what was happening to me was just what the doctor said might happen: the Wellbutrin was triggering a high state of anxiety.

What happened next was one of the few truly awesome moments of kismet that has happened to me throughout this whole sordid drug mishap. I said, out loud, "I don't think I'm going to be very much fun at this wedding. I am freaking out. I think my medication is causing me major anxiety and I don't know if I'm going to be able to handle this."

And the two people I said this to turned to me and said, in perfect unison, "Do you want a Lorazepam?"

And that, ladies and gentlemen, is Hollywood.

At first, I declined. I had so much on board at the moment that was messing with me that I didn't want to add anything new and unknown to the mix, especially since I was about to be in a crowd of people I didn't know at an event that I desperately wanted to be present for.

Then I realized that Lorazepam was Ativan, which I had once in the hospital after I had my babies, to fantastic effect, and that the doctor had already said that class of drugs was on the table to add to my current load if necessary, and that I was already in about as bad a shape as I could be in, so I said, what the hell.

And I took half a pill. Half a miligram. A teeeeeeny dose.

A while later, I felt quite a bit better, and it was clear that no ugly side effects were forthcoming, so I took the other half.

And friends, I felt FANTASTIC. Not high, not altered, not floaty or mellow or even relaxed. I felt like myself. My REAL self. More like myself, in fact, than I have in years.

That pill took the edge right off. ALL OF IT.

And that gives me some information to discuss with my doctor. For starters: my anxiety is fucking REAL and it's been dismissed for YEARS and I've even dismissed it myself and have thought that wanting to jump out of my skin for the past year and a half has just been the result of the intense therapy I've been doing and not the result of a medication that's been driving me even crazier.

I didn't know that's what anxiety felt like. I didn't know what to look for. 

I do now.

So when I came back from LA, I called the doc and told him what had happened. He told me to drop back to 300mg of Wellbutrin and we'd get me off of it right away.

I'll be switching to Cymbalta on Monday, which targets anxiety, depression, and also body pain, all of which are major factors for me, and I'll see if this is a better fit. I'm going to talk to him extensively about my PTSD and make sure he's including that in his decision about what drugs to prescribe. But I need to get all of this back under control so I can move forward, and I can see now that the last year and a half has been something other than what I thought. I've been in the grips of anxiety, not being pushed out of my comfort zone by therapy. 

I'm sure that's happened too, but I don't know who much the second was clouded by the first.

After a couple of days back on the old dosage, I was still freaking out and the anxiety was running rampant, so I called back and asked him to prescribe me something to help me get it under control until I can get this stuff out of my system. He gave me some Klonopin. It has been nothing like the 100% normal feeling of Ativan, alas, but it's been slightly better than nothing. I feel a bit sedated, which I guess is the goal for this med. It's just not my goal

Despite all the medications I've taken over the years for migraines and depression  and stuff, I have never had an adverse reaction like this, and never felt "heavily medicated" like this before. Right now, with all of this going on, I feel more anxious about all the meds I'm taking than anything else. I'd just like to feel calm and peaceful.

I would totally take a pill for that, right now. I am not averse to that. Not now, I'm not. I mean, I'm doing the goddamn work to learn how to get myself there drug-free, and I haven't forgotten that this is the goal, but man, it sure would be nice to take the easy way for once and find the pill-pushing doctor and seek the short cut.

Why do I always have to be the responsible one? Why do I always have to choose the long-term solution over the short-term relief?

I mean, I totally get the value of the permanent fix, the safe choice, the holistic method. For god's sake, I think I've more than proven that.

But man, that Ativan allowed me to experience one of the most glorious weddings I've ever been to-- my cousin marrying his long-time partner in a newly-legalized ceremony that they-- and we-- fought long and hard to win the right to have-- and it was truly one of the great pleasures of my life to have been there to share the night with them and see how much it meant to them to take part in this thing they never dared to dream they'd be able to have...

And if a little shortcut now and then to get to have a memory like THAT is wrong, then god damn it, I don't want to be right.

I don't want to toy with dangerous, habit-forming drugs. I just want to feel like myself again. Not my new self. My old self. My pre-all-this-bullshit-self. My enjoyed-her-fucking-life-self. My didn't-walk-the-medication-tightrope-self. 

Realizing that something I thought was helping, wasn't, was a real blow to my confidence. And it just feels like more time, wasted. I am tired of wasting time.

I AM TIRED OF WASTING TIME.

I am tired of being at the mercy of chemistry, within my body and without. I am tired of forces beyond my control having WAY TOO MUCH OF A SAY over how I feel and how I act and what I am able to accomplish in a day.

I want my life back. I want it back. I thought I was getting closer to getting it back, and now I really don't think I am. I feel back to square one. My system has been poisoned. I now have yet another thing to recover from before I can back to the business of recovery. This is not acceptable to me.

Project Monkey Off My Back 2.0: Remove the extra fucking monkey that jumped on when I wasn't looking. WHAT THE FUCK, MONKEYS?!

Hey, that could be the title of my book, when it comes out. Or the subtitle: 

"The Girl Who Lived, or What the Fuck, Monkeys?!"

Or maybe a band name: Kate and the Fucking Monkeys.

Okay, maybe I should stop now. Did I mention the Klonopin?