Observations, Learning, and Activities for the New "Over 21s"

Posts tagged ‘Medications’

Sneaky Depression

Depression must have been following me around for a long time. I’m not sure when it caught up with me–I didn’t even know it had. It’s not like one day I woke up with Depression snoring next to me. There was no lightning bolt marking its sudden appearance. I wasn’t feeling particularly sad or seeing everything in black. I’m not sure if I was feeling hopeless or particularly morose. Days didn’t drag or fly by; they just blended into one another. I hadn’t been feeling particularly energetic, but I blamed the fatigue in part on the hot and humid tropical weather. When the pets napped during the mid-day heat, I often found myself joining them, even though the air conditioner kept me comfortable so I wasn’t being directly impacted by the weather. Arthritic back pain has been my steady companion, and I blamed most of the fatigue on the constant struggle with Pain. I miss being able to take my Naproxen to keep Pain at bay. It had worked really well for me, but it also was complicit in a near-fatal bleeding ulcer incident nearly a year ago, and I’ve had to stay away from it ever since. So I blamed my lack of awareness of Depression on Pain. Pain kept me distracted while Depression slowly permeated my body and my soul.

That I became aware of Depression’s presence was sudden. It was about two weeks after my last visit to my psychotherapist. I was thinking about how I don’t really like her, and that I don’t know why she insists on continuing to see me. The session wasn’t terribly productive, and I realized that her voice had taken on tones of dislike and condescension. She was telling me that I am a selfish bitch (not in those words) who turns away from any group or individual who doesn’t agree with me–that it’s my way or the highway. This took me by surprise. It had taken me most of my 65 years to work up the nerve to simply be able to say to myself, “This is not how I think or feel or see things. I can walk away from this.” I wasn’t feeling bad about this type of thinking and subsequent actions, and I didn’t understand what brought on this tirade from her. For the year or so that I’ve been seeing her–generally once a month, with a three or four month lag recently–we’ve discussed my issues with family and my husband. I rarely talked to her about my social life or activities. Yet she was talking as though we have known each other well for years and shared a circle of friends. The thought going through my mind was, “Is this professional behavior in a therapist?” In the US, I had never experienced this type of reaction from a professional therapist–some insurance plans won’t pay for antidepressants without a prescription from a psychiatrist. I started wondering whether she had been trained in The Netherlands or elsewhere, and if this was professional behavior there. Granted, the country of Sint Maarten is more like a mid-sized US town, with its population of roughly 45,000. Adding the 40,000 or so residents of the French side of the island, the whole island takes on the proportions of a small city, with each side having its own culture within the greater culture of the Caribbean. My next question to myself was, “Has she been talking to other people about me? If so, whom would we know in common?” And again, thoughts of professional behavior went through my mind. I had pretty much made up my mind that I would be cancelling my next appointment (coming up next week), but decided to let it stand and re-assess during or after.

As I continued to ponder the strange session, I started thinking about my activities as symptoms and how likely it might be that Depression had caught up with me again. I started thinking about my life over the past year. I had taken a vacation from my husband and ended up overstaying my welcome with my children. I came home to discuss separation with my husband, but then bleeding ulcers almost killed me in the middle of the night–twice within two weeks–and how instrumental he had been in getting an ambulance here quickly. He visited me more in the hospital during my two five-day stays than he ever visited me during major surgeries back home when he worked a block or less away. Since he doesn’t drive, and since the hospital is almost on the other side of the island, that took a major effort on his part. Life on a small Caribbean island is vastly different than the conveniences associated with large urban areas in the US. He had to rely either on friends or on taxi services to visit me, since buses don’t run near enough to the hospital for easy access in the tropical heat, and visiting hours are extremely limited.

The night I returned from the hospital after my second stay, I noticed that one of our two cats was acting strangely listless. Over the next three and a half months, she spent more time at the veterinary clinic than at home, first for a pancreatic infection, and later for feline diabetes. The male cat missed her, and started to jump into the car whenever I had the tailgate open, possibly hoping she was in the car. He did that late one night when my husband was unloading the car from my earlier grocery trip. My husband doesn’t always notice things at the best of times, and I had forgotten to tell him of this cat’s new habit. I didn’t go anywhere the next day, and the car was sitting in the tropical winter sun all day, with me wondering why the cat hadn’t yeowled to come in. My hunt for the cat ended when I found him the following day, when I needed to run to the pharmacy. I would never have to hunt for him again.

A few weeks later, I began to notice that I was losing stamina instead of gaining it during my exercise sessions in the community pool. At first, I thought it was emotional stress from losing one cat and having an ill one. I drove to the doctor’s office to discuss the condition and was sent for a blood draw because the doctor thought I looked somewhat anemic. Because of local holidays, it would take longer to get results than usual, and we had been scheduled to visit a neighboring island for a conference my husband needed to attend. I was feeling weaker and weaker and tried to beg off, but my husband seemed more concerned about the fact that we had already paid for my fare and a rental car, and insisted that I would feel better from a change of scenery. By the time we returned, I was feeling much weaker and took the first opportunity possible to visit the doctor for bloodwork results. My blood count was so low that the doctor could not believe I drove to the office. I was not even allowed to drive the half kilometer home to pick up pajamas and other hospital stay essentials (locally, you provide your own pajamas, toothbrush, soap, towels, etc.) before I was whisked away to the hospital.

During the five days I spent at the local hospital, the staff doctors managed to scare me to death about the condition of my colon (since the ulcers had healed quite well, it had to be my colon, they reasoned), saying that I would need to have half of it removed and that I was taking a chance that I would bleed out from a burst sac in my colon at any time. I was not about to have surgery on the island, so we scheduled a visit to the Mayo Clinic in Florida for a consult and possible surgery. It turned out that my colon was fine and that my problem with anemia was because–after a total of eight units of blood transfused into me during my three island hospital stays–the hospital doctors had never thought about prescribing high dosage iron supplements. In essence, my body had shut down blood cell production after the two bleeding ulcer episodes, and that was the cause of the anemia, not internal bleeding from my colon. Much relieved, we returned to our island condo on Christmas Eve, with no pets to greet us and several days of no pet distractions. When I was finally able to bring home the dog and ailing cat, it was like celebrating Christmas a few days late.

Shortly after the New Year–on my birthday, in fact–I had to take the ailing cat back to the clinic, as she was refusing food and water, even from hand-feeding and forced hydration from an eyedropper. For the next nine days, the clinic tried to order various insulin types for her, trying anything to get her to come around. On the tenth day, I received a call from the veterinarian asking us to consider her suffering, as nothing was working on her. Before we were able to get there, and much to staff’s surprise, the cat had chosen her own time to die, and we said goodbye to her inert body. Both cats were just five years old when we lost them. I mentioned that we were interested in any stray or unwanted kittens that might be dropped off there. Surprisingly, we were able to adopt a kitten the same evening–not to replace the cats we lost, but because neither my husband nor I were ready to have a no-cat home–and we were hoping to distract the dog, who seemed depressed with both cats disappearing from home. The kitten was to be euthanized after closing, but my cat’s death allowed this kitten to retain her life. I suspect that the kitten was still alive just in case we were thinking of adopting a new one.

Shortly after I was told I needed colon surgery, and feeling a little down, I began to read books that always made me feel good and made me laugh. During our two-week stay near the Mayo Clinic, I began to download all the books by my favorite author, Terry Pratchett. It had taken several years before the first volumes of his Discworld Series were available electronically. I decided I wanted to read all the books from the first to the last because they made me laugh (and more than half of my Pratchett library was in a storage facility in Glendale, California). In an effort to cheer myself up, I read all 40 books of the series in roughly six weeks. The day after I finished the most recent book, Terry Pratchett died, leaving me jarred from the coincidence. In the meanwhile, I made a new friend here in the community, and she pulled me out of a good deal of my funk. She had me going to the beach and helping her find things to stock her new store at the Jersey shore, and I was finding myself perking up quite a bit. When she returned to the US, I began to sink again, the only thing saving me was the drawing lessons I started taking, thanks in large part to my friend’s chatting up a gallery owner on the French side of the island. My instructor also got me interested in oil painting. In addition, I got involved with a business that forced me out of the house. So I had a few new activities to throw myself into so that I could avoid seeing Depression sneaking up on me.

That day when I was pondering my last therapy session made me realize that Depression had grabbed me in its clutches and wasn’t letting me go, accounting for my ups and (mostly) downs.  Why hadn’t my therapist seen this, or why hadn’t she suggested the possibility that I might be depressed? My husband, who notices so little about me (think Sheldon on The Big Bang Theory), was preparing himself to broach the subject with me, but had some hesitations about how to begin. When I told him I thought I was depressed, he was relieved, and confessed that he thought so, too. So why did the therapist not notice two weeks earlier? It’s not like she didn’t know about all the events that had transpired over the past year. Why didn’t she see that many of my newer activities were an effort to pull myself out of a dark pit?

Fortunately, I am not a person who believes that there is ever a time when no hope exists. The idea of a purposeless life crosses my mind on occasion–like when Depression is stalking me–but I never really believe that things will never get better. I don’t always make lemonade when life sucks, but I tend to take a proactive approach to my existence. So…

The following day, I went to see my doctor. I told him I was pretty sure I am depressed. I explained my fatigue, my inability to motivate myself to perform even the easiest of tasks or my favorite activities, the hours of extra sleep, the restlessness, the inability to concentrate on anything. He agreed that I was probably depressed and prescribed some medication. In general, antidepressants take anywhere from two to four weeks before any improvement in mood or attitude is noticed. I’ve been on enough of them in my life to know. But when they kick in, the world takes on a whole new meaning. I’m almost three weeks into the antidepressants, and I’m feeling better every day.

Depression, you may take your sweet time taking over body and soul, but you’re not unbeatable. You are not a permanent fixture in my life. It may have taken me a while to notice that you have sneaked up on me again, taking the color from my world, and damping down the moments of joy that pass almost unnoticed because of your presence. Depression, you are being pushed out much more rapidly than you have entered, and I’m feeling good that I recognized you even when a psychiatrist did not. So yeah, maybe I do turn my back on situations that I deem immature or demoralizing or just plain stupid. But how is that bad? There are a lot of people I know who have some strange qualities–whether stranger than mine, I don’t know; I can’t judge–but it doesn’t mean I don’t like them despite their quirks. I don’t assess people on whether they agree with me or not, but on whether they are good-hearted and caring people. They can be self-centered, annoyingly upbeat, frustrating, flighty, overly single-minded, funny, klutzy, cute, ugly…but if they’re “good people,” I can usually set all those things aside and like them for who they are. Heaven only knows why some people continue to like me enough to call me Friend, even after they have gotten to know me and understand where I’m coming from. They don’t even have to understand me, as long as they still believe I’m good enough company to hang out with once in a while, or that my heart is in the right place. So yes, sometimes it takes a pill to help me see how many people make up my world. Sometimes, Depression, you can obscure the fact that I am not alone in this world. But you can never make my subconscious believe you because, deep inside, I know better.

Depression, you have been part of my recent life for too long, and you’ve made me blind to many of the little joys in life. It’s time to banish you. There may be a time when I’m off medication and life comes down on me again like a ton of bricks. At some point in the future, you may think you will win. But don’t delude yourself. Even if a therapist isn’t correctly analyzing me, I do a lot of my own self-assessment. I can turn and walk away from situations that will never change. Depression, you may get in and obfuscate, but you will never obliterate. Go away now. I’m turning away and leaving you behind.


Sudoku and Me

Sudoku Photo

Lots of people my age look forward to the Sudoku in their daily newspaper. Some older people swear that it is a memory aid, for sharpening or maintaining memory that may be faltering. For some people it works. For others, well…let’s just say it’s hard to complete a puzzle when you can’t find the pencil that was just next to the paper a moment ago. These are not the reasons I play Sudoku every day–or at least every day I get a newspaper (no Sunday papers here on The Island). I play Sudoku to test my logic–and what effect my medications are having on me. But mostly it’s the logic aspect.

Some puzzles–ones that give no logical clues to a mass of “pencil marks” so that only trial and error with educated guesses can help solve the puzzle, or let me know that a different educated guess should be attempted–are ones I solve only when I have hours with nothing to do, a luxury I rarely have. For some of the solutions, a pattern emerges if I leave the puzzle alone for a day or two. Others are so convoluted that a “guess” has to be made 5 or more times, meaning that all the erasures have worn holes in the newspaper and the original puzzle needs to be transcribed into my Sudoku Excel template so I can erase to my heart’s content  on “real paper.” However, most puzzles with high difficulty ratings are quite orderly and can be worked with only a little bit of educated guessing.

In the newspaper, the Sudokus progress in difficulty from “Easy” on Monday to “Difficult/Hard” on Fridays. Saturday puzzles are always rated “Difficult,” but, as I stated above, often involve more guessing than logic. So, for me, it’s the Monday through Friday puzzles that are both enjoyable and tests of my current logic abilities.

Why test my logic? Because I take a pharmacopia of daily medications. There are pain relievers, cholesterol controllers, blood pressure equalizers, muscle relaxants, and–for when life is driving me crazy or I simply can’t get to sleep–tranquilizers or other prescription sleep aids. And then there”s the medication to protect my stomach lining. I used to take OTC or prescription-strength versions of pain relievers, but a “surprise case” of bleeding ulcers put a stop to that. So now my mobility is severely limited by the amount of pain I feel, and that means that by 3:00 PM, my spine decides it’s time for more curvature, which increases as the clock progresses and prevents me from standing for more than two or three minutes. It’s no fun looking like a question mark without a period underneath. But pain has nothing to do with logic unless it’s overwhelming. However, some of the other medications do affect my thinking processes, even after the “getting used to” period has long passed. And these are the ones whose effects on me I monitor like crazy.

All medications that effect the nervous system–including many medications to reduce pain–affect how the brain functions. If, a week or two after starting a new or replacement medication, I find that my memory is worse than usual, I visit my doctor and insist on something different. Take Lyrica, for example.You see the advertisements for it all the time on TV for use in preventing or easing the pain of diabetic neuropathy. It had been prescribed in the past (long before it became the pain reliever for people with diabetes) as an outright pain control medication for anyone, and continues to be recommended by pain management specialists, especially to help patients get past pain to sleep at night. The commercials give a long list of possible side effects–except for what I consider the most important one: they affect memory, and worse, the effect may be permanent. When I was taking it, I realize that it wasn’t just that I was forgetting while under its influence; it was that the lost memories were not recoverable, unlike with most other memory-effecting pain relievers. Think of this as getting so completely drunk at a party that you can’t remember what you did that was so entertaining to others at the party. After a while, your memory of some of your insane activities comes back, and you become so embarrassed that you can’t look other party participants in the eyes for quite a while. While taking Lyrica, my memory of events never comes back. It’s like those memories have been sucked into a black hole. My husband and friends would report that I am acting perfectly normally–going about daily routines, driving, etc; things that are in “muscle memory”–but I have no memory of having lived those days. Ever. And I suspect that there may be a permanent effect on certain memory functions for which, if the patient is not aware of this little publicized side-effect, a decent work-around cannot be developed. A patient needs to be aware of memory loss before reporting it, after all.

The brain is a marvelous organ. There is no such thing as a single “pathway” to things that have been learned, behaviors one has acquired, etc. The brain basically distributes information in such a way that, even if it takes a little longer to recall a memory, that memory can still be accessed. But some drugs seem to build a titanium wall around memories accumulated under their influence, and no amount of soul or mind searching ever breaks through that barrier.

If one goes to web sites such as WebMD or even CDC, many “nerve” medications list memory loss as a possible side-effect. What they can’t tell you is if you will be one of the persons affected with memory loss, especially permanent loss. Each individual has slight variations in reactions to any medication; some individuals have significant problems. The information these sites give you is the “normal” reaction, and “normal” has enough variations to stud the night sky with galaxies of stars. “Normal” refers to how the middle 67% of the population of patients (or individuals who participated in the clinical trials, anyway) reacts or reacted. Unfortunately, physicians often do not report variations that are not listed, so unusual variations that did not turn up in clinical trials may never be listed–unless some medical researcher specifically looks for a specific side-effect after the drug has been FDA approved and is on the market.

For example, it took the medical profession years to discover that, although benzodiazepines had become a drug of abuse, one-third of the people who take them never develop a dependency on them. And then there are the dosage variations: patient size is also not necessarily an indicator of the proper dose for the prescribed purpose. Dependency means the patient cannot function without them, and often means an increased dosage is eventually needed to obtain the original effect. Patients with dependency do not forget to take their prescribed meds–ever. I am a good example of a person who does not become dependent on benzos. Also, I start forgetting to take the benzo within 10 days, and remember that they were prescribed only when I become overwhelmed or anxious. By then, I can’t find them, as I have a somewhat unique filing system for my medications. Even when I organize my daily meds into those little pill organizers they sell at the drug store, and then run out and can’t get to the doctor for a refill prescription, it might take me ages to remember I am supposed to have them on hand. A person with a benzo dependency would never forget to get that refill prescription written.

But what I learned from all the various meds–including every blasted anti-depressant on the market–is that they affect the nervous system, especially the brain, and (in my case) logical thinking. So I monitor my logic daily with Sudoku. If I can’t solve a Monday through Friday puzzle, I start experimenting with which drug (or combination) is responsible, and then go to my physician with my findings. Because doctors are naturally skeptical of patients’ self-accounts, I first discuss my “findings” with my husband (sometimes,when a physician doesn’t believe me, I ask him to come with me). My husband is a neuropharmacologist—that is, a scientist who studies the effects of drugs on the nervous system, especially the brain. He has also spent his entire career teaching medical students, and actually keeps up with what’s new in the field. He loves being married to me because I seem to have paradoxical effects to most of my prescribed medications. Thus, give me a low dose of benzos and my energy level skyrockets; give me much larger doses and I just might exhibit the intended effects. I’ve been used as an example of paradoxical effects in too many of his lectures to count–at least I’m useful to him, and he starts researching studies in which others react as I do.

But back to the logic testing: Sudoku is my method of self-monitoring, and it lets me know when I need to re-evaluate what’s going on with me. If I have trouble with the puzzles early in the week, I know I’m in trouble. It may not be from drugs; it may be that I’m becoming anemic again (which affects thinking, also). But I know that there is something not right and I do something about it–mostly drive my doctor crazy, but he’s used to that in me, and has found that I am generally right about something being wrong. I’m not a hypochondriac–I’m simply very aware of small changes in my behaviors. But then, I’m aware of small changes in behaviors of others as well…

Bottom line: Sudoku is my friend–and a very useful one at that.