Taking a step back to go forward

Last night I took that extra half a capsule of Effexor. None this morning. So by afternoon I was feeling pretty bad. And it wasn't just physical withdrawal- that seemed to be doing better- except for a really bad headache. I felt listless, I couldn't concentrate, I was irritable. I was miserable and I couldn't function. I almost went home early, but managed to stick it out to see my patients- forget about paperwork.

I can't afford to be less functional, even to get off of meds. I'll lose my job. So, I am going to take that half a capsule of Effexor in the mornings- I think that will be enough to get me through the day. And I will keep taking a full capsule at night. Which will be a total of 225mg, half of what I had been taking just 3 weeks ago. And I am going to stick with this until I see my psychiatrist at the end of August. Then hopefully I can try to go lower- and get some smaller denomination capsules to do so.

I've been on Effexor for at least 12 years- although not always at such a high dose. I would have a breakthrough depression and the dose would get increased, and so it would go. So I shouldn't be in such a rush to get off of it- my brain has to have time to adjust. Also- I have spend more of my years alive on antidepressants than off of them. I don't know what will happen if I really get off of the Effexor. Can my brain handle it? Or will it always crave the super-high levels of serotonin that only an antidepressant can give?

On other fronts, my IBS seems to be cured- no, managed. Because I have to follow the FODMAPS diet. But it works. It seems pretty amazing to me that it could be that powerful. I always used to think that I had one food that must be my trigger- maybe lactose, or gluten, or fiber. I should be so lucky. It is many foods, many triggers. Not just one thing- and that is what makes the diet so powerful. But it works, so I am not complaining.

I received my first FODMAPS cookbook in the mail from Amazon. I ordered two others that haven't come yet. I have been eating very limited things- I am going to try to cook one new thing every week. And I need to try to get more vegetables in. My go to vegetables like cabbage and broccoli are off limits for now. Eventually I can try small portions of them- see if I can tolerate them- but for now, no.

Eating my words, of course

I had said that I would not go back up on the Effexor, even if it was just to go back down on it more slowly. But today, even after taking my 150mg capsule this evening when I got home, the symptoms have not subsided- so I suspect tomorrow will be even worse. And really, it is only just a couple of weeks since I was taking 450gm.

So I took another capsule, opened it up, and dumped out what I thought was about half of it. Then I put it back together, and swallowed it. That would get me to about 225mg, which is half of where I started. Plus I am taking it all at night- previously I had split my dose. I will do this until the symptoms go away or at least become manageable. Slower is better in some ways- fewer withdrawal effects to deal with. But you don't get the rewards as fast either, which is the motivation for doing this.

I have decided that if I wind up having to go on another antidepressant- I will give prozac another shot. It has worked before. Not the cleanest drug- it has a lot of interactions that make it messy, but it has a good track record with me. The only better ones for me are the MAOI's. But I get so orthostatic going on them I am really impaired- it would take a long time to get me up to good dose and be able to function. Plus a lot of doctors won't prescribe them- and I need really high doses. But I think they are out just because of the orthostatic hypotension. Hopefully I am not going to need another antidepressant- I am just planning ahead.

My step mother told me that she thinks it is possible to get admitted to a hospital for a "wash out" of medication. But I don't want a washout of all meds. I just want to get off of Effexor, and see where I am then. I don't know if I want to go further that this or not, I can't know ahead of time. I have to see how much that buys me- and how I feel then. I'm not against meds if they are helping me. I am against things that are not helping me.

It is just really hard to tell what is making you better and worse sometimes. Especially over the long term- which is how most of these drugs are prescribed. And that is the major problem of psychiatry.

I think the increased Effexor is knocking down my withdrawal symptoms a couple of notches. Good. But a short term effect and not something that I should base long term decisions on.

Effexor Withdrawal

This was my second day of 150mg, taken at night. And my second day of withdrawal. It was worse than yesterday. I hope it doesn't last too long. But my symptoms are only mostly physical. I did have to take a tiny bit of klonopin at lunch- but I had been doing that a lot recently, so I don't know if I can blame it on withdrawal.

By the time I got home today at 6pm I couldn't take it anymore- I took my night dose of Effexor. I felt so light headed and numb and tingly. The headache responded pretty well to aspirin. I'm getting used to the top of my head tingling. But when I feel like I am going to pass out- that is the really hard part to deal with.

Of course I know I am going down on it way too fast. But yesterday was an accident- forgetting my AM dose- and after feeling so much more alive emotionally- I just can't get myself to go up on my dose, even to go back down again more slowly. So I will put up with these withdrawal effects and hope that I don't get too debilitated. And for the last 150mg, I will go down much more slowly. I suspect that is where it is going to get very hard, getting off the last bit of it. Or maybe not. Maybe the rest of my meds will give me enough of a buffer that it won't be so bad.

Nobody properly warns you when you go on these meds how bad it can be to get off of them. You should be able to go to detox or something. When I would try to go off of Zyprexa in the first year and would start getting manic, I didn't understand it was a withdrawal effect. I thought it was proof I needed the drug. No one told me. And when I said I wanted off of Zyprexa, no one tried to wean me off- instead they tried to switch me to other antipsychotics, which always had intolerable side-effects- so I went back to Zyprexa. 

But I am down to 5mg, which I am ok with for now. I think it does help with the depression- and soon I will no longer have the Effexor on board. 

The morning wasn't too bad- I think I still had enough Effexor in my system from the nighttime dose. But as the day progressed I felt worse and worse. Now I just want to collapse. My whole body tingles, and I feel very weak and lightheaded. And yet, I made it through the day at work, and even stayed late to make two splints for a patient (which turned out well). All is not lost. I can do this. As I tell all of my patients- it is just going to take time. 

I'm getting off of Effexor

I have been blaming the wrong med.

For so many years I have been feeling dead inside, I have this inertia, I can't get myself to do things- and I write it off as my mood disorder or my Zyprexa. But really, I know when it started- 12 years ago when my meds were changed and I was put back on Zyprexa and started on Effexor, after my overdose.

I complained about the numbness, etc., to my doctor- who put me on Adderall, which seemed to help. Until I had to stop taking it due to tachycardia. And by then I was never sure what was causing what, and what was just dysthymia. But I found myself not caring about things. I showed up to class late, and didn't get papers in on time. Normally I procrastinate- but the anxiety gets me going in the end. It no longer did. I remember that when the med change happened.

It takes a superhuman effort to get things done. And there are days I just don't think it is worth it. But today I had a glimpse that it might not have to be this way.

So I had cut my Effexor down to 300mg from 450mg. And then today I had to get fasting blood work done. I overslept, I was running late, so I didn't get a chance to pack my AM meds. I told myself, this will be an experiment to see what happens on even less Effexor. I had taken 150mg the night before, and was missing my morning 150mg.

Well, aside from chills and headaches and brain zaps- around late afternoon I started feeling very alive! Like I can't remember the last time I felt this alive unless something amazing was going on. I can't remember feeling this alive with just daily life. I could even do my notes at work without supreme effort.

And I started to remember what happened to me when I made the med change- and how much harder it was to finish up grad school on effexor instead of parnate, with all of my inertia. It was the Effexor all along- and not the Zyprexa. I've been blaming the wrong med. I'm not saying Zyprexa is blameless, but I think the Effexor is worse.

And the effect started at a really low dose- way before I got up to the high doses. So going lower is not the answer. I have to get off of it. Maybe everything else that I am on will have enough of an antidepressant effect that I won't need one. I am hoping. It is scary, though- the two times doctors have tried to manage my depressions without antidepressants it has been a disaster. But maybe Provigil can be my antidepressant.

So I am now down to 150mg at night. I hope I can stick to this and not have too much withdrawal. To go lower I really have to wait until I see my psychiatrist and get smaller pills- I don't have the courage to go from 150mg to nothing. Although I could open the capsules.

I am also taking Provigil, Lithium, and Zonegran- which all increase serotonin, so I think that is helping with withdrawal.

It is going to be an interesting visit with my psychiatrist next month.

Hoping my brain and my body can adjust

I am on a new diet and less meds. I think it will take time for everything to calm down. Today I just want to stay home- I don't want to go grocery shopping or into work. I started getting very anxious this afternoon and took a quarter milligram of klonopin- now is not the time to try to be to stingy with that as well.

But- even though I don't want to go anywhere- I don't really feel depressed. Anxious, yes, but not depressed. And this is good- that I can reduce my Effexor and Zyprexa and not feel depressed. And the anxiety? That is what klonopin is for, I guess, if it gets too bad. As long as I am taking these tiny doses, I am not going to worry about it.

I got my script in the mail for my lithium level, but I don't think I can go until Tuesday- when I go to work late. But by now, I really don't think it is lithium anymore. I am so much better. After this weekend, I don't even think I need to go to the doctor.

The problem now is that I need to go grocery shopping again. I am not very good about doing that. I am running out of food that I can eat. I still have a pantry full of food that that I can't eat! Well, maybe two shelves of food- mostly beans and lentils. And some frozen broccoli and cauliflower. Maybe in a few weeks I can try eating small amounts of forbidden foods- a little every day or two. That is what they say. Which would be good, because I think that many of the off-limit foods are very healthy. Not to mention tasty.

I found a new sci fi show on TV- "The Lottery." I like it a lot. I watched it today. Yesterday I watched "The Strain." Also really good. I wasn't too impressed with "The Last Ship," but I only watched the pilot. Maybe it gets better.

And I am trying not to eat. Since my stomach has settled, I have become very hungry. I just want to eat.

I'm impatient

I think I should be 100% better right away. But when I read about this diet, they say to give it several weeks. And I am not even 100% compliant. Little thing I don't think about- the onions in the spaghetti sauce that I ate yesterday were likely the cause of much of my GI distress. I looked at the bottle today- onions are pretty high on the ingredient list, and onions are supposed to be the worst offender. I need to find new spaghetti sauce or make my own or do without. I wasn't thinking- until after the fact.

The other time I was having trouble was after breakfast. I was eating eggs- with ketchup. One of my lists says that ketchup is okay, the other says no- but the bottle says that it has onion powder in it- so the answer is no. And my body is saying no. It is possible to make your own ketchup, and not that hard- so I will have to do that I suppose.

The only saving grace about this diet is that I do not have to give up coffee. I was pretty sure that would have to go. But it is okay- although I think only in moderation.

It is a new enough diet that the various lists don't agree with each other and some things haven't been tested. I still can't find good information on chocolate.

What is interesting is that if you follow this diet, the research shows that you really alter the microscopic biome of your intestines. They don't know the significance of this- if it is good or bad. It decreases the total number of bacteria in your gut but increases the diversity of the bacteria.

No Man's Land

It was too good to be true. Things are still much, much better- but I am not cured on this new diet. I just don't know whether things are bad enough to warrant a trip to the doctor when I already have an IBS diagnosis. I guess I will give it the weekend to see how it goes- then call a GI doctor on Monday. Because even if it is just IBS, I need information on how to manage this.

I think I am vetoing the Zyprexa increase. I felt too out of it today, I didn't like the way I felt. Even though the anxiety was better. I will have to find another way to manage the anxiety. Plus, I am hungrier today- and I can't be eating so frequently the way things are going with my stomach.

At work I felt so bad physically- I had chills and felt feverish for a couple of hours. I felt exhausted and had a sinus headache most of the day. I had the worst stomach pain after lunch that only went away after going to the bathroom. I came home and can't find my thermometer- but the chills are gone anyway.

Of course it wasn't a good paperwork day. I was just trying to make it through the day- fortunately it was an early day.

Someday I will have a good day again- when body and mind both feel good. I just don't know when. Until then, it is a struggle.

I can't deal with the anxiety anymore

I have some things going on that are very anxiety provoking. I hoping that they are time limited, and that I just have to get through the next couple of months. A lot of it is my own making- things that I didn't do because I was depressed, etc. Anyway, I have been struggling with depression and anxiety the past week. The depression is much better now that my GI symptoms are better, but my anxiety is even worse. I can't deal with it - today I actually got paralyzed at work.

I am going back up on the Zyprexa, at least until these anxiety-provoking things are finished. I really liked needed a little less sleep, not thinking about food all of the time, and having a little more energy. But then there was the insomnia and the paralysis from anxiety. And summer was a stupid time to cut back, anyway. That should be a winter thing to try- when my energy tends to be lower and sleeping is easier. It was also a stupid thing to do so close to the Effexor dose decrease- I just got cocky. That went so easy. But now I don't know what is causing what- although I think it is more likely the Zyprexa than the Effexor.

So I am home and took the increased Zyprexa- back up to 7.5mg, and I feel so much better. Well, it is enough to spring on my psychiatrist next month that I am down on 1 drug. Now I don't have to tell him that I am down on two. I'll talk to him about wanting to eventually go down to 5mg again. I don't know why I have that number in my head. Well, in part because at 5mg the hunger gets better.

I didn't check my mail today. He is supposed to have mailed me a script for bloodwork. He really didn't seem concerned about the lithium level- he said I am on the low end. But he is not the one who has had lithium toxicity, serotonin syndrome, agranulocytosis, and I'm just getting started. If I had had that drug-induced seizure (interaction between nortriptyline and prozac) while driving, and not at work, I might not be alive.

I feel like a different person

I was at work this morning and something was missing. I couldn't figure out what it was. And then I realized that I couldn't feel my stomach. I don't think that has happened in months, if not years. It doesn't always hurt, but there is discomfort, fullness, something. I am always aware of it. Today there was nothing.

I am doing the FODMAPS diet, which limits poorly digestible carbohydrates that can ferment and cause trouble in the colon. It seems to have a very high success rate for IBS from what I have read, and I am a believer.

But I feel like I am back on an MAOI- only it is even more restrictive. I went grocery shopping for the first time today, and I was reading labels and checking lists on my iphone app to see what I could buy. I think I bought anything I thought I could eat- I wasn't even looking at prices. I spent $140. I also bought blueberry lemonade. I never buy sugared drinks- but I was thinking, I can eat lemons, blueberries, and sugar (the only ingredients), plus I was very thirsty. I was a little bit out of control today.

Supposedly after 6 weeks you can try re-introducing small amounts of high FODMAPS foods and see how your body tolerates them. I hope I can someday use up all of the lentils in my pantry! But I might have to give them away.

Every time I eat I get a little bit scared, still. But it seems that if I stick to this diet I am okay. I have my life back. Possibilities are opening up again.

I'm a believer

Breakfast was low FODMAPs, and I did well. Lunch was not 100% compliant, and I felt the consequences- but it wasn't too bad. And then dinner was 100% compliant again, and my bowels have been happy- even though it was my largest meal of the day.

It will just really suck if I have to live the rest of my life this way. But one day at a time. That is all that I have to worry about.

It is a lot more restrictive than the MAOI diet, and I am having a hard time finding things that I can eat that doesn't involve too much time in the kitchen. I have figured out a breakfast, a lunch, and a dinner that I can make without too much trouble. But that is it- one breakfast, one lunch, and one dinner. I haven't figured out more than that. I will eventually want variety. And I will eventually want Moo Shoo Pork with my beloved cabbage, but that is another issue.

From what I have been reading- I think I probably have bacterial overgrowth of the small intestine. It matches symptoms, and is a frequent finding in IBS. The short term cure is antibiotics- but it is a short term cure. The long term cure is probiotics and dietary change- actually I don't know if this is cure or management.

Otherwise, my apartment is the cleanest it has been in a while. My landlord had to come in today to let the electrician in, so I did some last minute desperate cleaning. Other people keep us civilized. Left to my own devices I let things go. That is kind of what spurred my to get my hair cut last week- my boss made a comment about how long it was, and was I growing it out or just hadn't gone to get it cut.

I need more social interaction, I know. I have just been derailed recently because GI symptoms of that severity do not mix well with social interaction. Fortunately at work it is easy to slip to the bathroom- I have had jobs where that was not the case.

I think I a postponing my half marathon. I didn't start training. There is one in March near my brother I want to do. I want to get out of a trip coming up- I think I made a mistake agreeing to go. I don't even have my passport yet but it may be too late. I have realized that sometimes I over reach.

It is okay to make commitments- as long as I can get out of them, as long as they won't too greatly influence other people. I have to be flexible. And listen to my gut, when my gut says no.

And yet, I don't know that. Everything I have is because I took a leap of faith, and did what didn't feel possible at the time- but I just knew there had to be something better than where I was. So it is confusing. When do I jump? When do I say no? I haven't figured it out yet.

I'm not in the clear

My IBS is back. So far it is not quite as bad as before I went down on the Effexor, but it it pretty bad. It started a little on Friday, but was mild enough that I hoped it didn't mean anything. Then this weekend it has gotten bad- which interestingly corresponds with me going down on the Zyprexa. Zyprexa is a serotonin antagonist. But I really don't know what is going on. Only that I am not going walking by the river today.

I think I will call my psychiatrist tomorrow about getting a lithium level. My level is low enough that is could double and I wouldn't be toxic, but just to be sure. And if that is fine, I will just invest in some stockpiles of Imodium. I hate the idea of taking yet another drug to regulate yet another part of me that my body apparently can't manage. But I don't know what else to do.

Maybe my PCP can refer me to a dietician. Maybe my insurance company will pay for that. Maybe I can figure out what to eat on a FODMAPS diet. Maybe that will help me. But it is such a limited diet. Maybe that is what my body is trying to tell me: don't eat.

Snowpiercer- I was wrong about the movie

The movie has stayed with me- even though I thought it would not. Kind of haunting. I get dark images from it- it was a dark film. I seem to like those kinds. I think it is that I don't believe any other kind of vision.

I kind of have a dark vision of humanity's future. Although perhaps not quite as bad as this movie- or at least not in the near future. I think that we will eventually turn to geoengineering, and that we will eventually mess it up. We can't sustain it forever.

If this were a kinder universe, peak oil would have hit a little sooner. There wouldn't be quite so much extractable oil (and other fossil fuels) in the ground. As it is now- there is enough so that if we get it all out and burn it all up we will make the planet uninhabitable- at least for humans.

Stopping the use of fossil fuels- it is so ironic. We are going to have to stop using them eventually, because we will run out. They are a finite resource. So why not just stop using them a little bit sooner? We are just speeding up the process.

I think that all of the billionaires should take their money and buy up the rights to fossil fuel deposits so that no one can get at them. Of course eventually no one may respect that as things get tight- but it might work. Bill Gates- instead of saving Africa, save the world.

My low key weekend

I just watched "Snowpiercer" on-demand from my cable company. It was a good movie, but nothing that will stay with me. The ending just seemed to have come straight from the Matrix movies. But it was a good movie.

I am sleepy today, and maybe that is because I took a smidge more klonopin last night plus some benedryl. Yes, I am lowering my Zyprexa again. I think that the problems I have had at 5mg have really not been from the lower dose directly- but because I take more klonopin, especially to sleep, and then get rebound effects which set me off. So I am going to watch my klonopin use and taper if I have to take more than a quarter milligram, and hopefully I will be okay. If I am not okay- I will just decide I do need more Zyprexa and that will be it. But I have to test this theory.

I am already less hungry today. I only had lunch at 3pm. You wouldn't think that going from 7.5mg to 5mg would be that big of a deal, but it is. Yesterday, at the higher dose- I was so hungry that I pretty much had two dinners. 7.5mg is where my appetite peaks for me with Zyprexa. I don't think 10gm is any worse. Or maybe I am just so numb that I don't notice how hungry I am.

I told my step mother that I had gone down to 300mg on the Effexor. She asked me what the "next step" is. I don't know that there is a next step. My pro-med psychologist stepmother has become ant-med. At least for me. She said that meds are not doing what they used to for me. I really don't know what she means. When were they working better- when I was in and out of hospitals? I think that what she really means is that they didn't totally "fix me." They got me to work- but not to stability, not to a husband, etc. I think she expected more from all of these meds- from me on all of these meds. Sometimes I do too. But that doesn't mean I am getting off of Effexor.

Two psychiatrists tried to manage my depression without the use of antidepressants on the grounds that I am bipolar, and both times I went to such depths of hell for such lengths of time that I have no wish to try life off of antidepressants. That is actually how I wound up on Zyprexa- off of antidepressants I went into a psychotic depression- despite taking 3 mood stabilizers.

So Effexor, yes. Lithium, yes. Provigil, yes. Thyroid hormone, yes- especially since the lithium is making me hypothyroid. Zyprexa and Zonegran- I don't know. Probably yes at some dose, hopefully lower. And then something to sleep, maybe. I would love to be able to wean myself off of those. There was a time I slept without taking anything- but it has been a long time.

I hope I can sleep without taking so much tonight. I'll read or watch CSPAN book TV before bed. No movies- anything exciting will just wake me up. I make that mistake sometimes.

Feeling okay mood-wise, and I'm surprised

I cut my Effexor from 450mg to 300mg last week, and my mood has been good. I am pleasantly surprised. The withdrawal effects I have had have been physical, not emotional. Of course it helps that I am no longer having serotonin toxicity. I knew there was something wrong with my body- I just didn't know what. Now I am freed from wondering what terrible disease I have and how sick I have to be before I go back to the doctor. 

I think my body is not totally recovered. I am really tired. I went shopping today- did some walking- and my legs were just really tired. No way I could walk another 10K today. So I am going to have to start slow with my milage. Tomorrow I start my training- what got put off because of being sick. I have almost two months to build up some base mileage, and then is is a 12 month plan to train to walk the half marathon on my birthday.

Even though I was physically tired, I did have enough energy to go shopping and get a haircut. It is a really good haircut, and I had really let it go- I have been looking awful recently. But I like this cut. I can't let it go again like this.

It's a scary world out there today

Between the airliner that was shot down and the Israel/Palestinian conflict, it is a scary world out there today. But I didn't know about the airliner until one of my evening patients told me. I didn't go out for lunch, and we have no news at work. And no cell phone service- not that it would have mattered because I wasn't getting the internet on my phone anyway.

I have been having trouble with my phone. Ever since Friday, I can't get on to the 3G network. I have tried changing settings, and doing everything I can think of- except the most obvious one. Turning off my phone and turning it back on. I had to go to a discussion board about problems with connectivity to get that tip- and it worked. I am so glad. I was afraid that it was the antenna and that I would need a new phone. And I am waiting for the iphone6- so I didn't want to have to buy an iphone5. I'll stick with my 4 until something really different comes out. Or it stops working- whichever is first.

I had fun patients today. I made a good splint. I had a lot of down time to do notes. It was a good work day. Except for the stress that we are all under at work- we are under a shrinking time window for the Joint Commission to come and inspect our hospital, and because our gym is new they will probably come to see us. Yikes! Lots of brushing up on and fine tuning policies and procedures, etc. Cleaning and organizing.

Maybe I can take the rest of the summer off?

Going better than expected

My effexor reduction is going better than expected. I had a little more withdrawal symptoms today, but not intolerable, and aspirin helped. My bigger issue is my lack of sleep. I just couldn't stay awake for the first part of the day- but the afternoon was better.

It is probably too soon to say, but my mind feels lighter on less effexor. That is the best way I can think of to describe it. And I wonder if I want to go further- but only know not to do that for a while. And probably I will need my psychiatrist to give me smaller pills if I want to.

It remains to be seen how much of my irritable bowel syndrome remains on the lower dose of Effexor. I'm guessing it won't totally go away- if only because my stomach continues to hurt, even though I am no longer having diahrea. But maybe my intestines hurt just from everything they have been through recently.

But life seems possible again. I feel like I just need a couple of days for my body to recuperate. And a good weekend to get things done. To get on track again.

This is weird, but I think it was the serotonin

Last night I thought that this was feeling just too much like serotonin syndrome. Not a terrible case of it- like the one in which I thought I would die- but not good. I only took one of my Effexor capsules last night. Today I am cured of the runs.

I was wondering- why now? And then I realized- the last time I filled my Effexor, they gave me the real thing, not the generic that I normally take. The FDA is investigating quality issues with some of generic manufacturers, and I know that there have been some recalls. I'm not sure when I started taking the real thing- maybe 3 weeks ago? And I am guessing that it is more powerful than the generic. Generics only have to be 80% of the brand.

Today I did pretty good with the less Effexor. Some mild withdrawal symptoms, the most curious one that I get is the top of my head tingles- and I had that a lot today. My mood was up and down- but no worse than yesterday.

I hope tomorrow goes as smoothly.

Now if I can just get to sleep tonight. But I think that just as much as a new sleeping pill- I could use an AC in my bedroom. This apartment only has one in the living room, and the apartment is an L, so it really doesn't cool the bedroom. I mostly use my fan- and this doesn't help my sleeping. Last night I had the AC on but I still didn't sleep. I was up really late. Fortunately it was my late day at work today. But tomorrow is my early day. I have to sleep.

Exhausted and Frustrated

I am still having the runs when I dare to eat. I feel so drained and a little light headed. I am trying to make myself drink. But even that comes out.

Last night I had a low fever- but my fevers never seem to mean anything. In fact, whenever I go to the doctor, every test is normal. I think I need Dr. House.

This feels like it has to be more than irritable bowel syndrome. But I thought that when I went to the gastroenterologist 8 years ago. I made the appointment after I had an "accident" walking home from work.

I was too afraid of that happening to get a haircut after work today, which I really needed to do. Plus, just too tired and worn out. I feel exhausted. And on top of everything, I couldn't sleep last night. And I refuse to push the klonopin too much- I took benedryl which helped.

I just want to feel physically good, so I can walk and do my work and clean my apartment and push myself towards my goals. But I feel so awful, and I don't know when this is going to end.

A part of me can't help wonder if this is meds- but then why would it be so episodic? It feels more like serotonin syndrome than lithium toxicity (and it is pretty sad that I have had experiences with both). But serotonin syndrome would explain the fever. There just isn't any test for it- the only way to see would be to stop the Effexor, which is more than I feel capable of right now.

FODMAPS?

I felt so dehydrated yesterday I thought I would pass out. Guzzling water helped some, but what really helped was when I found some sports chews we had bought for the 10K but I had never eaten. Then I started to feel a little better. I had some calories and electrolytes in me. But I was up much of the night with gnawing stomach pain and continued bathroom trips.

So I am looking to see what I can do for my IBS. And I found the FODMAPS diet. They say it can help 80% of people who do it. It is based upon not eating foods that have high levels of hard-to-digest carbohydrates. And it seems that I have been doing everything wrong.

It is a very restrictive diet- and many of the foods that you can't eat are things I have been eating a lot of recently in an effort to be healthy- many fruits and vegetables. So I thought when this recent episode started after eating a steak dinner a couple of weeks ago it must be the steak- no, it was probably the asparagus.

Lactose and gluten are out, of course, on this diet. But that I wanted to do anyway. Unfortunately apples are out. Cauliflower and cabbage are out (although some people say that fermented products like sauerkraut might be okay). Onions and avocado are out. And my go-to foods, beans and lentils, are out. But I kind of suspected they would be. Whose belly really feels better after eating beans or lentils?

So meats,eggs, rice, potatoes,salads, green beans, hard cheeses, berries- is probably what I am going to be living on. Well, I am exaggerating- there are a few more things I can eat- but not much more that I normally eat. Oh yes- I can have my lactose free milk. No to chocolate, but yes to coffee.

I think I have to give it a try. I'm hoping I find that I don't have to be 100% adherent to it. But for now I just want this to stop.

I finally have food again

I made it to Costco today to pick up my Provigil. While I was there, I bought a lot of groceries. There are still a few things to pick up at the grocery store, but mostly I am set for a while.

Unfortunately I didn't buy anything low-fiber- I should have. I am still having so many bathroom trips I don't know what to do. What should I eat? All I know is that eventually this will settle down again- it always does. But it could take a good long while to do so.

Sometimes it is bad working in healthcare. I find myself wondering- maybe this is Crohn's Disease. I actually had a colonoscopy 6 years ago because of this- and the gastroenterologist told me that everything looked good, that this was probably just IBS. But a colonoscopy doesn't see the small intestine- although he said he was able to see the very bottom of it and take a biopsy of it.

But my mom has this really bad, so I think I just have her genes. Lucky me.

If I just knew what I should be eating... Just tell me what to do.

Except that it would probably involve me giving up coffee.  And that is my favorite drug of all.

My new favorite thing: dry shampoo

A lot of people (and sometimes myself included) seem to think that if you have your depression at bay enough to do X, then you should have no trouble doing Y. Well, maybe. But doing both X and Y may be asking too much.

So people who see me get to work on time and treat patients might think that I have no trouble with taking a shower (or sometimes even brushing my teeth) in the morning. And many days, they would be wrong. Some days it is hard enough to get myself out of bed and out the door. And I wind up asking myself- do I want clean hair or to get to work on time? I can't have both today.

And so I am loving the dry shampoo that I can just spray in my hair and wait a couple of minutes and brush it through and then I am good to go. I have bought myself another day before I have to take a shower. There is something about the thought of taking a shower- I don't know what it is- that does not mix well with depression. And it really is never bad once I get in the shower, I just think that it is going to be.

Anyway, no shower this morning, but I did make it to work on time. I also forgot to take my morning meds- I didn't have any food for breakfast, I was going to stop a Smoothie King for a smoothie. I forgot to pack my meds. I felt kind of strange today, but really not so bad. I did have my provigil with me.

Tomorrow I start my half-marathon training. I am really taking it on faith that I can do this. I have a bad ankle and in recent years a bad hip- which I think stems from the ankle. I walk with my foot very slightly turned in- and when I make myself walk with my food turned out, no hip pain. I am very overweight. I am hoping that the training does not make things worse, only better, as my body adapts to it. It remains to be seen. I know I need to be very slow in my milage progression.

I have found my first race. It is a great one for walkers- a 7 hour time window! They use the marathon time window for the half-marathon as well. It is about a three and a half hour drive away from me. It is in December, the day after my birthday.

Tomorrow I walk 3 miles. It should be a piece of cake after the 10K. Except that I am having a flare-up of my irritable bowel syndrome. That has me worried. I may have to change where I planned to walk to a park that has a bathroom. It has been really bad recently- even since my trip over July 4th.

Why did it have to go there? Why do people always assume?

I went to see my acupuncturist the other day. I told him that my depression was much better. He said that he could tell. He asked me if I wanted to work on my weight, as well. It wouldn't cost anything more than what I was paying for the session and he could just add more needles to my ear for afterwards.

I didn't know what to say. So I said yes. But if I could have had time to think about it, I would have said no. Of course I want to lose weight- but this is not how I want to do it. I don't want to lose weight using something external to me that has to be maintained indefinitely. Because, really, it would- I can't see any other way it could work as long as I am on my meds. And I don't want to be doing acupuncture forever- I can't even afford it. And I was going for depression. Why couldn't he leave it at that?

Well, the next day I was ravenous- I was so hungry all day long. Although probably because I skipped breakfast because I had no food at home. But still- not a great testament to the power of acupuncture to help with my apetite. And that sealed my decision. I am quitting acupuncture. I think it has done what it was going to do with my depression- and my bank account cannot afford more.

Maybe it is just my ego that was hurt. But I am not going back. He should have asked me at the end of the session- for next time. I had no time to think. I know that he meant well. Or maybe he was just trying to hook me into continuing to come for treatments. But even if he meant well, I don't care. I am tired of unsolicited "help" about my weight.

At least my grandmother didn't mention my weight this year. But then again, she now has pretty bad macular degeneration in both eyes. So who knows what she saw.

There are things you do because you don't know how bad it is going to be

Last weekend we went to a public pool with a three-story high water slide. My aunt tried to get me to go with her- finally I went. I don't know why, I hate things like that. I guess I thought that it couldn't be that bad at a public pool, and that with all of the twists and turns it must slow you down before it pops you out at the end.

I was wrong. Perhaps because I am heavy and gravity likes me- or perhaps because I was lying down and didn't know to sit up to slow myself down- I raced down the slide gathering speed. I thought I could slow myself with my hands, but the tube was too slick with water so this didn't work. I felt so out of control. I was panicking. And then the next thing I knew, I was pushed out and under the water with what felt like a lot of force.

My aunt wanted me to do it again so that she could take a picture. No thank-you. Once was more than enough.

Now I am thinking of doing something else, and I am wondering if it is only because I don't know how bad it would be.

After doing the 10K, albeit as a walker, with no training, I got to thinking. What if I were to do something that required training? The next thing up is a half marathon. People do walk half-marathons- even marathons (although that takes so long I would want a lunch break!). You just have to find a race with a long cut-off time. Some of them will close the course before a walker's pace can finish.

So I am looking into that. I even found a website with training plans. Now I just have to find the right race to give me focus. And that is really what this is all about. Having a goal, having focus in my life, and hopefully achieving a goal.

Back home

I survived my both my trip to my mom and her family and my 10K on the 4th of July.

As was the case last year, I really didn't do any preparation for the 10K- in fact I was spending a lot of time in bed due to depression. But I was walking, not running, so I made it. And this year I was walking with my mom (she didn't get in last year). I wanted to stick with her, just in case. She is 73 and on Coumadin and just generally someone you worry about. It was frustrating at times- I am a fast walker, she is a slow walker. I had to slow myself down, even stop and wait at times. But we still made it to the finish line, which is what counts. My time was 15 minutes slower than last year.

My ankle held up better than last year- I used this "Jimmy Copper" compression sleeve the entire day of the race, not taking it off until the night. So no swelling. Some pain, and a little difficulty weight bearing later that day and the next day, but not as bad as in previous years.

The next day we went swimming, which I think also helped my ankle.

My family is another story. My mom is primarily taking care of her mother, with some help from her sister- but it is getting very hard because my grandmother is getting very difficult (well, she always was). And it is really taking a toll on my mother. Of course no one listens to my suggestions. And then it is bad between my mother and her sister. The whole household is toxic.

Both my cousins are having job issues right now- one just lost his job, the other working part time after losing a full time position. And I realized I am very lucky to be working.

But it was hard to see my mom doing so badly.

I got my phone call from the doctor

Well, from her assistant. She told me that all my labs were fine. I asked if I should be concerned about my lack of eosinophils. She said she would check with the doctor. She did. The answer is no- it would only be a problem if things went in the other direction.

I guess I believe it. I'll probably run it by my psychiatrist just to be sure- which may be sooner than planned. I really need to make an appointment with him. I think I need a new drug to get me to sleep. I have a new theory as to what is going on with me- that it is the klonopin that is making me crazy. I am taking a whole half milligram at night- which then gives me all kind of withdrawal during the day. I had to take a quarter of a milligram twice today- I was so anxious at one point I thought that my hands were shaky.

I went back up on the Zyprexa because I felt this way- but it didn't buy me very long. I don't think I really needed to- I think it was just the increased klonopin and rebound effects. Or that is my theory. And I need to talk to him and try to get something stronger for sleep.

Meanwhile the joints in my fingers are killing today, and it is all my fault. Too depressed to grocery shop this weekend- I bought a large pizza. I really think that gluten is bad for me. I tested negative for celiac, and it doesn't happen consistently, but I think there is a correlation.

Let's face it, there are no easy answers. I need to be very diligent about what I eat (very hard when struggling with depression and grocery shopping- let alone cooking- is hard). I need to do some kind of mild to moderate exercise every day. I need to sleep more hours than most people. I need to keep my stress low. And probably I need less meds. At least less klonopin, and maybe others. And then maybe I will have a chance of not feeling so physically awful so much of the time.

It's the interplay between the physical and the psychological that gets to me. Do I feel depressed because I feel bad physically? Do I feel bad physically as a manifestation of my depression and anxiety? I never know where one starts and the other ends. It gets confusing.