My Brain as Blackwell’s Island

22Nov08

I’m a cranky critter today, but so far it has nothing to do with the office. It has everything to do with the fact that the rheumatologist wants me off Effexor XR and on Cymbalta, so I’m taking today off both, pursuant to his orders. And once again, I didn’t think the Effexor XR was doing anything till I stopped taking it.

Serotonin is an amazing thing. On one brain-level, I know that everything going on in my head (and there’s an entire asylum in there, let me tell you) is caused by insufficient brain-juice, which is fascinating when you consider that it’s all got to do with how much of certain chemicals are attaching to the ends of certain neurons. That part of my brain is Nellie Bly, watching the asylum objectively from inside it but without being (or trying not to be) overly distressed by it.

The rest of my brain is Blackwell’s.

I also hurt more off the XR, which is expected; but what surprises me is that my level of distress at the increased pain and the not-increased fatigue, spasticity, myoclonia, and ataxia is totally out of proportion with the actual level of the symptoms. The pain is up to a 7 from a 6; the distress at the pain is up to a 9 from a 4. It’s like the pain went from x to x+1, while the distress went from x to x^23 on multiple vectors. (obviously, I am not using real maths.)

And of course the random-ass muscle twitching and random-ass walking into walls hasn’t changed at all, but now every time one or the other happens my brain goes “OMFGWEREGONNADIEOMFG” instead of just “:P”. And so of course then my brain has to go “OMG SHUT UP” and the freaking out part has to go “WAAAH DON’T YELL AT ME,” which is also distressing.

I took half a Tramadol because of the increased pain and because it’s also a serotonin-acting med, so I thought it might quiet the Greek Maenad Chorus. Which it has a bit, though it’s also, as usual, making me stupider. It also made me decide that it’s time to put my internist, my neurologist, and my rheumatologist in a cage and let them fight it out.

1. My neurologist wants me on the Skelaxin, Sinequan, and Maxalt and off the Tramadol. He does not give a shit about anything that’s not my headaches. He wants me on the Dilaudid because when the headaches are that bad, nothing else works.

2. My rheumatologist wants me on the Tramadol, Sinequan, Cymbalta, and Maxalt and off the Skelaxin. He thinks I am a depressed hypochondriac, which must be why he also apparently wants to give me serotonin syndrome. (Seriously – Tramadol, Sinequan, Cymbalta AND Maxalt? I’ma fucking die!) He also wants me off the Dilaudid, which I agree with on principle but not in practice. Because I hate Dilaudid with a passion, but I hate the pain I take it for more. (Also, for whatever it’s worth, the ER doctors all seem to think that 4 mg of Dilaudid when my pain is a 7 is perfectly appropriate, whereas at home I take only 2 mg of Dilaudid only when the pain hits a 10. So nyah.)

3. My internist wants me to have an MRI and lumbar puncture. He thinks I may have MS and have every right to be depressed because whatever I have, it is very real and also very progressively disabling. He wants me off the Dilaudid in principle but understands that’s not going to happen right now.

PHYSICIAN DEATHMATCH

In better news, all this MS business has made me stop taking certain things for granted. I had a great time clearing the foot of snow off my car this morning, for example. Partly it was fun because it was a very light, dry snow, so I could just tap it and FOOM! But partly I enjoyed it because right now, I have no way of knowing how much longer I’ll be able to do things like clean off my own car. I don’t mean that in a pessimistic sense – for all I know, I’ll be cleaning snow (or more likely, acid smog) off my brain-powered hovercar eighty years from now. But not knowing removes that sort of grumpy resignation that typically accompanies chores. Whether I’ve got eight years left or eighty, I’m currently bound and determined to enjoy the shit out of every possible activity.

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