Highway to the Danger Zone

     Do you always follow your doctor's advice?

I do not.  I am a little bit of a renegade when it comes to my medication.  On more than one occasion I have upped my meds, or changed them completely, without checking with my doctor, or even really letting her know.  So far it has worked out.  Maybe I am just lucky, or maybe I am like Maverick from Top Gun- except that instead of jets, I am use mood altering drugs.  Totally bad ass.


     And the analogy totally works because my doctor is pretty much Stinger.
     Seriously, she is.  She scares me a little.

     I am not saying that I endorse my behavior for any one other than myself, but sometimes, my doctor wants me to do something: try a new medication. lower a medication, add a medication, and I just don't agree.
     I actually really like my doctor, (everybody likes Stinger; he's doing what is best for his men.) but you don't really argue with her, or even really discuss things with her.  When I started to slip into a depression after the baby, I wanted to increase my Cymbalta from 60 to 90, but she thought it would make me too manic, so at first she just insisted I get more sleep.  Don't you hate that?  I mean- I had a six month old baby who had GERD and hadn't slept fore than an hour-and half-consecutively in two months.
     "You just have to.  You have to get more sleep.  Your ego is writing checks you body can't cash."  Blah, blah, blah.  Easy for her to say.
     Three weeks later I am back in her office, spiraling into despair.  She wants to put me on Seroquel, which I have been on before, and I hate.  But there's not debating it. Back in her office again within six weeks and she wants to up the Risperdone and lower the Cymbalta.  She wants to do this and that, and each thing takes at least three weeks to work through.  Every time I go in there I ask her to please just raise the Cymbalta and she looks at me like a disappointed grade school principal: "We could raise it up to 90mg, but I really think that it may make you manic, so I'd like you to try...".
     Ugh.  "Negative Ghost rider, the pattern is full."
      I even brought Erik with me once to try and convince her, and she didn't listen.
     So, I took matters into my own hands and went ahead and just started taking three of my 30 mg pills instead of 2.  I felt so much better.  I didn't even tell her until I run out of meds a few months later.  (Do not ask me how I managed to collect so many extra 30's.  I have no idea; I'm Maverick!)
     Now that we are going to have another kid, she wants me to taper down again. I was fine with tapering down to 60 mg, but she wants me to go all the way down to 40mg, and I don't know if I see that happening.  I understand why she wants to do it, but frankly, it's not her life we're playing with here.  What can I say?  "I'm dangerous."

Don't call me a liar

     Ugh!  I take it all back.  Months ago I wrote a response to an article regarding medication and the authentic self: it was all a lie.
     Okay, it wasn't a lie exactly; I still stand by what I said about your authentic self being the best version of yourself, even if that means your medicated-self.  And you definitely should look for a medication that makes you good because no one should have to feel drugged just to manage their daily lives.  There are way too many drugs out there that for anyone to have to suffer.  That's what I said and I really do believe it.
     Here's what I didn't say though: finding the right medication sucks.
     Right now I am on 90mg of Cymbalta and my mood is fantastic.  It is completely responsible for pulling me out of depression: a feat which Risperdol, nor Abilify nor Serequil could manage.  But it is not perfect.  Most notably, it gives me a really bad stomach ache about an hour after I take it.  I've tried taking it with food, I've tried taking it at night: nothing works.  So, each day we have a one hour period where I stalk around with the stance, temperament and vocalization pattern of a mountain gorilla, all while LO presumably licks the bottom of the dishwasher or something.
     If I were to follow my own advice I would be harassing my doctor to come up with something that did not force me to channel Animal Planet, and yet, the pattern continues.
     Because I DON'T WANT TO CHANGE MY MEDICATION.....
     Experimenting with medication means wrestling with all kinds of potential side effects including weight gain and mood swings, and headaches, and muscle tension, or insomnia, or exhaustion, ontop of which the darm medication probably will not work as well.  I mean, I have been trying to find the perfect medication since I was ELEVEN and this one works good enough, so...
Ugh.
Whatever.
I mean, if in three years LO begins beating her chest to warn her nursery school classmates that she feels threatened, then I suppose I'll look into what my other options are.

Medication and your authentic self

My friend Kaitlyn recently published this post from a guest blogger on her site.  It has to do with medication and whether or not it makes you your "true" self, another version of yourself, or someone else completely.  This is a question that I know a lot of people wrestle with.  After all, everyone wrestles with their identity to some degree, and when you are taking medications that fundamentally change your brain chemistry, identity issues are bound to pop up.  In the blogger's article, she tries to determine whether she *is* the woman she becomes when suffering from her ADHD , or if she *is* the woman she manifests when on medication.
Personally, I do not believe that I am the nasty, ill-tempered, dark human being I become when I go off my medication.  Depression is a disorder: not a personality trait.  Science has determined that depression is due to a chemical imbalance; so I think it would be inappropriate to say that my true self is the manifestation of that imbalance.  I wouldn't say that a person with epilepsy is most truly him/herself  when having a seizure.  I wouldn't say my father is most truly himself when have a schizophrenic episode.  I wouldn't even say that a person is most truly him/herself when they are really tired.  I guess I like to think that a person is his or her true self is his or her optimal self: who they are under the best conditions, not the worst.That is not to say that I do not believe that I am a complete and total nutcase.  I definitely understand that that cranky, misanthrope I become when I am depressed is me, it is just not most authentically me.
Additionally, I think that if your medication makes you feel anything other than the most authentic version of yourself, then you need to change medication.  There are a ton of medications out there, and if you feel stifled, or wired, or just inauthentic, there is probably a medication that can get you to a better place.  Medication should help you manage your day to day affairs, and help you accomplish the goals that your disorder is stopping you from achieving.  If anything else is happening, there is something wrong.

Define "Improvement"

     I am the most pathetic mom ever.  Children are going to read about me in their history books as the most ridiculous mother who ever mothered, and shake their heads in pity for me.

This is how I look now when I put LO down for a nap.

     "But teacher," one little girl will ask hopefully, "Didn't she ever bathe at all."
     "Not for days and days, Sarah. And she only buttoned up her pants if she went grocery shopping, but even then she unbuttoned as soon as she got back in the car.  It was a very sad and sorry state of affairs."
     Sigh.  I don't know how other woman do it.  I read their very clean and proper parenting blogs about their beautiful children of whom they take gorgeous sunlit photos, wherein they wax poetic about how to grow your own kale for baby food, and how refurbish an old dresser so that it can be used as a credenza.  I'll bet they have never discussed with their husbands the possibility of training a pack of dogs to raise a baby.
     Truthfully though, things aren't that bad (not that things not being bad actually changes any of my aforementioned behaviors, it just means I feel better about them).  Thanks to Ferber, LO is sleeping in five hour chunks, which is a massive improvement from two weeks ago when she was waking us up every 20 minutes.  The first night she cried for an hour at least three times during the night, but she was actually kind of doing that before Ferber, so that isn't that bad.  No, the hardest part of Ferber is definitely the heart wrenching guilt.  I still have to wear noise dampeners to put her down for a nap, even though she only cries for about five minutes.  It is really hard not just run into her bedroom and hold her to my chest.  When she is awake I am always searching her face for signs of resentment.  Poor little girl.  I know it is silly, but I can't help feel like this is ultimately going to affect which nursing home I end up in.
     I am also working through a medication change right now, which stinks.  My friend Kaitlin just had her book published (which has me in it and totally makes me famous. You should totally buy it right now!  Buy it!  Buy it!) about how antidepressants are a solution, but not in the way one might hope.  For example, when LO wasn't sleeping, I was getting super depressed and I had to raise my Cymbalta.  Unfortunately, the Cymbalta makes it really hard for me to sleep.  Now that LO is sleeping, I am not.  So they added risperidone, which definitely helps my mood, but makes me gain weight like it is my job- so not that good for my mood from a a certain perspective.
     Oh, and it sometimes makes me feel like I am going to throw up.  That doesn't really help my mood either.
     All in all, things are getting a little better.  Medications are tricky and you just have to keep working at it I guess.
Or find a very reliable pack of dogs.
   

Back in the Matrix

So, yeah... I guess I have been pretty depressed lately.  It's hard to get perspective when you are in the middle of it, but just from reading those last few blog posts...whew!  I totally went emo for a while there didn't I?  The funny thing is, I am not sure that I feel any of it is untrue, I just feel more okay about it.  Do you ever get that?  Adjust your meds, and then suddenly you feel more okay about stuff?  I still have the same opinion of my situation, but just I just kind of feel alright about it.  As in, "This sucks, and I'm okay with that".

Meds are like that.   I have a bi-polar friend who resists medication because when he is unmedicated he sees "the real world".  He's right of course. There is actually such a thing as a "positive illusion" that affects "normal" people more than those with depression.  In other words, "normal" people kinda live in a happy little Matrix-world, and people with depression are all the people outside the Matrix who wear really bland colors and have to eat that gross food, and know that humanity is imprisoned by robots.
Only we're not the cool people outside the Matrix who can bend it to our will and stuff; I think those are the manic depressives.  It's no wonder we're depressed really.
Anyway, in that movie, as in actual life, I never understood why people wanted to live outside the Matrix.  Maybe on medication I don't live in the "real world", but so what?  Yes, inside the Matrix you are living an illusion and robots are sucking your...life source or something... but are illusions really that bad?  In the Matrix there is good food, and television, and carpeting.  Yes, it has its problems, but at least we aren't constantly being hunted by giant octopus-shaped killing machines.
In my friend's case, I think he just doesn't want to give up the sexy dance parties.

When it is your blog, you can exclude any and all references to my uterus...or just make them shorter

I have decided that I am going to write a little more specifically about my miscarriage.  I am a little self-conscious about it because, well, as it turns out there are not many people who hold an intense interest in my reproductive discharge.  Go figure.  Oh well. anyone who is grossed out by this kind of stuff can skip this entry.
Here's the thing though: I didn't really know what to expect when it came to my miscarriage.  Obviously every case is different so my doctors kept describing it in very vague "you-will-experience some-discomfort" terms, so outside of what I had seen in movies, I had no idea what was going to happen.  From what I could gather, a miscarriage involved blood-soaked sheets, quiet and quick gasps of air, followed by a montage of me and my husband talking to doctors and embracing gingerly.   That whole event would last about two minutes.  If it was a particularly dramatic miscarriage, I expected that I would become delusional and never really recover.
Once again, life failed to live us to my Hollywood expectations.  As far as I can tell, my miscarriage started the moment I conceived; spotting upon conception.  I had spotting- daily bleeding but not enough to fill a pad- for two weeks.  It was when I started filling a pad that I started to get nervous.
Wait, no, that's not true.  I was nervous immediately upon learning I was pregnant, because, as previously mentioned, that whole area is generally regarded as an unfit environment.  Once I started filling a pad, I knew something was wrong.  This was no longer a "well, I am always anxious about everything" scenario, but a "we have to do something NOW" scenario.
We got the first appointment at my doctor's office that morning, and test confirmed that I was pregnant: I had an HcG level (the pregnancy hormone) of 120.  However, my progesterone levels (levels that sustain pregnancy) were at 3: during first trimester there should be a minimum of 10.  Such a low progesterone level indicated that I would probably miscarry.  The deciding factor would be the rate and direction that my HcG levels changed.  They were suppose to double every week.  If they decreased, I was miscarrying.  If not, there was an option to treat with pregnancy injections.  I would need to wait a week to see how my hormones shifted.  Doctors told me that I should go home and try to relax because stress could increase the likelihood of miscarriage.  Nothing like knowing your unborn child's life is on the line to help a girl decompress.

But then, the next day she was fine, right?

I got the news that I would miscarry at work.  Thank God because it left me no choice but to keep it together. Still, I had no idea what to expect, and again as previously mentioned, I had no idea what I was looking for.  There were times when I would feel really bad cramping, think to my self "this is it", and then just pass a really big fart and be all better.  I bled for a month, sleeping on towels because I was afraid I would ruin our bran-new sheets.  I was massively depressed.  It wasn't the broken hearted, "I am an empty shell without my beloved child" unhappiness that I had seen on movies.  I was only pregnant a few weeks.  No, this was the despondent, lonely, disassociated, broken-hormone stuff that comes with clinical depression.  It sucked.   Finally, I woke up one night with bad cramps: not like, labor cramps, but just period style bad cramps.  By morning I had heavy black, mucus-y discharge.  It was like a bad heavy period, but was mostly over within a day, followed by a few days of light bleeding afterwords.  Shortly thereafter my mood improved, and my poor sweet husband stopped asking "is there anything I can do?" every hour or so.
Now, we are just about ready to try again, which is scary, but you know, kind of the way it works.  Hopefully things will work out better this time.

meds and pregnancy

The whole medication and pregnancy thing is a little but weighing on me.  Taking them can increase the risk of miscarriage, and quite possibly some of the most disturbing birth defects EVER: an imperforate anus? internal organs on the outside of the abdomen? Absence of a brain? Gahhh!
And yet, NOT being on medications has risks too: low birth weight, lower APGAR, lower IQ, and increased risk of miscarriage and stillbirth.  Blech.
Doctors suggest that you should stop taking them "unless you absolutely need them".  That may be the single most useless piece of advice I have ever heard from doctors.  As if there is a whole population that only use anti-depressants socially. Okay, I know there actually are college students and the like who use Aderrall and Wellbutrin, but it seems unlikely these people are looking for pregnancy advice, and an underground ring of housewives getting their highs from recreational Zoloft use somehow doesn't really ring true for me.
I am MISERABLE when I am not on medication, as are the people in my immediate area.  Additionally, I just don't think that counseling is a good substitute for me.  I know that some people need a little montoring, some behavioral guidance, and they are good to go, but I am sure that my depression is 100% biological.  I feel like treating my depression with counseling would be like trying to teach me to be a little taller.  I am just not ure talk is going to cut it.
But then again, it may be worth trying.  This miscarriage was horrible, and if it could lower my risk of suffering through another, maybe I could try it for the first nine weeks.

We can neither confirm nor deny our ability to give a straight answer.

I am fairly certain that the entire medical industry in America is hell bent on providing the American public with absolutely no answers what-so-ever.  For years I have had abnormal Pap smears.  After each scary result wherein they suggest I may have cancer, but can't be sure, "it's probably nothing to worry about", they tell me to definitely come back in six months so they can run more tests and tell me how abnormal I am.  Awesome.
Then, I bleed upon conceiving.
"That sounds serious.  We should definitely see what happens in a month."
I bleed more, and my HcG levels are dropping.
"This is a very bad sign.  Come back in six weeks and we will definitely tell you that we are very concerned."
Super.
Finally, Tuesday I go in, and everyone is very grim faced and sympathetic.  "Yes, we are concerned.  Come back next week for another test.  We will have more platitudes we can give you as we stall for answers."
I can't take it, my voice trembling, I finally get the balls to ask, "Is this typical period for a miscarriage?"
"Well, you know, we need to watch it closely and work with what we have..."
"Yes, but generally, how long does a miscarriage take?"
"Everyone is different.  If this continues for awhile we will investigate."
"How long would you say?"
"Well, we don't want to intervene unnecessarily..."
"But what if I am still bleeding after the next several tests?""I think it is important to let nature take its course."
For a moment I briefly consider lunging over the desk and throttling the lovely spiritely woman who is clearly determined to make me cry.  I decide to try one more time before settling on manslaughter.
"Do you think I will still be bleeding in a year?"
Her expression demonstrates she thinks I am being ridiculously over-dramatic.  Finally, a straight answer!
'So sixths months or less?"
She purses her lips and looks insulted, "I would certainly step in before sixth months."
I honestly feel a wave of relief.  I go for broke: "Two months?  Do you think it will be longer than two months?"
"Listen," her tone no longer compassionate or sympathetic.  She leans forward and looks me into the eye.  I feel as though she is being honest for the first time, "If after our test next time I don't see necessary progress, we will do an ultra sound and probably consider a D&C.  If your levels do fall, but you are still bleeding by the end of the month, we will need to intervene.
I would thank her, but the sense of relief has made me choke up; I can only nod.

Progesterone and You

      So as I mentioned in my last post, I have low progesterone: kind of, I guess.  I mean, I took this hormone test one time and my doctor said I did have low progesterone, as well as whacked cortisol, testosterone, capital letters, and vampirism.  Okay, she didn't literally say the vampirism thing but I assume that's what she meant as her voice started to trail as she various other hormonal inadequacies.
     It was alright though, it was not as though I was surprised, my depression is supposedly a hormone disorder after all, and now I had this chart conveniently detailing explanations for just about everything that ever went wrong with me.  Weird periods?  Low progesterone.  Hard time sleeping?  Out-of-sync cortisol.  Pimples?  Warts?  Often feeling cold?  Sugar craving?  Hormones were the explanation for everything!  Hooray!  I was saved!  All I would have to do is take a pill and everything would be fixed, right?  Yeah, maybe not so much.
     First of all, I had to drive like an hour and a half to this tiny maybe  not so legit pharmacy that was the only one in the area that would give me the special blend of stuff I needed.  That was a little sketch.  Then the fact that it came in a brown prescription bottled wherein the only thing written the label  was "hormones" gave me pause.  Finally, after taking the pills for a week and raging into two unreal screaming fits, I decided maybe this is not quite the right cocktail for me.
"Oh did I not mention that super natural bitch fests are a side-effect of the medication?" my doctor sweetly intoned.
So clearly "better" has several levels of meaning.
The real problem with the low progesterone is the problems it causes for pregnancy.  Low progesterone is the leading cause of miscarriage, can be treated with clomid, but that of course has side effects in and of itself.  While I was having my hormones checked to verify my miscarriage, I registered a 3 on my progesterone level.  Pregnant women will need at least a 9 to sustain a pregnancy.  Studies have shown that women with depression are more likely to miscarry than other mom's.  Fortunately, low progesterone is pretty easy to treat, and while the treatment can reduce the easiness of getting pregnant, it is definitely worth a try.

People hate my lady-parts

So here is the skinny:
My husband and I have been trying to conceive for about 4 months.  We've been using the fertility awareness method, and we finally got pregnant about amonth ago, really the first time we could really time it right.  (Woot!  Let's hear it for cervical mucus!)  Unfortunately, I am now in the process of miscarrying, which obviously sucks; on a lot of levels.
The thing is, I kind of knew I would miscarry.  Yes, I am a super-neurotic, so generally speaking I would not correct anyone who dismissed this idea as me crazy-ing it up again, but I think in this case, anyone with my reproductive history would probably suffer from feelings of uterine inadequacy.

The first time I went to a gyno, she pretty much verbally abused me.  Here I am, sixteen, who has in the past suffered from severe back aches and cramping.  This doctor stomps in as if she has been massively inconvenienced by my reproductive organs.  She was all frowny and jabby, sighing and clicking her tongue.  Finally she lets me sits up and says to me, "You have a very tilted uterus and probably have endometriosis..  You will probably never have kids."  Then she pretty much just got up and walked out, probably off to go kick some puppies somewhere.
Later, a doctor who was much sweeter, consoles me, "No, no,no, you don't have endometriosis.  There is no way to know that without sugery.  No, you have low progesterone, that's while you'll never have kids."  Oh, phew!  I feel much better.
So, abnormal pap, after abnormal pap I had prettty much grown accustomed to doctors hating my uterus.  However, despite all these questionable results, doctors would always kinda shrug and say, "Well, when you are ready to have kids, we'll see what happens."  Easy for them to say; they would not be the one having a miscarriage.
So at this point I pretty much regard the entire region as a hazardous area, especially after the last miscarriage.  I have a doctor's appointment in two weeks, and while I am eager for it, I am terrified.  I am envisioning myself in the stirrups, a green glow eminating from between my legs and reflecting off the doctor's horrified face as she shields her eyes screaming, "Look away!  Look away!".  There will be yellow incident tape and hazmat suits: it's not gonna be pretty.