Obligatory Update

[Edit: 2018.10.30. There are some horrific mistakes in what is written below. The worst are inexplicable use of incorrect homonyms of the intended words. I am not fixing them. I don't care to do any more than make this note, just so any imaginary reader knows that I know how stupid I am.  For some reason that is important to me, or something.]

Obligated to who or what?  I guess a little bit of OCD in me that thinks that I've been blogging all my health bullshit, I might as well make sure I keep it up-to-date.  Apparently I lost the little bit of OCD that gave a shit about style or grammar.

This is what old people do.  We talk about our gross boring health bullshit, and bad writing, while you anxiously wait for us to die.

I almost did, maybe.  Yeah, probably.

If I had written this months ago, it would be peppered with amusing anecdotes demonstrating how profoundly I distrust all medical professionals..  But now I have either forgotten or lack the will to try to remember.

So, just the basic facts:

I almost died of acute congestive heart failure.
It took medical professionals an unacceptably long time to figure this out.
As a result of their aggressive treatment for congestive heart failure, I was released from the hospital while in acute renal failure.

So now in addition to calories and carbohydrates, I have to severely limit my sodium intake and closely monitor and limit my intake of water, or anything that is composed in part of water.
Watching sodium is a good idea anyway, and I was already giving that some attention, but this is a whole new color of threat level.

Limiting fluid intake is counter-intuitive, after a lifetime of doctors and everyone else hammering away about the importance of adequate hydration.

It's even better that all that.  If I over-due the fluid intake limiting thing, I go back into renal failure, and get horrible leg cramps when I try to sleep.

So life is now insert apt metaphor or simile here.

Oh yeah, I also have an enlarged heart because I have basically been living in a constant state of congestive heart failure for decades.  It just took a minor sickness, over-treated by chicken soup and electrolyte-laden beverages to push me into a sufficiently acute state to be diagnosed.

So the good news... yes, I am capable of perceiving the presence of and dutifully reporting good news about myself... When I have the balance just right and I am not leaning hard towards acute this or that, especially the heart failure thing, I can actually walk at a brisk pace for several blocks, even uphill, without collapsing in a wheezing pile of oxygen starvation and a heart like a hulk fist trying to beat it's way out through my sternum. 

One more thing: when they did a CT of my chest before they had any idea what was wrong with me, whoever wrote up the interpretation of my imaging noted a large number of various sizes of something he called "nodes" in one of my lungs.  Not one doctor read this.  I did, and I pointed it out to my Primary Care Physician.  The follow-up CT to see if they're still there and if they have grown is in the next month or two.

If God exists, he hates me.
If the universe has intent, it wants me dead.
If everything happens for a reason, the reason is so I will die.
I have far outlived any purpose I may have had.
My possibilities for satisfying any selfish personal goals have narrowed to nothing.
My psychiatric medications have robbed me of my vital powers of self-delusion.
I'm just running the clock out.
But how in Hell am I supposed to plan a decent suicide if I am constantly being forced to fight for my worthless piece of shit life?

Ok, time for grandpa to take his pills and go to bed.

Hey, let's obsess about drugs and mental health some more!

[New Improved Editorial Note, June 14, 2018: Holy Mother of Goats, I am an idiot!  As you read, if you read, this post, not that I recommend it, please mentally replace the word "Zoloft" with "Ambien" everywhere it occurs in this post.  I am also on Zoloft, but as prescribed by my psychiatrist, not my PC. I don't even have a PC any more. He moved. I meet a new one next month, because this is all information of vital interest to everyone!]

 [Editorial Note: I just noticed that this blog entry is virtually identical in content to the immediately previous one.  Well, damn it, I put in the time, so it stays, and stands as more evidence that I am, pretty much literally, losing my mind.]

At my annual wellness exam, my primary care physician made it clear that what I have been doing to get myself to sleep for the past few years is dangerous, likely responsible for my recent problems with equilibrium, memory, and general cognition, and a suspected contributor to risk of developing Dementia.

Fine talk from the very doctor who prescribed enough Zoloft for daily use when my chart already showed that I was on high doses of another Benzodiazepine.  Yet, it is still my fault that I, against all warnings, added alcohol to the mix.

Clearly, at some level, I knew what I was doing.  After all, for awhile my nightcap to accompany Zoloft, Clonazepam, and sometimes Diphenhydramine (Benadryl) was my favorite skull mug filled with a combination of Nyquil, Vodka,  Kool-Aid, "Rescue Remedy" and whatever else struck my fancy.  I called it "Death Grog" so, yeah, that's on me.  Those are years without a lot of memories attached.

Essentially, what I was doing to get to sleep was roughly equivalent to what some people do to try to end their lives.

This led, of course, to stumbling sleepily through mind-fogged days, and a lot of napping.  When I was needed to be awake for some task, usually driving, my drug of choice was Monster energy drinks, sometimes two or more a day.

The vicious cycle this creates led to mental health symptoms that somewhat resembled Bipolar Syndrome, and more.  Alternately spazzy, irritable, prone to panic, cognitive deficits, and almost catatonic periods of disassociation.  That's probably not a complete list.

So, here's the good news.  Dropping Zoloft cold turkey seems to have no withdrawal symptoms.  I have long since abandoned Nyquil and Benadryl.  Eliminating bedtime alcohol and drastic reduction of caffeine intake, have all, one week into the process, proven easy.  I no longer have difficulties with maintaining wakefulness, so long as I am allowed to follow my natural sleep patterns (roughly 4AM to Noon), and my moods swings are less extreme.

Not to worry, I am still beset with depression and anxiety.  I feel completely worthless and unworthy, and can't handle noisy, bright, crowded situations, or any kind of direct interaction with people that lasts more than a few seconds.

The Latest Version of More of the Same

Maybe there is just enough story here to justify a return to telling.

I have a profound feeling of isolation and powerlessness, given that there are things that plague my mind which I cannot share with anyone, not even my marriage partner of over 30 years.   Not even with my psychiatrist, with whom I have an appointment "tomorrow" (later today).

I had an appointment with this same psychiatrist some months ago, arriving at least as burdened with needful, for me at least, things to say as I am now, but the very first words out of his mouth were "How is your lovely wife?"   You see, he had met her, and like everyone else who meets her, the fact of my existence became part of her, much more interesting, story.  She does not make this happen by intent.  It is just the natural response everyone has upon meeting her.  She is amazing, and putting up with me as a husband is just one more way in which she is amazing.  I know it sounds like I am resentful, but I really am not, most of the time, and when I am, I always come to realize that my feelings were wrong, ungrateful, and petty.

She is not the reason I have problems.  She is the reason I am still alive.  Her, and my granddaughter.

I would not be writing this if I believed that anyone, even my original singular assumed reader, was going to read it.  Paradoxically, I am motivated to write largely because I made a link to this blog the sole external link on my Bandcamp page.  I am still arguing with myself about why I would do such a thing.

Here's the story:

I have been having disturbing incidents in which it seems that my psychiatric medications do not appear to be working.   At the same time, I am noticing, subjectively at least, a decline in my general cognitive function.

I had already made this next appointment with my psychiatrist when I came due for an annual wellness exam with my primary care physician.  Much to my surprise and discomfort, they had a whole new questionnaire addressing, quite specifically, mental health.  I had been comfortable compartmentalizing my physical and mental health with two different care providers, but I felt an obligation to complete what was put before me, and to do so honestly.

Apparently, my honest answers set off some silent alarms, or the whole intake procedure for a wellness exam had been radically altered.  Once I was ushered into an exam room, a nurse orally administered a much more comprehensive psychological evaluation, followed by additional questions from my doctor.  The primary focus seemed to be on risks of suicide.  Maybe it is a risk management thing. There was more weird shit, but I am getting tired, and my window of available sleep time is narrowing.

Notably, however, I was taken aback by newfound warnings from my GP about the risks of Zolpidem (Ambien), which he had long ago prescribed to me.  Suddenly now, after at least two years of daily use, I am warned that this drug can contribute to both short term and long term cognitive deficits, and problems with equilibrium, including an elevated risk of developing full-on dementia. I am now terrified that the damage is already done, while also trying to cease use of Ambien "cold turkey".

Almost as if motivated by learning of my barely controlled anxiety and depression, he also told me that my decision to cease use of a CPAP machine several years ago was probably causing permanent brain damage, and would also increase my risk of developing dementia.

Hooray.

So, a lot to cover with my psychiatrist, if he lets me finish a sentence or two, and very little time left to sleep.

More than enough.  Goodbye.

The Neverending Ending

Same. Same. Same.

I give up.

I am done.

Where do I get off this merry-go-round?

I am not suicidal.

Suicide would be redundant.

I am already long dead.

Or more precisely, my life story ended but I forgot to die.

God is not vengeful.

The Universe is not cruel.

They just forgot to kill me.

They forgot me completely.

All of the pain and regret and fear and disappointment are just a dull ache.

Is this done? 

Can I stop writing this now?


I should not have started.

Sins of Omission

...

Riding the Rollercoaster of Psychoactive Pharmaceuticals

This may be destined to join my pile of unfinished drafts.  I barely have enough motivation to start.  I feel some vague obligation to document my changes in drugs and dosages and give my impressions of net effect, but the current net effect makes it hard to care.

I am so weary of this process of trying to make me, or my life, better, through drugs or any other means.  I'm ready to settle for where I am and who I am, no matter how disappointing and diminished that may be.  I won't be sitting comfortably, but at least I won't continue building this resume of hopes and failures.  There is no room left for hope.  That isn't as bad as it sounds.  Hope is the great deceiver. I'm ready to be my version of real, no matter how bleak my reality may be.

For details, since the last posted update...  I think I was on 150mg/day of Sertraline (Zoloft), and the same 4 1mg doses per day of Clonazepam I have been on consistently for years.  When I had been on 100mg of Zoloft for a little while, I had a remarkable improvement in all aspects of my subjective mental well-being and ability to function socially (sorry if this duplicates previous posts), which lasted for about 3 months.  The increase to 150mg Zoloft seemed to make no difference, except perhaps to make worse some physical side effects.  The next strategy to address both effectiveness and side-effects, was a decrease of Zoloft to 100mg and the addition of 100mg of Bupropion (Wellbutrin).  This was given an adequate trial period and found to have made no difference to side-effects, and a subtly perceived worsening of intended primary effects.

Now, I am less than a week into being back on 150mg Zoloft and Zero Wellbutrin. I know it is early to judge, but I feel nearly as bad as I did before starting Zoloft the first time.  My Psychiatrist told me that there should be no withdrawals from dropping the Wellbutrin because it was a small dose for that drug.  So if these aren't withdrawals, what the fuck is going on?

My sleep is fragmentary, my attitude and mood are slightly unstable, my anxiety, and perhaps my untreated (untreatable?) ADHD are messing with my cognition and general ability to cope.  And, of course, I feel hopeless, worthless and unworthy.

I don't think I have manic episodes, but for some damned reason, I got this idea in my head that I wanted to enlist some musician friends in a project to put on at least one live performance of the full album "The Point!" by Harry Nilsson, consisting of both songs and narration with underscore.  I had this idea that it was a work largely unknown to most younger generations and that it had a message, in fact several possibly useful messages, that is relevant to their lives and the current state of things.
The initial response from my primary collaborator, the one who would be writing the charts for all the other musicians as well as performing, was very enthusiastic.  Then, when it came time to contact another important potential collaborator for the project, I found my self terrified by what I had set into motion.  To try to reassure myself, I have tried to sing along with the record several times, and I just can't sing worth a damn.  I used to sing all the time, when working or driving or just about any time.  And I used to sing karaoke, first the usual kind, and then with a live band.  Although I can't make myself believe that I was ever even marginally adequate at singing, I do remember getting positive responses from many people over the years.

Now it has been nearly 6 months since I have sung in public, and about 10 years since I have sung and believed that I was singing passably well.

At least it is early enough in the project that I can kill it, or at least remove myself from it, without having wasted a lot of other people's personal investment in it.

There was some other shit I was going to say, but I'm out of energy and motivation again.  When will I stop writing these pointless fucking things?  Soon.

Changes in Dosages, Initial Observations of Results, Areas of Concern

My most recent visit with my psychiatrist was a week ago as of this writing.  During this meeting it became apparent to me that I should have been keeping more detailed and frequent records of my changes in medications, dosages, mental state and behavior, and that I should have started doing so much earlier.  I am not completely confident that my doctor's own notes were as comprehensive as I had assumed them to be.  In recent years we have conducted trials with a wide variety of antidepressants and anti-anxiety medications, with a wide variety of mostly poor results, before arriving at the combination of 4mg of Clonazepam per day in four 1mg doses, and one 100mg dose of Sertraline (generic for Zoloft), per day.  After a few months of positive results, the Sertraline seemed to become less effective, and was increased to 150, with no remarkable improvement.

My condition going into this appointment was not terrible and not great.  I found both depression and anxiety to be within tolerable control most of the time.  However, the ability to comfortably engage with others socially was gone.  The courage to leave the house for any non-mandatory reason was gone.  I was curious if there was any way forward that could return me to some social activity, particularly going to see local bands, book readings, etc. Additionally, some common side effects which I had been tolerating for quite some time became a matter of concern for me.  I wanted to determine if such problems could be mitigated, or should be accepted as permanent.  Any intelligent reader can read between these lines.  I was willing to compromise, trading a setback of one kind for an improvement of another, but of course it isn't that simple.  The brain and body are massively complex and we're basically just throwing pharmaceutical darts at it to see what happens.

Nonetheless, based upon some presumptions based upon poorly documented past experience it was decided that I should taper back down from 150 to 100 of Sertraline, begin 100mg daily of Bupropion (generic for Wellbutrin) immediately, and keep Clonazepam as-is.

At this juncture I have completed the decrease in Sertraline and have been on Bupropion for a week.  It is too early for conclusions, but a good time for noting changes thus far.

I have become more irritable, which is very disappointing because I had quite enjoyed being less reactionary and paranoid.  Related or not, my cognitive function seems to be in a slow and steady decline since before the current trial.  I still feel no closer to returning to social function, or to "domestic function".  I realize now that I spend most of my time with passive distractions, to avoid thinking about the very things about which I am writing.  Introspection is my enemy, as it always leads me to either despair, or failing the energy to be dramatic in my self pity, to the logical conclusion that I am simply done.  My story, such as it was, has long been over, but I'm still here for no compelling reason.  I feel obligated to remain alive to putter incompetently through the few practical tasks for which I am still useful, but grow weary of how I seem to constantly disappoint.

To complicate matters further, I have had inconsistencies in the scheduling of my dosing, and have even made errors were some doses were entirely skipped, or two doses were apparently taken much too close together in time.  I use a 4 by 7 weekly pill organizer, which helps some, and is the primary source of evidence for discovering my lapses, but I think I need something more comprehensive, either an app of some kind, or a simple handwritten journal of what I take and when.

The Clonazepam had saved me from a lifetime of internal terrors I do not wish to describe, but I regret ever attempting a pharmaceutical approach to my depression.

Hey, I just ran out of motivation to keep writing this shit.