Out of the foggy night: Overmedication and abandonment issues

I was overmedicated on mixed psychoactives (in plain English, my doctors had me on too many pills for CRPS) and, at the beginning of February, I ditched most of them. The following weeks were pretty hideous in an interesting way, as my brain’s natural chemistry struggled with the messy extrication and departure of the pharmaceuticals.

It feels like washing my dirty laundry to say this, but I suspect I’m being too finicky: LOTS of people get overmedicated by well-meaning medicos who don’t talk to each other.

The pills I stopped were SSRIs and SNRIs. (I can’t remember which was which.) The upside to this class of medication is that it specifically relieves nerve pain, in addition to helping lift depression. (I wrote an article, buried in my archives, about the tiny handful of neurotransmitters, and how each one has many jobs. Serotonin, for instance, helps digest protein in the gut; dopamine mediates decisions. I’ll dig it out and post it on the Biowizardry blog.)

When you have CRPS and you’re overmedicated on neurotransmitter Reuptake Inhibitors (of whatever flavor), your brain is in the toilet and there’s no way to tell which mental blurch is due to drugs and which one is CRPS. I couldn’t always tell how well I was thinking, though I kept trying anyway. Perceiving how I felt underneath it all was like trying to determine the shape of a bomb while it’s still in the box. I was usually clear about what I remembered and what I wasn’t sure about… but just try getting anyone to believe you when they already know that your brain is not firing on all four cylinders.

There’s a lot of grey area in the grey matter, when you’re overmedicated and have CRPS.

I’m not sure how much more crap there is to clear out, but I know I’m a lot clearer about what’s going on right now. I look back on the past two years with some dismay, as I try to rebuild the relationships I dented, and (most painfully) try to understand why those who should have known better had simply abandoned me to that foggy night.

[photo credit http://www.flickr.com/photos/jfraissi/2165047274/]

But anyway.

I am remarkably clear, now, about what I remember and what is nothing but a sudden hole in my mind. I’m clear about whether I can think right now or not. I’m able to feel the brain crank up and crank down, so I can communicate to others, “I can do this!” or “Gotta stop now!” And, for the first time in years, I can get something done on some sort of schedule. Not a consistent or reliable schedule, not to any sort of clock, but just to know that I CAN do something is quite a step. I’ll take it and be thankful!

I still have CRPS. My medication is still problematic. I still have sudden, random, Swiss-cheese-like holes in my memory and cognition. BUT — and it’s a big but! — there is no grey area in my grey matter any more. I know if I know, and I know if I don’t know.

And that’s information I intend to use.

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Radiation and sudomotor silliness

My hands and feet have been getting very swollen. My hands puff up on the phone or computer especially; with a bit of training, I bet I could learn to feel just how many rads are coming off of which hotspot, just by the icky feeling and instant puffiness. (Puffiness is driven by a neuro-vaso-muscular response called the “sudomotor response.” Also drives sweating.)

I left the computer off & unplugged for 24 hours. Left the phone at home while I was out today. Hands: hardly puffy at all, until now — they’re inflating as I touchscreen this entry. Mood: ooooh, grouchygrouchygrouchy. And such a headache…!

Think I’d better back off on the radiation. I do not need that kind of physical or mental alteration. I do need the tech, but I can manage it better.

I knew my hands inflated near my devices, but the confirmation that they don’t inflate normally was a relief.

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Dopamine, poverty, and pain: the lighter side

Executive decisions are made in the forebrain. The information that goes into them comes from the sensory cortex (nearby) and the hypothalamus (back in the dark heart of the brain.) The execution of those decisions happens in the pituitary, among other places. In short, there’s a lot of nerve-impulse mileage laid down between the moment you feel the itch in your armpit, check your surroundings for privacy, scratch away, and give a happy little sigh of relief. Lots of neurotransmission there.

Dopamine is the neurotransmitter of executive decisions. It’s a daughter chemical of adrenaline, and your adrenal glands share blood supply with your kidneys; interestingly, Chinese medicine views the need to make too many decisions as being hard on the kidneys. Makes perfect sense to me. But that’s a red herring.

The key is, without dopamine, the decision can’t get from the frontal lobe to the action parts of the brain. Dopamine levels can be knocked back by pain, drugs (including the prescribed ones), depression, poor diet, and — of course — overuse.

People who have crippling pain have to make exponentially more decisions than those who don’t. Every action is measured against an internal set of standards that don’t exist for normos: how much pain will lifting that cost me? That car door — which way should I turn my hand to minimize damage when I pull it? How many function-dollars do I have left in my body’s account — enough to do laundry _and_ shower? Or should I do just one? If so, which one is more necessary?

Poor people have a similar ceaseless train of calculations running in their heads, but with different parameters. Can I get a little meat this week? What are my produce options, since there’s no good market in this area? Which neighborhood’s market has the best prices? Have I got the bus fare? Will I get into trouble over there? How do I blend in? Can I call in a favor to get some Tylenol too? These headaches are killing me.

As a poor person with pain, I figure I make easily 20 times as many decisions — on a slow day — as a normal person my age. When I was still overmedicated, I used to feel like a loser for not making 100% perfect decisions 100% of the time; in fact, I occasionally just goofed. And the trouble with living within such narrow parameters of function and finance is, the occasional goof can put you behindhand for a very long time.

It’s easy to sneer at those who make weird decisions like paying for a flat-screen TV instead of a semester of junior college. But try wringing out your dopamine every single blessed day, week after month after year, and see how well you do. These people don’t have decision-making disorders, so much as decision-making overload.

If you’re poor or in pain, take some credit for getting through the day. Cut yourself a little slack. Take a moment to rest and relax. See, it’s easier already.

Being hypercritical just uses up your dopamine faster. Why? Because criticism is the result of long strings of decisions. It’s very dopamine-expensive. (Ever wonder why hypercritical people don’t seem very happy? Now you know.)

Take a moment to be happy, to notice what’s good. Those moments rebuild your store of decision-making, anti-depressant dopamine. Each natural, happy little sigh is a shot of the stuff.

Sniff that flower one more time. Scratch where it itches (preferably in private.) Feel the sun warming your head. Laugh with your friends. There’s a reason why it feels so good. It really does make you stronger. It freely gives back what life makes you use. And it’s not too hard to find a reason to be happy.

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Chalk boored: cortisol and dentition

My teeth were crumbling. I thought that was churlish of them, especially since I was moving at the time and had quite enough going on.

My naturopath has gotten them back to something more toothlike and durable, but the thing about tooth chips — like stretch marks — is that there’s no undoing them.

Another blow to my vanity, or what’s left of it.

I’m told this churlish chalkification was due to the effects of the cortisol my body now has again — and responds far too strenuously to. This makes sense at a basic level, since mineralization is one of the things cortisol affects. I haven’t looked into the specific science but, since I can chew without fearing for my molars now, I’ll accept the explanation and keep going.

I’m glad my teeth are stronger. I can probably live without using them for pulling needles and trimming cuticles, but I was stumped for ways to chew my food without them. As it is, I suspect beef jerky and rock cakes are entirely in my past.

Think I’ll have an apple for breakfast. Wonderful thought. It really is the simple things that make life sweet.

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Expected vs. Actual: planning for WC settlement

The lawyers have finally agreed that it’s time to put this turkey of a Worker’s Comp case to bed.

My lawyer said that, for one thing, I get a mathematically-determined
“apportionment” for being 30% disabled (yes, the Governator thinks I can do 70% of the work I was trained for — writing and patient care — with no freakin’ hands!) The amount would buy a midrange car, but not insurance or gas.

In addition to that, I can either continue fighting with them for every scrap of care my doctors are willing to go to bat for, or hold them up for cash on the barrelhead in return for letting them off the hook in future.

My lawyer figured they might be persuaded to give me the equivalent of another midrange car. This adds up to roughly the cost of a moderately tricked-out Tesla Roadster.

That’s not chump change, but put this in the tailpipe and smoke it …
I suggested plotting out future expenses and seeing how close that amount (the Tesla) would come to meeting the need. So I did.

Turns out that, after writing the check for the Roadster, they’d still
have to move the decimal one place to the right. And that’s for basic lifetime care — nothing fancy, no further disasters or complications. Just regular doctor visits, generic meds, some minor surgery (although
with CRPS there’s really no such thing), and acupuncture at about the same rate they’ve allowed so far. Over a million dollars.

Think they’ll move that decimal point?

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