Get You Some of That – Medical Treatment for Medical Illness

…Continued from yesterday.

Cole_liveCole Swindell – Get Me Some Of That

Why do I feel so horrible when I start a treatment that is supposed to help?

Medication treatments for depression and anxiety, and some other brain illnesses, often worsen how you feel before you feel better. I can’t tell you how many patients have told me that if they had known this before, they never would have stopped their mediation(s).


Yesterday, our post discussed a Dr. Jones and Presley.

Presley fired Dr. Jones when after following her directive, he subsequently experienced an extreme panic attack. Dr. Jones may not have done anything wrong in her treatment recommendations. Presley was just an individual, as compared to a “number on the curve” of treatment responders. Escitalopram, the medication discussed as an example yesterday, (one medication option out of many), may have been dosed at an initial amount that Presley’s body couldn’t handle “straight out of the gait”, so to speak. But likely, if he had started at a lower dose, maybe ½ or even ¼ of the tablet, and then waited for his body to accommodate to the medication. Then Presley would have tolerated it. Presley would have tolerated slowly increasing the medication if approached, rather, piece-by-piece of a pill. I’ll even joke with patients,

I don’t care if you lick the pill. Just get on it.

When slowly titrating a medication, it allows the individual’s neurotransmitter receptors to down-regulate whilst the agent floods the receptors. If there is a neuron targeting another neuron, there’s a baseline balance in time. There is a baseline understanding between these neurons. An agreement, of sorts. “I’ll sit here and receive your messages,” (neurotransmitters, or chemical messengers such as serotonin, norepinephrine, and/or dopamine). “I’ll then carry those messages on your behalf to their intended recipients,” (such as the amygdala or hippocampus). But then this person artificially takes a higher quantity of these messengers, for example, by way of medications, and floods the system. The receivers, (or neuroreceptors), have to adjust to this to establish a new healthy baseline. 

In this initial time of treatment, when 1st introduced to the increased neurotransmitter-load, (ex: as released by a tablet of Escitalopram), there can be a negative response, such as panic and/or depression emotions. We call this, “initiation side effect’s.” Once the neuroreceptors get used to the new load, then the response improves. 

After accommodating to the new pharmacology, the brain is allowed to experience the blessing that comes from treatments, and heal.

Some individuals are outside of the curve and cannot tolerate the standard initial treatment dosage, like Presley was. Some are inside, and can without much difficulty. The point in treatment, though, is that the person just needs to get on it.

Get on treatment. However you do it. You have to make the treatment work for you, an individual, in your own way. The prescriptions are there to serve you. You aren’t there to serve the medications. I like to analogize Jesus’ statement,

The Sabbath is there for man, not man for the Sabbath.

Make it yours as an individual and reap the benefits; the blessings inherent there. (See Mark 2:27). 

If you don’t get on the treatment, you won’t get better. Anything less than this will be inadequate. It’s like drying water off your face with a hand towel while still walking in a rainstorm.

What is your agenda in treatment? List it. Write it out. Then, go get you some!

Outside a medical approach is like flicking water off in the context of a rainstorm. If your agenda is getting to your healthy self. Get out of the storm and get dry. Then go get it. 

You have a medical condition. Treat it with the assistance of a medical professional. 

I don’t go to a plumber to help with my electrical home repair. I don’t go to an accountant or a church counselor to treat a medical one. 

The plumber, the accountant, the church counselor are what they are. This is not minimizing their efficiency in their own fields of excellence. But why do we seek care in psychiatry from those who haven’t studied this? From those who are not experts in this? Maybe stigma keeps us away from psychiatric care. Maybe misinformation directs our search for mental health treatment elsewhere. 

Self-Care Tip: Get you some medical therapy for medical illness.

Question: What are further concerns you may have about taking medications? How would you prefer your medical providers to work with you? Please tell us your story. 

But I’m Not Someone Who Likes Taking Meds

pill

Presley couldn’t breath. A truck just drove through his thorax. A monster-hand was closing around his heart. He couldn’t swallow well. Was something stuck in there? Dizziness nearly dropped him, but instead of moving to sit down, like any other normal person would do, he bolted. A fire chased him. He had to escape or he would die. In the bathroom where he found himself, the mirror reflected a sweaty face and crazy eyes. Was he dying? Presley’s phone looked blurry as he dialed, 911.

Please help! I’m having a heart attack!

That was the first time this had happened. After the third visit to the emergency room over the past month, Presley was able to avoid calling 911, although still convinced he was going to die when the next episode hit. He agreed to seek counseling, where he was taught different skills to connect his mind and body, to slow his breathing down, to process, even when he was convinced he was dying.  For a time, Presley improved. It was like it never happened. He was almost able to convince himself that it wouldn’t happen again.

This turned over and over, feeling like he was going to die while losing his mind, re-engaging in counseling, thinking he was better, stopping counseling, and then another violent emotional event, thinking for sure, he would die.

It was after his second trip to the ER when he received the recommendation to schedule an evaluation with a psychiatrist. But he preferred to work through this in therapy. Presley didn’t like pills. He wasn’t someone who medicated. An olive-skinned athlete, he lived clean and didn’t believe there was much that healthy living couldn’t cure. And Presley did live clean. He ran fifty miles a week. He ate raw foods. He read his Bible.

After several months of this, his therapist, Dr. Wu, recommended he get a psychiatric evaluation. However, Dr. Wu agreed that he would continue to work with him, whatever Presley chose. (Was this the right thing for Dr Wu to do?) Presley chose, no. No psychiatrist. What would a psychiatrist do to him anyway?! He wasn’t crazy. (Except when he thought he was.)

Presley visited his primary medical physician, Dr. Belinda Jones. It had to be better than seeing a shrink!

Dr. Jones, I don’t want to take meds.

Dr. Jones, cleared him for any medical condition that might be contributing to his events. Only then was she able to convince him to try a “safe antidepressant”, escitalopram. After one pill, Presley had the worst event of his life. He’d never had any experience that was more terrifying. Presley didn’t go back to Dr. Jones, “of course.”

When these emotional tornadoes hit more frequently, he became paralyzed with fear that he would have them in public and be humiliated by them. Presley stopped going to work.  If it wasn’t for his rent, he’d never go back. But he had to. So finally Presley agreed to see a psychiatrist. …

To be continued

  • Sincerely, Dr. Q

Questions: What would you tell Presley? 

How would you like your physician and/or therapist to handle this, if it were you?

Why is Presley so opposed to taking medical therapies?

Please speak! We need to hear you.

Self care tip: Keep on! 🙂

STOP! DON’T STOP! The quandary inside of us when deciding to take medication

Everyone says “Hi” to my dog, Timothy… Way more than to me. Silence.

Is it the springy fluffy hair, I wonder? They walk up, even speed, out of an unseen shadow without inhibition and rub him down. He is pleased every time, to say the least. Do I regret all the painful laser hair removal treatments I got years ago? Hm. I am half Lebanese after all and few really know how much fur I really came with.

(Curly-cue.)

Steve came looking for help. I spied him in the hallway before clinic. That’s always a little awkward for some reason. Running into someone out of context. Like we both are caught out of costume and the curtain just pulled up. (Gotcha!)

His strings pulled in, an inner tension, apparent even then. He looked susceptible to emotional or physical attack when we caught each others eye. I could see him wondering if this was “her”, his psychiatrist. What was he expecting?

When patients come in for treatment, it’s comparable to anyone acting on a realization that they’re vulnerable, asking help from a stranger. It can take immense courage.

Part of this understanding is what contributes to the awkwardness of meeting in the hallway, out of context. We are both a little undefended there.

So what would bring a person to do this to themselves? It doesn’t sound pleasant when put this way – vulnerable, asking help from a stranger.

Steve had a wife, kids, a job, a house, and a pet. Inside this bubble, Steve didn’t think he had reasons to feel the way he felt. He looked for them and felt stupid because everyone told him how good he had it. Nor did Steve see reasons to behave the way he behaved. He described his story, a rolling out of his life, like that of a hand stitched carpet. In it, we saw together that he had anxiety then, and then, and then. He had coped well mostly, until he hadn’t. Then he would spend some time falling out of circulation and incurring losses. Then he’d recover and forget. He’d forget that worse patch and redefine the lines around the man. Then again the lines would smudge, he’d get anxious and irritable beyond “control”, grapple within the darkness of the white noise, which panic brings, grapple for reasons why the anxiety came again. His identity would be so threatened, the suffering, the feedback from everyone around him would pull on him, that the lines of his person frightened him into treatment.

There Steve was. Timothy at his feet with his puffy furry head in Steve’s lap. Steve asking for help. At the same time as asking for help, he would also refuse, stating caution.

“I don’t want to change myself.

I like being the person who gets things done so well.

I like accomplishing things.” (He thought it was his anxiety that allowed him to do this.)

It reminds me of the, “Stop! Don’t stop!” that I’d tease my brothers with when we were kids.

People think that taking medication changes who they are. Understand that in order for this to be true, that would mean medication changes DNA code.

“Doesn’t it change my brain chemistry?”

Let’s say that were true, that medication changes brain chemistry. Still that isn’t changing your DNA. The DNA is what gives a person “personality,” or, what many of us say, “Who I am.”

After getting laser hair removal, I didn’t change my DNA, but I don’t have as much hair. When my kids were born, I checked, and sure enough, DNA…. They’re gorgeous! Wink. (That’s done with one heavy cluster of eyelashes around my dark Lebanese eye.)

Question: What are your fears about taking medication?

If you have taken medication, how did you see it affected your identity?  What happened to who you call, “Me?”

Please SPEAK! We need to hear you. Keep on!

Self-care tip: Self-care means taking care of yourself even at the biological level. It starts with “Me.”

 

I Can’t Make Friends – Anxiety

voyagerMr. Clark stopped talking and walked to the ringing rotary phone on the wall.

We were experts, as 7th graders, in anticipating what phone calls would be about. I’m surprised we never got around to making bets. I missed my chance to be a bookie. When the phone rang, it could mean someone was in trouble and had to go to the principle’s office.

Everyone was quiet waiting to see if their name would be called. No. That wasn’t it.

It could mean there was a school announcement. It could mean there was something wrong with our bathroom plumbing! But it had never meant that a space ship had exploded. Seventh grade was not the time to grasp what this meant. If we couldn’t grasp it, if our perceptions were unable to see it, then it could not actually exist. Right?

We kids had other things we were trying to sort out. Boys and girls. Getting your period or facial hair. Zits. What Melissa said about you when you thought she was your friend. These were space occupying in our minds. There was little room for understanding that this phone call announced the end of 8 lives, a billion-plus dollars blew up, nor especially not what it meant politically! Spouses and children, watching and cheering in the bleachers live, front row and center, witnessed as their own individual loved one exploded into tiny particles.

Mr. Clark walked, white-faced and perspiring, to the radio, asked for silence over the hum that had built up, and we heard. The challenger, the 8 people aboard (one of them a teacher), in 1986, was gone.

A spaceship exploding is about what anxiety feels like. That may sound extreme but it is the truth. And those who have experienced it, as if their were going to come apart, will do anything not to experience it again. This urge to avoid anxiety expresses itself in emotions and behaviors. But often, when anxiety doesn’t reach a full explosion, the afflicted individual doesn’t even know that they are sensing the urge to avoid, nor how they are responding to this avoidance. The afflicted person and those who know him get think that these medical symptoms are actually the afflicted’s personality. “It’s just the way I am.” 

You may be someone who feels inner congruence with decisions. By temperament, you like closure! But even so, against your own hard-wiring, you find that you have trouble making decisions. How you talk is driven by indecision. You’re couching what you say, being careful. Your self-esteem erodes.

Manuel had some similarities to this, but also, on top of his medical condition with avoidance symptoms, his personality was one that got energy from being alone. That doesn’t mean Manuel didn’t like people or interpersonal relationships. It just means that he got energy from being alone. And he did stay alone most of the time. When around others, the energy poured out of him like lemonade through an open spigot. However, he wanted others. Being lonely was not his goal. But there he was, more energy when alone combined with a thrumming buzz of nerves when he tried to make friends, when he tried to date, or when he was approached by someone spontaneously in public who asked the time.

Fudge! She only wanted to know the Blinking! Time! he screamed inside.

Manuel had some friends with whom he was deeply bonded to by shared experiences. But he had gone on to college and his friends had not. It was niggling in whispering thoughts that he might still be hanging out with them because they didn’t disrupt him. Because he came apart. Terror, like a spaceship exploding in the atmosphere after take-off, filled his perceptions, if he tried to hang out with anyone else! And Manuel didn’t like thinking about his friendships that way. They lost value when tattered by that persistent wind. Nor did Manuel like thinking about himself as someone who couldn’t get other friends if he wanted to. As someone who would use the faithful. Friendship by default? No. He felt shame just thinking it and he knew it’s falseness. In his most essential self, he knew he loved them for more than proximity. But he really didn’t know if he was weak. It was a possibility. And besides! What girl would want a weak man?

People with anxiety have barriers to any number of connections in life, like coming up to an energy force field we can’t see. There are interpersonal connections we might have had, but never initiated or explored because the anxiety held you in place. This is what anxiety does to us. Anxiety takes away our freedom to choose. And as the consequences and fruition play out, we live out the related losses.

Manuel came to me because, “Mom told me I better come and talk to someone.” Mom was fed-up with his isolation, hours of video games, and she had noticed that he was spending even less time with his childhood friends. 

Talking to Manuel, unearthing these patterns in his life, his insight grew a bit. But once he looked at anxiety, even with a sideways glance, which was anxiety provoking in itself, he came up against the need to decide,

Should I treat?

Deciding to treat is a decision to make between the patient, perhaps including their support system, and their treating clinician. When there isn’t a clear answer though, like a blood test that shows the vitamin D levels are low, we respond with vitamin D replacement therapy, but in these areas of diagnosis, it often feels nebulus to the patients on what to do.

When the decision doesn’t have clear form, like an undefined space, go toward the data. You may trust your clinician to know that data integrate it into all the information that goes toward deciding on treatment. Or you may choose to spend time researching and evaluating the data on your own and then go forward. Either way, if you stay with what you’ve been doing, you will remain ill and the illness will progress over time.

So either way, going with the data, either via your clinicians recommendations directly, or indirectly. Accept treatment. In fact, run toward it! You will have a much higher quality of life. And… those around you will too.

Self-care tip – Go toward the data!

Questions: What had influenced your choices in treatment or not to treat? Please tell us your story. We need your voice!

Sweaty and Worried – Generalized Anxiety Disorder

Hank had to sing an Italian song for his tests.

His music instructor did not believe that he had been practicing two hours a day. When Hank asked his voice teacher to sign off on those hours, his voice teacher still did not believe him.  He had nothing to feel shame about.  “Then why did I?” Hank wondered.  Card in his hand, signed off, Hank resentfully kicked at the rocks covering the path back to administration.

Looking out over mostly empty hard wooden seating in the music hall, Hank slaughtered the song. Even so, it was still the best performance he had ever done.  His father was there in his stained tie and largeness.  His mother in her too many colors, smiled loudly.  She was tone deaf.  Frank’s shame followed him.  He had practiced.

Hank’s older brother dressed in silk shirts, a big gold medallion, a tuft of hair coming out of his barely suppressed neckline.  When they prayed, Hank heard these smacking noises, and thought, “Pray for my nausea,” hoping they would stop kissing.  His brother always had a girlfriend.  The girlfriend was at his recital.  There were noises.

Everyone was scared Hank’s brother would marry too early and maybe marry for the wrong reasons.  His dad was always like, “Wait, wait!” But with Angie, Dad was like, “Get married now!”  Angie was the best in a long line of noisy kissers.

They asked Hank to sing at their wedding.  They insisted.  His brother, his brother’s girlfriend, his parents – they spoke in harmonics all at once.  “Hank!  You sing like Sinatra! Don’t worry so much! You should sing!”

In a rented tuxedo, Hank sang.  The mike didn’t work.  Aunt Augusta told him to sing louder.  Aunt Augusta didn’t hear well, even if there was a mike.  Hank forgot his words and had to start over.  Sweat filled his shirt and he thought about the dry cleaning.

Hank has never had a girlfriend and he is almost twenty-five.  Standing in front of all those people without the song lyrics, the only words that came to him were, “I am like a sweaty doorknob.”  His brother, facing a battle of his own between his ruffled shirt and his manliness, did not help.  Hank thought, “He is probably waiting for prayer so he can start kissing.”

The second year of college, Hank got caught with pornography.  “Hank!” His mother pulled his ear, towing him while she shook the fisted magazine through the house.  He didn’t listen to her words.  He only listened to his memories asking his music instructor for his signature. Was it as bad as the wedding?  Talking to Sarah or walking across the campus greens were bad. He fingered his worries like a beaded necklace.  He worried a lot.  Worry and shame.  He wished he could have a girlfriend but thought that was a hopeless cause.  Hank was already planning on buying a new magazine before Mom had thrown that one in the garbage.

It is so easy to explain away why Hank is the way he is.  We have heard enough to say, his parents, his brother, his isolation, his treatment from teachers.  We can use these to say, “Who wouldn’t be anxious, worried, down, and isolated, when going through these experiences?”  If we did though, we might miss the generalized anxiety disorder, the medical.  Conceptualizing the medical in this way can be so difficult.  We could call it, “the un-reasons why” we feel and do what we do.  So then we don’t have to deny it.  The un-reasons why don’t have to make sense.  They are un-reasons, after all. We don’t have to deny them by our inherent need to point at the cause and effect, or explain into uselessness the reason we are this way.  We don’t have avoid eye contact just because they can’t be seen.

Hank, like so many of us, is included in the statistics that generalized anxiety disorder, or GAD, is one of the top reasons why we don’t get intimate with others.  The anxiety is distracting.  It isolates us.  It preoccupies our thoughts.  It fills us with self-doubt and develops over time, almost inevitably if not treated, into depression.

Getting by with something as subtle as GAD, or other brain illnesses such as degrees of depression, have potentially devastating effects on what occupies our life-line.  The moments that construct the overall devastation may be explained away by one injustice or another, by what are thought to be personality quirks, or simply by neglect of self. But they could be different. The moments, the otherwise same moments, could be different.  The same rude, distrustful teacher, the rejection from Sarah, the quiet mike – those moments could have been different with the same guy, different only in his brain health.  Brain health makes the sameness different.

As Nancy A. Payne, of New York University (NYU) Silver School of Social Work, wrote about treating brain illness,

“There is tremendous satisfaction gained from facilitating the transition from profound illness to equally profound recovery.”

The life-line takes courage to look at.  It takes courage to believe that the effect of our negative thoughts and distorted perceptions could indeed have that pervasively profound effect.  It takes courage to consider that medical treatment can likewise, profoundly change our quality of life.

Hank tried to take his life with a rope before we met.  I’m so glad he didn’t break his neck or die.  He is now well treated and his disease is in remission.  His life-line has changed.Bo-J0zyIEAA_Y3h

Questions:  What are you brave with?  What do you spend your courage on?  Tell us about it.  We gain so much from community and connection.  Keep on.

Self-Care Tip:  Look also at the un-reasons, at the reasons less apparent, at what isn’t seen – look  into those reasons of why we feel and do.

To Use Tension, Or Run From it…

English: Waterfall near Lepena, Slovenia Slove...

English: Waterfall near Lepena, Slovenia Slovenščina: Slap, Lepena, Slovenija (Photo credit: Wikipedia)

A few days ago, we talked about tension being a tool for balance.  Col, in her comments, asked to expand on this.  Aside from feeling incredibly tense about it, I thought, “Ah!  All right.”

You’ve heard the term, “One’s man’s junk is another man’s treasure.”  Tension is like that.  It’s all kieshy now and pop! to meditate into oblivion, (I exaggerate,) and “medical” marijuana couldn’t be easier to get, but where do we get the opposition that provides so much of the pleasure in the calm?  Tension.

If you’ve never been quite calm yourself, imagine standing under a waterfall trying to dry off  when people say, “relax.”  (Got to love it when people say, “Calm down,” or, “Relax!”  …Ahem.)  Using tension as a tool for balance is learning to do something else in the downpour other than drying up, like take a shower or make a rainbow.

This is easier to say than do, for sure.  But just simply knowing that tension isn’t the enemy is a great boon.

Question:  When have you noticed that tension is a tool for balance in your life?  Do you use tension or run from it?  Please tell us your story.

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Be a Celebrating Hero

An Asian black bear, shot after charging the &...

An Asian black bear, shot after charging the “Old Shekarry”, as illustrated in Wild sports of the world: a boy’s book of natural history and adventure (Photo credit: Wikipedia)

Potty-stench made going to the bathroom awful. Phong would wait for days rather than use a public bathroom. Just going near one left him showering for hours under scalding water and layers and layers of soap. He would work through three bars of soap at a time before he could even think about stopping. Stopping before was too horrific. If he did, before he stopped feeling dirty, than something horrible would happen, or so his thoughts shouted at him. The devil would eat his little girl.

Phong knew that was not going to happen but the thoughts were tormenting and nothing made them better. Sometimes he would rather die than see the bloody gruesome scene in his thoughts another day.

Obsessive Convulsive Disease is a bear. Getting treatment is seriously scary. The treatment not working is petrifying. And just about anything in between is fear invoking. You get the picture. Who will go up against a bear like that?

I remember in the Disney*Pixar movie, Brave, when the dad, Fergus, yells:

Mor’du! Elinor, hide!
[Elinor and Merida run off, one of Fergus’ men passes a spear to him, Fergus charges towards Mor’du (in bear form) but he snaps off Fergus’ spear, then we see Elinor and Merida escape on horseback, then Fergus holds up his sword at Mor’du and shouts]

Fergus, like the beast he fights, growls a bellow:

Come on, you!
[suddenly Mor’du lunges forward and the screen goes blank]

Eventually we learn that Fergus won but suffered the casualty of his leg. The amount of adrenaline in that time and sympathetic hyperawareness Fergus experienced is just close to the amount that Phong has daily or multiple times daily sometimes in his Exposure and response prevention (ERP) therapy and medications. In ERP, he has to choose to expose himself to this nearly incomprehensibly horrible fear, respond to it and then wait until the fear lessons. This is a bad case of, “it must get worse before it gets better.” But Phong does it. Mostly. He just does not want this to go on and like a prisoner of war, he is eating the grass under the fence line to survive. The man has courage. Can you imagine going through that kind of cortisol crisis every day?

And as mentioned, on top of that, he takes his medications. Anyone who takes medications, knows that we don’t need courage once to do it, but every day, hand to pills to mouth, we need sinew. Phong is one of my heroes.

Question: Do you know you are a hero? Any ideas, why? How do you celebrate that? Or would you if you would celebrate this? Please tell us your story.

Self-care tip: Growl a bellow at what you fight! Be a celebrated/celebrating hero.