Listening

OMG, kids, the past 48 hours.

I expected to have anxiety about starting the New Pharmacological Experiment. I was changing my normal routine, which can trip some anxiety alarms all by itself, in addition to starting not one but two new drugs I was very ambivalent about in the first place and going back to Physical Therapy. I was also stopping the Xanax, which I’ve been taking for about four months, and cutting my alcohol consumption by half.

On the surface, logically, this all sounded good. I might find a solution for my sleep issues, I might have less pain, I might have less puritanical guilt because I was switching to “legit” pharmaceuticals instead of evil, evil wine. I figured there would be an adjustment period, but I also was heavily pressuring myself to give this a solid try, and to be a good patient.

There’s a lot of pressure to be a “good patient” when you have a chronic, complicated set of issues that do not present straightforwardly and require a great deal of trial and error. I feel pressure not to be “crazy” so I try to be careful about how I present my feelings or internal process. I am fortunate in that my PCP is a friend and so there’s a lesser chance of him writing me off as a nut because I am not *just* his patient. There’s pressure to accept solutions as offered and be sincere in trying them. I can say I have, sincerely, tried PT/OT for my hands and for my ankles/knee and it did not work. That’s a check in the “good patient” column, meaning my sacrifice (money and time are particularly desirable to the medical gods) was acceptable. Other drugs, though, I have not always given a fair trial because, simply put, I’m afraid of them.

So there I was, Wednesday night, starting Cymbalta and Ambien. I was starting on a half dose of the Cymbalta and was to take that for a week then go up to the full dose. I had been strictly warned to take no more than 10 m of Ambien, not to mix it with Xanax or booze. The main reason I agreed to the Ambien was that it is supposed to be a sort of “knock-out punch.” They say to make sure you are ready to sleep before you take it, like if you took it then went to the bathroom they might find you wedged between the toilet and the wall, dropped in your tracks.

Ambien, in case you don’t know, is a hypnotic sleep drug. There are instances where people get up and do things they have no memory of doing when taking it. What I experienced Wednesday night was the sense that I was mostly asleep, but frequently very aware of being asleep, of knowing I had taken medication, etc. I put this down to anxiety, which, really, is the easiest thing to blame in my world, Oh, it is my crazy, deal with it. 

My husband and I ran some errands Thursday morning, including dropping off my PT referral, and I told him that I was feeling really hyper sensitive and like the anxiety was so bad I was barely hanging on. By the time we got home, I was feeling so completely freaked out that I went to bed for two hours; something I never do. I left once to go buy fireworks with the man and the child and then they teased me about something and I went back to bed. Everything made me cry, which I did off and on again the rest of the day. Again, we both blamed my anxiety about taking new meds, my anxiety about making big changes in my regimen, it was all Teh Crazy and therefore somehow not “real.” I noticed that I couldn’t stop clenching my teeth, and it was making my jaw and face hurt. Chalked it up to Teh Crazy.

I had, a couple of times, sought out the husband to tell him how I was feeling, and like I was not doing okay. It’s not that he ignored me so much as that he didn’t catch on to the seriousness. We both continued to assume that it was my brand of crazy and that it was something I would just have to get through. I took the Ambien and Cymbalta Thursday night. I took the Ambien at 9:45 pm, and at 11:00 pm I was still up, feeling outside of myself, and unable to settle. I consulted Dr. Google and took two Benadryl. Around 12:30 am I sort of fell asleep, in that I could tell I was lying down like I was asleep, but my brain seemed fully aware of that fact and it was like I watched myself sleep until 5:30 am when I was awake, again, for good.

Friday morning I was suffused with dread. My teeth and jaw ached from clenching them. I was beside myself. I plopped myself down in front of the man and said that I did not feel okay, I did not feel right, I felt like the world was ending and like I was not thinking right. I said that I thought the drugs were really, really bad for me.  I asked if I should call the PCP. He said he didn’t know, did I want to do that? I didn’t know, and I let that push me back to the, “I’m just crazy” benchmark. But then it seemed to all get worse. I started walking around the house, pacing relentlessly, unable to sit still. I felt nauseated. I started having trouble talking without quavering. I texted my PCP, apologetically, and related the following:

I’m sorry to bother you. The ambien doesn’t put me to sleep…what little I got (5 hours last night after 10mg) I feel like I’m fully aware that some of me is sleeping. My brain never shuts off. The anxiety is out of control and feels outside of me. I’m shaky and nauseated and can’t seem to stop clenching my teeth. What should I do? 

He called me, and we went over everything I’d taken in the last 48 hours. He said that I was having a very adverse reaction to the Cymbalta, that I was probably withdrawing from the Xanax and that we had changed too much all at once. He told me to take a Xanax immediately and to keep in touch with him throughout the day and to go to the ER if I got any worse. He said I would likely feel better around 24 hours after I had taken the last dose of Cymbalta.

This morning, finally, I am entirely myself again. None of this, apparently, was Crazy, it was an adverse reaction to meds. I wish I had listened to myself better. I wish my husband had recognized the signs more clearly. I suspect we are better educated at this point and I hope that we both get a lot better at not writing off how I am feeling as something that I am somehow at fault for. If I hadn’t called the PCP, if I had taken the meds again last night, I suspect I’d be in the hospital today, and losing even more time from my life.

The PCP and I will regroup Monday. I am not sure how I will feel about going forward with further changes. Probably anxious.