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Thursday, April 18, 2013

In the Public Eye

I'm please to report that my presence of mind three weeks ago to grab my camera and dash out to take a few pictures of the emerging tulips in some quickly melting snow has paid off!

"Look, ma, I'm in the paper!"

I'd submitted the best of the tulip shots to the "Reader's Lens" feature in the Seattle Times several weeks before, but had thought that my window of opportunity for having it selected had passed. To my delight, however, when I opened up the Travel section on Sunday morning, there was my photo! It was a timely publication, too, because I was feeling quite miserable and discouraged that morning because of an acute and painful return of my gastroparesis. While the printing quality of the newspaper couldn't capture the crisp detail of the original shot, it was still fantastic to see it there in the newspaper. An extra bonus: the paper's staff photographer who critiques the submitted photos had no criticism to offer!

Here is a nicer, crisper, clearer version of the photo.

I wasn't responsible for the art in my other instance of public exposure over the past week, but I did provide the writing and the model!

I mentioned back in my post about drawing dogs that I love the work of the lovely lady behind Blockhead Craftwerks, so when she started a new project called "Gotcha!", composed of short essays by adopters about how our special pets came into our lives, accompanied by Blockhead Craftwerks illustrations of said special pets, I naturally submitted the story of how Abbey came into my life! It's one detailed in a past post about my dog, but I like repeating it because it demonstrates why I'm such a believer in the healing power of animals. You can read the full story in the Blockhead Craftwerks "A Dog a Day" blog or see all the stories on BC's Facebook page.

Abbey © 2013 Blockhead Craftwerks

Now, if only Dog Shaming would publish the image of Abbey I submitted... (I'm rather ashamed of myself for trying to publicly shame Abbey, but I couldn't resist the opportunity to take part in a viral internet phenomenon that has been known to make me laugh on days when I'm feeling down!)

Wednesday, April 3, 2013

Tummy Trouble

I haven't been able to blog nearly as much as I would like these last few months because I've still been suffering the aftereffects of the virus I caught all the way back in October that knocked my stomach offline. I don't recall if I ever posted the final diagnosis, which was that the otherwise ordinary virus (which wasn't even very stomach-oriented--I mainly had fever and chills and fatigue with some lack of appetite) made my stomach cease to move and empty properly, so it wasn't doing a good job of grinding up the food I put in it and then it had trouble moving the food on into the intestines. The end result was lots of pain and nausea and a particular distaste for vegetables, which require a great deal of grinding, and fat, which causes the stomach to empty more slowly. The condition is called gastroparesis and it's thought that to be an autoimmune response when triggered by a virus. I've been taking Prilosec, which doesn't actually have anything to do with grinding or emptying, but it reduces the amount of acid the stomach produces, leaving more room for food, and lessens irritation of the stomach, giving it more time to heal. I was told by my GI doctor, back in the beginning of January, to take the Prilosec for two months, then, if all was well, to reduce the dose by half, and if that went well for a month, to start taking it every other day, and if that went well, to stop taking it all together after another month. If, at any point during this process, the stomach started to hurt again, I was to go back to taking two Prilosec a day and switch to a low-fat, low-fiber, mostly liquid diet for a while. Oh, and I should avoid catching any more viruses, because, apparently, once you acquire virus-related stomach mobility and emptying issues, you are vulnerable to having them reoccur any time you catch a virus in the future. What fun!

So the two months of taking the Prilosec went pretty well, though I had some trouble with hypoglycemic symptoms, and I was able to resume eating vegetables and fat and no longer had pain and nausea, so at the beginning of March, I decided to cut back to one a day. It did not go so well. The problem wasn't pain or nausea, it was low blood sugar. I'd already had to eat a great deal to keep up with my body's demands (and had gained weight as a consequence), but on the reduced dose, I was having to eat a full meal EVERY HOUR to maintain function. Otherwise I'd start yawning, then shaking, and then would come the nausea, irritation, difficulty speaking, and difficulty making decisions. I would become increasingly chilled and woozy and if I let it go too long, I'd get terrible migraines, too. Sometimes my hands would be shaking so badly I could hardly pick up food up off the plate to get it to my mouth. It was quite frightening. I couldn't drive because even if I didn't have symptoms, they would come on so swiftly and so severely that I could go from fine to unable to function in a matter of minutes. I tried to eat foods that stabilize blood sugar, meaning lots of fiber and protein, and I always had sugary juice and candy for when my blood sugar dropped because if I didn't catch it quickly (and sometimes even when I did), I would feel terrible for hours afterward. Anyway, I spent a week cramming my stomach full of food every hour and finally it couldn't take that kind of abuse any longer, so it stopped grinding and emptying properly again and I went back up on the full dose of Prilosec.

That didn't solve matters, however. I didn't go back to how I had felt before the taper. It was like my brain stopped working. I was spacey and shaky and couldn't think clearly. I lost much of my physical coordination and slept for hours and hours. I still needed to eat all the time, though I'd switched largely to liquids and soft things like custards. I'd finally gotten a glucometer to measure my blood sugar and the numbers didn't match up to how I felt. After several days of feeling absolutely terrible and unlike myself, I went to the doctor. The nurse practitioner who saw me downplayed the hypoglycemic symptoms since my blood sugar levels were within a safe range, though I disagree, believing that for some reason, most likely because of my medication and the state of my brain, my body's response to my blood sugar is off by as much as 30 mg/dL. I think my impairment at 90 mg/dL is very real and potentially very dangerous, even though 90 mg/dL is considered normal. However, I wasn't up to arguing with the nurse practitioner, who wasn't my regular doctor, and submitted to blood tests, hoping, though not expecting, to learn much. A few days later, the doctor's office called back with surprising news. The nurse practitioner thought the Prilosec might be interfering with my lithium absorption and that my level might be high, which I knew wouldn't be the case because I am well acquainted (unfortunately) with my body's symptoms for lithium toxicity. I can only tolerate a very low level of lithium, below what is considered the therapeutic range, so I had told her that if it came back as .3 mEq/L, that was normal. However, what the blood test revealed was that my lithium level was WAY lower than that. In other words, I had been suffering from lithium withdrawal. Lithium is my single most important psychiatric medication, so no wonder I felt awful! The solution was to wait at least an hour after taking my morning psych meds and my nighttime psych meds before taking my Prilosec. I very quickly started feeling better, though two and a half weeks later, my stomach still isn't quite back to normal function and I still have some trouble with low blood sugar, though not as severe as before.

So yes, the good times never end around here! I have no idea when I'll be able to get off the Prilosec and it can be rather depressing to think that that innocent little virus could wreak so much havoc, but, as with most of my health issues, it is exactly what my body WOULD do.

Here's the thing: there is a significant gut-brain connection. The enteric nervous system, with runs the body's gastrointestinal system, is often described as a "second brain," because of its complexity and ability to "learn," "think," and "remember." It is made up of approximately 100,000,000 neurons and contains more than 90% of the body's serotonin and 50% of the body's dopamine. I suffer from multiple brain-based disorders involving problems with serotonin and dopamine, so it's no surprise that, like many others with similar conditions, I have long had GI issues. It can go both ways--sometimes people who suffer from disorders of the enteric nervous system will find great relief in taking psychiatric medications, even though they do not have any diagnosed mental illnesses. In other words, one type of serotonin communication problem can be cured by the medication for another. I've also taken medications designed to treat GI issues that have resulted in psychiatric symptoms, so it's all very closely interwoven and no surprise whatsoever that I suffered from irritable bowel syndrome (IBS) since the time I was a baby. (Note: what follows is doubtlessly TMI for most people, but if you're at all interested in the different ways a gut can malfunction or would like to pity me for my many years of experiencing variations on the theme of gastrointestinal suffering, read on.)

It wasn't so bad at first. There were a few foods (bananas, raisin bran) that gave me cramping and/or diarrhea, which were easily enough avoided. Like everything else in my body (and life), it got worse when I hit puberty. Bananas weren't so much of a problem anymore, but all dried fruit became off limits, as did spicy food, and, worse still, I stopped being able to digest beans. This was very hard. I kept trying, hoping that maybe those post-Mexican-food bouts of diarrhea were a fluke, but I gave them up for good at the age of twelve after eating a bowl of chili for dinner in Butte, Montana (which is one hell of a depressing town, by the way) before driving on to Helena. We arrived at a freeway rest stop just in time, and the increasingly desperate hope that a rest stop would appear before the unthinkable happened, and the miserable time spent in the stall that followed, was enough to make me quit beans at last. It was terribly awkward to be a vegetarian that couldn't eat beans, but it was FAR more awkward to be a vegetarian that ate them.

When I was sixteen, I had my first serious run-in with gastrointestinal issues. Not so incidentally, I was going through the most severe depression of my adolescence. I developed epigastric pain and nausea and lost my appetite. I was repulsed by strong flavors and fat, so I primarily ate small amounts of white food-- plain rice, plain potatoes, plain white bread--and lost eight pounds. Eventually, I found my way to the GI doctor after the blood tests and abdominal ultrasound ordered by my regular doctor revealed nothing. To my extreme teenage mortification, part of the initial appointment with the GI doc involved a rectal exam. Other tests followed: an endoscopy that looked at my esophagus and stomach and found nothing but some irritation where they joined; a barium tracer test, where I swallowed two giant cups full of nasty fluid containing the radioactive element and then was X-rayed at regular intervals as it worked its way through my GI tract, revealing no abnormalities or movement issues. I took Prilosec and a stomach-coating slurry called Carafate to see if it was acid reflux that was causing my discomfort and the esophageal irritation, but there was no improvement. I then had a 24-hour ph test done. A probe, attached to a recording device, was threaded down my nose and into my stomach, taped in place, and worn for 24 hours. In case you were wondering, it was not the least bit comfortable! It did not record any incidents of acid reflux, either. The pain eventually subsided over the summer without its cause ever being diagnosed. It made for a miserable spring, though, and my school work (much to my dismay) was affected by my constant discomfort, my inability to eat, and my repeated absences from school because of medical tests.

My gut struck again three years later, this time in the form of diarrhea. Lots and lots of it. Blood tests and stool samples revealed nothing and so I found myself at the GI doctor's once again. This time around, I was treated to a colonoscopy. Here's the thing: if you're getting a colonoscopy as part of standard post-50-years-old cancer screening, the "prep" is not a big deal. If you need a colonoscopy because you're having intestinal trouble, the "prep," which purges the contents of your entire GI system, is horrific. Think simultaneous vomiting and diarrhea. After all that agony, I had to submit my bare bottom to the insertion of the camera. My only consolation was that a) I was sedated and b) this was what those doctors and nurses did ALL THE TIME, so my poor rump and rectum would be nothing remarkable (except for maybe its skinniness). Still, it wasn't exactly a fun experience and worst of all, it revealed nothing. The final diagnosis was IBS. I was told to eat lots of fiber, manage my stress, and hope for the best.

I was started on psychiatric medications a few years after the Summer of the Colonoscopy, which did lead to some positive changes in terms of my gut: my IBS sensitivity decreased a great deal and I could once again eat dried fruit, and, more importantly, beans! Oh, it was so wonderful to be able to eat beans again in all their varieties! I still couldn't eat spicy food and I began to have more and more trouble with cruciferous vegetables (cauliflower, cabbage, broccoli), but I didn't like cruciferous vegetables anyway, so that was no big loss.

While psych drugs may have improved things on the IBS front, my gut wasn't done giving me trouble. I'd always been an individual who tended toward loose stools, but in 2008, I got constipated. REALLY constipated. This was during the Geodon years (that's a whole other story) and I had one of my withdrawal episodes that left me in bed, virtually unable to move and extraordinarily nauseated, for a week and between not moving and not eating, my gut came to a halt and I developed a bowel impaction. That's a fancy term for "a hard lump o' stool that blocks your colon." Of course, it didn't get diagnosed as an impaction right away. There were various tests done, including a CT scan of my gut after being administered intravenous barium (much more pleasant than oral barium!). In the meantime, my slowed gut slowed me down. I got too sick and sluggish and queasy to work. My belly became hard and distended. I could barely eat and belched horribly when I did. For the first time in my life, I found myself carsick. I tried to keep active, but just walking around the block was an agonizing, exhausting, and sickening slog. You wouldn't think constipation could make you so sick, but it was awful. In the end, I went six weeks without a bowel movement or passing gas. The obstruction was eventually removed over a two-day course of laxatives and enemas (also on my list of Things That Aren't Fun). By the time it was all over, I'd lost sixteen pounds. Out of all of my unpleasant GI issues, the impacted bowel may have been the worst. I have been very paranoid ever since about the danger of getting constipated while in bed for long periods of time, especially since my top nausea drug can be very constipating.

Two years later, my gut was at it again, this time in the form of my old friend, diarrhea. I was pretty sure that it was related to reducing the dose of a medication I was on, but all my doctors disagreed. One, I'd been on the drug for months without it causing digestive upset, and two, it was not a drug that caused digestive upset. So I once again submitted to rounds of test and stool samples. I had to take several Imodium a day if I hoped to leave the house; otherwise I felt practically chained to the toilet. I started hoping that it WAS a parasite just because then there'd be something to treat! After several months of negative results and ongoing digestive woes, I went back up on my medication and the diarrhea went away. So I was right and the drug (which reduces neuron reactivity, by the way) had been causing the problem all along. Why I had no problems at 500 mg and persistent diarrhea at 400 mg is unknown, as is why I can now take 450 mg without any problems. Going back on to my previous dose didn't solve, everything, though. My gut was all out of whack, not functioning smoothly or properly, and I did develop the kind of constipation and vomiting that made me worry I was en route for another impaction. I also started suffering from episodes of severe cramping that were not accompanied by any kind of bowel movement. So back to the doctor I went. I got the diagnosis, once again, of IBS--it was just acting up in a different way this time. I was given a medication that helped enormously with the cramping, but I found that if I took it for several days in a row, I developed psychiatric symptoms. So it is strictly an as-needed drug to be taken in small amounts, but I'm grateful to have it.

As you can see, every 2-4 years since my teens I've developed some kind of major GI issue that usually takes several months and lots of tests to straighten out. It's just the kind of body I have. It's also why I included IBS on my disability application because it crops up again and again, making me sick and impacting the medications that I can take.

And so here I am, currently able to eat spicy food (which happened all of a sudden--a pharmacist told me that what the gut can digest can be switch quite abruptly when you have bipolar disorder), but not cruciferous vegetables or greasy, fatty food. My psychiatric meds likely contributed to the virus' impact on my stomach and now the stomach-soothing medication interferes with the absorption of my psych meds, which then impacts how my brain responds to my blood sugar level. So yes, good times!

The moral of this story: if you've got neuron communication problems in your brain, you've probably got them in your gut as well. I hope for your sake you are afflicted with neither!