Cymbalta: The Weaning Off

So far, one hour past my usual dose time. So far, so good.

Cymbalta: Day 9

It's not helping my pain, and it's blunted my anxiety to the point where I'm ambivalent to the point where I don't want to do anything, even things I enjoy. So while my pain and depression were limiting me, now the ambivalence is limiting me. Plus constipation (this is on top of the baseline of bathroom issues due to the bypass).

I can't tell. Is there merit in continuing to take it? I'm too ambivalent to tell. Perhaps that should tell me something right there, but still... ambivalent.

I am nauseated a good lot of my work day, and feel FULL (even when I'm hungry). Weird. Should I stop it? Should I wait until I see my neuro at the end of the month of March? IDK what to do, honestly.

Called the neuro, and he's on vacation until March 10th. My appt is March 25th. I can't go nearly a full month without stopping this.

Going to start weaning myself off it tomorrow. Going to step down dosing every other day, and just hope for the best. Going to take melatonin to help me sleep, get into better sleep hygeine as I do this, and hope for the best.

I'm convinced there is no medication that is going to help me, my pain, my anxiety. Convinced.

Cymbalta: Day 8

Perhaps it would have been useful for me to know up front, prior to taking the first dose, that Cymbalta would have constipating effects. Knowing I have had bathroom issues for three years since my gastric bypass, this would have been useful information.

So instead of having general anxiety and depression, I now have ambivalence (which just exacerbates my ennui) and a perpetual case of performance anxiety in the bathroom. Anxiety when I don't go, thinking I'm surely going to have an impaction issue eventually. Anxiety that since I'm not having (shall we say) "productive" activity, it will equate to an uptick in weight. And just a general sense of unwell "down there." 

Is it worth it? I mean. I'm not crippled by it. There *is* some activity each day (though Saturday was worrisome, as my poop was MIA). But it's not "satisfying." 

My colon is already "loaded for bear" each day (Colace, fiber, probiotics, magnesium supplements, hot coffee galore, and on Saturday it was all that PLUS Miralax--and still nothing). I'm adding prune juice to the mix, thinking I need to up the ante as it were. And of course, trying to keep myself adequately hydrated.

A normal person doesn't think about their poop this much. Do they?

Note to self: Milk Thistle

Day 1: Start taking.

Cymbalta:: Day 7

Cymbalta, day 7: 
Blunted. Ambivalent. Like so ambivalent I just sneezed so hard I had an eruption down below. Not sure which form of matter was involved. Is it time to go home yet? I need a nap.

Cymbalta: Day Four

Really no complaints, thus far.

Took my fourth dose this a.m., and so far I'm managing well enough, I think!

Positive observations:  

• It's blunted my anxiety considerably. Not sure if I'm any less depressed as a result. Color me: AMBIVALENT.
• Additionally, it's blunted my interest or passion for food. Everything tastes fine enough, though I do have a horrid after taste in my mouth. No excessive dry mouth either as I've experienced with other, similar meds. I'm just disinterested in it. I notice I'm not eating everything I pack for work, either.
• Also worth noting, I'm sleeping pretty soundly. To my knowledge, I'm experiencing neither night terrors nor sleep walking. 
• Weird note: Onset for menses was Tuesday, same day I started Cymbalta. Usually days 1-2 are heaviest,with about 4-5 days of it tapering off. Seems that it's tapered off in half the time. But then again, with the adenomyosis, I might burst a little pocket of whatever-it-is, and spot a few days from now--but such is life with this disorder:(

Negative observations:

• I feel I'm running a little on the warm side (I'm almost always too cold);
• I experience nausea within an hour of dosing and usually it lasts about 2-3 hours;
• I have a weird numb/tingle/twitchy thing happening, occasionally, from my knee to my ankle in the evenings.
• I don't notice any change in the overall pain issues: herniation in neck, diminished disk space/pinched nerve in low back, arthritis, adenomyosis, etc. 

Cymbalta: Day Three

Still muddling through. Still nauseated, though it is most intense about an hour after ingesting the capsule and lasts roughly 2-3 hours.

Sleeping pretty soundly, which is nice, and a rarity. Husband hasn't complained of my snoring, so who knows if he's sleeping sounder than I am. 

Later in the day I get a slight headache, though that could be from hunger, though I have noticed my hunger sensations have abated somewhat. My eating is "off," and I'm a bit indifferent to food.

Only negative thing I can say so far is this weird chill type tingle that runs down my right leg on the outside lateral, from the knee to the ankle. Not painful, it's just a very weird sensation. 

Beyond that, and the fact that it's done zilch for my adenomyosis or herniation pain, nothing else to report. Though, to be honest, it has blunted my anxiety a lot (which also might be feeding into the ability to get some sound sleep).

Stay tuned.

Cymbalta: Day Two

Took my second dose today. Still feel that foggy-headedness, and later on, the nausea presents itself. I'd say roughly 1-2 hours after taking it, the nausea kicks in.

I can't seem to locate my Zofran, which is possibly in my travel gear pain kit; so I've been sipping Coca Cola Zero to stave off the waves of unpleasantness. So far, I haven't heaved at work. SCORE.

Observations thus far:

1. It's curbed my interest in food. I don't know if I'm truly not hungry or if the nausea makes me indifferent to food or what, but I'm just "meh" about food right about now. 

2. I was starting to nod off a wee bit in front of the tube last night, so I got up around 11 to turn the lights out and head to bed. Before bed, I did manage to pop a melatonin (3 mg.) though I don't know if I should do that given the Cymbalta. I'll have to get a ruling on that. I just wanted to ensure I went to bed and stayed asleep. Which I did. And given the husband is away on business and not here to be my human alarm clock, when the alarm went off, I woke up, hit snooze, woke up and hit snooze, and woke up finally with no problem or any additional grogginess. 

3. While walking out to the car, and looking at all the snow that abounds, and I have been miserably depressed being indoors (I think I'm finally suffering from SAD from all this indoor nonsense), I actually said to myself, "Well, I guess this beats the alternative" (with the "alternative" I suppose being death).

I did have a chiropractic adjustment last night, and ate pretty light when I got home (I had crackers and cheese while I waited for my steak to cook, and once it was done cooking, I was indifferent to it). I slept pretty good. I think. Though without the husband here I have no knowledge if I woke up, if so, how many times, or if I had a night terror.

My adenomyosis pain is pretty sharp. Onset day was yesterday, and everything from my navel to my knees was nothing but a bundle of angry nerves. Can't tell if the Cymbalta is helping that at all. But the anxiety and anger and hostility seems a bit diminished today. Though, how much diminished? I don't know. I feel like the edge is blunted. Somewhat.

The chiro knows about the nonsense going on in Jersey with my family, and especially the negativity and the expectation that somehow I should be there more, despite the obviousness of snow storm after snow storm, and now with my assorted pain issues. Even the chiropractor said it's actually not helping my own pain issues. Again, obvious. But nice to get validation from someone else that insulating myself as much as I can from what I can is the only response I have at this point.

Side Note: The Closer

I've been bingeing on The Closer, as it's available on Amazon Prime videos. 

I found it fascinating they worked PCOS into her story line, despite the fact she doesn't appear to have any of the other symptoms of the disorder. No acanthiosis nigricans, no hair loss, no facial hair, no fat accumulating around her middle (despite the obviousness of this character's addiction to sugar). But fabulous to have a show that finally presents a character with this, as well as "premature menopause."

Though to be honest, and not to be hating (as I do love her as an actress) a more believable character with PCOS would be Melissa McCarthy's Molly from Mike and Molly. 

Cymbalta: Day One

Interesting choice of words in that warning.

"Fear?" Really?

FWIW, I'm taking this Rx for pretty much everything else listed,

save for the "fear."

Conversational Nugget

Endocrinologist to me: "You? Depressed? Srsly, I don't see it."
Me: "I'm high functioning and keep my shit to myself. I wish I were dead inside."

Frova Coupon

So I'll always be able to find it.

Post Therapist To Do List

Start Cymbalta.
Maintain boundaries with my family.
Consider finding a source for weed.

Medical Updates & Supplementation Tweaking

Two days ago I had appointments: First with my neuro who is local to me; and secondly with the endocrinologist who is in NYC. 

The appointment with the neuro was a bit more involved than it normally is. Normally, I just go for follow ups, he gives me my refills for my Frova for my migraines and we bid each other adieu for another six months. 

Thanks to the last six months of 2013 being so chock-a-block with unexpected medical wild goose chases (thyroid nodules, lung granuloma, etc etc), I hadn't had time to address all my "rainy day projects" (pain  management, follow up sleep study, colonoscopy, to name a few items), so I figured I'd start with the most pressing: PAIN.

Given I was going to explore pain management with a "pain specialist," and given that the particular specialist in question was a neuro, and given I ALREADY have a neuro, I figured I'd unload on him everything, to see if HE can address and treat those issues:

• Migraines
• Headache from herniation at my C4
• Adenomyosis/endometriosis pain
• Anxiety/Depression

I told him I was on Wellbutrin from November to the end of December, and it gave me horrid dry mouth, a persistent baseline headache, increased my predisposition to anxiety attacks, and brought me to a full on feral, frothing rage, and due to this, I stepped myself off it, as it truly wasn't value added. Also? Taking Frova (my migraine Rx) with Wellbutrin is contraindicated, so yeah, there's that.

He considered other things, the tramadol, my use of an occasional vodka tonic, and realizing nothing's really helping the pain, which is debilitating, and sometimes the migraines and adenomyosis pain are not running immediately in tandem with one another, so I'm losing between 2-4 days a month due to this, and really it's unacceptable.

In addition to the myriad of things going on with me, the latest Dx: Chronic Pain Syndrome.

His recommendation: Cymbalta. 

I'm pinning some hope on it that it will help me, even get my pain managed a smidge better, to allow me to be more predisposed to getting more active, which I am convinced will make me feel better for an assortment of reasons. I just hope it doesn't make me add weight.

Then it was off to the endocrinologist for my four month, standard appointment with him. Pretty standard fare. Nothing too alarming. A slight, 4 lb uptick in weight (perhaps due to an ineffective poop that a.m., and perhaps water weight due to my period due any moment now, or perhaps due to total inertia, thanks to the fucking weather we've been having (Mother Nature: A snow storm every week, really?).

We discussed my right lower quadrant pain and spitballed ideas about if it were related to the adenomyosis, or if it were related to something else. And he did a manual exam of the abdomen, and quipped about that pesky fatty liver syndrome, which I thought was managed or thwarted by the gastric bypass I had three years earlier. My triglycerides and overall cholesterol are great; however, either my good cholesterol is low or my bad cholesterol level is high (I don't know specifics at this very moment and I'm too lazy to pull out the blood work to verify, not that it matters herein, does it? really?) 

And again, the topic of my occasional cocktail came up. One a week (maybe one more if I'm at a function?) doesn't seem too outlandish, but given the concerns of fatty liver syndrome morphing its way into NASH (essentially non alcoholic cirrhosis of the liver), it IS a concern. Ideally I shouldn't drink, but if I want (because hey, life is meant to be lived), to try to limit it to one cocktail a week. So I guess moving forward, I should be very particular about the deliciousness of my weekly potable.

This is of particular interest to me, of which I find hilarious and ironic, given my mother's lecturing of me in December about my latent alcoholism, citing dad's family's predisposition to drink. One cocktail does not make one an alcholic. Funny thing here is, it's not dad's family's predisposition which is hindering me taking a nose dive into a vat of limoncello, but MOM's fucked up gene pool, given the fatty liver syndrome is from the obesity and insulin resistance issues on mom's side of the family. Hilarious, and of course, pointless to point that out to her, given she won't listen anyway.

Doc hooked me up with some samples of Lovaza, given that I am already on Omega 3 capsules. And lo-and-behold, my insurance will pick this up! So I'm happy about that, though I'm not sure of the merits this will have.

I had to laugh at the doc, as he told me some insurance doesn't pay for the Rx, but he's got a bunch of samples he can give me. I compared him to a heroin dealer, saying, "The first hit's always free." 

Part of my personal make up is that I like to try to find work arounds for life's problems. Kind of like puzzle solving. Well, I would like to keep having my weekly beverage. So, I have decided to dump off one supplement out of my daily routine (evening primrose oil) and bring a new player up at bat: a liver tonic with milk thistle.  Additionally,  I'd like to try to cut my carbs down, even though my intake is not carb-intensive, I need to try to find a way to wring out the fat out of my liver.

One more talking point was about calcium supplementation, and apparently there's a bit of conflict/controversy over how much is too much calcium. Doc suggested I read this article, and I found it interesting enough to warrant that I get a 24 hour urine collect done now, go 1-2 months taking a lower dose of calcium daily (dropping down to 1500 mg daily instead of 2000 mg which my bariatric surgeon recommends), then do another 24 hour urine collect right before my appointment in May. And at the May appointment, we will numbers crunch and see if by dropping my calcium intake if there's any negative impact. I don't want to overdo things, as too much calcium can mask other issues and adversely impact the thyroid.

So, the current supplement line up moving forward will be thus:
First thing in the a.m.:

Cymbalta 30 mg, 1x
2 Gummy VitaFusion Prenatal Multivitamins
2 Gummy VitaFusion Sugar Free Fiber Chews, 5 gm, 1x
Lovaza 1x
Colace 200 mg (1x)
Vitamin C, 400 mg
Feosol 325 (2 tablets)  *I boost to 3 tabs during menses
Alpha Lipoic Acid 250 mg
KAL Brand B12 spray (1-2 spritzes under the tongue)

Right before leaving the house, I take a zinc losenge, and then throughout the day I manage to get these in:

Standardized turmeric in capsule form
Boron, 3 mg, 1x daily 
Magnesium 400 mg, 1x daily *I boost to 2x daily during menses 
D3 2000 IU (1x) 
Calcium Citrate, 250 mg (3x) 
CoQ10 (50 mg, though I'm thinking of boosting this) 
Vitamin C, 400 mg

Then in the evening, I take:

Quinipril, 80 mg
Alpha Lipoic Acid 250 mg
Milk thistle 

Items highlighted in red are new additions to my line up. Note: The Lovaza was just an experiment, as my endo gave me some samples. I'm back to taking my regular Omega-3 fish oil supplement, as I did not see any marked change in my blood chemistry (and the doc never prescribed an Rx).