High anxiety
Due to the holidays and his going on vacation, I saw my psychiatrist Wednesday for the first time in five weeks. I started writing this as sort of a preparation for that, and yet another rave for Cymbalta.
As an adult, I first started seeing a psychologist back in late ‘91 or early ‘92. Pretty early on, she decided that anxiety was big issue for me. She explained that by whatever mechanism, my fight-or-flight response was stuck in a state of hypervigilance. There seemed to be no off switch or an “everything’s cool” setting.
This goes a long way towards explaining everything from my addiction to poor posture. Poor posture? Well, yeah. The physical component of anxiety shows up in my eternally tense shoulders prepared to strike (fight) and abs prepared to duck (flight) or to absorb blows. Together, tense shoulders and abs contribute mightily to my forward-leaning, stooped posture.
Last week, or maybe the week before, while I was at work something popped in my upper back, between the right scapula and spine. Boy did it hurt, and boy, did it feel soooo good. Some sort of knot in the muscles back there let go and suddenly, I felt like I’d gained two inches in height.
Since then, while I feel less creaky, I’m actually more creaky in the upper back region. Every movement, while easier to accomplish, is accompanied knuckle-cracking sounds as parts that have been welded in place by muscle tension for years, learn and become used to this idea of moving past each other.
Anxiety manifests itself in two other physical diagnoses, fibromyalgia, where I tense up rather than relax in my sleep, and in irritable bowel (IBS), as in scared shitless or at the other end of the spectrum, think of frightened birds taking a dump as they leap into flight. Indecision between the two causes the spasm.
Fortunately, as regards the IBS, that last big bout of it seems to have returned things to normal (or as near as I can guess what normal might be) since the ‘scrip for that shot up from $27.95 to $105.99 since I last had it filled in September.
The pharmacist had no explanation. “But you saved $98.10 by getting the generic.”
“Yes, the very same generic that cost only $27.99 three months ago.”
“Sorry, that’s what it says in the computer.”
Like most consumers these days, I give up when confronted with the computer defense. However, I fight back later, on my own. Over at drugstore.com, double the quantity costs $27.99. Cymbalta costs $20 less per refill there too.
I will not be returning to my neighborhood pharmacy. Not even for the one capsule (of the IBS stuff) that they were short. Fuck me once and you don’t get a chance to try for twice.
In any event, the psychiatrist appointment went much better than I’d expected. When he called to change the appointment he sounded angry when I told him I’d increased the dosage while he was away, even though last month we’d discussed doing it.
“No that’s not it at all,” he told me. “My position is that if I give a patient the latitude to decrease or stop the medication if we’ve discussed it and there are problems, that I also have to give them the latitude to increase the dosage if we’ve discussed it and it seems reasonably indicated.”
“Well,” I replied, “you sounded concerned anyway. Maybe I misinterpreted that as anger.”
“That’s only because you didn’t leave a message so it could be noted in your chart.”
“A paperwork issue?”
“Right. A paperwork issue.”
He seemed genuinely pleased, and just as excited as I am, by my report of the efficacy of the increased dosage. From there it was just negotiating a change in the ‘script to reflect that the stuff is priced the caps no matter what the dosage (60mg costs the same as 30mg) so I’ll save money going forward.
Then we agreed to a change in dosing schedule in order to leverage—not reduce or eliminate—the only side-effect I have, and that’s that it pretty much knocks me out when it hits, two or three hours after ingestion.
It’s unusual in that the effect is not that dopey, drowsy, anesthesized feeling associated with most medications. It’s more like the “It’s time to go to sleep now” feeling I get from the melatonin supplements I take at bedtime. In fact, it was only after I started taking the second cap in the afternoon that I was able to tied the effect to the medication.
So starting tonight, since it’s a weekend and all, I’m going to take the full 60mg after dinner and two to three hours before I retire. I’m also going to skip the melatonin and trazodone I’ve been taking at bedtime. Then I’m to leave a message with my report on Monday.
The sleep I’ve been getting in my Cymbalta-induced naps is terrific so there’s no reason to think the experiment won’t be successful. But if not, I’m free to add either the melatonin or the trazodone or both.
The psychiatrist is so cool with it all that my next appointment isn’t for a month, and this morning, my psychologist made the same suggestion. I don’t see either one until the end of February.
Go me!
