Sunshine and Lollipops

Tags

birding, birds, body image, chickadee, fun, gratitude, hair, weight loss

I tend to blog more when I’m upset, but I don’t want y’all to think that everything is always doom and gloom and panic and chaos, because it’s not. It’s just that when I feel well, I’m usually out living life, not writing about it.

Awhile back I started a gratitude journal, which is helping me keep a more balanced perspective on life. And there’s so much more to be thankful for than I could ever blog about. Really. So for the sake of balance (ha!) today I’m going to write about a few of the amazing and wonderful things that have been going on around me, despite the hormonal hurricane that just never seems to let up.

I’ve lost 60 pounds! I’m back to the size I was 5 years ago, and it’s marvelous. I still have a ways to go, but I can finally see my collarbones again, have only one chin, and actually recognize myself in the mirror. A size 12 is a real triumph after a size 20, and 32G is cause for champagne after 32J. I’m totally winning the love-my-body game! Well, aside from the evil ovaries.

Our card catalog is full of cameras.

I also have a really cute haircut. Instead of beating myself up about being utterly nonfunctional after a total hot mess meltdown on one of those wretched dysphoric days, I wiped my tears and went for a trim. Sure, I was trying to re-exert control. So what? I hated the haircut I had, so it was totally legit. I took in a picture of Ginnifer Goodwin’s adorable pixie cut, and the girl went utterly whackadoodle, leaving my hair about a third of the expected length. But I love it!

We went to the zoo this weekend, taking advantage of truly glorious spring weather, and I pished a bored kookaburra into responding! Pishing is a dying art in the age of mobile apps loaded with recorded bird calls, and in my opinion, less unethical than making a bird believe its territory is being invaded by a rival. Or in any case, less unkind than horrible little children screeching at the poor critters while their parents egregiously misinform them (read the signs, people – kookaburras are from Australia.)

But last weekend, I did sort of help harass some birds, all in the name of science and conservation, when I visited a bird banding station on Lake Ontario. Before anyone gets all PETA on me, it doesn’t hurt them and most birds are totally like whatever about it. Banding a small fraction of the migratory bird population gives us very important insights into biology and ecology; federally-licensed banders record the birds’ sex, age, weight, wing and tarsus measurements, and their fat stores – crucial for migration – are checked by gently blowing on their breast feathers.

Me and “my” wee chickadee!

Best of all, I got to hold a wild chickadee to release after banding! The spunky little chickadees are more aggressive than most larger birds, and she tried to bite my fingers. I listened to her tiny heart beating at an unbelievable pace that would spell instant death for humans: 550 beats per minute at rest! But that hyperactive heart is exactly right for the 12g of pure attitude that was my little “chubby” chickadee. Nature is amazing!

The field trip was part of an awesome class I’m taking. One of North America’s leading bird conservation institutions is in Central NY, and every spring they offer a field ornithology class. I waffled over spending the time and money, but Mr. Chickadee said I should do it because I’d regret passing up the opportunity. He was so right. I have to drive quite a distance and spend overnights nearby to minimize sleep deprivation (it really is a substantial commitment) but it’s been great. It has also encouraged forced me to unplug for 18-24 hours every weekend, which is good medicine.

So there you go. I wouldn’t exactly say it’s all sunshine and lollipops, but there have definitely been bluebirds singing this spring. Eastern bluebirds, as a matter of fact.

Weekly Photo Challenge: Culture

Tags

Boston Marathon bombing, community, culture, disconnectedness, fear, have one on me, parking meter, postaday, random acts of kindness, weekly photo challenge

This week’s photo challenge theme, culture, provided an interesting challenge for interpretation. And I have quite the heartfelt interpretation today…

Events like the Boston Marathon bombing can easily convince us that there is little good left in our species. The media creates a culture of fear that further exacerbates a culture of disconnectedness that undermine us all in every way. We lose trust and hope and so much more.

We need to reverse this cultural trend. We need reassurance that will never be forthcoming from the media. We need evidence that our fellow citizens are not apathetic automatons, ignorant idiots, or greedy jerks, but rather are caring people like ourselves.

I loved this “random act of kindness” in the wake of the Boston Marathon tragedy. I was proud of the undergrad who created it (no self-respecting grad student would ever use a heart-shaped exclamation point) for refusing to accept those destructive cultural messages; perhaps not all of those privileged kids are sheep after all. I wondered how long it had been there, how many other people had seen it and smiled, and whether they found it as comforting as I did.

Some sweet undergrad deserves a cookie.

Yes, Virginia, PMDD does exist

Tags

acetaminophen, aspirin, birth control, cranky, dysphoria, genetics, hormones, meds, naproxen, NSAID, oral contraceptives, PMDD, SSRI, womanhood

I now have two diagnoses that many people like to write off as medicalizing normal human functioning: ADHD and PMDD.

Lady business just plain SUCKS.**

I invite those poor deluded people to walk a mile in my shoes. I’ve previously discussed how debilitating ADHD can be, so today, it’s all about PMDD, premenstrual dysphoric disorder (with the excessive length and defensive tone brought to you by the letter D for Dysphoria…)

Most* of what the Internet has to say about PMDD is either useless and/or underinformed, or 2) contentious opinions with no real empirical basis (which fill me with rage) from people with zero exposure to what PMDD means in real life.

Let me set the record straight(er): PMDD is not stigmatizing or simply medicalizing a normal female experience, because this ain’t your mama’s PMS. Technically, with estimated 30%-80% heritability, it’s my mama’s “PMS”, which struck fear into our little hearts as children (none of us knew that was why she went bonkers on a regular basis, of course).

In fact, calling PMDD a “severe” form of PMS is beyond insulting – the fact that the symptom lists are the same is incredibly misleading and is likely the root of much of the irresponsibly ignorant opining in the media. The general public simply doesn’t understand what “severe” means in medical terms. As the amazing Ruby very aptly put it, it’s like saying that disembowelment is a “severe” stomachache. I do not jest when I say that it can be life-threatening.

Calling PMDD a ‘severe’ form of PMS is beyond insulting… It’s like saying that disembowelment is a ‘severe’ stomachache.

There isn’t yet much research on PMDD, but what they do know is that it’s not caused by anything to do with abnormal hormone levels, like you would see in PCOS. There’s evidence of low levels of serotonin precursors – the chemicals your body turns into serotonin – and in addition to the serotonin hypothesis, the general belief is that PMDD is caused by an abnormally oversensitive physiological reaction to “normal” hormonal variation.

So I’m just being oversensitive, you might say, as though I have a choice in it. But I’m really not that stupid, folks.

I don’t like…

• Pain that forces me into a whimpering heap
• Suicidal thoughts – they scare the shit out of me
• Lashing out at my poor husband with irrational temper tantrums at the least provocation
• Losing hours at at time over some triviality that sets me off
• Being so spaced out that I can’t talk coherently, read effectively, or follow the plot on a TV show
• Spending days crying
• Putting 90% of my energy into maintaining my composure because I can’t stay home from work all the time for a week or two every month
• Losing a quarter of my life to cognitive dysfunction and emotional lability

I only wish I were making this up, but there’s actually more that I’m not going into. A hell of a lot more. I have all 11 symptoms in a bad way. And me, I hit the jackpot! I’m genetically incompatible with the treatments shown to be most effective.

• First-line treatment is SSRIs, contraindicated by CYP2D6 ultrarapid metabolizer status, plus other (5-HT) genes: severe side effects extremely likely and sexual dysfunction guaranteed. With the right allele combination, SSRIs are poison.
• Physical symptoms are treated with NSAIDs like ibuprofen, naproxen, and aspirin. For CYP2C9 poor metabolizers like me, NSAIDs are not only less effective, there’s also greater risk of gastric damage.
• One oral contraceptive has been FDA approved to treat PMDD; apparently the drospirenone in Yaz is a meaningfully different progestin. My endocrinologist says that because hormone levels are not causal, oral contraceptives won’t help. On the cognitive-emotional end, so far I have to agree, though it does help physical symptoms and that’s very welcome.
• Doctors (five so far) are unwilling to give me real painkillers because – as far as I can tell – I don’t whine convincingly or loudly enough. It’s been brushed off so many times that I expect no help from anyone when it comes to managing pain. SIX THOUSAND mg daily of naproxen only takes the edge off the cramps. That’s cruel and unusual punishment for simply existing.
• Supplements and vitamins have been shown to help – PMDD is one of the few conditions where natural/alternative treatments have been studied more than pharmacological ones. I’m taking all the vitamins already, but homeopathy is mostly ineffective for me with the exception of Indica for pain relief.
• Moving to a holier-than-thou lifestyle health-wise generally helps – with the same recommendations as for every other mental condition – sleep hygiene, uber-healthy eating, exercise, weight loss. I’ve done all of that and seen no observable improvement to PMDD symptoms, although my general health is much improved.

This adds up to a pessimistic prognosis – to date, the best treatments either don’t work, cause intolerable damage, make only tiny improvements, or are just plain denied. As far as I can tell, I’m stuck with another 20-30 years of chronic part-time hell. I’ll have to endure rapid-cycling bipolar symptoms without any real hope of remission until menopause, which will itself make things even worse until that special time is over.

So let’s do some math.

12 months x 20 years = minimum 240 dysphoric episodes before my damn ovaries give out. If I’m lucky enough to hit menopause at 55, that is. Average episode duration ~ 8 days; 240 x 8 = 1840 days = 5+ years of guaranteed suffering, on top of the usual ration we all receive, menopause, and the sentence already served. That’s what I get to look forward to.

So go ahead, invalidate me and tell me you “don’t believe in” PMDD. Tell me that you believe suicidal ideation is a normal part of the female menstrual experience – everyone you know is doing it, right? Tell me that every woman has cramps so bad she can’t stand up, and that OTC painkillers are an adequate solution. Tell me that you think it’s OK to be simply incapable of functioning adequately a quarter of the time, and for doctors to just shrug and look away as if there’s nothing they can do.

What, you don’t think that’s normal or acceptable? Funny, neither do I. And I’m not alone.

*Candida Abrahamson’s blog has the best discussion on PMDD I have yet found on the whole entire Internet (as usual!)

**For my pre-menopausal comrades, if you’re adequately comfortable with your body, a menstrual cup is far more hygienic AND ecologically responsible AND economical AND comfortable AND convenient than traditional sop-up methods of dealing with flow. It takes a cycle to get accustomed, but seriously, I will never, ever go back!

A Moment of Optimism

Tags

academia, anxiety, career, disappointment, hope, job, meds, optimism, recovery, symptoms, treatment, work, worry

Sometimes the sun comes out and I think rationally for a few minutes.

When I’m optimistic that my optimism could persist for more than a week or two, it’s a pretty good day.

But I have to be careful about getting my hopes up. Suppressing hope entirely is maladaptive, but when you overreact to disappointment as badly as I do, the reason for smothering optimism is obvious: it’s self-protective. These days I try to find some balance and develop a touch more tolerance to having my hopes crushed – allowing myself to be hopeful and anticipatory about some things where I feel I can handle it, but choosing not to expect the desired outcome in other situations where it would still hurt too much.

I’m feeling hopeful about my treatment coming to a point where I have symptoms more or less in hand most of the time. With the various elements I’ve been trying out lately, I think it could look something like this:

• ADHD meds and Yaz, with Ativan as needed.
• A few supplements and vitamins – Fish oil, Calcium, Vitamin D, and B complex.
• Regular talk therapy, focused on acceptance and keeping life in balance.
• Meditation, yoga, and a brisk walk outside every day.
• Light therapy.
• Regular blogging and entries in my gratitude journal.
• Regular extended time off.

Sounds peachy! Easier and cheaper than the current regimen, with fewer side effects! But how do I get there? The answer isn’t obvious because a big piece of the puzzle is my work. Most of that self-care takes time, and the goal of keeping stress manageable means that I just can’t work as many hours as I could if I ignored my body screaming out for yoga and meditation practice (which doesn’t work very well, by the way.)

So I have to come up with a job that lets me live sustainably. I currently have 15 months left on my contract, and I expect to start looking for work in a few months. I plan to look more broadly than just academia, because I think that achieving that sort of “dream” treatment plan would depend on my job conditions.

My job would have to be like this:

• 40-50 hour work weeks, tops
• Leave work at work
• No weekends or evenings
• Analytical/problem-solving work
• Writing and editing work
• Teaching and mentoring work
• Limited number of concurrent projects
• Largely independent but routine work
• First class benefits
• Flexible hours, flexible time off
• Work from home part time
• Good pay
• Some travel
• Located somewhere Mr. Chickadee and I find acceptable

Well, when you put it that way, I might as well just sit here waiting for flying monkeys to bring me bags of cash…

The part where I’m only willing to work so much and I want to be treated really well, that’s where the tradeoff usually happens. And I just don’t know where to look for professional work outside of academia that would take advantage of my skills without raping my conscience and lobotomizing my overeducated brain. It’s a big, scary world out there, kids.

DBT Haiku

Tags

acceptance, DBT, mindfulness, practice, therapy, willingness

learning to accept

resistance slowly fading

I practice willingness

Bottle Me Now!

Tags

acceptance, birth control, cognitive behavioral therapy, diagnosis, dx, irritability, Lamictal, lamotrigine, meds, optimism, oral contraceptives, PMDD, seasons, therapy, Yaz

I sat down to write a post and drew a blank. The last couple of weeks have been relatively peaceful, stable, uneventful, and more or less productive. Nothing exciting to relate, and nothing much to complain about in the here and now.

This is one of several bucolic vistas on my commute. The lens flare is somehow just right.

The longer days and spring weather are a tonic; I just plain feel better when the sun comes out a little more often, when I’m not waking up in the dark, and when it’s warm enough to spend time outdoors (but not so warm that I have to retreat back indoors).

I said things in therapy today that felt amazing. Like, “I can’t do it all.” And then we both smiled (really big genuine smiles) because it has taken so long for me to say that, and not just say it, but also believe and accept it. After commenting that I seemed almost perky, Hippie Dude remarked,

I wish I could bottle you like this for when you’re just dragging.

I know exactly what he means. He asked if I was fixating on waiting for the other shoe to drop, as I usually do. I said, “What other shoe? I’m ignoring it. It’s not going away, but I don’t have to pay attention to it right now.” He seemed mighty pleased.

My moods have been fairly stable for the last month (a whole month!) aside from some irritability. The hormonal horrors have been muffled or muted or entirely absent. My system still needs a couple months to “settle in” but if this improvement sticks around, I’m going to declare it a miracle. I’m actually letting myself get my hopes up.

The Yaz seems to be stabilizing the hormonal layer of my mood issues, so we’re further reducing lamotrigine to 100mg. Three months ago I would have laughed and then cried (all day) if you’d said that I’d be titrating off Lamictal this spring. It’s terrifying, in a really complicated way, to let go of a drug that has served me well. But the idea of being free of it – well, that’s quite a carrot.

It’ll probably take the rest of the year to perfect my morning cocktail, but it suddenly seems possible. I can’t begin to express what an enormous relief that is. Seriously. It’s sort of mind-boggling.

At least for today, I’m feeling optimistic about getting my brain cooties under control. Not every detail has been accounted for as yet, and basically only time will tell, but it seems increasingly likely that the bipolar Dx could be rescinded. Although, ironically, one can argue that PMDD is a bipolar spectrum disorder – the affective symptoms sure can match – even though the cause is clearly hormonal. The DSM doesn’t rule that out, last I checked.