New York Times
I never fully appreciated myself until I lost myself.
And then, when I found myself again, I realized that I really was a prize.
This e-card-worthy sentiment washed over me on Wednesday, when I began to come out of a two-week immersion in what I can only describe as mild mental illness.
Otherwise put: I tried out a new migraine preventive medication, and lost a little bit of my mind.
I was trying out the new medication because my chronic headaches had become much worse again after a nine-month period in which, thanks to acupuncture, they’d gotten much better.
With acupuncture, I’d been able to lower my dosage of amitriptyline, an old tricyclic antidepressant now used to help manage migraines, by a third, and had, at the same time, reduced the frequency of my headaches by more than half.
I’d also, as a newly devoted patient of the Spectrum Center for Natural Medicine, turned into a greatly improved person.
I’d learned to lie, needles inserted, on a heated table, and look out a window for 20 solid minutes watching the clouds go by, totally at peace. I’d learned to relax to the sound of a gong.
I’d become a passionate devotee of Pema Chödrön, the Miss Porter’s School girl turned Buddhist nun, and had been lecturing friends on remaining “present” and “learning to stay.”
This new Zen-like quality actually led to a nasty fight down on a riverbank one warm day this past summer with my friend “D.”
I was standing in a shallow pool of pebbles trying to just Be, feeling the water around my feet and the wind on my cheeks, while she was feeling hot and complaining. Chief among her complaints: Dr. Phil had recently had the effrontery to invite someone on his show to talk about “The Power of Now.”
This had just made her sick.
“I have something to tell you,” I said.
Things did not go well from there.
(Full disclosure: while writing this, I had to email “D” for more information: “Remember when we had an argument down by the river about remaining present? Who was it you’d seen on Dr. Phil?”
“Eckhart Tolle,” she wrote back. “You would remember, if you had been … truly present.”)
I had even almost bought a crystal.
Then last month, my acupuncturist moved away. This was hard, and detrimentally affected my energy. My mother had a serious health scare, triggering one of those facing mortality moments that adversely affect everyone’s energy, too. Plus, I was given a do-or-die deadline on my three-years-overdue book on children’s mental health issues. And the economy collapsed.
Any one of these events could have been a migraine trigger. Together — combined, perhaps, with ragweed — they launched me right back to where I’d been one year ago, pre-acupuncture, in the darkest of the migrainous days, having headache after headache and popping pill after pill.
The only difference now was that my then-neurologist, too, had abandoned me. Sick of dealing with health insurance companies, he’d taken a job teaching and directing research at the National Institutes of Health. He hadn’t left me totally in the lurch. Before leaving, he’d given me the names of a number of good neurologists at a nearby teaching hospital.
“But you might not like their practice,” he said. He’d already gotten complaints. He ran an old-fashioned office; one doctor, one receptionist, one patient per appointment time. He usually ran late; he spent a lot of time talking during consultations.
If you asked him about drug side effects, he listed them for you. If you worried about them, he snapped at you.
“Maybe you’ll get them, maybe you won’t,” he said. “If you do, you’ll call me.”
He returned phone calls. He sometimes even answered his own phone.
“Will I have a heart attack and die if I take too many pills,” I once asked him about a certain medicine.
“You could take just one and have a heart attack and die, too,” he said.
This is why I trusted him.
The new neurologist’s office ran perfectly on time. All kinds of people were on hand to do all kinds of things with great efficiency and minimize the need for the doctor’s physical presence.
The new doctor wasn’t snappish. And he didn’t waste time on chitchat. I asked him for the drug I wanted, and he wrote a prescription. I asked about side effects. He said I shouldn’t have any.
I didn’t believe him.
I had already read the eight pages of tiny-type prescribing information on the new drug, which my old neurologist had thought I ought to try, too. Twenty-five percent of the patients who’d taken it in clinical trials had discontinued it due to adverse effects. In trials for migraine prophylaxis, 22 percent taking a therapeutic dosage had experienced “one or more cognitive-related adverse events” like difficulty with concentration, attention, memory and language.
But I didn’t say anything. I pride myself on not being one of those patients who walks into a doctor’s office with a ream of Internet printouts and cuts the doctor off at the knees.
And I wanted the drug to work. I really did. I particularly did because the new doctor told me that the one side effect I was likely to experience was weight loss (up to 25 pounds’ worth of weight loss), and the promise of weight loss (particularly the thrill of a health-threatening 25-pound weight loss!) sweetened the pot irresistibly.
The first week, on 25 milligrams, not much went wrong. I couldn’t concentrate, but then, I hadn’t been able to concentrate for the previous year, ever since I’d given up my eight-cups-of-coffee-a-day habit for the sake of fewer migraines. I was tired and a little bit irritable, but that wasn’t so unusual, either. I did have the strange experience of having a supermarket checkout clerk stop his work to ask me if I was O.K., when I raised my hands to my face to cool my cheeks, which were suddenly burning, and then to have my husband Max and the girls echo his words, as I made the same gesture nightly at dinner, but I assured them that I was indeed O.K.
Everything was O.K., except that, as 25 miligrams turned into 50, such questions, coming more frequently, began to feel more and more like an insult to my integrity, an assault upon my honesty; they were an insinuation that I was lying about nothing being wrong.
And then everything began to get a little funky. Everything tasted bad. Everything became too much of an effort: working, not working, talking, listening, being with people, being alone. I couldn’t concentrate. I couldn’t sit still. I couldn’t tie one thought, word or sentence to another.
“What is wrong with you?” my daughter Julia finally snapped on Monday when we went out to lunch and she beat me in three straight games of tick-tack-toe. Bored with winning, she attempted to ask me the questions on a parent questionnaire that had come home in anticipation of teacher conferences.
What are your goals for your child in math this year?
“I hope she will learn what she needs to learn,” I said.
What concerns do you have about your child’s progress in math?
“I hope that she will make progress.”
“MOM!” she shouted. “Those aren’t answers.”
“I’ll try harder,” I said.
What concerns do you have about your child’s work habits?
“I hope,” I said, thinking hard, “that if I need to be concerned about her work habits, someone will tell me to be and then I will have concerns.”
You can imagine how this story ends. After all, here I am, stringing one word after the other. I left a message for the new neurologist at 8:45 on Tuesday morning. I said that I was having serious cognitive and mood-altering side effects.
Unable to work, I sat at my desk, by the phone, and waited.
At 4:30, I emailed Max: “I am going over to the neurologist’s office to blow my brains out. Please be sure to collect the life insurance and file an adverse event report with the F.D.A.”
“Sounds like a plan,” he replied.
The doctor’s office — that is to say a nurse — returned my call at 5:15. I had decided on my own by then to taper off my dosage but was still feeling wretched and wasn’t inclined to let her off the phone easily.
Didn’t doctors usually react quickly — and with some concern — when patients reported adverse drug reactions? (According to Sidney Wolfe, the director of the health research group at the non-profit Public Citizen, adverse drug reactions kill about 100,000 people a year and land 1.5 million in the hospital.)
Well, she said, not in this case. “It wasn’t something that was particularly unpredictable.”
No, it really wasn’t.
It isn’t unpredictable that a patient will get little or no information on drug side effects from her doctor — or any kind of real responsiveness if she has a bad reaction. Studies 20 years ago showed doctors to be particularly unresponsive when it came to such concerns, and there’s been no sign of progress since then, Wolfe told me. “There’s pitifully low awareness,” he said.
It doesn’t much matter in the grand scheme of things if someone semi-loses her mind, then gets it back again. The case isn’t one for the record books; that was made clear to me by the nurse, who eventually promised — the next day, when my powers of speech had been fully restored, along with my ability to effectively harangue — that she would indeed relay my story to the doctor.
But it’s scary to lose yourself, however unimportantly. Scarier still to think of what happens to those who don’t manage to save themselves.
Steve - I recommend reading comments by readers with personal experiences are worth a read at this link.
http://warner.blogs.nytimes.com/2008/10/16/adverse-effects-2/?dpc
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