My Pharmacist Is Trying To Kill Me

So I go pick up my Celexa yesterday. (And to answer your question, Robin, the reason I'm on that and not Lexapro is that Lexapro is supposed to be stronger, with fewer side effects. We don't want stronger. Stronger was too much for me. And my psychiatrist isn't sure that Lexapro really has fewer side effects than Celexa, though he does say it has fewer side effects than you'd expect for a drug that's as strong as it is.) Before I'd dropped it off, I"d looked at the presciption, just out of curiosity, so I knew what I was supposed to be getting: 20-mg tablets that I could break in half so that I start slow, with 10 mg, and then titrate up to 20 until I see Dr. Oui again in a month.

Here is what I got: a bottle of clearly-marked 20-mg tablets of Celexa, with a label on it that says, "Take one tablet each morning for seven days, then take two tablets (20 mg) each morning." Um...Two tablets would be 40 mg. Which would be way too much, way more than I'm supposed to be taking. And for someone like me, who responds rather, shall we say, robustly to these meds, that might just have blown the top of my head off, much like what happened to me when I went from 50 to 100 mg of zoloft way back when and really thought I was going to die from the shaking and the diarrhea and the panic.

Thank goodness I bother looking. What happens to people who don't? Or who just read the instructions and follow them? They become statistics, is what happens.

(And yes, I'm taking them with me to the drug store this afternoon to pick up a second prescription, and I'm going to ask them what the hell happened there, because really, there's just no excuse.)

Out With The Old And Ineffective...

For those of you playing the "what brain-altering-but-generally-ineffective pharmaceutical is on TC's shelves now?" home game, my psychiatrist and I decided today that the Effexor is out for good (I'll be titrating down the last little bit over the next week) and we're going to give Celexa a whirl. along with a significantly increased dose of neurontin.

Apparently, Celexa is a very close cousin to Zoloft, except milder (read: generally less effective). I did great on Zoloft, at a relatively low dose relative to my diagnoses, until it began to make my anxiety ratchet up higher than even the thought of Stalker Girl coming at me with an arsenal of weapons had done. So we're hoping that Celexa will give me the depression relief with less, if not completely absent, anxiety. Oh, and fewer of the other side effects, as well. And if it does increase the anxiety a little, there's the neurontin to help me cope iwth it, which I didn't have when I was on Zoloft.

Plus, Zoloft was good, really good, for my, um, marital relations, if ya know what I mean. In that realm, Effexor was Bad. Very, Very, Very, BAD. So very bad that that point alone would have made me want to go off of it; the not-working thing was just the capper.

So now the leftover Effexor will join all those other half-finished bottles of medications in my bathroom. It can hang with the ativan, and the klonopin, and the zoloft, and the lower-dose of xanax. I almost wish I could donate all these drugs to some worthy cause. I mean, damn. There must be plenty of underprivileged, under-insured people out there who are depressed or anxious. In fact, now that I think about it...ARE there any organizations that redistribute unused drugs? Or is that so fraught with liability issues that nobody in the world would possibly touch it?

Anyway...We talked a lot about hos disappointed I am in the way all of this is going; I had a similar discussion yesterday with my therapist. As I said to both of them, I know that there's the whole 'no pain, no gain,' thing, but it sure does feel like I'm worse off today than I was more than two years ago, when the panic attacks started, and that I'm disappointed that I can't yet handle this alone--as in, without major quantities of meds.

Dr. Oui, my psychiatrist, gave me a really good analogy to work with, though. He talked about my going around for years and years with this anxiety building up, and this low-level depression over the way things in my life were going, as if I were someone who'd been wounded in an accident, but kept insisting that there was nothing wrong, no big deal, just a flesh wound, it'll go away. But finally, when it was good and festering, I went to see a doctor to have it opened up and cleaned out. And that, he says, is what I'm doing in therapy, and why I'm finding therapy to be fairly painful and frustrating at times.

His job, as he put it, is to help me get to a place where my therapist and I can clean out the wounds without my being in such excruciating pain that I try to rip off the arm of anyone who comes near me. Hence the durgs, and the need to keep tweaking them until the pain is not gone, but tolerable, so that we all, as a team, can finish the job of stitching me back together.

Yeah, I know. It sounded a lot less hokey in his office, trust me. Must be the voice.

In any case, that's the deal. And so now I wait...for the Celexa to kick in, for the anxiety to lessen, for the insomnia to lessen. For the wound to be clean enough for stitches, and then for the scar to begin to fade. Seems like an impossible dream, a place I'll never get to, but it's good to have an actual goal.

Woooo!

It's hard to feel completely shitty when you're a winner!

Many thanks to Jay and Kim and Ann...That was definitely the bright spot of my week to date.

Seeking Spirit

Over the past few weeks, I've been immersed in reading/listening to Anne Lamott's books on faith: Traveling Mercies and Plan B. I had two predominant thoughts throughout. One was that I envy her, desperately, her ability to have faith, to place herself and her life in other hands, to be able to find comfort outside herself when the insides are hurting. That is just what I need.

The second thought was one of pure joy: I can have this! I can do this! This is within my reach!

You'd think that wasn't something that should have taken 41 years for me to figure out. But it has. And here is why: In reading Anne's works, and in listening to the words of people I respect and whose morals and values and goals for the world mirror mine, it's recently become clear to me that religion is not necessarily, as my father used to say, "simply one man's reason to hate another man." Clearly, that's true of many people. And it has been my motto, my modus operandi, the way I've always approached all things related to god and to faith. People who talk about praying or going to church or who reference God casually in conversation have always scared me rather than inspiring me.

But now, people like Anne and Rich and others like them are opening my eyes to the fact that there are people who rage against the way religion and so-called morality have been co-opted by people who hate and discriminate and exclude. They're trying to take back their faith from those people. They're teaching me that you can be both a believer and a liberal, that you can imagine a God that is just as angry as I am about the way our country is going. They're teaching me that you can be intelligent and faithful, that you can be imperfect and yet still loved. That you can believe in God yet not despise those who don't, or who believe differently from you. They're even teaching me that you can be funny and irreverent and questioning and skeptical and full of life and smarts...and that those things are not incompatible with faith.

Those are things I've never really been able to believe. But now I do, or at least I'm starting to. And that's good, because that's just the sort of thing I need to believe in right now. I feel a very strong need to explore my faith, my Judaism, to give myself up to something outside myself a little in order to make the parts inside me a little stronger. But I've always thought that such a quest would be completely incompatible with who I am. I'm starting to believe that that isn't necessarily so. I'm starting to believe that I can be me and be spiritual. I'm starting to believe.

The Panic Reflex

I hate this feeling. I hate it. There are times, when I'm in the thick of a panic attack, that I feel like I would sell my soul (only slightly used! a bargain at any price!) or perhaps a limb, if only I could extract a guarantee that I'll never feel this way again.

Instead, I've somehow managed to incorporate it into my physical repertoire without needing any kind of trigger any more. It starts with the tightness in my chest, and then a constriction in my throat much like the one you get when you're about to throw up...except I don't feel nauseated at all. My fingers start to tingle, then my feet, then my cheeks, and finally my jaw, which also grows numb. And so here I sit, in full physical panic...

...and there's not a single thing wrong with me.

By that I mean, I'm not worried about anything new. Nothing happened today to spike a panic attack. I'm not worried that I'm having a heart attack, or that I'm going to die, or that I'm going crazy. I know exactly what's going on. I'm sitting here recognizing, expecting, every single symptom. I just can't seem to hit the off button, is all.

Oooh, now my legs are numbing up, too. Maybe I'm pancking about panicking. Probably I am. Except I'm not afraid about what's going to happen; I've been here often enough to know the terrain by heart. I'm just going to have to wait another 15 minutes for the half-dose of Xnax to kick in, and if it doesn't, I'll take the other half. I'm not actually freaked about anything. I just hate feeling like this, is all.

Thursday. I have another psychiatrist appointment on Thursday. I really hope he'll be able to find SOMEthing in his magic bag for me. Because this is just plain DUMB.

A Not-So-Individualized Education Plan

At N's IEP meeting last week, we were told about how extremely bright he is, how charming he is, how much fun he was to test and observe. These are all things that make a parent's heart smile, and they surely did mine. But they weren't what I wanted to hear, not really. What I wanted to hear was, "N has XYZ Syndrome, which means that he will be getting ABC therapies and treatments, and you no longer have to worry about diagnosing or treating or understanding him, because everything you need to know can be found under the heading of said XYZ Syndrome on Google, and we'll be taking over for you from here on out."

Clearly, what you want is rarely what you get.

They did also tell us that my 4.5-year-old tests two years behind himself in his peer interaction skills, putting him in the first percentile for said skills. Considering that I've been going around saying, "I'm thinking he's at about a two-and-a-half-year-old's level in social skills," and that that is EXACTLY where he tested, it's somewhat gratifying to hear. Considering that it means that 99 out of a hundred children his age are better at interacting with their peers than he is, it's somewhat terrifying to hear. (It's a number I'm used to, though, considering that his height at weight are often at the same level...I'd say he's one in a million, but he's really one in a hundred.)

In the end, they told me that my son, while really behind in one or two areas, does not qualify for special education. I'm still not sure what to think about that. The explanation for why he doesn't qualify makes sense--they think he has the skills, but is choosing not to use them, for whatever reason, be it anxiety or personality; still, that means that a class that tries to teach him how to say hello to another child when they meet is likely to be a waste, since he knows what to do but doesn't want to do it.

And yet, all this leaves me rather bereft. Because, ultimately, what they told me is that he needs help, he's far behind, but it's up to me to fix it. Again. Still. And I'm not sure about my ability to do the job. I have the passion, for sure, but not the training, and certainly not the patience. I think I may be just a wee bit too close to my subject, to be honest.

Still, I don't regret this process. The school psychologist told me she'll be watching out for him in kindergarten, and that all I have to do is say the word and she'll do a mid-year assessment or an early intervention or whatever he needs. Plus, any future IEPs will have this assessment as their base, and I won't feel the need to justify asking for help; it'll be right there in their files that there is indeed a deficit that could one day need addressing.

And besides, how can I regret doing something that resulted in an 18-page document that talks nonstop about my all-time favorite topic: my children.

All of this has left me feeling rather raw and anxious and yet gratified and pleased with myself at the same time. Very mixed emotions. Very raw nerves. Very much in the same place as where I started. Very determined to move him forward, however I have to do it. And I CAN do it. I think...

I'm a good-enough mother; I'm a good-enough mother; I'm a good-enough mother...

Tight

My skin feels tight, stretched to its limits, especially on my hands and feet. I'm bloated, holding water, holding on, holding in. I know this happens to people when it's ungodly hot, which it currently is, but aside from my pregnancies, it doesn't happen to me. DIdn't happen to me. Now, it happens to me, it seems. I'm worried, scared, somehow angry with myself for whatever I'm not doing that I ought to be doing that would allow my body to let go.

My throat feels tight with stress, anxiety, anger, sadness.

My chest feels tight, too. That's panic. Hello, panic, my old friend.

I walked this morning, even though it was in the 80s by 8:30, when I left. Walking has become an addiction. People glance at me worriedly as I pant my way up the hills at least a few times a week, no matter the weather. We live in the foothills of the San Gabriel mountains, and there is no getting around some pretty steep ascents on the way home if I want to actually go somewhere on my walks, which I do. So, yeah, I often pant, and redden, and look a little shaky on my now-swollen legs. I'm not surprised they look at me that way.

This morning, as I strode my way to Starbucks and my "you can make it back up the hill" grande decaf light vanilla-mocha frappuccino, I was listening to Anne Lamott's "Plan B: Further Thoughts on Faith," which I got from my Audible.com subscription. As I listened to her speak about struggles and faith and parenting and letting go, I felt a slow loosening.

Here is what I heard: I'm imperfect. I make mistakes. I am, nonetheless, deserving of love. And I am not alone. I don't have to hate myself for my shortcomings. I can, I should, try to work on them, but I do not have to hate myself for them. They are part of my package, part of me, and I'm not the only one who was packaged this way. I am not unworthy. As my therapist would say, I'm good enough.

Yes, I know I sound like Stuart Smalley. But it's true. I am good enough, I am smart enough and, goshdarnit, people like me. Not everyone, and not always. But they do. I need to, too. I need to let go. I need to lighten up, to loosen up. I don't want to be tight any more. I want to be able to bend and stretch and move easily within my skin and my mind, and even my soul, whatever that means.

And so, on the way back from Starbucks, as the both the heat and I climbed back up the hill and my face grew redder and redder, wetter and wetter, I drank my frappuccino, stretched my arms above my head, shook out my wrists, took deep breaths, turned off the iPod, and let my mind wander unfettered.

I'm home again, and tight again--a phone call from N's teacher about his potty issues, a work-related issue, an unhappy silence--but I had those moments of looseness and freedom and of being OK about being me, and that will get me through the rest of the day.

Rings

I've noticed, lately, what with the extra mumbledy-mumble pounds I've been carrying around (yeah, thanks FXor, don't let the door hit you on my fat ass on the way out) and the inferno that is LA and my only-spot-airconditioned home, that my wedding ring is just the eensiest bit uncomfortable. And so, last night, with the aid of a little soap, I slid it off. And then forgot to put it on again this morning. And freaked each time I noticed that my finger was bare.

The only other time in our almost-ten-year marriage that I was without my ring for more than a couple of minutes was during my pregnancies, when I wore it around my neck on a chain.

I was commenting on how weird it felt to Baroy, but how necessary it'd been to remove it, considering the depth of the dent in my flesh it left behind.

"Yeah," he said. "I hate the feeling of a ring on my finger in the summer, which is why I hardly ever wear it this time of year."

"Hold on. Do you mean to say that you don't wear your wedding ring all the time?" I asked.

He just shook his head at me ruefully. "Nice powers of observation you got there, TC. I've NEVER worn it every day."

Huh. For some reason, that bugs me, though I don't know why. It's not like I worry that without it he'll start cattin' around or something. But still...

So, a quick poll. If you're married, do you wear your ring all the time? Does your partner? How do you feell about this, if you feel anything at all?

Air

I had it in my mind, this trip 'back East,' to measure my response to the place a bit more, to look at it with Tamar's eyes, to try and understand how it can be that someone with whom I connect in so many ways can have such a completely different take on New York City than do I.

I failed, miserably.

Maybe it was the fact that, during the five days I was there, the sun only briefly and only very occasionally pierced through the grayness blanketing the area. Maybe it was the typical-for-summer-but-not-usually-so-omnipresent humidity, which left me feeling suffocated with each and every sojourn outside, as if stepping into an instant panic attack.

But I tried. Really. I did. I went into Manhattan twice--once with the kids to see my father for the first time in four years (well, it was THEIR first time in four years; I've seen him once before, briefly), and once by myself to have lunch with an editor-friend for whom I'm doing an assignment. I saw lots and lots of family, spent time at my friends' home and at my sister's, held my two-month-old nephew for the very first time, even took a solo walk through my old neighborhood when I started feeling overwhelmed and 'moody.' There were moments of sweetness, but none of them connected to the place. The place felt grey and oppressive, like the air. It felt sad, and frenetic, and pretentious. It felt shabby and grimy and smelly. The more I reached, the more I tried, the shorter I fell in the attempt to recapture a feeling that I must have once had, a love for a place I'd lived in and grown in and made myself in. The more I tried, the worse I felt, until I finally gave up, feeling depressed and isolated.

Sunday, after playing baseball on a local junior high field near my sister's house on Long Island, we went to get a Slurpee at 7-11. I was sipping my drink as I left the store, only to be confronted by my sister's glare.

"Could you be any more from LA?" she said.

"What?" I responded, confused.

"That guy was standing there, holding the door for about an hour, waiting for you to wander through! You move so slowly, like you have all the time in the world. People here actually like to get in and out of the store, you know."

As she said this, a family jumped into the SUV parked next to my sister's car, and glared at her impatiently as she tried to buckle N into his car seat, then peeled out of the spot the second she'd closed the door.

"But it's 7-11!" I said. "Why the hell would anyone be in such a hurry to get into or out of a 7-11?"

She just shook her head at me and laughed, and I felt myself slip into a state of irritation that wouldn't leave me for the rest of the day. No more trying, I thought. It's just too hard. It's just not me.

And so, when I got off the plane yesterday in Ontario, about 45 minutes southeast of my house, I felt almost giddy. I was home. This place, I get. It's not the LA that people think of, but it's where I live, and it's the life I'm comfortable with, and if that means I'm at the opposite end of the spectrum from people whose opinions I share in so many other realms, so be it. As my mother would say, that's what makes horse races.

The Underbelly Defense

Jane writes bullshitlessly (no, it's not a real word, but you understood what I meant, right?) about how funny she feels about the praise she gets when she talks through her struggles with depression online. She wonders what exactly it is she's doing that others see as so brave; except, of course, she says it way better:

Am I really that honest? Or more to the point, why is everyone else so afraid to speak the truth? What, I ask you, is the potential consequence of this shocking action? That someone might be put off or not like you? Gads. The HORROR. Someone might not like you? How would you live?

I've got news for you people. Someone already doesn't like you, even if you're the nicest person in the world. Give it up.

I nod my head as I read Jane, when I'm not wiping tears of laughter from my eyes. But the truth is, while I agree with her wholeheartedly, my 'openness' about my own issues is less about being unafraid of what others think about me than it is a defense *against* negativity.

Here's how I figure it. If I put it all out there, write about my struggles with depression and anxiety and obsession and panic and maybe-hypomania online, anyone who comes after me is going to look like an intolerant and insensitive boob. I mean, really. What kind of coward attacks a creature lying there with its soft, pink underbelly fully exposed, staring trustingly into his or her eyes? There's no fun in going on the offensive against someone who's refusing to respond defensively. Even more to the point, there's no fun in trying to stigmatize someone who's already called herself every name in the book. If I repeatedly refer to myself as crazy, that's one less potentially hurtful barb you can sling my way. By being disarmingly honest, I do precisely that--I disarm you, or anyone else who might be capable of hurting me with judgement and derision.

There's still plenty of stigma attached to mental illness. It's one of those few remaining areas into which political correctness has not yet made its final inroads. Words like 'retard' have rightfully lost their cachet, yet it's still more-than-common to be called crazy or nuts or insane. But those words really only sting if they're used on someone who doesn't see herself as crazy or nuts or insane. And so I throw those words out there, invite you to use them, and smile all the while, to show you just how much they don't hurt. I know who and what I am. I'm OK with me. I'm crazy about crazy. I'm intimate with insanity. I'm knowingly nuts. If you're going to hurt me, you'll have to find some other way. Because when it comes to my mental lack-of-health, there's nothing you can say to me that I haven't already said to myself.

The Thing He Doesn't Realize Is, The Real Gift Was What He Said

I came home in a slightly foul mood--more common than not, these days--and went up to use our bathroom. When I came out into the bedroom, there was Baroy, holding a wrapped box.

"What's this?" I said, puzzled.

"A gift. For you."

"But..."

He stopped me before I could start. "I was going to wait until my birthday [his 50th is in October] to give this to you, but you can use it now."

"But..."

"You'll understand when you open it, but I've been wanting to get this for you for a long time. You've worked so hard this year, and you deserve better than to always have hand-me-downs."

My mind was a blank, so I opened it. It was a new--and incredibly tiny--digital camera. (The one I've been using was one I bought for him for his birthday five years ago, hence the hand-me-down comment.)

There are many reasons for me to be over the moon about this, not the least of which is that I'm heading to New York next week to meet my brand-new nephew, and will want to take many photographs of him. (His parents--my stepsister and her husband--suck at sending photos.) And the other camera is a bit dated, technologically. Still, I was more touched by the mere fact of the present than by what it was.

"But why?"

"Because I wanted to," he said. "Because I wanted you to know that I've noticed how hard you've had to work this year, and I felt like you deserved to have that noticed."

He noticed. Hell, he not only noticed, but he parted with some portion of the money his mother is sending him for his birthday to show me that he noticed. That box could have been filled with rocks, and it still would have made me smile...

...though not quite as wide as my brand-spanking-new, totally awesome new camera did.

Things I Learned About My Son At His Evaluation Yesterday

1. N knows his telephone number. I think I've told it to him twice, in preparation for trying to make sure he knows his phone number and address before kindergarten. I would have sworn up and down that he couldn't even recall the first three numbers, and then he goes and rattles it off like it's his name. WTF?

2. Despite the fact that I told the psychologist questioning us while the other four young ladies cooed and gooed and laughed and squealed over N (sigh...so much for my conundrum; he fell in love immediately and flirted his little heart out, and they are SO going to think I'm insane for asking for an evaluation) that N really doesn't express things like being hungry, but will rather wait for us to ask him what he wants for any given meal, he then turned around no more than ten minutes later and announced, "I no want to do this any MORE! I HUNGRY!" Yeah, thanks for that backup, kid.

3. When asked, "What do you do if a stranger comes up to you and asks you to get in a car with him?" N replied, "Say PLEASE!" And then looked all proud of himself. Note to self: Stop working on phone number. Start working on stranger danger.

4. He's really smart, probably smarter than even I thought. The supposed-to-be two-hour testing took three, partly because they're using a new test that they're not quite as used to and so it slowed them down, but also--they told me--because it took a long time to get him to hit a "ceiling" on the test. So, for instance, when they were looking to see what sort of number knowledge he has, they had him count, then checked if he recognized written numbers, then wanted to see if he has one-to-one correspondence down, then asked him to do some simple addition with objects...and when he'd apparently aced all of that stuff, they moved on to seeing if he could do written arithmetic questions. I wasn't able to watch too much of his testing, being that I was answering a slew of questions with Baroy, but at one point I turned around to see one of the ladies reveal a line of 3 + 2 = ___ problems, and I was shocked. I doubt he got any of them right; he's all of 4.5 and I've never done that sort of workbooky stuff with him. But still, to realize that he's already at that level in math was kind of impressive to me, in my braggy-mommy way.

5. There really is not a single young lady who he can't charm, and with whom he will not flirt.

6. We are SO not going to get any services out of this school district. But at least I ended up making friends with the psychologist, who actually works at our elementary school, so it will be easier to go to her formally or informally in the future if we run into problems. (Not that I'm giving up on this quite yet...not until *I* am convinced he's really doing fine...but it may not be a battle I can win.)

Our Regularly Scheduled Angst

I have a conundrum.

OK, so, see? We're going to this preschool evaluation for N today. There are going to be about four or five people there, looking at him...a school psychologist, a speech/language pathologist, a general education specialist, a special education teacher, and a school nurse. And I'm torn about what I want them to see.

I want them to see my very special boy. I want them to tell me how very special he is, how wonderful. And then I want them to say, "But, yes, we have a program that can help him overcome the social hurdles he seems to be encountering, and we can help him become an even better N."

The problem is, he's progressing really well right now. I'm not sure they're going to see the same N that others have seen and worried about. I'm not sure they're going to want to spend even a penny of their very precious special ed dollars on him, because there are so many kids who are in a much worse position. And if I weren't this kid's mom, I'd probably agree with them. But I am this kid's mom, and I know that even with his progress, he's still going to have a hell of a time in kindergarten, and I think we can "save" him if we just get him a little therapy right now.

So I'm going armed with his own preschool's assessment sheet from earlier this year, and my posts about what's been going on. (I figure if can't hurt.) I'm looking for the shirt he darned near chewed to pieces at the Little Gym recently, during a day when he actually almost participated fully. And I'm going armed with the wisdom of many moms who've been where I am before. But I fear it's not enough. And that's where the conundrum comes in.

Part of me wants to talk to N the whole way there, get him psyched to show off all his tricks, because I'm his mommy, and I can't help but want people to see how wonderful he is. But the other part of me wants to sabotage him, get his anxiety going, make sure he clings to me the way he often does in strange situations. Part of me want to tell him that the people we're going to see want to meet his imaginary friends, so he should show them to them. Part of me wants to scare him and tell him that he may have to go in a room with a bunch of children he doesn't know, just to get him all riled up.

I don't think I can do it; certainly, not all of that. It's just a little too Munchhausen-by-proxy for me. Still the temptation is mighty strong...

I'll let you know how we do later...

50K

A blog milestone, and I missed it, what with being so absorbed in simultaneously celebrating, enjoying spending time with friends, and worrying my very little brain off about the school district evaluation we have for N in about, oh, two hours...

But that's not the point. The point is, 50,000 blog hits = Cool!

And now, we return you to our regularly scheduled angst...