Severe Depression, Me and MS
A New Version of an Old Problem
I think I said previously in another blog that I met my diagnosis of Multiple Sclerosis more with a sense of relief than with one of trepidation. Finally I understood why I was becoming tired easily, Why life was 'flattening out' mentally, why the brimming joy I'd always felt about life seemed to be going away and the reserves of energy I've always felt when facing a challenge weren't there any more. At work in the ER (excuse me, 'ED'...ridiculous) I had always risen and started sprinting to where the ceiling speaker directed me when a code was suddenly called. Now I just felt tired. (I still ran to the code and did my best.)
When my Internist examined me and found weakness, left partial homonomous hemianopsia with macular sparing and nine beats of clonus in my left foot, six in the right, she ordered an emergency MRI of the brain and spinal cord. This was done immediately and I actually enjoyed the experience of womb-like encapsulation in the MRI tube, the time of enforced self-reflection and the hypnotic jungle-drum beating that went on through the exam. Except that the three techs who ran the study wouldn't talk to me about the emerging results and told me, 'your doctor will call you.'
James Bond famously said that anxiety was 'interest paid to danger before it's due.' I like that. One of my favorite clinical teachers told me once that when a real problem presented itself to him he would sit quietly by himself for a few minutes, think the thing through, decide his course and go to bed. There was nothing else to do and damned if he was going to sit up worrying about it.
The Eventual News
Just as a note: I wrote a very long piece here on how this worked out and now my spastic right arm somehow erased it all and I am starting the capsule over. Oh, Anglo-Saxon is a wonderful language to swear in; so many guttural German syllables and explicit barnyard descriptives! My rule anymore is never to take the name of the Lord My God in vain but 'For Unlawful Carnal Knowledge' and it's Similars may be used freely if needed but always in private.
Anyhoo, The day before, I'd seen my optometrist and he had shown me a disturbing incompleteness in the vision of my right eye. This, with my known general tiredness and the stumble-bum action of my right Anterior Tibialis after a ten mile run led me to gather Harrison's Internal Medicine to my bosom on the sofa in the living room after my wife and the kids were asleep to 'Review the Bidding.'
I didn't even consider MS then; it is usually a disease of young women and I was then almost fifty. Any other diagnosis was possible, I thought.
Creeping Diabetes Mellitus. I knew I was pre diabetic and I had no control over myself eating-wise. Possible associated Atherosclerosis with possible mini strokes...hmm...maybe. I considered but rejected the idea of cancer: no headaches. The result of a poorly resolving addiction? No. Never happened. Syphilis or some other 'Loathsome Disease' I'd picked up in college? Good God, No. Never. I finally decided the most likely thing was mini-strokes from subclinical atherosclerosis and developing diabetes.
After my MRI, I dropped my wife off at home and went to Starbucks to drink coffee and sit under the open then-cold November afternoon and await the dropping of the Sword of Damocles. It came a few minutes later. A call from now my internist.
'Dr Vetto, I'm afraid you have Multiple Sclerosis.'
Oh, Be Joyful ! my mind yelled privately as she she spoke into the silence I left and began to enumerate Support Groups and how I could be a useful cripple, I guess. She meant well and God bless her, anyway. A very tough situation for her. I asked her for the names of neurologists I might call. She was helpful and I took her advice and set up a follow up appointment with the office of the gentleman she recommended.
I was so happy. That day I sat with my opened journal and listed 'All the Bad Things it could've been.' I filled two pages, College Ruled. I decided what to do.I would continue to carefully practice but would retire if anything particularly Untoward developed. This finally happened a few years later when I was practicing somewhere else, in a level-three facility.
My mental status was, has always been, Spot On to but my walking became a problem and when I saw it I was retired in a week.
Now For Depression!!
The above, my evolving and finally-revealed diagnosis of MS, sounds like somebody's bad idea for worse comedy. All-in-all, It worked out for the best. To sum it all up, I had a probable auto-immune diisease which I knew would have a variable course and might end up self-curable. What it was Not, I had voluminously outlined in my journal. I was a practicing ER Doctor, a 'Boarded Fellow of the College' and very aware of what I could do, what I should do and the proper point at which to retire from the scene, which I did, probably a year or two before I really had to. Galen saiid, 'First, do no harm.' I have followed this my whole life. I left the profession in good standing.
Like many Physicians, I have OCD, Obsessive Compulsive Disorder, the too-diligent need to complete self-imposed tasks to perfection and 'Damn the torpedoes, full speed ahead!' My new neurologist, who knows an embarassing amount about MS, started me on Sertraline, an SSRA (selective serotonin-reuptake antagonist) as a specific for the commonly-understood depression got by many or most Sclerotics. I have taken this religiously for several years. The only addendum I imposed to this treatment was that I have always taken a lower-than-recommended dose which would cover my OCD but wouldn't treat depression.
About two weeks ago I decided to try to live my life without Sertraline. This drug, like other members of its family, takes about 2 weeks to reach an effective level in the blood. Upon ceasing a daily ingestion of Sertraline, the blood level drops and the protection it provides against depression (and OCD too, I guess) leaves, possibly forever...
When my mind is released from external tasks, as mine usually is since my retirement from active practice, it may grasp onto something, anything, an idea or situation real or imagined, and Play with it. I worry about it. I became entangled in what I would term 'an uncontrolled Do-Loop', a mistake in writing computer code in which a program enters a subroutine from which the there is no way to end it and the subroutine repeats and repeats and repeats. The word 'worry' originally meant to 'play with incessantly.' When a cat catches a mouse, if it doesn't eat it at once, it will start to play with it, slap it, tease it as it attempts to escape from the small arena the cat keeps between its paws. The mouse eventually dies, probably from an overdose of cortisol I guess. My little mind spent two days worrying about a social situation I saw on a TV program I watched on-line. It was silly and I knew it. Hulu let me run every episode of the program until I'd seen all of them. I watched the situation resolve. I felt like crying with relief. My shoulders shook with the emotion. I was so glad my wife was at work, that my kids were elsewhere. How do you spell 'stupid?' Well, the situation did not resolve For me. I continued to run and rerun the made-up scenario in my mind even when I knew its outcome. The identical emotional rush, the same eventual catharsis, the same sobs with the sure knowledge that the crisis resolved, would always resolve and that I was unable to stop the routine, that I would run through the buildup, the emotional rush, the resolution and always return to the beginning to do it all again.
On the third day of my 'worry fit', it ended. I was in my kitchen loading dishes. I was not actively running the scenario again and again through my brain as I'd been doing but it was on my mind. It was the tumultuous cloudscape overhead and I knew it was the sore place I couldn't stop messing with, worrying. I rose from placing a dish into its' rack and in an instant it was all gone. The dark film was wiped from my brain. Dear Lord, that felt good. Why did this happen? I was happy the nonsense was gone, sure, but what exactly had changed to explain it? I went through what had happened. I'd awakened with the morning Gloaming, as is usually the case now. I got up. I went Into my bathroom to shave, shower and take my morning meds. I take a lot of pills. Byetta, pioglitizone and Metformin for DM II, multivitamins without iron, Vitamins D3 and K2 for MS (per a recent Brazilian study), Aubagio for MS (a mainstream med the study for which I have become a part of. It is a magical, whimsical med which is purported to consolidate and decrease the numbers of my MS lesions. It is laughingly expensive, $12,000/month. I take it because my neurologist asked me to and because, being part of the study, I pay nothing for it. The final drug I take is a gram of Vitamin C, morning and night. I take it simply because Linus Pauling, an amazingly smart man, said it was a good thing to do.
I also take Provigil, (Modafinil is its chemical name). This is the Dopamine Reuptake Antagonist I mentioned in a previous blog. It focuses my mind and makes me more alert. When I came out of my worrying fugue two days ago, I had taken Provigil about a half-hour before. Could this have helped clear me? I don't think so. I'd taken Provigil each day for awhile. I think the Sertraline was out of my system finally and the worry-fit had been the after-effect of its leaving. I had had the worry-fits while I was taking Provigil. In any case, I feel better now. I am likely to start worrying about Something, lord knows what, if my mind is not occupied. I try to stay occupied. I live with depression and OCD.This is just who and what I am. I'll offer it all up for my sins.
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