no more please no more

I think the cold has contributed greatly, in that aside from getting into my bones I spend most days wearing heavy coats, hunching my shoulders and hunkering down in them, with my hands in my pockets. Bad posture. Bad for hands.

Been chewing Nurofen Plus like they're lollies. Terrible bad lollies that, if I take two at a time and wait an hour or so, provide real tangible relief. They're the shit. They've also burned a hole in my gut and when I shit I stain the bowl bloody. Lots of it. Clots of it. Fresh and infringing on McDonalds red.

I stopped taking them of my own volition, and stuck it out until my next GP appointment. Told him this. He told me I should not have been taking ibuprofen with Celebrex. I don't recall this, I'm sure I've checked with multiple pharmacists every time I buy yet another box of Nurofen. I'm sure I've even checked with my GP, multiple times. But, these drugs, they make things fall out of my head. Maybe they made that fall out of my head.

Clearly the Celebrex was not enough, so he gave me a prescription for Tramadol, to be taken twice a day instead of the Celebrex. He told me it was an opiate, and there may be some nausea and drowsiness, and it was simply a matter of getting my dosage right. He's still treating me for fibrmyalgia, he says, so this will be targeting neurological pain. I asked him if it was okay to take Nurofen with this. He said no, I wouldn't need to take it you see. But you said we had to get the dosage right-

Off I went with my prescription. $38 later. The pharmacist sought me out. I shouldn't be taking Tramadol with Cymbalta, and should talk to my GP. My GP prescribed them. Oh. Well. They really shouldn't be taken together, so if you feel any nausea, any side effects, stop taking them immediately.

First tablet Sunday morning. No noticeable effect. Second tablet Sunday night. No noticeable effect. The pain could have been less, but it's hard to judge on weekends, there being considerably less time spent in front of the computer.

Third tablet Monday morning. Intense cold sweats, shakes and faintness on the train in, to the point of pushing for a seat and still not being sure that I wasn't going to keel over. This getting progressively worse during the day. Not having any flex time or sick leave without certificate to my name. Not being able to go home because I'm so behind at work I just can't justify it. Not being able to go home because I was certain I wouldn't last the trip. Spent five hours of work day mostly faceplanted on my desk and concentrating very hard on breathing.

Early afternoon the nausea took a step back, only to be replaced by drowsiness. "Drowsiness" is too light a word however. Diet narcolepsy perhaps. I did a quick dirty google on Tramadol. Lots of talk of seizures, and Serotonin Syndrome, and the fact that it is highly addictive both physically and psychologically.

I left work early to head over to Richmond, where I finally had an appointment with a psychiatrist.

Finally? I don't know. As if that is a good thing. The first session is always given to backstory and context, and I cried, because I can't break any of this down into small, easy to swallow pieces. It is either all - drowning and choking on everything - or nothing.

Cymbalta and Tramadol, the psychiatrist said. They should not be taken together, ever. The interaction can bring on Serotonin Syndrome, which isn't something that requires a dosage level be met, but can come on at any time. Stop taking it immediately.

Try Pristiq.

Who the hell comes up with drug names.

I've prescribed Pristiq to patients with both depression and fibromyalgia and had success, she says. You'll only have to take the one pill a day.

She does not give me a prescription, but sends a report to my GP, whom I am seeing later in the week.

For some reason, I am not relieved to be given professional permission to cease the Tramadol.

The drowsiness remains for the following day. I nearly miss my station. I nod off in a meeting I am chairing. I nod off while penning a sentence. I nearly miss my station again.

Questions. What the fuck was my GP thinking prescribing me these two drugs that would interact negatively? Does he have any fucking idea what he's doing?

Do I really want to try yet another drug?

And fail?

Friday. I see my GP. I tell him that the drug incapacitated me, and that the pharmacist and psychiatrist both stated emphatically that Cymbalta and Tramadol should not be taken together.

He shrugs and says "Well, that's where we're at now isn't it? We have to try these things, because we're running out of options."

He told me nothing other than it was an opiate and I'd probably get a bit of nausea. He did not inform me of anything. He made the decision for me. If I'd known, I would have decided against. I keep my mouth shut. He writes me a prescription for Pristiq. A box of 100mg and 50mg. Take the 100mg for a week, and then bump the dose to 150mg daily.

He doesn't tell me anything about this drug either.

I go home, and read about it. All the standard side effects you'd expect from an SNRI. Welcome home night sweats and muscle contractions, hello again insomnia and appetite loss.

What frightens me this time, what really frightens me, is that Pristiq has a much shorter half-life than Cymbalta. Pristiq is also marketed as Effexor, and I have read and heard many stories of people caught out by that - not randoms, people I know and trust - and being hit by severe withdrawal within hours of missing a dose, if that. Cymbalta has quite a long half-life. When I first started taking it I was prescribed Seroquel as well, in order to have a crutch to support me for the three to four weeks it took for the Cymbalta to kick in. Weekdays I take my dose when getting out of bed, at sixish. That's fine, that's regular. Weekends, however, I might not surface til 10, 11, 12.

Cannot do that on Pristiq.

Went to pick up prescription. Different pharmacist pulled me aside. Gave me advice regarding what other pain relief medications may be taken in conjunction with - Nurofen and Panadol with codeine are good for go. When I described the effect of the Tramadol, he said I'd probably had the beginnings of Serotonin Syndrome.

Had I? I didn't think- don't I know the effec- I've researched Sero-

The drugs. They make things fall out of my head.

$68 later, and I can tell you Pristiq are small, pink and square.













I am so tired of this. I don't believe I have fibromyalgia and therefore treating fibromyalgia won't help me. I hate these drugs. I hate what they do to my mind and so what they do to me as an idea. I'm in here somewhere. I must be. But I'm so tired of this. I'm so scared. I don't want to do this anymore.

The Good, The Bad, And The Otherwise

Back in February 2010 I was referred to a specialist, a rheumatologist. He twisted my joints, poked and prodded, made a couple of comments about Asimov and sent me on my way.

My Doktor, upon receiving the rheumatologist's findings, gave me a "...wtf?" look.

Regional Pain Syndrome

The symptoms of CRPS usually manifest near the site of an injury, either major or minor. The most common symptoms overall are burning and electrical sensations, described to be like "shooting pain." The patient may also experience muscle spasms, local swelling, abnormally increased sweating, changes in skin temperature and color, softening and thinning of bones, joint tenderness or stiffness, restricted or painful movement.

The pain of CRPS is continuous and may be heightened by emotional or physical stress. Moving or touching the limb is often intolerable. The symptoms of CRPS vary in severity and duration. There are three variants of CRPS, previously thought of as stages. It is now believed that patients with CRPS do not progress through these stages sequentially. These stages may not be time-constrained, and could possibly event-related, such as ground-level falls or re-injuries in previous areas. Instead, patients are likely to have one of the three following types of disease progression:

1. Stage one is characterized by severe, burning pain at the site of the injury. Muscle spasm, joint stiffness, restricted mobility, rapid hair and nail growth, and vasospasm (a constriction of the blood vessels) that affects color and temperature of the skin can also occur.
2. Stage two is characterized by more intense pain. Swelling spreads, hair growth diminishes, nails become cracked, brittle, grooved, and spotty, osteoporosis becomes severe and diffuse, joints thicken, and muscles atrophy.
3. Stage three is characterized by irreversible changes in the skin and bones, while the pain becomes unyielding and may involve the entire limb. There is marked muscle atrophy, severely limited mobility of the affected area, and flexor tendon contractions (contractions of the muscles and tendons that flex the joints). Occasionally the limb is displaced from its normal position, and marked bone softening and thinning is more dispersed.

Upon reading the symptoms, I returned the "...wtf?" look to my Doktor.

The only symptom I had and have in common with this condition was pain. And you know, that's a symptom I have in common with, say, piranhas. Does that mean I have piranhas? No. No, it does not.

As such, we elected to overlook that diagnosis and continue with physiotherapy, which had been making significant improvements. For a while. Well. Yeah.

Hands started to deteriorate again, no matter what I did or did not do, which lead to the prescription of Cymbalta among other things, and, eventually, another referral to the rheumatologist.

My Doktor had specifically chosen Cymbalta as it has been proven to be effective in the mitigation of chronic pain. Curious, I asked my physiotherapist about the idea behind Regional Pain Syndrome and the theory my Doktor appeared to be latching onto in regards to overactive nerve activity and a brain that no longer filtered properly.

"Absolutely," she said. Although the problem with my hands may have started as a very straight-forward Repetitive Strain Injury, it had gone on long enough that the nerves would have changed with the conditions they found themselves in. In layman's terms; the nerves expect pain, so they make it. The brain expects pain, so it receives it.

I had my doubts when my Doktor explained his reason for the Cymbalta. Pain is not something that should be covered up. It's there for a reason, it's the best warning sign you get that something is wrong. There have been many, many steps backward on this "road to recovery" my hands have taken me on. One of the biggest was late last year. The Doktor had given me Celebrex, with instructions to take one a day for a month, and see how that helped. I was having adverse reactions to over the counter painkillers, and thankfully the Celebrex had no such effect. It's a slow-acting medication. Not designed for quick pain relief, but for chronic pain relief. It only kicks in after a few days, once appropriate amounts are in your blood.

It was lovely, being without that pain. Lovely.

At the end of the month, when I went off the Celebrex, the pain returned and was significantly worse than previously. I could only assume that without the pain to hold me back, I was working too much and not realising, and doing even more damage to my hands.

That terrified me. I wouldn't take any more painkillers after that, except at night when it was the only way I would get to sleep. The pain was necessary to keep me in check. I needed the pain, to listen to.

However.

I was getting better.

I could see it when my physiotherapist tested the tension in my nerves, and I could feel it when she went at my muscles and nerves with her frighteningly effective hands. I could feel it when I moved and when I stretched.

Improvement = more pain?

No comprende.

The rhuematologist twisted my joints and poked me hard enough to bruise and made some more comments about Asimov, and then wrote on a piece of paper "fibromyalgia" and peered at me over his glasses.

Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure...Other symptoms include debilitating fatigue, sleep disturbance, and joint stiffness. Some patients may also report difficulty with swallowing, bowel and bladder abnormalities, numbness and tingling, and cognitive dysfunction. Fibromyalgia is frequently comorbid with psychiatric conditions such as depression and anxiety and stress-related disorders such as post-traumatic stress disorder. Not all people with fibromyalgia experience all associated symptoms.

"I've seen this," I said. "When I was reading up on Cymbalta."

He gave me his recommendations - to raise the dose of Cymbalta or stay on Celebrex indefinitely - and sent me on my way.

My Doktor was well pleased to hear this, his hypothesis being confirmed by a second source, until I pointed at that at the current dosage of Cymbalta I had noticed no different in pain levels and given the somewhat UNRELENTLINGLY ARSEHOLEY side-effects currently afflicting me, no way in hell was I going to start a higher dosage.

And that's where we are now. I'm to stay on 60mg of Cymbalta for the next couple of months. Should the current side effects of RAGING INSOMNIA and SOB-INDUCING RESTLESSNESS abate, I will try a higher dosage in the hopes it alleviates my chronic pain. If not, I'll drop back to 30mg of Cymbalta and stay on Celebrex for...however long.

I've done my reading around on the intertubes, and I have my reservations about the diagnosis. Fibromyalgia itself is something of a controversial condition, and when I look at the symptoms and requirements of diagnosis, my face gets a little skeptical. I'm not sure I tick all those boxes.

But, what my physiotherapist said makes sense to me, and she is the one who knows my condition best. I trust her opinion.

The majority of those I have shared this diagnosis with have expressed quite sharp-edged dismay, to my surprise and gratitude. Yes, well. The idea of living with chronic pain isn't exactly a happy ending. It's not something that really featured in my plans for the future, you know?

That said, I'm descended from people who pay sweet bugger all attention to pain. They shrug off cuts and don't notice bruises, strain and pull and twist things and simply treat them gently till they've calmed down, barely even notice when they're sick because, hey, it isn't actually stopping them from getting on with things. One of the problems in talking to my medical posse about my hands, for the entire duration, was being able to express the "level" of pain. When it's bad enough to keep me from working, then I notice it. Beyond that...look, I'm uncomfortable all the time, so I don't really pay it any attention, sorry.

The pain was there to stop me from doing damage. If my nerves are simply crying wolf, and there is no damage being done?

Fuck yes I will live with chronic pain. Fuck. Yes.
Fuck yes I will take medication indefinitely. Fuck. Yes.

Because what this means is the damage is not that bad. What this means is physically I can and am recovering.

What this means is I can think about writing.

I have a future, again.

BOOYAH.

Which isn't to say I can throw all caution to the wind. I'm currently filling another position at work, a role that involves more computer work than my own, and combined with the recent spate of blogging; I feel it. Oh boy am I feeling it. Ouch. Ow. Argh. Getting a bit carried away with this heady air of possibility. Oh air. Oh air.

This may be the first breath I've taken in 21 months.