PUCKETT: Pain Management, Cymbalta And Napping Every Three Hours

I have no appetite.

I apologize to everyone repeatedly because I seem to have a pronounced case of CRS and can't remember what I said. Luckily, I'm not in the habit of lying so I don't have to worry about keeping my story straight.

I started taking Klonopin to regulate my sleep schedule because Zanaflex had me waking up every two hours and walking into walls like a zombie, so now I'm waking up at 5 a.m. and napping every few hours throughout the day.

I'm on 120 mg of Cymbalta every day.

And my friend Hanae just laughs when I tell her about my medical regimen and the constant changes. She says they all sound like rejected names for Transformers. I guess that makes me Optimus Fucked.

This post started because I was reading over the comments on a previous entry about Cymbalta and was just a little bit stunned by how familiar it all sounded.

While I haven't had any problems with suicidal ideation, I have gone from 30 mg / day for a week to 60 mg / day which was recently increased again by my neurologist to 120 mg / day to help manage pain.

Here is what I know from direct observation and medical tests:

1. I am constantly thirsty and have dry mouth. I wake up in the middle of the night and drink two to three glasses of water.
2. I have short-term memory problems. I forget little things. I forget big things. I have to write everything down and even then, I sometimes forget it. I depend on other people to remember it for me. One commenter called it brain fog. That's a great way to describe it. I feel groggy when I wake up and groggy for most of the day until I take my meds in the evening, get groggier and pass out. In addition, it's difficult to focus on anything - tring to read and retain the information often seems pointless so I try to find "Quantum Leap" in syndication. My brain can process TV. My brain has difficulty processing more conceptual or theoretical stimuli.
3. I have NO libido. I finally understand the kind of frustration women can have when trying to reach orgasm. Without being too graphic, I masturbated for nearly half an hour one day without being able to reach orgasm. I don't bother trying now. Another side effect is a lack of erections - even the proverbial morning wood.
4. My blood pressure is normally around 120/70. The last time it was taken in a doctor's office (about a week ago and before the increase to 120 mg / day), it was 138/90. I commented that it seemed high and the nurse explained it away by saying that it's normal to have elevated blood pressure in a doctor's office. The only catch is that my blood pressure is usually 120/70 in a doctor's office. I don't get edgy in doctor's offices - not even when they tell me to turn my head and cough. Not even when they pull out the KY and a rubber glove. Being in a doctor's office doesn't explain that difference.
5. Fatigue. Oh, yeah. I'm asleep by 10 p.m. or so. I wake up at 5 a.m. Take my first nap around 8 or 9 a.m. Take another in mid-afternoon. Back to sleep by 10 p.m. Exhaustion? You bet.
6. Dizziness. Yes, I've had some balance issues - a little staggering here and there.

The problem is that some of these symptoms can't be clearly identified as side effects of the medication because there are too many other potentially contributing or complicating factors. While most of the stuff that will kill or cripple me, including MS, has been largely ruled out, there are still dozens of possible conditions that could account for the fatigue, the memory problems, the dizziness and so forth. They could stem from the pain that I'm in, which is the reason my doctors prescribed this regimen in the first place. They could stem from atrophied muscles which, despite my best efforts, are likely on the decline. They could stem from fibromyalgia, which my mother had and which is the current best guess for a diagnosis. They could stem from pharmaceutical or chemical interactions - after all, I am on an anti-convulsant, an anti-depressant and an anti-anxiety medication and I'm not convulsing, depressed or anxious, nor was I before all this started.

What I know is this: I am experiencing a number of the side effects identified in the documentation that came with Cymbalta. I am experiencing a number of the anecdotal side effects that commenters have described.

What I also know is that the only thing (besides opiates) I have found so far which effectively treats my pain in any significant way is yoga. Yoga practice helps me maintain my flexibility, rebuild my strength, regain my energy for a brief period of time and temporarily reduce my pain. I don't feel as groggy or fogged after it and I usually get an hour or two of something that feels like my life before all this started.

However, because of all this, because of the pain and the grogginess, I'm unable to work, unable to drive and am still on disability and will be for the foreseeable future.

I still have my sense of humor though, although it's not really on display in this post. I guess that's because I just woke up from a nap and already feel like taking another one.

I don't post much around these parts, although I do read this blog as often as I can. When every day seems the same as the one before it and that day was hazy, filled with pain and nothing different than the day before, what's to report? When the treatments consist of increasing dosages, why bother writing when I can lay in bed and drift off to sleep ... or simply pass out from exhaustion, pain or a combination of the two.

And don't take this as depression. This is my reality. My primary means of resistance is yoga. My secondary means is teaching myself how to quilt, come hell or high water. It's just slow going when I have to learn how to iron and somehow learn and remember how to use my sewing machines and the quilting techniques that I'm slowly picking up in my less groggy moments.

After watching my mom treat her fibromyalgia with QVC, vicodin and sitting on the couch until she killed herself, I think a different approach is in order. After all, I already know one way that doesn't work.

Posted by Puckett at September 17, 2006 10:56 AM
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