Prozac and Other Drugs

“Stop worrying so much and have faith that things will work out.”

My mother posted this inspirational meme on Facebook yesterday. It fell in my timeline above an article about the skyrocketing rates of depression and mood-altering drug use in this country and below another meme by a mom friend imploring me to remember that every day with my kids is precious and to cherish every moment.

Every moment? EVERY SINGLE MOMENT?

Here’s the thing, and this isn’t a mom blog – I’m about to take a left turn here – but have you even met my kids? Baby A and Little A are two of the most precious, amazing, inspiring beings to ever walk my earth. They’re sweet and kind and funny and their laughs make my ovaries hurt and my heart open like a freshly bloomed fucking daylily.

But my kids  - like all kids – are assholes.

They spend at lease 67% of each day fighting, spitting, choke-holding, complaining, whining, putting-their-cereal-bowl-in-the-sink-while-simultaneously-proclaiming-hunger-ing. They are children. They are a GIANT chunk of my world and the source of all my joy. But fun? Cherish? No.

I digress.

What is the deal with everyone telling me to be happy all of the damn time?

I recently moved to a new state. Brand spanking new rules, home (teensy apartment), car, “friends” (don’t have any yet). New DMV to figure out. New tax laws. New everything. We like new. New is good. I’m basically a modern day gypsy. But this move meant we also left behind a bourgeoning group of people back in Texas. People we knew. A home literal feet from people who had a cup of sugar or would share a cup of coffee in the morning. A place where the kids could play in the street and nearly everyone knew everyone else’s name.

And leaving that? It was brutal. Not just on me this time, but also on the kids. And, to some degree, I think, on my happyshiny husband for whom the world is literally the place he kicks up his heels and whistles while he works.

Since arriving, I’ve received a lot of well-meant advice about keeping up my chin! and how Things will get better! and Remember how much you hated Texas at first? and Just have faith! And these are all true and meant with love – but here’s the thing – I like to FEEL my emotions. All the way through. For me, even in sadness is a sprinkle of joy and it is, in fact, the sadness, that helps my bipolar, busted-ass brain remember the beauty and awe-inspiring grace this world offers me. I am unable to feel the joy without the hint of sorrow that accompanies it.

Did you see that Pixar movie yet? See the damn movie and you’ll understand.

This obsession with constant happiness isn’t something I’ve ever understood – but starting with my casual reading of “Prozac Nation” I knew that something was terribly wrong with the idea that people should always be in a state of Nirvana. The entire natural world is about balance. What even IS joy if it isn’t tempered with sorrow? But most often that translates in my brain as, “What’s wrong with me that I can’t snap out of it? Is everyone else right and I’m being morose? How is everyone else so goddamn happy all the time?”

And then, as these things happen, little A brought me a message from the capital “U” Universe last night.

He’s had a lot more trouble than all of us on this move; with his explosive temper, sadness, irritability, etc.  He’s hitting the pre-teen years with a motherfucking VENGEANCE. And that’s cool, I remember that: body all bubbling over with new hormones, aching from growing, brain on fire to be in control of your own life. Again – watch that Pixar movie, mm’kay?

So, he had another outburst and we sat him down and told him we had run out of consequences and we were interested to know what he would do with himself. And he

BROKE.

DOWN.

In painful, emotional, anguished tears. He broke down into a puddle of sorrow right there on the foot of our bed. He misses Providence. He can’t figure out how to control himself. He misses his friends. He misses his freedom. He hates himself that he can’t just get happy. Sound familiar?

And so I held him while he felt it. Big A excused himself to the bathroom because watching mine and Aidan’s simultaneous grief was too much for him, I think. He wants so desperately to fix us, sweet man. But he can’t. He can do what he is so good at doing with me in the throes of my own mental illness breaks – he can hold me while I move through it. Grief like this has to be moved THROUGH not AROUND. It is a constant fog, not a mountain. You cannot detour around your own mind.

So I held little A. And he cried. And I cried. And through our sniffles, we talked about all the things we loved and missed about Texas. Then we talked about all the new things we have in Virginia and how much better it will feel once we also have people here. We made a plan to get through it together. We would find our happy, but it might take a while. We agreed to give it a year.

Happiness isn’t always the goal. It can breed a static mind and loss of sense of citizenship, it can blur the vision and still a creative soul. Discontent drives people toward change and betterment of self.  Anguish can clear the mind. Tears can cleanse and sadness can bear fruit. Left alone, it will fester and turn into bitterness, but cultivated and allowed to breathe – sadness turns into a kind of rich, deep soil that will grow up into joy and, I hope, wisdom.

So, next time you find yourself in the uncomfortable position of being with someone when their sadness sets in – I’d ask you to try and hold in that desire to immediately distract them with happiness and instead, hold them while they seek their joy. You might find yours on the same walk through the rich and complicated garden of the human mind.

Love Letter to Texas

Reflection is a tool for the settled. As a confirmed gypsy soul, I’ve never once felt settled in my entire life, until January of 2015. Right about that time, I realized that in a sea of politicians who loathe everything about my politics, an ocean of citizens who truly, passionately believe their state is better than all others (most of whom have never visited and have no desire to do so), and right up to my armpits in a land uniformly focused on empowering businesses and leaders that are devoted to ensuring that the United States most certainly does NOT move in any progressive direction…right about that time, I realized I was happy.  I’m not talking just full of giggles and amusement, people. I found serene, calm, peaceful, beautiful, and graceful joy.

It happened all at once. I decided that I needed to get more exercise, so I committed myself to walking the kids to and from school with my new Spring semester teaching schedule. Every morning, I dutifully packed two lunches, scooped up papers into two backpacks, laced up my black and white Nikes, and took off the 0.6 miles to their school, the 1.3 miles around to the “back lake”, and the 0.4 miles back to our front door. I would then do a little yard work, say hello to Ms. Doris who lived across the street, and then pop inside to poach an egg, toast an English muffin, and make a French press of coffee for breakfast. I’d grade some papers, tidy up a powerpoint, plan my lectures, then settle in for some morning television before I cleaned the house and then walked the 0.6 miles there and then back to the school to grab the kids and come home in the afternoon and get ready to teach night classes. Brutal, hectic, beautiful.

No heart racing anxiety at the solitude.

No panic at the echoes of my own mind.

Just birds chirping, productive silence, and the occasional maudlin lady-rock album.

And then, glory! came the Valentine’s day dance.

I joined the PTA in August at Parent’s Night, as good Texas suburban moms are supposed to do. At that same Parent’s Night, JDH and I spotted a couple we(I) instantly new we(I) wanted to befriend. They had a little dude in baby A’s class, hovered over him at his table, and generally screamed “WE MIGHT/MAYBE/PROBABLY SHARE SOME OF YOUR VALUES BECAUSE WE ARE G – A – Y, GAY!!!”

Because, dear reader, you know we left our gaggle of good progressive gays in North Carolina to move to Texas and I mourned the loss of my liberal paradise with vigor. Gays? In the suburbs? In Texas? What had we found?!?

It turns out, we’d found two of the best, funniest, most committed parents/people/friends in all of Texas. Further, one half of this unexpected power couple was a PTA juggernaut and my door into the mysterious world of friendships with women.

She was there at the setup for the dance.

I am not a leader or a person who wants to be in charge in the PTA. I am a worker bee – service oriented and comfortable with being the person who is there. I show up. Whenever, whatever, and for any crap job that needs done.

I showed up for Valentine’s Day Dance setup and got noticed as being vaguely familiar (which makes sense as I’d been accidentally photobombing these people for months). I struck up a conversation with L, mentioning my kid talked about her kid a lot (true) and wasn’t that such a coincidence, (lie – I’d been trying to work up the guts to speak to her for months) and mentally made a note to speak to her again at pickup on Monday. It worked. I got invited to “Taco Tuesday” and met a whole gaggle of the kindest, most engaging, and genuinely nice women I’ve ever met.

I cannot express to you the magic behind this group of women and subsequently, the entire neighborhood. It opened up to me after that Tuesday. With the approval of L, I was in with the cool kids. Play dates. Cups of coffee on the porch. Spring break plans – it was all on the table! The president of the PTA and I drank beers on my porch. The treasurer and chair of fundraising and I counted chocolate money at our taco place over breakfast. We made weekend plans, our kids got to know (and love) one another, and we generally got along.

So, Providence was perfect and by proxy, Texas became something I didn’t bear, but embraced. I found a community in which I could play a small part and it felt amazing. It was incredible to feel that sense of belonging again, when I had been sure it was lost.

And then, the news: Big A was seeking a promotion, one that would allow me to go back to school. Nirvana! But wait – what about our paradise?

Ultimately, friends, you know the answer to this question. We are four days into our new move – crossing the country once more to a new beginning.  The idea that I won’t ever have this magic again – these women again – is terrifying. But I keep returning to L, the catalyst to my happiness. She and eventually her wifey C opened the doors to my joy by making me feel brave enough to speak out loud in a group of very diverse women united by our dedication to our children.

We might return to Providence someday, I hope we keep these people collected in our long term repository of love and friendship – but if we don’t, I am determined to take the lessons I learned in that serene and verdant copse and share them.

I intend to show boldness and honesty in spirit and conduct., to remember grace and acceptance of diversity of all types. Commit to the benefit of the group and the welfare of all. And above all, find the willingness to say, “hello” on the first day. With these values, new communities can be built and love can be discovered. So thanks, Providence.

Sick Again? Scumbag Body.

Sick again? Jeez, you. Will you stay healthy already?!

I’m sorry, self, I just can’t.

okay then. Here we go. What’s the problem?

Cough, stuffy head, wicked headache, and I just feel awful.

You probably picked up a cold from your tiny, adorable human life-ruiners! I know what to do. First, pop a lozenge and keep up with them. If they’re menthol, they’ll help you breathe a little as well. Take 600 mg (3 pills) of standard ibuprofen to ease the swelling and pain plus a dose of ephedrine to kill that stuffiness. Couple this with copious water consumption, lay off the coffee, and get a little more sleep in the presence of a cool mist humidifier to keep everything upstairs nice and moist. Sanitize or wash your hands if you just HAVE to be in public and remember you are hemorrhaging virus in about a 3 ft. radius every time you sneeze or cough. This should pass in 7-10 days, but it might linger.

What now?!??

I’m sorry, I seem to have developed a swollen and red throat.

Greeeaaatt…do you have a fever?

No. Not yet.

You probably are on your way to a sweet bout of strep. Proceed with caution. I’d grab that ice/heat pack and alternate hot and cold on your neck to ease any swelling or pain and consume your body weight in hot, salty (salt is antimicrobial in some cases) soup. This will ease the swelling and get you nutrients that are easy on the body…it’s going to need its energy for fighting this off. Your tonsils (those weird masses on the sides of the back of your throat just past your teeth) are going to get big. 

Maybe huge. This is okay – they are filling up with cells designed to eat the bacteria they’ve caught in these gross indentations called crypts. If they turn white, this is a pretty good indication you should bail on home remedy and head to the doc. I’d tolerate fever as much as you can and only take ibuprofen or acetaminophen when you must. Hide under the blankets and kill your brain cells browsing the web or better yet, sleep. Don’t make out with anyone for a couple of days and set your current toothbrush on fire after purchasing a replacement.

Oh my god, seriously?

What? It’s just a migraine.

JUST a migraine?

You’re likely a pro at this, but maybe not. For me, this is ALL about caffeine, water, ibuprofen, coldness, and darkness. The trick to pain is getting ahead of it and STAYING ahead of it. The instant you feel a twinge, a hint, a suggestion of pain, pop your first dose of whatever your chosen migraine drug is. I like Excedrin for run of the mill headaches and a combination of ibuprofen at 600 mg twice per day and acetaminophen twice per day (at separate times) plus a few shots of espresso and a cold pack. My migraines tend to be instigated by my menstrual cycle or stress. In fact, stress headaches are my go to. I can tell these are the culprit when my neck is also in pain. At which point I’ll lay on the ice/heat pack alternating like a crazy person. I also really like a black tea with peppermint at this time. There is no truly fascinating science behind this treatment and you should see a neurologist at least once if you suffer from migraines to make sure it isn’t something more serious.

You can stop now, if you want, the rest of this is a bit more in depth about how I treat our ailments at home and why...I appreciate the read even if you bail now.

When I first considered writing this blog, I got a little nervous because I’m not an MD. I’m not THAT kind of doc. I’m the research type. But after careful consideration and with you, dear reader, understanding that I'm not giving you medical advice, I can't...but am in fact just telling you what happens in my house, I decided to proceed. I’m a mom, a teacher of medicine, and a woman in possession of a pair of tonsils that have betrayed me yearly since early childhood. I am also a believer in relief of symptoms without impairing the actions of the immune system.  Some of this might be useful to you. I don't know. If not, just click that X in the upper right corner.

Oh, you're still here?!?!? Cool.

The human body is a miraculous machine capable of fighting off most pathogens it encounters. In fact, in childhood, when you get your immunizations, what you are doing is actively showing your immune system what some particularly nasty pathogens look like so that if they ever get inside you again, your body fights them off and destroys them before they have time to do any real damage to your tissues. This is immunity – you create a highly trained army of “memory cells” which are capable of immediately responding to a particular threat. More on that another day.

Before we go on, we should get some terminology out of the way. It’s important when you speak with your physician (which you should ALWAYS do after a prolonged illness or if you experience rapidly worsening symptoms or any impairment of breathing) that you speak with as much accuracy as possible. Your doctor can only help you if you are totally honest and brutally precise. In short, you get the best care when you give the doc a quick, accurate picture of you, your health, and your symptoms. Here are some terms and concepts you should know:

1.       What the hell is IN me, even?!? (The pathogens) – your most common ailments will come in one of two forms. A bacterium is a living organism that rapidly clones itself once it finds a warm wet place in your body that it likes.

a.       Bacteria have a favorite environment based on species, but several (streptococcus, staphylococcus, and clostridia) really love living in and on the human body. You cannot avoid bacteria and in fact, you shouldn’t as not all of them are bad guys. Bacteria like things warm, but not too warm, wet, and full of organic materials and often, iron. Your blood, tissues, and especially the tubes of your body (your digestive, respiratory, and reproductive tracts) are precisely perfect for many microbes. Because bacteria are living, they can be destroyed with antibiotics if they have not mutated to notorious “superbugs” which again, we can discuss another time. Bacterial infections tend to come with pretty high fevers – above 101°F, lots of local pain and swelling, and a red, tender area (think puffy red throat). Your body is capable of destroying bacteria, but it can take some time. Antibiotics are like specialized weapons that give your army a leg up on the matter. However – antibiotics come with a few very important responsibilities: You must take all of your antibiotics, even after you feel better. This will keep you from killing only the weakest of your invading enemy and leaving the strong bacterial cells to multiply and make you sick AGAIN. And second, you should be aware that the antibiotics will kill not just the bad bacteria but also your good cells (called normal flora). You should try and replace these cells by eating LIVE CULTURES. Pill form is the worst form to replenish normal biota. I typically go for plain yogurt with a little fruit or, if you normally consume it, other fermented foods like kimchi can also replenish flora but not as many studies have been done on these when compared to yogurt.

b.      Not running a high fever? You just feel like shit? Achy all over? Feel tired and maybe a little slow? Have congestion and runny nose but not a bright red throat? Fever about 100°F or 99 and goes away in the day and comes roaring back at night? You probably have a virus. Viruses are nasty, lingering little dudes. The notorious two are rhinoviruses (like the common cold) and influenza. The first takes rest and fluids to combat. Your immune system has to mobilize, target, and bomb the cells containing these viruses. This response by your body takes TONS of energy…which is why you feel so bad when you have a virus. Further, every virus has a set of cells it prefers to infect – mucous membranes, the cells of the lungs, the genitals - and those cells have to be destroyed and then replaced. More energy. Unfortunately, viruses aren’t technically alive. They are what we call an obligate intracellular pathogen – that is, they must be inside your cells to multiply. Few drugs and ZERO antibiotics help with these infections. Your immune system must do the work. An exception to this is influenza, which prefers destroying lung tissue. If you go from 100% to right about 5% in less than 24 hours, you’ve got flu. Go to the doctor. Tamiflu and a few other antivirals must be administered very early in the life of a flu infection to work. If you are very old or very young, this is essential. If you’re in the middle (18-50-ish) and in good health, you can fight off flu, but it’s going to take a while. Good luck!

2.       Symptoms – the uncomfortable parts of being sick. These come from how your body responds to a pathogen or to chemicals the pathogen makes.

3.       Fever – your body makes chemicals to increase your core body temperature. While this is uncomfortable, it is also your BEST WEAPON against many pathogens. In fact, fever is such a good tool that in myself and my kids, I don’t really treat fevers that aren’t above about 102/103. For me and in the lab, the magic number is right about 101/102. If you can stand it, keep that fever there. Bacteria will die and viruses may or may not fall apart. HOWEVER – in infants below 2 or people with underlying issues, do not treat fever in such a cavalier manner. It can get out of control quickly. Use your best judgment.

4.       What kind of event is happening?

a.       Emergency – an emergency is an event that will threaten life if not addressed.

b.      Urgent (as in, Urgent Care) – a situation that is serious but not necessarily life threatening.

c.       Not urgent, but uncomfortable – a situation that is not threatening life and can probably wait until the morning when the doctor’s office opens.

5.       What can I do? And this is where my medicine cabinet comes in. I keep a few things on hand that keep us out of the emergency/urgent care. Full disclaimer - I'm not a pharmacologist. These doses are for me, not you. Seek a docs advice for your dosages and you can always use THIS SITE for good drug advice. I have two boys, one with asthma. They need care and often. Here goes:

a.       Cuts/Scrapes/Bruises: I keep iodine, Neosporin pain relief, hydrogen peroxide, alcohol, bandages of all shapes and sizes, tape, gauze, and ace bandages on hand. All purchased at the dollar store or generics from Target. My general rule is that if I can stop the bleeding in less than 2 minutes, the wound stays closed under bandage, and isn’t longer than my middle finger or wider than my pinky-nail, it gets cleaned with running water, a drizzle of hydrogen peroxide, and wrapped up. Checked in 12 hours or so. If it’s formed a scab, new bandage with a little Neosporin to prevent wicked scarring. Bruises get ice, pressure, rest.

b.      Sprains, strains, pulls: I keep a large sock full of white rice around along with peppermint oil for any pains of this nature. Heat in the microwave for 2 minutes, dab on a drop of oil, go to town. Ace bandages wrap to compress and stabilize. You can learn to do this HERE. When wrapping, you should take care not to go too tight. I tend to see if I can fit my index finger between the skin and the bandage and have it go easily but snugly. This is a good indication that you’ve got pressure, but aren’t restricting blood flow which is a big no-no. If there is a LOT of swelling, discoloration, or obvious change to the shape of an appendage, go to an urgent care or to your doctor. Large bone breaks cannot wait as bleeding is a possibility, fingers and toes aren’t really cast-able so let your insurance be your guide. I’m sure a real doc would say to go in to get them wrapped. And if it looks like this? Visit the ER, dude, quit reading my blog.

c.       Respiratory problems: I keep menthol chest rub, decongestants (ephedrine or some other ephedra drug**caution if you have high blood pressure), an expectorant (cough inducing mucous thinner) like guaifenesin (generic mucinex), and cough suppressants (dextromethorphan). These drugs do different things. Decongestants work on the swollen blood vessels in your face and alleviate pressure and pain. Guaifenesin is taken with tons of water and indeed thins the mucous in your nose/throat/chest so that it can exit your body more easily. Cough suppressants suppress your body’s natural cough reflex so that you can get some rest. I tend to use these ONLY at night. You cough to get the mucous out of your body. The mucous was produced to trap and isolate pathogens. If you don’t cough out the mucous, you run the risk of prolonging your illness. Decongestants fall right in with pain relievers for me. I also keep generic allergy meds in the cabinet for my allergic peeps. I like the $4.50 target loratadine (Claritin) and diphenhydramine (Benadryl). If you have asthma or someone in your home does, you should also have their asthma meds and, at a minimum, I think, an albuterol inhaler for in lung steroid administration.

      *** When in doubt - if you or someone you're looking at is extra loud with the breathing or losing color in the cheeks or turning even the slightest hint of blue? ER or 911, post haste. I have, more than once, even though I know better, ended up with a kid in the ER because his inhalations were too loud and his abdomen was involved in his breathing. Just don't chance it, mmmkay?

d.      Sore throat – I keep chicken stock, lozenges with menthol, throat spray, and lots of ibuprofen. Ibuprofen is a good anti-inflammatory and will ease swelling, chicken stock works to pull out excess fluid in the tissues of the throat (the saltier the better, unless you are hypertensive), and lozenges and throat spray will numb things up. Unless you are having trouble breathing, see white spots, or see the back of your throat is fire engine red AND you have a high fever, I wouldn’t head in to the doc.

e.      Pain – I keep acetaminophen (Tylenol) and ibuprofen (Advil) and naproxen sodium (Aleve) on hand. If I’ve hurt myself in a way that is going to last, I take the naproxen because the dose is smaller and less often. I use acetaminophen on the boys as Aidan is allergic to ibuprofen. And my blood is likely 30% caffeine and ibuprofen on a given day. For migraines, I use a cup of coffee and a high dose (600-800 milligrams) of ibuprofen. Based on your weight, you would want to check with your doc about your dosage of ibuprofen.

One last little note: generic medicines ARE the equivalent of their name brand counterparts. They must be chemically identical in the active ingredient department. If you are still buying Tylenol and you have the dough, no problem. But generic medicines are just as good as their counterparts and you can save some precious pennies by looking up the active ingredients in your favorite Over the Counter (OTC) medicine.

Good luck!

Blatantly stolen images from the internet because I'm not famous. Yet.

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http://www.tabletsmanual.com/img/wiki/bacterial_and_viral_tonsillitis.jpg

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