Saturday, October 4, 2008

a long-overdue update

I'm ba-ack!

It's been a truly difficult few weeks for me and I hadn't felt up to posting. But it feels like maybe things have leveled out a bit, so here I am.

I posted a few weeks ago about needing to recover after a combination of Botox and family visiting. I thought I was in the clear, but the past few weeks brought worse.

The Botox reaction lasted longer than a week, and combined with a bit of withdrawal from the Lyrica to make me pretty miserable. I started having some weird symptoms, namely irregular heartbeat and tremors, which prompted my headache specialist to send me back to my PCP. I saw the NP at my PCP's office, who ran a full panel of bloodwork and had me wear a 24-hour holter heart monitor to see if we could discover anything. The bloodwork came back normal, and the holter didn't find any "documentable correlation" between my symptoms and my (very regular) heartbeat.

All of the testing and results took about 2 weeks. During those 2 weeks, the Depression and Anxiety that have been creeping up on me started to take over my life. I hardly posted on the MMC forums. I withdrew from DBF. I became very moody and irritable. And I felt horribly sick the whole time.

This past week it all came to a head. My insomnia came back full force. I left work early on Monday to come home and rest. We've had company staying with us this week, friends from college, who don't know much about what's been going on with my health. DBF has been unusually stressed at work. I asked for accommodations at work when a better desk opened up on my team, and my boss gave the desk to someone else. I felt like no matter what I tried to do, nothing was helping me to get or even feel better. I did have an appointment with my new therapist on Wednesday, but having to go through my family history was painful and only made me feel worse. (Though, in the long run, talking about some past issues will undoubtedly help me.)

Once I got the results from the holter on Thursday, I gave my headache specialist a phone call yesterday to let him know everything turned out normal, and my irregular heartbeat had disappeared. The tremors seem to be a holdover from the Lyrica and come on when I've overexerted myself. He returned my call yesterday but I missed it; fortunately he was on-call this weekend and called me first thing this morning.

What a difference a 20-minute phone call can make!

A big part of my Anxiety was my contradictory feelings that one, I am not ready to try any new preventive medications because of my awful side effects with them; but two, I couldn't face sitting around and doing nothing. So therefore (I thought) I had to try a new preventive. Faulty logic, I know. Medication isn't the only treatment available for Migraine Disease.

When I called my doctor on Friday and spoke with his NP, I told her that I'm not ready to try the propranolol he prescribed for me, and wanted to talk about alternatives. When Dr E called me this morning, we went over the symptoms I had been having - irregular heartbeat and tremors - and he saw from my call in yesterday that they've cleared up. Well, the heartbeat has. I told him the tremors only seem to come on at night after I've overexerted myself.

I explained to him my reluctance to try any new preventive meds, because of all of the awful side effects I've been having. He seemed to understand that and we discussed it for a bit. He also asked about my stress at work (somewhat stressful but I don't take it home with me) and my general emotional state (not so good). He asked straight out about any Anxiety/Depression issues, both of which have been worsening as my Migraines continue. I was relieved he brought it up without making my Migraines/CDH into an emotional problem. He recognizes that they feed each other, a sort of chicken-and-egg problem.

I asked him about supplements as preventives (in particular, CoQ10) and any alternative treatments I could try (I've tried acupuncture and biofeedback/relaxation in the past). He's not convinced that any supplements will be enough for a complex chronic case like mine. He thinks I need the more aggressive meds, but recognizes that I then run into trouble because of my sensitivity to side effects. But he is willing to go that path if that's my preference.

He gave me the option of a referral to an internist in the area who also has a degree in herbology. He trusts her, and I like that she has a background in both eastern and western medicine and uses them together.

So, I have a few options. I can try the propranolol that he prescribed for me last month (very low dose). He's a bit hesitant about this because of the potential side effect of depression. He also suggested I try an SSRI (Celexa) at a low dose, instead of the propranolol, to help ease the Depression/Anxiety and hopefully work as a preventive as well. I have the option of taking a med holiday until I feel ready to try something new. I can also get the referral to the internist and try the supplementation route. If I decide to try acupuncture or biofeedback again, I'm sure he will help out with a referral for that as well.

What I'm going to do is sit on these options and think about them over the weekend. I feel much better after talking to him. He really seems to understand my reluctance about meds and didn't at all push any drugs on me. And I appreciate that he understands my need to think over all of these options before I decide what to do next.

I still have a long way to go treatment-wise. My Migraines are less severe with the Botox, but I still have Migraine/CDH pain constantly. I know it will take time to find a way to break the pain and get the frequency down. But I have confidence that Dr E can work with me to find a successful treatment regimen. When I got the call back from his NP telling me to see my PCP for the irregular heartbeat, I was worried I had been brushed off and he was giving up on me. I feel very relieved after my conversation with him this morning. It's obvious he genuinely wants to help me and is willing to work with a difficult case.

I hope to be posting more frequently again. Over the next few days I'll be catching up on everyone's posts. Hope all are AWAP!

Be well,


Flix said...

Greetings from the other side of the Atlantic Ocean.

I have been dealing with depresion/ansiety over 20 years. I'm 36. I have transformed Migraine. I practice relaxation, but my mind go by its way sometimes. Lately, my secret is let this thoughts exits. I only try to observe them from the distance.

It have been helpful for me to decrease my ansiety/depresion. I have less pain

I would like to encourage you like when I first read your blog. I felt like I was not alone.

I hope you will have moments to forget the pain. I do

Sorry for my english, 15 years have passed since I studied it. I can read, but to write...

Eileen said...

I am happy to hear that your doctor took time to speak with you, instead of just a rushed return call.

I am sorry you are still dealing with all this junk. I have not been/felt the same since that one stinkin dose of CymBARFa - seriously - it's been like weeks!

I have not been much into the blogging as of late either. I feel like I am in a cycle...wake up with Migraine, go to work with Migraine, try like hell all day to get rid of Migraine, come home with Migraine, abort Migraine! Go to sleep. Repeat.

Sooner or later, girl, we are going to get a break!!!!!

Much love to you!

Megan Oltman said...

MJ isn't it amazing how much difference it makes to feel like we have alternatives, and have someone in our corner who can help us sort them out, even if none of them are perfect and there is no one, sure answer. So glad you've got Dr. E - he sounds great. And good for you for taking some time to decide. Let it simmer on the back burner of your mind - you'll know when it's cooked.
- Megs

Heather said...

MJ, good luck with getting your meds straightened out. I am glad your heart results came back alright.

I'm glad also that your doctor was willing to hear you out. I went through the same thing at my last two appointments. Unfortunately I think they are all scratching their heads right now!

Please keep us posted on how your internist appointment goes. I've been hedging on seeing one myself. I would love to hear what you think.

Take care, girl. You're awesome!

Migraine Chick said...

I'm so sorry to hear about all this. That was so nice of your doctor to really speak with you about all this. I can relate to having reluctance to try any new preventive meds, because of all of the awful side effects.

Barbara K. said...

I give you a lot of credit for taking charge of your treatment. It's so hard to weigh all the pros and cons of alternatives. I hope your choices take you down healing paths.