December 18, 2017

coming up for air

The thing about gastric bypass surgery (mine was in June 2016) is that they know very, very little at this time about how drastically it changes your body chemistry, brain chemistry, and psychology.  They know your gut flora repopulate with entirely new and different critters, but not why.  They know it often reverses diabetes, but not why.  They know the suicide rate among women nearly quadruples afterward, but not why.  Studies are under way and in a few years, perhaps we'll start to gather some answers.  But for now, it's the Wild West, the frontier, and in short, I had no warning.

My surgery pushed me from dysthymia/cyclothymia into bi-polar II.  That doesn't mean it would not have happened at some point anyway; I fall uncannily into the demographic profile.  I've wrestled with the specter of depression since age 11, but can only recall a couple of instances in my mid-30's when I felt that I was in an inexplicable good mood for a few days.  Nothing prepared me for a three-month hypomanic episode.  And the worst thing about your first one is, you don't know you're in it.  You don't have an explanation for why you're suddenly talkative and the class clown at work, obsessed with Facebook's new video chat feature, sex-crazed, and all but devoid of empathy for the thoughts and feelings of your loved ones.  For me, I just figured I'd changed because of the surgery, that this was the "new me" and everyone, including me, would need to adjust to it.

The funny thing [read: not funny at all] is, I was taking Trintellix, an atypical SSRI, at the time, and that made me nauseous post-surgery, but I didn't know it was the med causing the nausea, so I took loads of Zofran, too, which has its own seratonergic effects.  My meds were poisoning me.  I was in the middle of a hypomanic episode and taking substances that were almost guaranteed to steer me toward a suicide attempt.  And they did.  But that is a story for later.

Now I know about the bi-polar disorder.  I'm on different meds, but right now, my psy-doc is weaning me off of Wellbutrin, the last antidepressant med left standing in my cocktail of pills.  Today is the first day I've been able to come up for air in over a week.  Depression has had me by the hair.  Not the kind of depression where you'd really just rather stay in bed and don't feel like engaging in your hobbies.  I mean the kind that makes you look at your family and despise yourself because they deserve so much better than having to endure your presence in their lives, your illness and the days when you can't even lift your eyes to meet their gazes.  The kind that makes them ask you if you're safe.  And you can know it's artificial, you can know that it's temporary, but that doesn't stop it from pinning you to the floor from its onset, a bullet train to the bottom instead of a gentle traipse downward.  

That's the thing about the depression side of bi-polar.  You wake up one morning after a few weeks of being level and thinking that maybe this is going to last for a long time, and find that hopelessness and brooding followed you into the shower, and brushing your teeth is physically taxing, and that you're late to work because you've been standing in your closet incapacitated and in tears from the stress of having to make a simple decision about what to wear.  Yesterday was fine.  Next week will be fine.  Today, you've got to tell your co-workers that you're Mr. Hyde.

I do mood-charting for my psy-doc.  I fill it in daily, religiously.  I thought the past few months accurately depicted a kiddie roller coaster or maybe a sine wave.  I write things on it in the margins and draw arrows to the day, like "ovulation," "respiratory virus," and "bus crashed in front lawn."  You know, things that might impact what's happening.  

I handed it to him at our last session.  He looked at it and said, "This doesn't look bad at all."  I stared at him blankly.  What constitutes "bad" to him?  Another suicide attempt?  Do I need to etch frowny faces with angry eyebrows on the bad days, so hard that I break my pencil lead?  He conceded that I might be under-reporting.  The hypomanic days aren't bad, because my current meds keep these swings brief and low-key.  I know them when they come because music sounds too slow on those days.  My co-workers point out (because I ask them to) that I'm talking even faster than normal.  And I get artistic.  I drew a picture with colored pencils for my wife and framed it.  Guess what?  I don't draw.  

He wants to put me on lithium.  I keep telling him that I'm not a lithium candidate because of my gastric bypass and trouble staying hydrated.  He forgets and at our next session, starts the lithium conversation again.  I have to explain again.  I think I'm going to be shopping for another doc soon.

Today feels a bit better.  I've come up for air.  And I'm learning that you don't take even a single hour of level mood for granted.  

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