April 29, 2018

lamictal

My psychiatrist used to be a monk and then he stopped being a monk and got married and had five kids, and now he's a raving liberal and wears turtlenecks, probably because he misses the presence of the collar or cowl or whatever it is that monks of his former order wear.  I have held off on going doc-shopping after working with him for a year because the frustration I experience when talking in circles with him about getting my meds honed and refined is outweighed by my belief that his personal history means he's a really interesting person and if we just keep trying, we'll be able to communicate.

Here, "communicate" means he listens to what I say and gives me what I ask for and doesn't argue with me.  I see nothing wrong with holding this bull-headed, immature attitude.  It complements being crazy.  If I were to suddenly present as reasonable at an appointment, he'd narrow his eyes with suspicion.

No worries there.  I'm bringing some printouts of totally legitimate studies to my appointment tomorrow, just to annoy him.  He wants me to try some different, hard-core mood stabilizers, and I keep refusing on the grounds that I suck giant donkey dicks at staying hydrated and it would soon be a toxic disaster.  I take Lamictal and these printouts say that I'm not absorbing it.  Lamictal has a pH of 5.7, meaning it breaks down and gets absorbed in the stomach, where the environment is more acidic than it is and can therefore tackle it, and not further down the intestinal train tract.  Since I have a gastric pouch and a stoma (which is just a hole at the bottom that lets things fall out and move on, because the pyloric valve that normally squeezes shut and keeps things in the stomach until they're ready to be jettisoned is sitting over attached to the bottom of my other stomach, being a completely useless overpaid slacker), the Lamictal gets the same fifteen-minute appointment with my pouch that I get with my psy-doc.  It's just started talking but everything is rushed and nothing gets explored in-depth, and before it knows it, it's being pushed out of the door, barely touched.  My body isn't breaking it down; I'm getting its first layer and nothing more.

Dr. Google says I'm right.  I have proof.  The papers I'm bringing are from NIMH and PubMed and he must respect them, at least for a few seconds.  I don't know which of us is going to win.

The doc has been adamant that there is "no proven therapeutic benefit" to going up on Lamictal beyond 200 mg, and he would be right, except that I'm different.  I refuse to try lithium and I don't want Tegratol and most of all, I don't want to continue having a mood chart that looks like a game of connect-the-dots.  I think connecting the dots from this past week would make Cthulhu.  (I spelled that right the first time, bitches.)  I want to wake up each morning relatively level and stay that way.  I want to connect the dots on my mood chart and end up with a picture of an EKG reading of someone about to croak whose pulse is three beats per minute.

My strongest argument:  What's the harm in trying?  I'm vigilant about the rash thing.  If my arm itches, I scratch it but also compulsively look at where I just scratched to see if the horrible Stevens-Johnson rash has chosen that day to appear.

And if it doesn't work, then I'll cave in and allow Tegretol or one of the other big-gun meds that probably mean I can't get life insurance ever again because I've crossed a threshold of fucked-up-ness.  So be it.

But I think I'll win.

Update:  Sonabitch, there's a blood test they can to do tell if your blood level of Lamictal is right.  Rare, but available.  So I'm going to have it done this week and then we'll know where to go from there.  I was not a very good patient today.  I told the doc I'd prefer to just stick my head in a hole in the ground and pretend I don't have any mental illness and let the world crash and burn and do nothing about it.  He said I can't because I have a kid.  Why do they always play that card?

Update two:  Lamictal test came back showing a therapeutic level, but quite low, so we're going to try upping it to 300 mg to see what happens.

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