Wednesday, November 28, 2007

I hate those motivational posters. "Successories" is one of the companies that sells them. Even the name 'successories' pisses me off, to be frank. I had to go see someone in HR at work yesterday, and the woman I spoke with (the very person who interviewed me for the position I currently occupy, in fact) had a framed motivational print in her office--'ambition' or 'committment' or something similar. Now, our entire HR office moved several blocks down the street from the main hospital in August. This leads me to believe that everything in her office was intentional--carefully selected. She didn't accidentally end up with this thing; she didn't inherit an office that had it bolted to the wall. It was on purpose. To which I can only respond: take this.

That's right, it's Despair.com, home of the "demotivators" calendar. Go, and see, and laugh with fiendish glee.

Sunday, November 25, 2007

Coming out of the drug closet

Ok, ok...I'll admit it. I'm a pharmacology nerd. I don't plan on dispensing drugs like candy once I'm a psychiatrist, but I personally take a handful (not just a figure of speech--literally a handful) of psychoactives everyday. And I've tried a lot of other drugs, too, in the search for the combo that gets me un-suicidal but not manic or numb/depersonalized, un-manic but not suicidal, not too anxious but not utterly lethargic...by the way, I'm not talking about uppers, downers, all-arounders, pot, acid, mescaline--I'm talking about prescribed drugs, which (in one of the curious contradictions of the free market) are several orders of magnitude more expensive than weed or crystal, and in some cases, more expensive than heroin or cocaine.

So what have I tried?

First there was Zoloft. Which I took for eleven years, from the time I was eleven (50 milligrams) which was titrated upwards to 250 mg when I was 22--by this time I finally decided it wasn't working for me anymore, even at above-PDR megadoses. I stopped taking it a few months ago, switching it out for a large dose of Effexor (which, coincidentally, I'd previously been on in combination with Zoloft). I did a 'cross taper' to prevent debilitating side effects of discontinuation, and stilll ended up having crazy out-of-body feelings and some severely severe depression. For a couple days I avoided driving, because (hand to God) I felt like I'd had 2 or 3 beers. And for the record, I'm one of those cheap dates who's already bobbing and weaving after one drink. I knew I wasn't paying attention to the road as I was driving, but I couldn't MAKE myself focus; I just didn't care--"You're just staring at the clouds. I think you--I mean I--should be looking at the road. But I don't really feel like it. Wow, that cloud looks like a fillet of asahi tuna." And then, once the Effexor got leveled out (and the depression continued), that got titrated up too. I noticed that I was losing more weight than usual, but the psychiatrist kept ramping it up anyway, and now I'm on a crazy-high dose (375 mg--usually reserved for psychiatric inpatient therapy).
Also taking gabapentin--what we once knew as "Neurontin," and what some docs are probably still foolishly writing 'DAW' for more than triple the cost. It was prescribed off-label as an antianxiety and antiobsessive; it's approved for nerve pain, specifically an after-effect of shingles called 'postherpetic neuralgia.' Oh, yeah--I'm on Depakote XR, too, off-label again.
And between those early days of Zoloft monotherapy and my current polypharmacy regimen, there was Wellbutrin (made me manic), Remeron (made me sleepy, and when I wasn't sleepy, a bitch on wheels--my mother finally made the doctor d/c it, because as she told the psychiatrist, "I can't live in the same house with her much longer if she stays on this medication. If you want to keep her on it, fine, but you're going to have to take her home with you."), lithium, which made me much happier/more even-keeled but also made me gain 30 pounds, Lamictal, which made me break out in a rash (and since that could be a precursor of a serious allergic reaction called Stevens-Johnson Syndrome, also made my psychiatrist d/c like there was no tomorrow) and Seroquel, approved as an atypical antipsychotic but often given to anxious folks with insomnia issues to help them chill. And, prn, a gift from the Goddess called lorazepam, or Ativan. It's one of the most potent benzodiazepines out there (packing several times the punch of Valium and its cousins). It seems to operate primarily on the assumption that if you're knocked on your ass you won't be anxious. Which is true, it's hard to have a panic attack when you're asleep. Interestingly, it's also used in controlling seizures-- especially during DTs (alcohol withdrawal), or with status epilepticus (when someone has a continuous seizure for a long period of time). AND it's an antiemetic. Whew! Beat that, Compazine! Lorazepam has a high affinity for GABA-receptors (recognize 'GABA'? Yeah, it's the same neurotransmitter that gabapentin plays with, explaining why both these drugs have somewhat sedating effects). So I've taken atypical antipsychotics (no, I've never been psychotic), SSRIs, SNRIs, atypical antidepressants, and benzos. Back in the day I probably would have gotten ECT and Elavil, had memory loss and had to give up cheese and wine. In some ways times have definitely changed for the better.

So screw the stigma. I'm not taking these to brighten an otherwise mediocre life; right now I need these in order to function. I want to come off them at some time in the future, but for now I'm over a barrel with the depression and the pharmaceutical companies. I'm not pleased about this, but I'm significantly more pleased than I would be if I were catatonic in bed.

Wednesday, November 21, 2007



Be thankful for...your liver(!?)


The heart gets all the press, and for obvious reasons: when your heart stops beating, that's it. You're gone. The brain is a media darling, too, as are the lungs--and for the same reasons. If either one stops functioning (stroke or respiratory arrest) you're either dead or severely damaged if things don't get moving again in a hurry. Hell, even the kidneys and pancreas have stepped into the spotlight, what with the explosion in diabetes education. But for my money, the organ with the mostest--the brilliant but forgotten stepchild, if you will--is the liver. Often overlooked but desperately important, your liver is the kid in high school who finished group projects while the rest of the group jerked off; it's the person in your office who quietly works after hours without complaining about it the next day. It reads the memos about TPS reports (Office Space joke about anatomy and physiology--what's the nerd quotient for that? I guess it could be worse...it could've been a Star Wars analogy). Maybe I like the liver so much because I identify with it...a little too much. Is that healthy?


So what does your liver do, I hear you asking, besides processing those lunchtime martinis and after-work glasses of scotch (or, depending who you are, the gulps of the Jim Beam you keep in the bottom drawer at work, cleverly concealed beneath old memos about the company's drug and alcohol policy...yeah, everyone knows, and your breath mints aren't fooling anyone)? Well...


Your liver stores iron. When you're sick especially, your liver 'sequesters' iron so that the little beasties invading your body don't have access to the mineral they need to survive (which is one reason why you may have heard not to take iron when you're ill). Before you're born, at which point your bone marrow starts to kick into gear, your liver makes a lot of your blood. It stores 'quick energy' for your body in the form of a complex carbohydrate called glycogen, which is then released during physical activity when your blood sugar starts to drop; thank your liver that you don't have to eat every twenty minutes to keep your blood sugar relatively steady. Your liver also makes and regulates clotting factors, keeping you from bleeding to death when you get a paper cut or that monthly visit from much-despised Aunt Flo. It releases hormones that affect where and when you store or release fat (though please don't blame your liver for those love handles). It manufactures and releases cholesterol, a certain amount of which is necessary for the smooth functioning of your various parts--your cell membranes are largely made of cholesterol, if you'll think back to freshman biology. In addition, Madame Liver manufactures and controls the release of bile from the gallbladder, enabling you to digest the fat in your Dunkin' Donuts Pumpkin Spice donut (DD has recently arrived in Missouri, and though I had vague memories of it from the summer I spent in Philadelphia, where they seem to be almost as numerous as Starsucks, and the drive-through on Highway 13 in Ithaca which I never even drove through, I have to say I'm duly impressed. Still not as good as Krispy Kreme, but hey, what is?). And, of course, your liver breaks down all the drugs (of course, you only take the legal, prescribed ones...right? Oh, it's OK, your liver isn't going to call the cops if it has to deal with a little THC now and again) and mildly poisonous substances you come into contact with over the course of an average modern day.

So give your liver some appreciation today. It's located under your ribcage, mostly on the left side (I mean--right; left is just where you feel for hepatomegaly and tenderness, I think)--give it an affectionate little pat for all it does.

Monday, November 19, 2007

The pneumonia now cleared from my system (thanks, Z-pack! Thanks, doctor who was willing to prescribe a broad-spectrum antibiotic because no one does outpatient sputum cultures!), I have...a cold. Not a bad cold, yet...it's that first little bit of a cold, the foreplay of a cold (but much less fun than traditional foreplay). Thank God I'm not a hypochondriac or anything, with all the furor over Adenovirus-14.

So I'm taking zinc gluconate (the only form double-blind studied for treatment of rhinoviruses), bulking up on the vitamin C (yeah, the 'proof' for its efficacy is equivocal, but I still believe Linus Pauling...OK, maybe it can't cure cancer, but oranges do taste good) and drinking an herbal tea that's a mix of lots of botanicals that are good for such infections. Totally unproven. So you see my approach to illness runs the gamut from well-proven to witch-doctory.

What's that? You want to know what's in the tea? OK, I'll tell you, but first let me say (duh) I'm not a doctor; I don't even play one on TV since Kate Walsh edged me out for the spot on Grey's Anatomy. Thus, I'm not advocating that you go to your local co-op and buy loose herbs to make this mix, nor am I suggesting you put it in a tea ball and steep it for 3 to 5 minutes. And I will certainly not warn you that it tastes like ass, and that it will require the liberal application of honey or Splenda or whatever your sweetner of choice is. Talk to a qualified herbalist before you start drinking weird stuff, tell your doctor what you're taking, and be especially careful if you're pregnant or breastfeeding. OK. Enough with the equivocation.

Holistic Cold Killer
Comfrey, Catnip, Cayenne, Hyssop, Horehound, Licorice, Mugwort, Sage, Yarrow, Peppermint and Cinnamon. Go easy on the hyssop and sage, f'real.

Ho ho ho! OK, now that the puns are done (feminist or anti-feminist? From whose point of view? When is it acceptable to point out that people may be participating in their own oppression, and when are they engaging in what some would consider 'degrading' activities of their own free will and for their own enjoyment? Discuss, keeping in mind that Gisele Bundchen--the one in front, in the sparkly bra-- is one of the highest-paid models in the world)...
Does the Victoria's Secret fashion show make ANY woman feel good about herself? I read recently that after a mere three minutes of looking through 'fashion' magazines, 76% of women reported feeling 'depressed, guilty and ashamed of their bodies.' Supposedly 2/3 of Americans are overweight--surely being confronted with the titanium abs and steel buns of Brazilian teenagers with D-cups is a little distressing for them? And estimates for the number of Americans with eating disorders run from 8 million to 10 million--I can guarantee more than one anorexic flips through the Victoria Secret catalog to compare her body to Adriana Lima's, rather than to look at the bras. So if this form of advertising makes everyone feel shitty about herself, why is it still around? Why do women still allow themselves to be kicked in the teeth by messengers of 'the perfect body,' then stand back up and pay for the opportunity to get sucker-punched again? Never mind that the average model weighs 23% less than the average woman, and often falls into the 'anorexic' range for BMI (body mass index). We're sold the picture of sexiness and health by women who, almost by definition (here I'm quoting from years of eating disorder literature) lack libido/sex drive, probably aren't menstruating, and are losing the fat tissue that makes up 'real' breasts (hence the need for implants). Of course there are more serious, non-cosmetic health problems too, but really...
Granted, the Victoria's Secret girls look marginally healthier than the ladies on the high-fashion runways, but that's like saying having pneumonia is great because it's not lung cancer...

Friday, November 16, 2007

So, I came out to a bunch of people at work the other day. We were sitting at lunch, and my boss and I were discussing the recent visit of the Dalai Lama to the US (and to Ithaca, of course, where I had the excellent fortune to see him speak--he's indeed an inspiring and holy man). My boss, M, brought up the contrast between his visit and the recent appearance of Ahmadinejad (I think I spelled that right--and without looking it up anywhere! Who's the shit?) at Columbia University.
"It's amazing that we could have two such different people visit our country at the same time," he said, "The Dalai Lama talking about peace and love, and then this crazy man who denies the Holocaust and says there are no homosexuals in Iran..." First, let me hip you to something: anyone who uses the word "homosexual" rather than gay or queer is either a psychiatrist/ psychoanalyst in 'professional' mode, someone who not only isn't gay but doesn't have many 'gays' in their close circle of friends, or else is so deep in the closet they're finding next year's Christmas presents. That aside, I used the opportunity (why the hell not?) to out myself in front of roughly ten people in the break room.
"My first girlfriend was Chinese," I said, "And she tried to teach me some of the language--now I can say hello, 'I love you,' and order a few items from a menu. Anyway, she asked her mother, 'Mom, what's the word for a man who likes men, or for women who fall in love with other women?' Her mother answered her, after a long pause, 'That doesn't happen in China.'" I guess it went over well. The conversation didn't come to a grinding halt or anything, though I could feel a few people making a mental note: Homosexual, check. Just adding it to their list of attributes about me. I guess it helps that I've only been there a few months, so not many people have a really solid mental picture of who I am outside (or inside, for that matter) work. They're still piecing together, "German studies major. Former oboe player. Echo research assistant. Homo. OK, cool."
The only bad thing about being out to people who I suspect may not know a lot of gay folks (or who, for religious reasons, are opposed to that 'lifestyle'--which, by the way, I think is a hilarious way to put it--it makes me think that there must be a gay/lesbian lifestyle catalogue out there somewhere that I'm missing, a la Martha Stewart Living, with Indigo Girl CDs, flannel jackets, Danish Modern furniture and Subaru Foresters) is that then I feel oddly responsible for being a stellar example of humanity, for the sake of the 'family.' If I fall behind on a project, then the whole queer community suddenly becomes lazy or incompetent. If I snap at someone because I have PMS and they took the last of the coffee on a Monday morning, it's because all lesbians are bitchy and aggressive. I'm sure not everyone does this sort of thing consciously, but I know I do it myself sometimes, or poke fun at myself and others for some stereotype: When I'm jamming to Melissa Etheridge, painting an, ahem, yonic-looking calla lily (look up the word if you don't know it, it's fabulous), and a friend walks in and laughs; my Jewish friend who always scours the racks for the lowest possible prices when we go out shopping together; my Irish buddy, in the Marines, who puts away the stout and lager like it's going out of style.
Ultimately (here comes the PSA--public service announcement, for those in the medical field, NOT prostate-specific antigen) life's too damn short not to be who you are, not to move from your center just as you are, whether that puts you in the line of fire of hateful idiots or puts you in lockstep with inane stereotypes occasionally. Be you, because if you don't, there isn't anyone else to do it.

Wednesday, November 14, 2007

Hello, everyone out there. I can see the counter. I know someone's coming here. Why not be a chum and leave me a note? Provide me with some much-needed ego gratification? Besides, I wanna know who you are...for purely non-creepy purposes, of course.

Speaking of creepy purposes, did anyone catch the recent spate of news stories on Taser Parties? As many of the stories have noted they're like tupperware parties (after all, what could be more quintessentially feminine than buying expensive crap to put the food you've cooked for your family in?), but (duh) with Tasers. Ha ha! Women with weapons!, the anchors seem to say. Women with the power to defend themselves instead of just cooking! Wow, that's just *crazy!* Ha ha! Bob, what's the weather looking like tomorrow (squirms uncomfortably)?

I can just imagine--

Hostess:Now, Jane, the invitation explicitly advised you not to be late. Would you put down your purse and come up here for a demonstration, please? *Zaaaap*
Jane: Aaaaaaarrrrruuuuuuugh.

Apparently they're available in a range of colors, including metallic pink. Get a new Barbie or Dora the Explorer Taser for the young women in your life! (Ok, I just made that up, but still--metallic pink? This is a weapon, dude. Would anyone buy a metallic pink Beretta? Maybe I don't want to know the answer...) Many problems with this. How best to tackle them...

Well, there's the fact that women still need such items in the first place; but because the world isn't going to change overnight (though castrating sex offenders might be a step in the right direction--ahem), the fact that companies are preying on women's fear of attack/sexual assault to sell such a product is also disturbing. I guess what bothers me is that these are emphatically WOMEN'S events; the idea of using tasers to defend yourself has been thoroughly feminized in this instance, made into a fun little get-together in order to strip women's need for self-protection of all political and social overtones. The problem isn't that you live in a society where one in four women will ultimately be sexually assaulted; the problem is that you don't have a bright pink Taser. Use your power as a consumer rather than your power as a activist, your power as a mother or sister, your power as a woman. Enough with "Sisterhood is Powerful." What's powerful is 50,000 volts to some guy's junk (which is undeniably true, but doesn't make the former any less important).

What would I like to see instead? Passion Parties. A make love, not war kinda thing. Put down that Taser, that Mary Kay, that Pampered Chef whatever, and pick up a Jack Rabbit vibrator, a silicone butt plug, and a bottle of Lickety Lube (though I've gotta say, all the flavored lubricant I've ever been, shall we say, fortunate enough to encounter has tasted like a cross between cough syrup and saran wrap). Or there's Pure Romance. Of course, these aren't always the highest-quality sex toys...for those, go to Blowfish or Good Vibrations. Come to think of it, my old Good Vibrations catalogs are probably still coming to the co-op I left last year. Hmmm. Maybe one of the freshmen will find a catalog in the mailroom and get a little education.

Monday, November 12, 2007

Oh my Jeevis, is it that time again already? I think I feel the stirrings of surging progesterone and my estrogen done fell off a cliff. To those not endocrinologically inclined, it's PMS time. And thus, time for another rousing edition of Things (and People) that Piss Me Off.

1. Nameless guy at the gym who gets on the treadmill, cranks it to 10 mph, and then holds on to the grip bar with one hand (pounding LOUDLY and in an inconsistent rhythm) like he's had one arm amputated and just managed to catch the door of the bus to The Free Money, Beer and Sex Club with the other. Dude, you're not conditioning yourself in ANY way. You're teaching your body bad habits. You're asking to either have your arm ripped out of its socket or your knees reduced to cartilage pudding. I've tried being a good example (look, I'm running at 8 mph but my hands--ta da!--are nowhere near the grip bar! See how cool and un-annoying that is?), I've tried glaring. I thought maybe I was alone in my loathing until the girl at the front desk told me, "Man, I hate that guy." Vindication!
2. Mitt Romney. Not because he's Mormon, not because he's Republican, but because he's a tool. Ok, maybe a little bit because he's Republican.
3. The writer's strike. I want my Daily Show and Colbert Report, dammit. Couldn't care less about Letterman et al, but don't deny me Jon and Stephen! They make an otherwise bleak social and political system livable, like the underground leaders of Potterwatch in H.P. and the Deathly Hallows (yes, I think that's an apt comparison, and yes, it's probably not the most academic example I could come up with, but screw it, maybe I'm on strike too).
4. The following grammatical errors/ words and phrases: "irregardless." It's not a word. Stop using it. "Pacifically." Unless you're discussing the ocean between California and Japan, you're using the wrong word. "Whenever" confused with "when," as in, "She got out of surgery whenever they finished fixing the hole in her heart." Unless they fixed the hole in her heart multiple times, you want the word "when." See the difference?
More to come. I'm tired.

Sunday, November 11, 2007

And the attempts to recruit subjects for clinical research trials continues. The next phase of the study has started up, and with it the relentless search for more patients. First, only people who have had two very specialized and expensive tests in the past month are eligible; second, these people must have a sufficiently severe heart condition to justify this testing, but not have really really bad heart disease, lest the 'stress' part of the trial--using a drug that dilates blood vessels and thus makes the heart beat harder and faster to compensate--could actually push them into having a heart attack. Needless to say, the procedure is pretty damn safe, which is why it's the standard cardiac stress test protocol, but there's always the chance that someone with pulmonary hypertension or sever aortic stenosis or a 90% LAD blockage will end up on the wrong end of it, and we don't want that to happen. So, long story short, once I make sure that people are sick but not too sick, I check to see they've had an angiogram and a nuclear stress test. If they have, then I go on to see where they live. Since our hospital is kind of a big deal, people from all over two states get life-flighted to us. Someone who lives 50 miles away is probably not going to drive up for an appointment and two follow-ups. Next, I assess age: people under about 60 are usually working and either can't get away from work or don't answer my (daytime) phone calls anyway; people over 80 are generally considered too old to be in the study. So that narrows it down. Of course, the unemployed 45-year-old is a good option, since he has time and would probably like to have the study stipend. And that makes me feel like a horrible person, an exploitative asshole. A lot of the people I recruited last time were unemployed or disabled. Of course, they didn't get hurt, they got paid for their time, and in the end it was a mutually beneficial partnership. However, once this technology makes it out into the real world and physicians are charging a couple hundred bucks a pop to use it, unemployed folks without insurance aren't going to be the ones benefiting from it. One of the principles of human testing ethics is that the people who are ultimately going to benefit from the drug/procedure should be adequately represented in trials, and people who aren't going to use it shouldn't bear much of the burden of testing it. I dunno. Am I still young and idealistic? I guess.

Wednesday is our department's "Spirit of Thankfulness" catered lunch. Which means everyone else will eat turkey, and I will make a meal of cranberry sauce, green bean casserole, and stuffing. Which is fine with me; when you don't eat the main dish, you can get away with taking more of the side items (which are usually what I REALLY want, anyway). That's the calculus of the buffet line, right? Or am I committing some horrible breach of self-serve etiquette? And why can I not remember how to spell etiquette? Oh, right. It's 2:14 a.m.

Several people at work are really bummed out. One guy's dad died; a woman who shares my office has been taking time off to be with her dad, who's dying too. I know there's not a cure for grief other than time and loving care...but in the interest of superficially sprucing things up, I'm thinking I'll make hand-turkeys for the other women who share my office (there are five of us--it'll be like third grade!!) and possibly bake some pumpkin bread for the bereaved. Because baked goods heal all. Unless you're diabetic.

Saturday, November 03, 2007

Today, fresh-baked POEMS.

Naked and Terrified

You are asking me to go
into the world
naked and terrified,
a Godiva without
so much as a horse.
And so I am valiantly
peeling off
as much of my dead
skin as I can manage,
thick translucent sheets
the color of granite,
cring out every so often
as burn victims do
when charred tissue
is scraped off
(and the pink below
is exposed
to the rush of
real
live
stinging
air).
-AG


Nothing to Fear (after Hafiz)

There is nothing to fear,
and there never has been.
You have always been wrapped
in a mantel of light,
despite your best
misguided efforts
to tear it away from your body.
It's true,
you have fallen,
but always into
the hands
of Love.
-AG


Prince of the Air (EMS)

Both his hips were broken
in the fall--
or rather, I should say,
his pelvis shattered
upon impact, as did everything else--
Conclusion of a multi-storied trip
between the kingdoms
of the sky and ground.
Bystanders said he stood
up on the ledge
for twenty minutes,
never looking down,
before he dove, and was a Prince of Air
for two full seconds, constellation dark
against the seeting swarm of stars above.

His limbs, spread at odd angles, must remain
as such until the coroner arrives,
proclaims him dead, stamps him a suicide,
so we can load him in the ambulance
and drive him, sirens silent, to the morgue,
this one past saving:
the one that flew away.
-AG