Friday, March 26, 2010

I need iron

Yōtetsugan Iodide iron pill c1850
My doctor's office called, and my test was negative, so I don't need a gastro workup at the moment. I'm not good at feeling relief. I have 35 years of practice at immediately beginning to worry about something else. But I am making progress--I did recognize that I was glad not to have an invasive procedure. My doctor prescribed an iron supplement for the next 6 weeks or so, and then I get another blood test to see if my hemoglobin goes up, and then we go from there. My OCD doesn't like this, but there's no way to definitively capture what is happening in my body for all time. This kind of diagnostic omniscience is not available, as much as my desire for absolute certainty keeps knocking at the door. I was proud of myself for only spending a few minutes reading about iron supplements, before buying a bottle and taking a dose. In the past I'd still be in research mode, planning the perfect method for ingesting the perfect iron product at exactly the right time, and driving myself crazy.

Monday, March 22, 2010

Part 4: My First Prescription for SSRI Medication


I last left my story of medication for OCD with Dr. Celexa in 2001, and his confidence that a med would fix any side effects I might have if I started on Celexa. Shortly after, I began researching whether Celexa was the right medication. I was terrified of making a mistake. In the midst of this, my therapist, Molly, started a session by saying, "This is going to be hard for both of us. I need to have brain surgery, and will be out for 6 weeks." OCD doesn't leave a lot of room for learning how to cope with the chaos of life. Yeah, I researched her surgery, and that anesthetized the anxiety for a fleeting moment. I had spent years researching things, and by the time I surfaced from whatever the current search was, life had moved on without me.

Nobody wants their therapist to have brain surgery. It is a scary, scary thing. Molly came through the surgery, and left me a groggy, anesthesia and pain killer influenced message on my voicemail that she was ok. I was still re-reading all the entries in the phonebook under "Psychiatrist" and realized there was one I hadn't called because she was farther away, but I had started driving again, and it occurred to me that I could get there. Dr. S. actually called me back, and could see me within a week. She had her office at her house, a McMansion on a cul-de-sac.

I sat on her leather couch, going over my questions in my mind, and as if this would somehow compel me to ask them, rather than mentally rehearse them in hopes of perfection, which would never come. She listened to my fears about side effects, and gave it to me straight. She said that she liked Zoloft, that maybe this was because the drug rep came by more often than other ones did, but she had clients who did well on it, and it had a short half-life, so if I had side effects, I could stop the drug and have it out of my system relatively quickly--not as abruptly as Paxil, but not as dragged out as Prozac.

Dr. S. said she'd start me on a low dose, 25 mg, and slowly titrate it up. I had done repeated searches on the concept of titration, so it was a relief to hear someone actually discuss it, though that didn't last long, since the OCD can always find a new concern. She gave me the prescription, on a slip of patterned blue paper, like the inside of a security envelope, and I went to the drugstore to have it filled. I bought a little guillotine to cut the pills in half. This was April of 2002. More to come.

Related Posts

Part 1: OCD and Medication Decisions
Part 2: Starting Medication While Struggling
Part 3:The Limits of Research in Making a Decision
Part5: Feeling in the Jaw: Side effects
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety

Thursday, March 18, 2010

OCD Never Keeps a Deal

Let's Make a Deal!
My hemoglobin was low, and my doctor sent me for another blood test and gave me a home test for blood in my stool, saying, "You are too young for these, but I don't want to worry or have you worry." She said it was probably due to my period. I asked her what the test involved, and she said "It couldn't be simpler." OCD was all over this in a flash.
What if I do the test and it starts a spiral of diagnostic testing? If I am too young, why is she giving me this? What if I do the test wrong? I have to wait until 3 days after my period, but I spot a lot. The disclaimer says that bleeding may not happen all the time, so I have to take two samples. What if I pick the wrong days?
It couldn't be simpler. Not with OCD. Fortunately, I don't have the specter of contamination fears as well, but the health anxiety was up to full volume. I decided to get the blood test first before doing the home test, then if it was normal, maybe I could put off the test. But no. My hemoglobin dropped again, and my doctor asked if I'd done the test, and I said no. She said something about urgent, and gastro workup, and it totally made me like a deer in headlights. When I talk to doctors I have trouble thinking clearly, and my mind goes blank. The OCD wants to get in there and "fix" things, and this doesn't usually bode well.

I did the damn test, and now I'm waiting for the results. I saw Leonard yesterday, and he said that OCD wants certainty and claims it will then leave me alone.
But certainty is not a real choice.
OCD is one-minded and will take over my life, and restricts my ability to think. Leonard says that OCD is what makes the anxiety of waiting intolerable. No one likes waiting for test results, but OCD makes it worse, with constantly trying to figure it out, retracing my actions, freezing and not living my life. He left me with this idea, which I struggle with, but also is hopeful:
I can be ok even when uncertain.
Related Post:
Seeking Reassurance

Thursday, March 11, 2010

Jeff Bell's Rewind, Replay, Repeat: A Memoir of Obsessive Compulsive Disorder

I read this memoir as soon as it came out, and was moved by the author's honesty and ability to communicate what OCD is like from the inside out. Jeff Bell is an accomplished radio host, and kept his obsessions a secret from those around him.

He opens with the image of being 6 years old and driving past another car, with a little boy shouting "Hi!" and having an urgent need to know who the boy was and why he said hello, repeatedly asking his mother about it. I remember at age 8 becoming obsessed that I might need to go to the bathroom after I got into bed, that I would not be able to sleep if I had any pressure in my bladder. When I first got into bed I would bolt out of it over and over, feeling the compulsion to keep checking, keep attempting to empty my bladder.

OCD is relentless, and I could feel Jeff Bell's pain as he started fearing he'd hit someone while driving, and feeling compelled to go back and check the road. That he somehow functioned at all is amazing, with this other full time job of struggling with the OCD. It's like the relay a gym teacher had my class do when I was in the 11th grade--we were to put on a full set of clothes over our swimsuit, swim to the other side, take off the clothes and give them to next person in the relay. We did it because our teacher said to, and OCD wants that kind of power. It says, "Drive to work, but if you hear any sound, go back to make sure you didn't hit someone."

Scheduling your life around these demands is exhausting, debilitating and destructive to yourself and those around you. It's like swimming in waterlogged clothing. It's also paradoxical--if as a child I was afraid I wouldn't be able to sleep, repeatedly getting up to empty my already empty bladder made sure that I wouldn't be able to sleep, but in the midst of the intense anxiety created by OCD, I did what it commanded.

Jeff Bell has a new book, When in Doubt, Make Belief, which I am looking forward to reading. Let me know if you've read it.

Another Good Book:
Freedom From Obsessive Compulsive Disorder

Tuesday, March 9, 2010

5 Things My Husband Does to Help me Cope with OCD

  1. Supports me, not the OCD. He is empathetic to my struggle and my pain, but he doesn't reassure me in order to keep the peace.
  2. Uses his sense of humor to highlight the ridiculousness of some of my OCD fears. He doesn't mock me, but the OCD is fair game.
  3. Stays curious about the disorder. He read Jonathan Grayson's book Freedom From OCD on my request. He's not a support group kind of guy, and he isn't interested in going to the International OCD Foundation Conference with me, but he does educate himself about OCD.
  4. Encourages me to do exposures, and is willing to get involved. If I am obsessing about what task to do next, he'll suggest I flip a coin. In the rare cases that his ADD mind actually gets stuck on something, he'll try an exposure out himself.
  5. Affirms my decision to see an ERP therapist, even though it's expensive, because he sees the progress I've made.

Friday, March 5, 2010

Skin Checks and OCD: Never Enough

After being diagnosed with squamous cell skin cancer, the dermatologist advised that I have a skin check every six months. At first this sounded wonderful! I thought it would make me feel safe, and because my doctor mandated it, I didn't have to feel the tension of deciding whether or not to go to the doctor.

But OCD had other ideas. I did ok for the first few months and but by the last few weeks, I would be on hyperalert, noticing variation in color or texture on my skin, and in the tug of war about what to point out to my dermatologist. I'd be sitting there in a paper gown, obsessing my brains out, full of pressing dread. My doctor would walk in looking like an astronaut with her special magnifying goggles, and my OCD would go on the loose:
What if she misses something? The nurse told me to leave my underwear on, what if something dangerous is hidden? Should I ask her about the tiny bumps on my hands after a shower? Am I crazy? If I don't ask I will be swamped with anxiety. If I do ask, I will be humiliated, and the reassurance won't last two minutes, and I'll find a new symptom. I must be a bad person to be struggling with this. She's wear magnifying lenses for godsake, how could she miss something? But how do I know she actually saw everything? Why isn't she worried about the underwear? Oh, god, I'm worrying about underwear. I'm a mess.

I felt cursed that my desire to be watched over and taken care of turned into an ever deeper pit of obsessing. As I've been seeing Leonard for ERP therapy, I have learned to have more compassion for myself and how hard it is to actually have something physically wrong related to an old obsession. I've learned that I'm not a bad person for having OCD. I've learned that I can cope with having skin cancer, and that the OCD was more painful than the surgery.

Related Post:
Skin Cancer Anxiety

Wednesday, March 3, 2010

Singing from Myself

Quartet in costume leading an old fashioned singing school. Photo used in Cornell Reading ...
There was an article in the paper about research on music and the brain, and how trained musicians were better at picking out speech from background babbling. They could cut through the noise to the meaning. Several years ago, I read that singing uses a different part of the brain than the obsessing/compulsing part, and I started singing in the shower in hopes of getting a little peace and to keep moving through my day.

I sang a lot of verses of Kum-by-Yah, the only song I could really sing out, and discovered that it did free up some space in mind from the crowd of intrusive thoughts and compulsive figuring things out. I found a voice teacher, and after much indecision, decided to take lessons, even though I wasn't sure if it was the "right" choice(ie. existential questioning about whether I really wanted to sing, and how did I know for sure, and did I enjoy it enough etc.) Later I joined a choir. In the past, before my therapy with Molly, this was all unimagineable in the midst of my social anxiety, and the novelty of choosing to do something I wanted to do.

I feel good when I sing. It's not that the anxiety and obsessiveness disappears, but that I can find myself in the midst of it, and be present in the room, in the moment, be someone beyond my OCD. Like the singers in this research study, I can pick out what is meaningful when I'm singing.

Monday, March 1, 2010

Seeking Reassurance for my OCD Fears Part 2: My Husband

I concealed my anxiety from my husband as much as possible for the first couple years we knew each other. I was ashamed of my fearfulness. One summer during college, I moved in with him because I couldn't find a job. I had a blast of anxiety that I had a swollen lymph node behind my ear and that this meant I had cancer. Without a job, I spent hours obsessing, lost in anxiety. I went down to the tiny public library, with its creaky floors and looked at medical reference books, which gave a momentary hit of relief, and then the anxiety started up again. I finally told him about my anxious fears. It felt like confession. He had great compassion for my suffering.

My pattern became long stretches of anxiety, which I hid from my husband as long as I could, and then several times a year, I would reach such a depth of anxiety that I would confess my fears to him, and cry raggedly into his chest. One summer in grad school, I felt tingling in my fingers, and had a burst of anxiousness, and went to the library to read medical reference books, and saw an entry about Guillain-Barre Syndrome, which results in the nervous system attacking itself and patients can be completely paralyzed but still conscious. My OCD latched onto this, and dogged me with fear. We were getting ready to leave on vacation, and I didn't want to ruin it by admitting my fear, but when we stopped for lunch on the journey, I could barely focus on him sitting across from me. The anxiety had slipped me from my moorings. I couldn't eat.

Finally, I blurted out my anxiety, and I remember how sad he looked, as he took my hand in his, across the table. "Don't you want to go on vacation with me?" He didn't know what to do, and he was afraid that he had done something wrong. Later, when we got to our destination, I lay down, still wrapped in fear, and as I closed my eyes, listening to my worry over and over "What if I have Guillain-Barre? What if I am paralyzed?" I suddenly had the thought that if I became paralyzed, my husband would take me to the emergency room. There wasn't anything else to do. He would take care of me, do what needed to be done. I was still scared and shaky from all the adrenaline, but I had a flash of reality in that moment.

As I flipped through a newspaper, I came across an ad for a research study on anxiety disorders, which listed tingling and numbness of the hands as a symptom of anxiety. In that moment I had a choice to make. My best guess was that the tingling was from anxiety; Guillain-Barre was much less likely. The OCD still wanted absolute certainty that it wasn't Guillain-Barre, at the expense of being in the present moment with my husband, on vacation, being alive, rather than the living dead. I chose to stay as present as I could. I was scared, but I wanted to escape the tyranny of the anxious thoughts.

Related Post:
Seeking Reassurance from Others for my OCD Part 1