Anxiety and stomach adventures — update

I haven’t blogged for a week or two about how I’ve been doing in this regard. A lot has happened (good and bad), and I’m still struggling through things. Am I better than I was shortly prior to Christmas? Yes, definitely, but the ordeal is far from over.

I’ve since seen my (usual) physician, and we discussed things. First and foremost, he more or less disagreed with the Urgent Care doctor’s prognosis that I was suffering from acid reflux. He was shocked to hear that despite my continual mention of suffering from anxiety and being an agoraphobic, she did not prescribe me anything that would calm me down. I explained that I made it through the week by taking a friend’s 0.25mg alprazolam (Xanax) pills, and that they had really helped — including being able to function while at work (though with some difficulty the first night), and that this indicated benzodiazepines worked for me.

I was happy to find out that he wasn’t upset I had taken Xanax (I think he said something like “no, I’m not angry, sometimes you just gotta do what you have to to make it through things until you can see a doctor”), especially given that the dosage was lower than what was normally prescribed.

However, he was understandably reluctant to put me on benzos, since most of them create a physiological dependency on them after prolonged use. He agreed that they work very well for short-term use.

My doctor’s conclusion was that the stomach pain I was experiencing was very likely the result of panic disorder, where I would go through “phases” of feeling bad, then okay for a little while, then horrible again. I articulated my concern over the possibility of a gall bladder infection, and asked him to review the lab work that the Urgent Care doctor had done. He did so while I sat there, and he agreed with her conclusion: I appear healthy, and although he can’t completely rule out the possibility of gallstones, strongly doubts that was the cause of the issue.

He performed some pressure tests on my lower back, concerned about possible kidney problems, but no issues there. (My mother, on the other hand, has had kidney stones in the past, so there’s a chance I may one day have those as well. Joy…)

He prescribed me two medications: clonazepam (Klonopin, 0.5mg) and sertraline (Zoloft, 50mg). My doctor wants the Zoloft used long-term. I’m supposed to use the Klonopin much like I did the Xanax, while the Zoloft I’m supposed to take at half-dose for a week, then increase to the full dose. One catch: Zoloft takes 2-3 weeks to really “kick in” and start working.

As for the omeprazole (Prilosec) the UC doctor prescribed me, he said (verbatim) “You can keep taking it if you want to”. What a bizarre response. I guess the way it works is that if you don’t have ulcers or GERD, it doesn’t really hurt you, but if you do it helps.

I continued with the Prilosec (I’m completely done now), and started with my new medications on 2008/01/05. I’ve also been taking 1 Klonopin per day, though I should probably switch to half a dose instead.

One good thing I’ve noticed: the Zoloft does not give me sour stomach like Paxil did. That right there is a huge plus for me. I hated taking Paxil because it made my stomach super upset, which is why I couldn’t take it before work (stomach upset on the way to work == panic attack).

I’m not entirely sure if Zoloft is the right medication for me — it’s an SSRI predominantly used as an anti-depressant, panic disorder, and social phobia. I’m not a psychiatrist, but I really don’t classify agoraphobia as a “social phobia” per se, at least not in my case. I’m not “afraid of social situations”, I’m afraid of being in an environment or situation where I don’t have immediate access to a toilet. The panic attacks (well, up until a few weeks ago!) have only happened when I was in those situations. I hope it does work out for the better, though, or else I might have to go this route. ;-)

This situation is somewhat complex. You see, I’m on vacation until 2008/01/18, so I really won’t know if the medications are working until after I return to work. For all I know, I’ll go to work the night of the 18th and have a panic attack, which would indicate the vacation has done very little for me, and the medication absolutely nothing. But there’s also a good possibility I’ll feel completely fine on the 18th and everything will be great from then on out. I’m keeping an open mind, and not being pessimistic.

My workplace’s HR department is also greatly concerned about all of this. They want to talk to me about all of the benefits I have available to me, and they also want to talk about how they can change things for me in the work environment that might make working (or at least the transition — not sure yet) easier for me. I haven’t spoken to them yet, so I have no idea what’s on the table so-to-speak.

I’ve somewhat dedicated myself to an experiment: on the night of the 12th, I want to bike to work. If I can’t make it there all the way, that’s fine — I’m in no obligation to be there. If I make it there, I want to see how I feel. I’ll have my two co-workers there (including the one who took me home the two nights back in December), so if I have to be taken home, that’s a possibility. I want to sit down and read some Email and just see, generally, how I feel. I want to see if the medication is helping, and I want to see if the vacation has de-stressed me at all.

About the vacation and de-stressing…

The first week was “wind down” week. I kept waking up thinking “oh fuck, I’m going to miss work!”, and felt overall tension in my entire body. After that week, I started actually relaxing. I watched a lot of Netflix movies, played my Wii, ate some new Korean food, completed some personal projects I’ve had lingering for quite some time (including cleaning my kitchen sink, which was filthy, and now looks amazing). I also slept: a lot. In fact, I’d say I was sleeping 13-14 hours a day.

But now it’s the “final week”, and I’m starting to think about work again. My boss did tell me that if I needed more time that we could work something out (translated, this probably means “you can have it”), but then again HR might consider this whole thing medical leave so I might have that option as well. Basically what I’m saying is that I think it might be too soon to go back to work on a regular/consistent schedule, since I’m not even sure if the new medications will help. I just simply don’t know. I sincerely feel I need another 2 weeks, I really do.

Yesterday, I logged into work from home (for the first time in weeks), and spent some time reading work Email. I felt okay while reading it, not stressed, because I knew I didn’t have to read it all right then and there (we get 400-500 mails a day, and that’s not an exaggeration). I go through about 80% of it before I decided I was finished for the time being. I realised I read all of it “in preparation” for going back to work on the 18th, because I didn’t want to be stuck at work reading mail hour after hour… I’d rather it be a gradual thing.

There’s also one other thing I want to note: I’ve lost nearly 15 pounds (7kg) since this debacle began. I was at 191 (86kg), and now I’m at 176 (80kg). I lost the majority of it during December, and my friends have noticed (“Your arms and face look so thin compared to before”). I’ve been eating a bit more now, and my diet is different (I’m eating edamame fairly regularly), but I still can’t bring myself to eat and eat and eat like before.

Anyway… so am I doing better? In general, yes. Though I still feel a little weird when doing things like biking to 7-11 to get some water, or visiting my Korean friends’ bento restaurant. There’s a bit of anxiety that happens when I get on my bike and go somewhere, and I hate it. I didn’t used to have that. But it all depends on how I’m physically feeling at the time: if my stomach and body feel good, I usually have no anxiety or worry at all. If I feel blah, that’s when it starts.

One day at a time…