Fix the Brain, Not the Body

I went to the rheumatologist today to do three things: 1) get set up with a new doctor, 2) talk about adjusting my main medication, and 3) ask about the current knowledge regarding fibromyalgia.

I like this doctor. He asked a lot of probing questions, such as "if you think you are having problems with mental acuity, why are you here rather than seeing a neurologist" and "who told you that the gabapentin might be causing such a problem." I figured these were good questions because firstly, I never even considered seeing a neurologist because the lack of mental acuity has gone on for so long (although it seems to have been getting worse, but then the last few years have been extra stressful) and I haven't seen any other odd neurological signs. At least none that I'd peg as such.

As for the second question, I told him that it had been suggested by friends who are or have been on gabapentin and found that this is a possible side effect. it has also been suggested by mental healthcare providers, too.

He was curious about everything dealing with my health, including my mental health. And then he gave me great insight into his interest in my mental health (and I really should have made this cognitive leap). The current understanding is that fibro is not a body problem at all: it's a brain problem. Specifically, it's a brain chemistry problem. And that is the center of the entire fibromyalgia universe.

It's why all the currently approved meds for fibro are brain-related rather than body-related: gabapentin, and its cousin Lyrica, are originally anti-seizure meds; Cymbalta and its cousin Effexor are anti-depressants that are both serotonin and norepinephrin re-uptake inhibitors; and a final medicine that I didn't get written down in time so I've forgotten the name, is also an anti-depressant. Doctors are trying to regulate fibro and its symptoms by manipulating brain chemistry. it makes sense.

I knew already about how fibro was considered a neurological disorder rather than a joint/muscle disease, and that gabapentin was an anti-seizure medicine. The point of using it is to quiet the brain impulses or transmitters or whatever is going wonky (yes, it's a technical term; why do you ask?) in the brain.

Absolutely Exhausted

'Absolutely Exhausted' is a phrase used by my mother since I can remember. Of course, I picked up this phrase from hearing it all my life. Most of the time, it's simply an example of hyperbole or poetic license, but there are occasions when it was ... or is ... a completely concrete description of my condition.

For example, there was the time I went to Knott's Berry Farm with my youth group when I was 15. My best friend, two boys we barely knew, and I spent the day and evening wandering around the theme park, riding on roller coasters and eating whenever we felt tired. The next day, not only could I barely move, I couldn't stand. I was absolutely exhausted. And my feet hurt.

When I was in my mid-20s, my doctor informally diagnosed me with fibromyalgia. At the time, few doctors had even heard of the condition, much less gave it legitimacy. But fibro (as my friends and I call it) gives concreteness to 'absolute exhaustion.' In fact, when the fibro is flaring up it makes me feel a lot like a block of concrete. Tired concrete.

Know what else causes 'absolute exhaustion'? Depression. Grief.  Eating poorly (too many simple carbs). Too little exercise. Poor sleep: too little, too much, not staying asleep, and so on. Basically, I have an absolute exhaustion trifecta, or quadrafecta, or whatever. And I am absolutely exhausted. And I have a plane to catch.

Okay, so I don't have to catch the plane for another 59 hours (is that all?!), but considering that I am almost welded to the couch I'm so tired and immobile, 59 hours — including time for sleeping eating commuting working errands laundry dishes packing reading email and picking up my new iPhone on Thursday — isn't much more than a blink. A slow blink. And slow is all I can do right now.

Fibro and fatigue have been teaching me about essentials over the years, and I am getting better at pushing aside the little errands and activities and things that are nonessential for travel (I almost don't overpack anymore!). But I still have a helluva lot of essentials to handle before Thursday night. And I am Exhausted — Absolutely.

How about you? Is 'absolute exhaustion' a poetic notion or a concrete adjective in your life? Do you have any family sayings that are truer now than they once were?