Wednesday, January 02, 2008

Wait, Wait, Weight

I loath prednisone. Its latest torture is cushingoidizing me. Cushing’s diasease is when your body produces too much of its own stress hormone (cortisol) which does all of the awful things that prednisone does to you when taken exogenously. It redistributes fat in your body; it gives you “moon facies.” I hate that most right now. My cheeks are round. I feel trapped in a body that has betrayed me and now doesn’t even look like me. I avoid mirrors anymore—the first-born who used to love the camera—and when I glimpse myself I wonder for a moment who I see. Because that person doesn’t look like me.

I’ve taken the prednisone since before I was diagnosed with lupus and blood clots. The neurologist recommended it first as a treatment for possible vasculitis (vessel inflammation) in my brain. They started me with a “burst.” 60 mg daily. They didn’t tell me about the mood swings. It amplifies everything. The highs become crazy manic rolling on the floor yammering away about nothing, or scrubbing the outside walls, or baking long into the night. The lows become tear-filled hours alone worrying about how to get through this, or thinking about mistakes I once made, remembering forgotten regrets. Full nights of emptinesses. They didn’t tell me about that. But now I know.

I know also about my face looking rounder. My cheek bones disappearing into the flesh that accumulates where it never was. I don’t like to meet new people anymore. I don’t feel like myself. I don’t look like myself. I don’t know this self. I don’t want to be this self. I want to be even-tempered and joyful and thin and active. I don’t want to have to worry about being in the sun when I go sailing with Jane on New Year’s Day. I don’t want my knees to hurt every time I start to get run down. I don’t want my friends to tell me they “know” what I’m going through. I don’t want to be buried yet.

My bones are probably not in the best shape either. I’ve taken the wonder devil drug for over seven months now. It thins bones. And skin. But it increases appetite and makes you gain weight.

And it’s not dosed for a resident’s schedule. Your body has normal ups and downs of cortisol through the course of a day, but extra prednisone overrides all of that. It masks your own fluctuations and gets you through a day (sort of) but then doesn’t last the night, which is a problem on thirty hour call shifts. I try to taper and I flare so I go back up on the dose. I haven’t been able to get below 10 mg daily since I started taking it. For a while I cut the 5 mg tablets into quarters and took 11.25 mg which is a ridiculous dose—no one goes to two decimal points on their prednisone dose. But at 12.5 mg I acted crazy. And at 10 mg it took all of my energy to get out of bed and the brain clot-feeling headaches came back.

I stared at my round cheeks the other day, after I’d struggled to get on pants that used to fit, and I let my tears roll down those foreign full cheeks long into that night as I reviewed this last year of my life. Fretting over every dark thought that seems exponentially worse in the wee hours of the morning: my lupus, my parents’ divorce, medical bills, work on Christmas, my stolen car, my new car payment, my lack of funds, my brain clots, far away family, friends I’ve hurt or lost, a lost stylus, a clinic patient with breast cancer, far away friends, lack of enough knowledge, loneliness, weight gain, empty bed, lack of time, shape-shifting future.

Even now, by the light of the computer screen, the list doesn’t seem as bad as it did that night. It still brought back tears, but they’ve dried already. It’s very warm in my apartment tonight. For that, I’m thankful. I’m knitting up my worries again, into caps and scarves. I live in a beautiful place. I ran along the water today. Overall, my body actually works pretty well most of the time—compared to a lot of bodies I try to treat. My brain works. Bryce is in town. I have missed him. I have wonderful friends. I still feel like I’ve misplaced my spark. I can’t find that happy thought that lets me fly with Peter Pan and Wendy. I’ve ridden these waves enough to know it will turn up. In the meantime, I try to eat less. And I reduced my prednisone to 7.5 mg. I hope I don’t flare.

1 Comments:

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10:54 PM, January 09, 2008  

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