Recently, I had a misadventure with my serotonin levels. As I posted earlier, I have been on Neuris 1mg- An Antipsychotic & Lexapro 5mg- An SSRI for my Generalized Anxiety Disorder since I moved to Thailand.
Now, the Lexapro, in Thailand costs 15 times what it cost in India. Always one trying to cheap out, on my last doctor’s visit, I asked him if he could prescribe me a cheaper alternative. He prescribed me Fluoxetine 20mg instead and I happily went on my way chalking this up as a win.
After a few days, I started noticing signs of heart palpitations and sweats through the day. I had recently joined a gym so I chalked this up to the workouts. However, the palpitations became worse with time.
It was not until my family left for vacation leaving me alone with my dog at home that the symptoms hit hard.
I was in a state of constant anxiety. My heart felt it was going to burst out of my chest. To make matters worse, I took a Lexapro, too. It really pushed me over the edge and after suffering all day from a constant state of agitation I dumped my dog with the neighbours and went to the ER.
They said I have Serotonin Syndrome, from an overdose of SSRIs. They shot me up with a sedative and sent me home with a few pills of Ativan. Ah! Bliss!
I slept for 11 hours and woke up the next day feeling much better. Things didn’t go back to normal immediately, but I could feel the improvements over the next few days; all I had to do was not take the SSRIs.
Lesson Learnt : Don’t mess with medication that work, just to cheap out.
PS: On SSRIs, I used to have vivid movie-like dreams. After stopping the SSRIs, the dreams stopped, too.
As discussed before, I have been on medication to treat my GAD for the past few years. I was lucky to have found a doctor who prescribed me medication instead of sending me to therapy. The medication had been working beautifully, but I always assumed that I won’t take them forever. When I moved to Bangkok, I decided to quit, as I won’t find a doctor here to continue the prescription. I put it off for many months fearing medication withdrawal. Running low on supplies, few weeks ago, I decided that that time was here.
I had been on the following medication to treat my GAD
With high optimism and hope in my heart, I started the process of quitting, one medication at a time.
Getting off Levowave was relatively easy. First I halved my dose for a week and then changed it to 3 days a week, then stopped completely. I had some confusion, irritability, anxiety, tremors for a couple of days but after that I was back to normal. No impact on sleep at all.
I assumed that the withdrawal for the other medications would be as easy. How wrong I was!
I assumed this one would be the easiest to stop, but I was dead wrong. I halved the dose and in just 2 days, shit hit the fan.
Night 1/Day 2 – Uneventful
Night 2 – On night 2, suddenly I woke up at 01:00 AM with my heart beating fast, for no apparent reason. I was up for an hour, but was able to go back to (restless) sleep afterwards.
Day 2 – The entire day I was full of anxiety, irritable and confused. Lost my appetite. There was also a phase where I had to abuse random strangers on twitter for no reason.
Night 3 – Night 3 was horrible. I slept at 21:30 but woke up at 23:00. After that whatever I tried, I couldn’t go back to sleep. I either felt too hot (sweating) or too cold (shivering). After tossing and turning for hours and rousing the rest of my family, I think I finally managed to fall asleep at 04:00. Libido was also up 10x. Heart rate was above 90 bpm throughout.
Day 3 – Day 3 started slightly better than Day 2. I started running again, which brought back my appetite. But later in the day, my heart rate rose above 100bps doing nothing. A sense of doom & gloom pervaded my brain and I had only negative thoughts.
Sometime in the afternoon of Day 3, I realised that I cannot go through with this and decided to go back on my remaining pills. I booked a doctor’s appointment to get a prescription to resume the medication.
Day 4 – I woke up refreshed after 10 hours of beautiful sleep. The world seemed brighter, and life seemed more beautiful.
After resuming my medication, I finally saw a doctor here. Fortunately, he was kind and patient and prescribed me medication to continue. Unfortunately, not all my medication is available in Thailand, so I have to switch medication.
I went to my favourite hospital and consulted an Ophthalmologist. She explained to me the process in detail. I had a Pentacam test which showed that my corneal thickness was in the risky zone. However, the Ophthalmology director gave the go ahead for waveform guided LASIK. I also needed a retina test which involved dilating my pupils and shining a very bright light into my eyes. The most difficult part was not wearing my contact lenses for 3 weeks. This was so that my eyes would go back to their original shape and provide the most accurate correction readings for LASIK.
During this waiting time I also contracted Blepharitis which delayed the surgery further. However, on 13 Dec 2016, the day finally came to get operated on.
I went to the hospital excited like mad, armed with money donated by my mother. They took one final set of measurements and started putting anaesthesia drops in my eyes every few minutes. Soon my eyes were numb and they took me to the procedure room.
The process itself was uncomfortable but not painful. They use speculums to keep your eyes propped open and ask you to look straight. Then they use a suction ring to keep your eye straight. This step feels like enormous pressure on the eye but is not painful. Your vision goes all wonky. Then a Femtosecond laser creates a flap on your cornea. The eyesight at this point becomes blurry. When they lift the flap, you can see only a bright light.
At this stage, another excimer laser re-models and corrects your cornea as per the requirements. You can smell something burning (your cornea). Then the surgeon restores the flap, flattens it and wets the eye. The entire process is repeated for the other eye.
The entire process only takes 15/20 minutes and after that you can get up straight away. Your vision is still blurry and you cannot look at lights. My wife helped me go home where I immediately went into a dark room. Even a small sliver of light from the corner of the curtains was excruciatingly painful. I spent the entire day moping in darkness, not being able to do much except listen to music.
The next morning was beautiful. When I opened my eyes, I could immediately notice that I could see clearly without any aids. I took a cab to the doctor and had my first post-op check up. She inspected the flap, gave me medicines and sent me home. At this point, my vision was not perfect, but it kept on improving over the next few weeks and months. I would still see Halos and blurriness around light sources at night for many months.
Reading and using the computer for the first few weeks put a lot of strain on my eyes but temporary reading glasses helped with that. I developed a habit to check my vision regularly by closing one eye at a time while driving and trying to read the license number of a car ahead of me.
Slowly but surely, my vision improved and thankfully, now I have 6/6 vision in both eyes without any visual aids. Now waiting for Presbyopia to strike me in the next few years and add a fourth installment to this series.
One fine day, me and my roommate Whoreko decided that we had had enough of eyeglasses and we would wear contact lenses from then on. We were in second year of college then and funds were short, so we went to an optometrist at Dharampeth and asked for the cheapest contact lenses they had. He gave us 1-year hard lenses and taught us how to put them on and take them out. Happily, we were on our way, with tears streaming down our faces from discomfort.
To say that these contact lenses were uncomfortable would be an understatement. They were uncomfortable all the time & dried up after a few hours. While riding motorcycles, they would shift from the wind and the eyes would turn red. Eventually, me and Whoreko both stopped wearing them altogether and went back to our shitty glasses.
Try as I may, I couldn’t adjust to life with glasses again & was miserable all the time. Eventually, when I was visiting my parents in Kolkata, my mother took pity on me and took me to GKB Opticals at Gariahat. The optometrist was very kind and patient with me and explained to me that the cheap contacts were not meant for extended use. She also explained to me that I have Astigmatism and the cheap contacts don’t address that. She prescribed me with monthly disposable toric soft contact lenses. They were very comfortable and provided me with perfect 6/6 vision. I could wear them for extended periods of time with no discomfort.
These lenses changed my life and were probably the most significant upgrade to my lifestyle ever. For the first time ever, I had perfect vision with incredible comfort. I was incredibly happy and looked forward to waking up in the mornings to put on my lenses. The only times I had issues were when dust got into my eye(s) while riding my motorcycle. I occasionally wore them for upwards of 36 hours straight & slept in them with only minor dryness.
However, like all good things, it didn’t last long. After 13/14 years of using them, I started to experience more and more frequent spells of dryness & discomfort in my eyes. I went to my optometrist but he was of little help, just stating the obvious. Eventually, it became so bad that I couldn’t wear contact lenses at all.
I decided that I couldn’t go back to wearing glasses again and would need a permanent surgical resolution yo my Myopia.
I was diagnosed with Myopia when I was 2 years old and have been wearing eyeglasses since. Both my parents were Myopic, so the genetic gamble was never in my favour to begin with. I don’t remember how it was like, wearing glasses all the time as a 2 years old kid, but it couldn’t have been pleasant.
I wore glasses all through primary & secondary school. My mother used to be furious because I frequently broke my glasses in the playground. Funnily enough, my glasses broke most often during exams. Then it would be a mad rush between studying and ordering new glasses from the optometrist. I specifically remember enjoying visiting Tosh Opticals at Paschim Vihar. They had nice modern looking equipment and air-conditioning. I remember us waiting for them to make the glasses while mother quizzed me on the topics for the exam next day. Since we spent most of the day at the optometrist, she didn’t have time to cook. We ended up ordering food from somewhere, which I enjoyed.
In the years that followed, I also dabbled with photochromic eyeglasses, rimless eyeglasses and gunmetal frames. That being said, at the end of the day, they were all eyeglasses and sucked balls.
During high school and college, I started realizing that the glasses were not doing my face any favours. I realized that I looked silly with them and started hating them more and more. Also, their weight would leave sores on the bridge of my nose where they rested. North-Indian bullies were not very friendly with glasses, either, calling me “chashmish” or “chamakkha”. I also realized that glasses provided inferior vision, as they didn’t correct the entire field of vision.
By second year of Engineering, I had made up my mind that I didn’t want to wear glasses anymore.
I have documented my struggles with mental health on this blog before. Considering the focus of the media on the mental health of famous people these days, I decided to write a longer rant about my own struggles.
During my college days I was a happy-go-lucky kind of guy. Although I did get depressed once in a while, I was never-ever worried about things. After college, while working a job I didn’t like, I also went through bouts of depression, but got over it quickly once I found a better job.
My second job was the best job, mentally, of my career. I had friends at work, I enjoyed what I was doing and I never even thought about work outside office. It was a shift-job where you could switch off completely after work.
It was in 2012 that I realized something was wrong. I suffered from IBS for almost 2 years. During this time I also turned lactose intolerant. I did read about the close connection between the gut and the brain, but I couldn’t figure out which affected which. After 2 years, I suddenly got better and didn’t think about it again.
Things started to go south again around 2016-17, when I wasn’t able to handle non-stresses from my work. I would lay awake at night thinking about trivial things from work, lost weight rapidly and couldn’t concentrate on non-work things. I tried things like meditation and mindfulness but nothing helped much. The mind just won’t stop racing and over-thinking.
This was the first time I decided to go see a shrink, at a hospital. I was hoping for a quick solution to all my troubles, but she prescribed me with very-expensive counselling sessions. The cost of the sessions made my issues worse, so I never went back. Thankfully, the shrink did give me a diagnosis, that of Generalized Anxiety Disorder. Eventually, this phase also passed and I forgot all about it.
Eventually, I decided to go to another shrink. This one was in a busy market popular with people I knew. I was ashamed to go see him. This doctor also confirmed the diagnosis of GAD and decided to prescribe me medications immediately. Within a few days, I was feeling much better. Although anxiety never went away completely, it is now quite under control, thankfully, to this day.
What I do
I use the following techniques to keep my anxiety under control
Medication, which I am slowly weaning myself off of.
Exercise – Even a short run helps a lot. Even walking is better than nothing.
Listen to music I love everyday, without fail.
Whenever I have too many thoughts at night, I write them on a piece of paper before I go to bed. Next day I action all the items on that piece of paper and then tear it away. I found this strangely therapeutic.
Stay as far away from Social Networks as possible.
I know many people have found relief with mindfulness, but for me it tended to make things worse. Maybe I was not using the tool correctly.
On the news, I repeatedly hear stories about the struggle of famous people with mental health, especially sportspersons. Although I am happy that they are raising more awareness for mental health, the impact of mental illnesses on them is much different than it is on regular people like us.
For them, quitting means an outpouring of support and being called “brave”. For people like me, quitting would mean being called a failure, losing my house and not being able to feed my family. So no, I don’t think these sportspersons are brave for quitting. They quit because they are filthy rich & can afford to.
Septoplasty: http://en.wikipedia.org/wiki/Septoplasty First, a little history:-
I have always been prone to catching a cold/having my nose blocked since a very early age. Every 2-3 months I would catch cold and be dependent on Otrivin for weeks. This trend continued well into adulthood. At one point of time, I was so dependant on Otrivin that I had to be weaned off it over a week, by inhaling steam 6-8 times a day. It was like drug withdrawal, but in the end, I was off Otrivin. However, I would still continue to get colds and resort to taking steam many times a day.
On some days, even without a cold, I would wake up with a stuffy/heavy face, a splitting headache which would simply not go away and generally keep me in a miserable state for a few days. An MRI due to some other reason revealed a polyp in my Sinus and revealed that I had chronic sinusitis and that my Sinuses were swollen all the time.
I consulted an ENT at the same hospital where I got my MRI and he recommended surgery to take out the polyp. I was not convinced, so I went to another ENT (Dr. K.K. Handa, Director of ENT and Head Neck surgery, Medanta Medicity, Gurgaon). He revealed that my Septum was also deviated (It basically means that the wall separating my nostrils is crooked) and it could be managed using medication. He asked me to use Nasonex and inhale steam for comfort. I had a few things going on professionally and personally so I put surgery out of my mind and continued to use Nasonex and inhale Steam whenever necessary.
This was almost a year ago. Since then, I have had sinus infections almost every month (sometimes more than once a month), had to see an Eye doctor because I felt pressure behind my eyes and be dependant on Steam inhalation to be able to breathe for a reasonable period of time. Finally, on Jan 15, 2013, I re-visited Dr. Handa and informed him that I had been having a miserable time and needed another way out. He immediately asked me to get a CT scan, after which we would explore other options. I got CT scan the very next day, saw the Doctor the day after that when he informed me that my Septum is especially crooked. This is preventing proper draining of Mucous from my Sinuses, leading to recurrent infections and also breathing problems. He asked me when I can come in for Surgery. I said I will be fine with a surgery on the morning of Friday, Jan 18, 2013. He asked me to speak with his assistant to sort out all the details.
I spent the rest of the day sorting out Insurance details, filling out paperwork, getting blood tests and an Anesthesia suitability test etc. I was admitted the next day, Thursday, Jan 17, 2013. I was told not to eat or drink anything after midnight, given an anxiety medicine and went off to sleep.
Image Courtesy: http://drug.com Day 1 – Surgery I was woken up at 6:00 AM by the nurse who sad I will soon be wheeled into a pre-op room. I was kept there with other surgical candidates for about an hour after which I was wheeled into the Surgery room. There were 2 huge lights on top of me. The doctors attached an IV line on my left hand (Ouch! That hurt) and asked me to relax. Then they placed a mask on my face and asked me to take deep breaths. The gas coming out of it smelled funny. After 2 deep breaths, I was out.
When I woke up, I was in a post-surgical recovery room, feeling awful. I noticed that I had a throat-ache, I was very thirsty and had something stuffed into my nostrils and something taped over my nose. I couldn’t speak as my mouth was dry and my throat ached but I somehow signalled that I wanted water. They told me that I couldn’t drink water for a few hours yet, but gave me a small dropper with a pitiful amount of water in it to wet my lips. I gobbled it all down my throat and was told I won’t get any more for a few more hours (Apparently water while still under the effects of Anesthesia makes you puke). I was wheeled into my room, where I was propped up just a little and allowed to rest. I was miserable. I was thirsty, my head felt like full of lead and having to breathe through my mouth caused my throat to ache more and my mouth to dry up. I asked what time it was, apparently, it was 14:00. I tried to sleep, but just couldn’t. I was finally given some water at 16:30 after which I sat up. I found out that sitting up made me feel much better than lying down; however, it also caused my nose to bleed and turn the bandage around it, red. I had a couple of fruit juices, met a few visitors (I don’t remember these incidents very clearly anymore). I had a hearty meal at night and then tried to sleep.
This was the worst night ever. I couldn’t sleep no matter what. My throat would dry up and start hurting every 10 minutes after which I would have to drink something. My nose would bleed and blood would start dripping off into the bed (I was later told this was not fresh blood, but crusts of dried up blood being dissolved by mucous and normal sinus discharge). Day 2 – Discharge
I had maybe 20 minutes of sleep the entire night and was actually grateful when the Nurse came and switched on the lights. I had a hearty breakfast and looked forward to my discharge. My surgeon along with a few other doctors came to see me. I told them about my lack of sleep and he prescribed me an anxiety tablet for the following night, to be taken only once. A doctor in his team changed my external-dressing (which was by now soaking wet and dripping bloody liquid) and told me I could go home in a few hours. I had a hearty lunch in the discharge room and then went home. I tried to sleep but didn’t manage more than 20 minutes of sleep. I changed my dressing myself a few timesas even this one was wet and dripping. At night I had a nice early dinner and went off to sleep. I actually manage to sleep 4-5 hours this time, even though I was breathing out of my mouth. Day 3 – Off with the packing I woke up early, had breakfast and got ready to go to the Hospital to get my nostril packing removed. I looked forward to being able to breathe out of my nose again. After waiting in the emergency room (It was Sunday and the OPDs were closed), a doctor came to see me. He made me lie down on a bed in the emergency room (The room was very depressing; people crying and wailing) and poured a few drops of Otrivin down my nostrils. He then used a forcep to pull and remove the packing from my left nostril. It was moderately painful and super awkward. The packing was easily 6 inches long and it felt strange being pulled out of my nose. As soon as the packing was gone, I felt blood/liquid pour down the back of my throat, followed by a gush of fresh air through my nostril.
He then used the forceps to remove the packing from my right nostril. This one was apparently stuck pretty bad and felt horrible. He had to tug pretty hard and it felt like someone was tugging at my brain. Tears poured out of my eyes. Even then, the packing didn’t come out all at once and he had to pull out multiple pieces. At one point, I blacked out for a few seconds, because of the pain. This was the most painful moment of the entire procedure, followed by the most blissful moment. Both my nostrils were open and I was breathing in great gushes of air like I had never done before. I never remembered so much air in my right nostril ever. I was still in pain, so the doctor gave me a painkiller shot and let me go home. I went home, lay down and slept blissfully for 2-3 hours. This was my first blissful sleep since the surgery.
I woke up after a few hours and took my first shower in days. It felt amazing and removed the heavy feeling in my face and head. I was still very tired and couldn’t stay up for reasonable amounts of time without feeling dizzy and going back to bed. I met a few visitors in the evening, had an early dinner and went to sleep. Breathability was 100% Day 4 – Cleaning
I slept for 13-14 hours with minimal interruptions and woke up the next day feeling much better and fresher. I had crusts of blood inside my nostrils, which I washed out using Solspre (Saline spray, which comes in a bottle). Breathing was down to 80%. I spent the day reading and watching Sitcoms on my computer. I had an appointment in the evening with the doctor to get some endoscopic cleaning done.
My friend came in the evening and took me to the doctor. After waiting for sometime, he asked me to come in. I told him that I was feeling much better. He used a suction device to suck blood clots out of my nose. This was also very painful, but much less than when they took out the packing. Breathing was back up to 90%. Another night of good sleep. Days 5-6 I can feel my Nasal passages closing up slowly. By the end of day 6, I have around 50% breathability in my left nostril and 30% in my right. There’s thick discharge all throughout the day, though blood is less frequent now. I can sometimes taste blood in my throat, which I guess is still from the blood clots getting dislodged.
I blew my nose particularly hard tonight and a lot of blood clots came out. Breathing is better, though I feel that something has dislodged in my left nostril and it feels kind of raw.
Thankfully, this congestion is expected, up to a month after the surgery and is not something out of the ordinary. The discharge eases up when I lie down, so at least I am still sleeping. Day 7
Last night, the right nostril was completely blocked, whereas the left one was at 60-70%. After I woke up though, right one opened up quite a bit and stayed at 40-50%.
I am going through a bad phase in life. It is as if my body is failing me.
I have gastro-intestinal problems since the last 2 years. I have undergone a battery of tests but have failed to get perfectly well. It is not a constant problem but comes and goes. I suspect that I am Lactose intolerant, so have decided to go on a completely Lactose free diet for the next 2 weeks. If that cures me, well and good. I have no issues giving up milk for the rest of my life. Lactase-enzyme supplements are easily available which when taken with Lactose-containing products prevents symptoms from appearing.
However, the internet is a scary place. When I search for my symptoms, I get a barrage of deadly and dangerous diseases starting with IBS and ending with intestinal cancer. Scariest is the possibility of Coeliac Disease. It has symptoms of Lactase intolerance as well as Gluten-intolerance. If that is the case, I will need to have a Gluten-free diet for the rest of my life, which will mean giving up on Wheat and almost every type of grain. With food being on of the biggest motivations in life, can I completely give up grains of all kind? I am not sure if such a life would be worth living.
I have decided to try a Lactose free diet for a week, failing which I will go see a doctor (again) and go through so many tests (again).
Meanwhile, my motivational factor is at an all time low and I feel depressed and discouraged to do anything productive, especially before the festive season is about to start.
Tonight’s party can be tomorrow’s nightmare. While heavy consumption of alcohol can liven up even the most boring parties, it can make the next day horrible and completely un-productive and make your head feel like a throbbing mass of shit.
Being a victim of this phenomena many times, I have found out a few ways you can salvage the next day. First of all, we must know why a Hangover occurs. A hangover is simply dehydration (loss of water and salt from cells) caused due to alcohol. Dehydration is caused by alcohol’s ability to inhibit the effect of anti-diuretic hormone on kidney tubules, which leads to a hyperosmolar state, which in turn causes shrinking of (by loss of water) the brain cells which causes hangover. Here’re a few tips which can be observed (while still proving to your friends that you’re a man) during and after Alcohol consumption
Drink large quantities of water. Alcohol consumption does cause excessive urination, and drinking even more water will cause even more frequent urination, but it does help. I generally have one glass of water after every full mug of Beer (or a peg of vodka/whiskey).
Don’t mix different drink types or different types of the same drink type (Hop-based beer with wheat-based beer, beer with vodka, beer with wine etc.)
Eat well. Prefer starchy slow-digesting foods like rice and potato, just don’t sleep empty stomached.
After(If you already had too much to drink and now its time to go home):-
If you feel nauseous and feel like you want to throw up, do so. Don’t hold the vomit back; instead let go and remove all the excess alcohol from your stomach. This will not only reduce the hangover duration, but will also lead to a good night’s sleep. Do remember to re-hydrate yourself properly though.
Keep a bottle of Gatorade (or similar) next to your bed. You are bound to wake up at night to urinate /feeling thirsty and drinking Gatorade helps. If possible, keep a couple of Dispirins (Aspirin) next to the bed as well and have them during one of the mid-sleep urine sessions. Most of the times, I feel this cures the headache by the time you wake up.
Have plenty of fluids and salts the next day. Avoid having more diuretics like coffee and soft drinks; which will cause more de-hydration.
Do some light exercise. Go running (not in the heat) or do some cardios. This will increase the metabolism rate of your body and metabolize the alcohol faster.
Consuming a large quantity of plain water may cause it to drain more salts out of the body causing a salt imbalance in cells. If Gatorade is not present, Lemonade helps (with lots of salt).
After a lot of unpleasant hangover days, I feel that these days I can get rid of my hangover by the time I wake up or by mid-afternoon max(If I have passed out and don’t wake up in the middle of the night).