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Today Miss Cactus introduced me to the pawpaw (Asimina triloba), the largest native North American fruit. They are apparently one of the rare temperate members of the Annonaceae, or custard apple, family; most of the related species are tropical. She has a pawpaw tree growing wild in her new backyard, and therefore has more fruit than she really knows what to do with right now. (Pawpaws don't keep or transport terribly well.)

The outside of a pawpaw fruit is sort of leathery yellow-green-brown with lots of brown spots. The inside is creamy yellow with huge black seeds, easily removed. The texture is a bit like avocado crossed with banana, ranging from relatively firm to very mooshy/squishy, and the flavor is... hmm... kind of like banana-pear with a hint of lemon, maybe? Or mango-guava-banana? Hard to describe, anyway. It's very sweet and gets cloying rather quickly; one fruit would probably be most people's limit.

It turns out that I am mildly allergic to raw pawpaws, but not terribly so -- a single Benadryl tablet was enough to mitigate the reaction, and I didn't start getting excessive phlegm/throat-closing issues until I'd eaten nearly a whole palm-sized fruit.

I don't particularly need to eat another pawpaw ever again, but I hear they make pretty good ice cream (which I would readily believe) and they can be subbed into almost any recipe in place of banana. Miss Cactus said she used a bunch in a banana bread recipe this week and it turned out well, so. :)
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I started my increased dose of Celexa on Sunday. For whatever reason, it is not technically possible to get a 30mg pill of Celexa (or generic), so our choices were either take one-and-a-half 20mg pills, or take three 10mg pills. Splitting pills is a pain, so my doctor and I went the second route. The pills are so tiny, I always feel like I'm going to lose them in the gaps between my fingers no matter how tightly I press them together. *hands*

Anyway, I have been absurdly exhausted this week, but as always I am unsure how much of that is the medication and how much is my generally terrible sleep patterns. However, I have noticed that I've been sleeping... not badly, exactly, but more lightly/less deeply? Also having more weird dreams, or at least more weird dreams that I remember because I'm just awake/aware enough to notice them as they happen. And I am pretty sure that part is a medication side-effect.

Anyway, I am trying a new policy of going the fuck to bed by 11pm every night. I have not had great luck imposing bedtimes on myself in the past, but I think part of the problem is that my previous bedtime attempts have been more in the nature of "if you are still up at this hour, something has gone Terribly Wrong and you must initiate Emergency Sleep Protocols immediately" and by the time I've reached that point, I am so tired I can't make good decisions anymore so I just stay up even later. I figure 11pm is early enough to avoid that pitfall, and also making my cutoff happen before midnight avoids another mental pitfall of "oh well it's tomorrow already; I might as well stay up another hour." So fingers crossed, I guess.

...

Tangentially, today I failed to give blood for the second month in a row, because I am a little bit under the Red Cross's minimum acceptable hemoglobin levels -- not to the point where I'm medically anemic, but still. I wonder if that might be a medication side-effect as well, and/or if it's contributing to my tiredness. I have been having some minor gastrointestinal issues that could mean I'm not getting as many nutrients from food as usual, in which case supplements might be worth looking into...
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I had my one-month followup appointment this morning.

We are upping my Celexa dose from 20mg to 30mg per day, with another followup appointment in early November, to see if that helps get me past the motivation/executive dysfunction issues. I also have the phone number of a local mental health organization, which should either be able to provide some therapy or direct me to someone with openings if I want to troubleshoot my coping strategies.

And I got a flu shot while I was at the office, because my insurance covers it and why not. :)

I'll pick up the new prescription tomorrow when I do my grocery run. Hopefully this time there won't be as many (or even any?) weird side-effects, since it's just a dosage increase instead of throwing a completely new and weird chemical at my body.
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I have my one-month followup appointment on Thursday, and... we will probably end up changing something, though I'm not sure what.

You see, since the weird side-effects leveled out, when things click, they are really clicking -- by which I mean, when I enjoy something it's in full technicolor rather than faded pastels -- and even when I'm floating the world is back in color rather than grayscale. But I am still drifting/floating and unable to get a stable grip on things for more than a day at a time. In fact, some of my depression-compensating behaviors have gotten worse, which I think is a reaction to knowing that when I get that connection/click to work, my ability to enjoy stuff is now working correctly, so it's like my pleasure-seeking drive is overcharged.

Unfortunately my compensating behaviors are mostly stuff like obsessive reading rather than dealing with necessary life tasks, and obsessive reading tends to screw up my sleep schedule which really does not help anything, so... something has to give.

*sigh*

Hopefully my nurse practitioner will have some advice.
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Weird food issues seem to be gone for good. \o/

My sleep schedule hasn't settled, though, which is probably partly my fault for not setting a consistent bedtime and thus not having a roughly consistent getting-up time. Since I take the pills with breakfast, this also introduces several hours of variability into that schedule.

Anyway, I was crushingly exhausted in the afternoons on Saturday, Sunday, and Monday, which resulted in two-hour naps on the latter two days. I was not similarly tired today, and I wonder if that's because I tend to drink tea (and thus get a dose of caffeine) much earlier in the day on work days. But I do the same on Saturdays -- albeit one hour later -- so... a mystery!

Additionally, last night I could not sleep for shit. I used to have mild insomnia as a child and teenager -- the kind where you just can't make your brain shut off no matter how tired you are -- but I had some meditative techniques that mostly worked and that had largely stopped being an issue by my early twenties anyway. (By which I mean, if I had told myself stories when falling asleep as a teen, I would have been up all night, whereas for the past fifteen years such storytelling has been my most reliable way to make myself fall asleep.) Monday night felt like I was eighteen again and could not fall into more than a thin and restless slumber for love or money. It was very frustrating, and I hope that does not repeat tonight.

My mood has been neutral to mildly positive, and while my motivation and time management continue to be iffy and liable to vanish without warning, the world does not feel crushing and impossible, so there's that. I feel like I will get my list of stuff done, even if I don't get to any given task on the first day I schedule for an attempt. That is a noticeable change. :)
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Weird food issues have disappeared -- I am now experiencing hunger correctly, and food once again has flavor. Yay!

I did an experiment on Wednesday night to see how the medication interacted with alcohol. The answer is that it is pretty much as I remembered from my last stint on anti-depressants: namely, that I get really mellow-floaty-detached on remarkably little alcohol, and the next day I feel like I've missed an entire week of sleep. So I will parcel out my two remaining bottles of hard cider on carefully chosen occasions when I have no responsibilities the next day, and the bottle of rosé wine in my fridge will remain unopened until such time as I have guests over to help finish it. And I will just not buy alcohol for the next couple years. *wry*

I am unsure if there's been any particular effect on my mood. I mean, the world is currently in color instead of flat and gray and distant. But I'm not really motivated in any sense, I still have a persistent sense of isolation/futility, and I've let a bunch of planned tasks slide these past few days. So I'll keep an eye on that going forward.
edenfalling: stylized black-and-white line art of a sunset over water (Default)
Today was pretty good, actually!

I was tired, but I'm fairly sure that was because I got inadequate sleep rather than a medication side-effect. Food tasted like food again, and I was... not eager for lunch and dinner, precisely, but mildly interested in the idea of eating. I also worked up the spoons to cook the steak and noodles I'd been meaning to cook for a couple days.

Of course, last night after I made yesterday's post I had some nasty gastrointestinal distress, so I wouldn't say everything is perfect, but with a pinch of luck I am adjusting and things will get better from here on out. :)
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Exhaustion returned with a vengeance, ugh. I had no motivation or energy through the majority of the day and eventually gave up in favor of a nap around 4pm. I slept for slightly over two hours and could happily have made it a four- or five-hour nap if that wouldn't have utterly mucked up my attempt to reestablish a regular sleep schedule.

I am still very unenthused about food. I had a weird moment around 6:30pm (shortly after getting up from the nap) where I felt like I might faint if I didn't eat something soon while simultaneously feeling vaguely nauseated at the thought of eating. I made myself eat some yogurt and felt better thereafter, to the point where I was able to talk myself into cooking the broccoli I'd had on hand for a couple days and eating an actual dinner. I mean, I didn't finish the dinner -- I put the leftovers away in the fridge for tomorrow -- but I got through about 2/3 of it and it had vegetables (broccoli), protein (steak), and starch (elbow noodles), so I count that a victory. It also didn't taste entirely of nothing, though lunch did taste horribly bland, so maybe there is hope that my taste buds and my brain will fix their currently glitched out connection?

Internal temperature regulation glitches continued, to my displeasure. They were worst between about 1pm and 7pm, but seem to have evened out for now.

I've also had a nagging not-quite-headache lurking around the edges of my skull all day, though that may be unrelated to the medication.
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I'm still very "oh yeah, food is a thing, isn't it?" Like, I can feel the physical sensation of hunger to the point of mild discomfort and my mental/emotional reaction is just kind of... "well that sure is a thing I am feeling" without any particular urgency to do something about it.

Normally flavorful foods also continue to taste bland and unappetizing, which is deeply weird.

Still kind of tired, though today that may just be because I was up late finishing my NFE draft last night, blargh.

I've been having some minor internal temperature regulation glitches -- suddenly feeling too hot or too cold with no correlation to the actual outside temperature. That is a thing my body likes to do to me any time I'm feeling generally rundown, though, so I figure it's probably a general "yikes, something is changing! throw the temperature alarm???" response rather than a medication-specific reaction.

Less gas today, which is nice!
edenfalling: stylized black-and-white line art of a sunset over water (Default)
Food is still very unappetizing. On the one hand, this does make it a lot easier not to eat excessive snacks at work. On the other hand, it's hard to convince myself to eat something nutritious for dinner when nothing sounds appealing and my comfort foods are all terrible carbohydrate things. (Well. I mean. Oatmeal is not terrible, but one cannot live on oatmeal alone -- though adding craisins and milk would probably extend the time limit.) I had to keep adding salt to both lunch and dinner to make them taste vaguely palatable, which is not great as a long-term strategy. (Though apparently low sodium is also a potential side effect of Celexa? Maybe that is why I am craving salt more than I usually do? (And trust me, I already crave salt a lot.))

In contrast to my sudden yen for salt, sugar is dramatically less appealing than usual. I was actually kind of grossed out by a chocolate chip cookie this afternoon, which was disconcerting.

Minor gastrointestinal discomfort, though I'm not sure if that's medication related or ovulation related, since I get minor ghost cramps/discomfort around every second or third ovulation and I'm pretty sure I'm getting my period in approximately two weeks. *wry*

Much less exhausted today, though still more tired than seems reasonable considering I slept nine hours last night.

No discernible effect on concentration/motivation, but I don't really expect anything on that front for another week at least.

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Elizabeth Culmer

October 2017

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