Depression

I have tried to be a generally upbeat person, dealing with the issues related to my disease and not letting it get me too far down.  The flip side of that is there is another process going on. Depression is its own disease, and one I have fought with for longer than I have fought the MS.  Add to that, MS can contribute to depression--whether it is an addition to the disease process or the compounding of everything that is going on, who knows.  But does it matter?

Depression is a beast.  It makes me feel like I am smothering.  I can see things happening around me, to me, as I am doing, but it is like I am watching from a distance.  The worst thing about it is the overwhelming feeling of being alone, unloved, not needed.  My head--the part that can pull away from all of this--knows this isn't true.  Professionally, I have had people tell me they need me, trust me, want me to be the one to take care of their animals.  That means I am doing what I always wanted to--I am the family doctor that people trust.  Personally, I have friends that love me.  People want me to join them for things.  We talk or do things when my crazy schedule allows.  My life gets so nutty because I have a lot of friends. Events at synagogue, dinner and a board game turned into a drinking game by forty/fifty somethings, an upcoming camping trip.....I can see these things.  And yet, I get that overwhelming sense of alone, sad, empty.  Fortunately, I have been through this enough times in my life to know those feelings aren't accurate.

Depression is like MS.  People can't see what is going on, so for many, they don't see the disease as something that is happening. When it can be seen--random crying fits, sleeping excesissively, sudden weight gain/loss--a frequent response is "you know that isn't true."  This is where "real" and "true" are two different things.  While it may not be true, it is the reality that is existing in your mind and it is what is real.  I have learned to counteract or sometimes just ignore those feelings.  But there are many who haven't. 

Ignoring it doesn't mean the feelings aren't there.  I know from vast experience, it will pass if I can just ride it out.  I have been on most antidepressants used (at least everything used until about 10 years ago).  I have been hospitalized for treatment of severe depression, including suicide attempts.  The only thing I can say about that is that it wasn't successful because I am meant to be here.  For me, drugs aren't an answer.  At best, I become so flat that there are NO feelings--bad or good.  At worst, it makes everything worse.  Add to that, weight gain, lethargy, and inability to think clearly. No thanks.  I will stay over here under the dark cloud, because at least I can see the cloud.  And the dark cloud will blow away.

About 10 years ago, I decided that the drugs weren't helping.  At that point I wasn't doing anything else, except ignoring it when it came up.  Over time, I have discovered some things that help.  Get enough sleep, but not too much.  That is one hell of a balancing act when trying to figure out if the overwhelming fatigue is related to the physical symptoms that are going on  or the mental symptoms that are going on.  Diet is also a big deal.  Junk makes it worse.  I am pretty sure that sugar makes it worse--great, I crave chocolate (it can help with depression for a minute), but it starts the roller coaster ride.  And exercise....yes I am a running junkie.  I am a gym rat.  Those of you who knew me in a previous lifetime know how crazy that is.  The medical profession has shown that exercise helps.  The endorphins, the act of getting up and moving, this helps with depression.  So, I know it is a good thing.   Going for a run beats alternatives that can be.  Sometimes it is hard to convince myself to get up and get moving, especially on a dark and dreary day.  But, it helps.  Even if just for a little while. 

Runner's High

Today was my long run.  Someone asked "why?"  Especially after I fell Friday night.  The short, possibly smart ass, answer is "because I can."  But there is more to it than that. A lot more.  When I run, I feel better.  The demons that are MS and depression and fear can't come on a run.  For that period of time, my mind is quiet.  I quit running with music all of the time about a year ago.  My trainer told me I needed to be able to pay attention to my body and my pace.  So I started running the shorter runs without music.  Then my mp3 player died.  That doesn't surprise me. What surprises me is that it lasted as long as it did.  It wasn't waterproof and when I run, especially in the summer, it is like someone turned the hose on me.  I haven't replaced the player.  Maybe I will, maybe not.  The time I run is peaceful.  I ask myself questions and figure out what is going on in the depths of my mind.  I pray.   I meditate and look at my life.  And then there are the times that my mind is silent.  That is the best.  All of the fear, all of the frustrations, all of the questions just stop.  I become more aware of my feet, one step then another.  I hear my breathing.  I feel my muscles.  The  silence is precious.  I just want to keep going.  Where is the turn-around?  Who cares.  How far have I gone?  Not far enough.   I am aware of where, how far, how long I need to run, but sometimes I wish for more.   I always tell someone my route and a time estimate of how long I will be gone.  For reasons of safety, I don't change it.  There is a cushion of 15-20 minutes.  If I say 3 and a half hours, don't worry until about 3:45.  At 4 hours, come find me.  I also don't push farther than I am supposed to go based on my training schedule because I don't want to hurt myself.  That sounds like hell--hurting myself doing something I love, then I can't do it anymore. 

I guess the real answer to why I run, is to make my mind be quiet.  Just for a little while.  For that time, the demons are gone.  They can't keep up.  They always come back, about the time I hit the road to my house and I start walking to cool down.  But, at least is it quiet for a  while.  Maybe some day they will be gone.  For me, that is the runner's high.

What if.....

I don't know which is harder.  The uncertainty of chasing down the symptoms and finding out what is causing it or dealing with the symptoms themselves.  Fortunately, most of the time, it isn't painful.  There are exceptions.  When my face has the trigemminal nerve spasms it feels like someone is holding a hot poker against my face.  This is an improvement over the trigemminal issues that led to surgery, but it is still damned unpleasant. 

The most frustrating thing is that, at least by the classic definitions, this is not related to the multiple sclerosis.  MS is central nervous system lesions--meaning brain or spinal cord.  I have recently had a brain MRI and it showed no new lesions.  So that means it is peripheral--relating to the nerves in my arms and legs.  Guess what kids. The EMG/nerve conduction study was normal.  According to the doctor who did the test that means the nerves of my arms and legs are transmitting just fine.  REALLY???? So I am making this up?  No one actually believes that.  They do a physical and poke my feet with a pin and I can't feel it.  They hold the tuning fork that should transmit vibration or cold against my toe and I can't feel it.  But, no one seems to know why.

I am back in the position of being the most annoying and aggravating patient the doctor may have.  I am a big believer in being your own advocate.  Doctors are human.  They (we) get frustrated when there isn't an answer.   There is a path that is followed based on physical exam and tests.  You go to point A, if this is the result go to this test, if not, go  that one.  This holds true up to a point.  There is something called "idiopathic peripheral neuropathy."  Idiopathic means "we are idiots because we don't yet understand the pathology."   Not really, but that is how one of my professors explained it.  It does mean we don't know why this is happening. I tell clients it is "doctor speak" for "we don't know what the hell is going on."  I have been told that may be the final answer.  So, for now, I am going to keep bugging them until we get to the end of any possible path.

In the meantime, I have to keep my stress down and be as okay as I can be.  We all know I have traded addictions.  I used to use chain-smoking  and junk food eating, and throw in a drink or three as my source of comfort.  Now, I use a run, the longer the better.  Some days that long run becomes more of a challenge than maybe it should be--legs cramp up, back hurts....but it is a hell of a lot better (and cheaper) than two packs of Marlboros a day with one or two sodas thrown in for good measure.  I am trying to find a way to deal with all of this.  I freely admit I am scared about it.  What if there is no good answer?  That worries me much more than what the cause might be.  I can be okay with whatever answer I get, I just need an answer.