Sunday, December 11, 2011

this is me: part 2

having the conditions that i outlined in part one of this series of posts means that i have to approach life quite differently than most other people i know. they're chronic conditions, so rather than treating them, i have to manage them, which has meant some pretty major lifestyle changes for s and i.


the biggest changes have probably been a consequence of the chronic fatigue. in the last few years i have gone from working as a high school teacher and studying psychology simultaneously, to only just managing one of my psych subjects at a time. i have tried to make up for this by finding ways to work that i can manage from home and at my own pace, and the penelope waits blog and shop have been the fruit of that endeavour. they certainly don't make me a 'living' but they make me feel that i'm not a complete dead weight, and that i have at least some small purpose.
i was seeing a specialist about my cfs before i got pregnant, and his approach was to try norepinephrine reuptake inhibitors, which have been shown to have some effect in increasing energy levels in people with fibromyalgia and cfs. i was on them for a couple of months and didn't find them helpful (in fact, i felt worse), and while i might have tried them for a little longer in normal circumstances, i stopped taking them when fruiby came on the scene, as they are contraindicated in pregnancy.
there is only one thing i can do in order to manage my cfs, and that is pace myself. this means planning my time and rationing my energy in ways that mean i can get things done. for example, if i need to go to the supermarket in the morning, i have to make sure that i keep my afternoon free to recover. if i have a busy few days where i have a bunch of unavoidable commitments that keep me out and about a lot, i have to accept that i will then have a couple of days where i am good for absolutely nothing and have to stay quietly at home. it's important that i don't let my energy reserves get too depleted for too long, because that's when i start getting quite sick. my glands get swollen and tender, my muscles and joints get very sore, i get cold sores, can't concentrate on anything, come down with viruses, and get emotionally fragile and sometimes depressed. i have to be careful not to take too much on at once, and i must always have my illness in mind when i'm planning my time. this 'energy rationing' is explained really well by christine miserandino's 'spoon theory', which everyone who knows someone with a chronic illness should read.


anxiety disorders are better understood than cfs, so more effective means of management are available. i have found a combination of therapy and drugs to be most useful. i'm not in therapy all the time, but i have a good therapist who has taught me some cognitive strategies for keeping things under control, and i can go and see her when i am struggling with this.
i have also been prescribed citalopram, a selective serotonin reuptake inhibitor which has been shown to have some use in reducing anxiety and controlling panic attacks. i was taking it for some time before getting pregnant, but weaned myself off when we started trying to conceive, because i had read that while it wasn't dangerous for babies, they could go through periods of withdrawal after birth if they were exposed to the drug through the mother during pregnancy and were then cut off. i have since had a doctor explain to me that breastfed babies don't experience this withdrawal, because the breastfeeding and weaning process also helps wean the baby off any effect the drug might be having on them. i wish i had known this before, because while i think i have been doing a really good job of managing without medication this last year or so, it has definitely been harder.
i have been having increasing anxiety symptoms over the last 3-4 weeks, and in consultation with my ob and my gp i am going back on a low dose of citalopram to try and get this under control before the birth.


in my case, managing depression is about managing cfs and anxiety. if i keep those two under control, i am far less likely to experience a depressive episode.
as an ssri, the citalopram also has an anti-depressant effect, so while i am on that i am also less likely to be depressed.


i am incredibly lucky to be supported by s in all of this. she understands how these conditions effect me, and is incredibly good at helping me identify my warning signs and symptoms when i am too distracted, stubborn, or tired to do so myself. she is always gentle and understanding, and is very quick to make me a cup of tea, or give me a hug when things are getting too much. i honestly don't know what i would do without her.
and now we are going to be parents together, and i am bringing all this baggage along for the ride. in my next post i'll do some musing on that.


this post is part of the three part series: part 1, part 3.

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