Announcement: On Vacation… of sorts

I will likely be away from the blog for about a week or so. My mac laptop’s power cord gave up the ghost and I cannot get a new one right now. This means I only have it until the battery runs out (which is in about 20 minutes). So if you write to me, please don’t panic if I can’t return your email/comment in a timely manner. As soon as I have a new cable, I’ll be up and running again. Fingers crossed.

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Loperamide Abuse/Misuse/Addiction and Cardiac Conduction Disturbances — Article Clearinghouse [UPDATE 23 Jul 14]

loptabMad Margaret’s Loperamide Clearinghouse is here!

Enclosed herein are just some of the medical articles  I’ve researched regarding loperamide. I will add more as I continue to dig through my stack (or discover new ones), so please stop back now and again.

So little scholarly information is easily or readily available to both the public at large and physicians trying to help their patients, I feel it’s incumbent upon me to provide pertinent data insomuch as I am able.

Publicly available web-based information is included with authors, source information, and a link to the original. Copyrights belong to original authors; no copyright by me is implied or claimed. These links and articles are provided for educational and public health purposes only.

Some definitions that will help comprehension for our non-medical personnel readers: QT/QTc, • Ventricular Tachycardia

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loptab3Cardiac Conduction Disturbances Secondary to Chronic Abuse of Loperamide: An Initial Case Report

Audi J,1 Layher J,2 Morgan B.11 Georgia Poison Center and Emory University Department of Emergency Medicine. Atlanta, GA;2 Athens Regional Medical Center. Department of Cardiology. Athens, GA

Journal of Toxicology, CLINICAL TOXICOLOGY, Vol. 42, No. 5, pp. 713–826, 2004

Conclusion: This is the first case report of an adult with cardiac conduction disturbances following chronic high-dose loperamide use. Negative toxicologic screens, cardiac studies and normal electrolytes, and resolution of cardiac abnormalities after loperamide cessation leaves no other plausible explanation for this presentation.”

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loptab3Syncope and Recurrent Polymorphic Ventricular Tachycardia Following Loperamide Misuse

Jeanna M Marraffa, Michael G Holland, Ross W Sullivan, Robert Seabury, Michael J Hodgman; Upstate Medical University, Syracuse NY USA

From “2013 Annual Meeting of the North American Congress of Clinical Toxicology”

Conclusion: Massive loperamide abuse may result in QTc prolongation and subsequent recurrent ventricular arrhythmias.”

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loptab31274: Loperamide: The Unexpected Culprit

Pokhrel, Kiran; Rajbhandary, Arunima; Thapa, Jhapat

 Critical Care Medicine: December 2013 – Volume 41 – Issue 12 doi:10.1097/01.ccm.0000440506.29056.c1
Poster Session: Case Reports

Discussion and Conclusion: Loperamide is not known to cause QTc prolongation but methadone, also an opioid, dose cause QTc prolongation. Loperamide is also structurally similar to Haloperidol which has potential to prolong QTc. To our knowledge there is no known cases of Loperamide induced VT-storm. A case series (n=216) of Loperamide overdose failed to reveal any cardiac toxicity but the maximum ingested dose was 0.94mg/kg which is much less than in our patient. Internet search reveals that Loperamide is popular among substance abusers to prevent opioid withdrawals and to produce euphoric effects. Hence, Loperamide needs to be further evaluated for cardiac toxicity at super high doses.”

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loptab31204: Ventricular Tachycardia Storm – Can It Be A Side Effect From Over the Counter Anti-Diarrheal?

Boppana, V Subbarao; Kahlon, Arundeep; Bhatta, Luna

Critical Care Medicine: December 2012 doi: 10.1097/01.ccm.0000425416.95852.ed
Poster: ABSTRACT Only

“The spectrum of side effects from high doses of loperamide is still unknown. Abrupt resolution of the VT, normalization of QT and lack of the need for an anti-arrhythmic after discontinuation of loperamide in our patient makes us believe a causal relationship, but the pathogenesis remains unclear.”

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loptab31.2 Loperamide Intoxication in the Pursuit of Opioid Effects: Report of Two Fatalities

J. Denton1, A. Youmans 1, V. Arangelovich 2
1 McLean County Coroner’s Office, Bloomington, IL; 2 Will County
Coroners Office, Joliet, IL

National Association of Medical Examiners
Abstracts of the 2013 Annual Meeting
October 12-15, 2013

“We present two deaths from loperamide intoxication from excess ingestion of loperamide pills, likely related to attempts at attaining euphoria. Thorough death investigation, autopsy, and additional toxicology testing studies were required to establish the cause of death.”

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loptab3Systems Pharmacology of Arrhythmias

Seth I. Berger, Avi Ma’ayan, and Ravi Iyengar* Department of Pharmacology and Systems Therapeutics and Systems Biology Center New York, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1215, New York, NY 10029, USA

Science Signaling; 3(118): ra30. doi:10.1126/scisignal.2000723

From P.10: “The identification of such potential signaling pathways provides initial insights. For example, two drugs, dasatinib and loperamide, used to treat different pathophysiologies, cancer and severe diarrhea can have QT prolongation as an adverse event and can be connected to the LQTS disease genes through the LQTS neighborhood (Fig. 5C). The paths can be short; for example, loperamide can be connected to KCNH2 through CALM1 (one step), and dasatinib can be connected to KCNQ1 through PRKACA and SRC (two steps), or more convoluted. Such a tracking exercise provides hypotheses about how these drugs might affect the QT interval and increase TdP risk, which can be used to design experiments in animal models or combined with whole genome information to identify “at-risk” patients.”

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loptab3Tissue distribution of loperamide and N-desmethylloperamide following a fatal overdose.

Sklerov J, Levine B, Moore KA, Allan C, Fowler D., Division of Forensic Toxicology, Office of the Armed Forces Medical Examiner, 1413 Research Blvd., Rockville, Maryland 20850, USA.

Journal of Analytical Toxicology, 2005 Oct;29(7):750-4.

Abstract: We report a case involving a fatal intoxication with loperamide (Imodium).”

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loptab3Loperamide Induced Brugada Syndrome

Sheyman, D.O. | Robert Crake, D.O.; Ohio Valley Medical Center, Wheeling WV; Feb 2014

February 2014 — Poster Presentation

Conclusion: 
Although rare, there have been reported cases of antihistamine, cocaine, and psychotropic drug induced Brugada Syndrome. Loperamide is another agent that could induce this syndrome. At present, there are no reported case studies that involve loperamide and Brugada Syndrome, however, because of the patients lack of family or personal history of cardiac problems we believe this may be the first case of loperamide induced Brugada Syndrome.”

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loptab3A Web-based Study of Extra-medical Use of Loperamide: “I just wanted to tell you that loperamide WILL WORK”:

Raminta Daniulaitytea, Robert Carlsona, Russel Falcka, Delroy Cameronb, Sujan Pererab, Lu Chenb, Amit Shethb; a Center for Interventions, Treatment, and Addictions Research (CITAR), Department of Community Health, Boonshoft School of Medicine, Wright State University, United States; b Ohio Center of Excellence in Knowledge-Enabled Computing (Kno.e.sis), Wright State University, United States1

Drug and Alcohol Dependence: LINK1: Poster session — LINK2: Published Paper
Accepted 3 November 2012. Available online 30 November 2012

Conclusions: This study suggests that loperamide is being used extra-medically to self-treat opioid withdrawal symptoms. There is a growing demand among people who are opioid dependent for drugs to control withdrawal symptoms, and loperamide appears to fit that role. The study also highlights the potential of the Web as a “leading edge” data source in identifying emerging drug use practices.”

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loptab3Characterizing the abuse potential of loperamide via physiologically-based pharmacokinetic/pharmacodynamic modeling and simulation

Garrett Ainslie 1,2, Evan Kharasch 3, Gary Pollack 2, and Mary Paine 1,2

1 Curriculum in Toxicology University of North Carolina Chapel Hill NC United States
2 College of Pharmacy Washington State University Spokane WA United States
3 Dept of Anesthesiology Washington University St Louis MO United States

April 2014 The FASEB Journal vol. 28 no. 1 Supplement 1053.6

From the Abstract: Increased restrictions on opioid prescribing may fuel alternate means of abuse. Anecdotal reports suggest abuse of the over-the-counter opioid loperamide when taken at supratherapeutic doses with CYP3A/P-gp inhibitors.”

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loptab3Loperamide overdose-induced catatonia: potential role of brain opioid system and P-glycoprotein

Enrica Di Rosa a1 and Antonio E. Di Rosa a2

a1 Department of Clinical and Experimental Medicine, University of Messina, via Consolare Valeria, 1, 98125, Messina, Italy
a2 Department of Neurosciences, University of Messina, via Consolare Valeria, 1, 98125, Messina, Italy

Acta Neuropsychiatrica / Volume 26 / Issue 01 / February 2014, pp 58-60

From the Abstract: We describe the case of a 20-year-old man who presented with severe catatonia following excessive intake of loperamide…”

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Editing note: I decided, out of respect to the authors, to not include content without permission aside from a notable quote that summarizes the article. But if you follow the links, I assure you, you’ll find what you’re looking for. Originally published 03 Apr 14.

 

 

 

Posted in + recovery, addiction, depression, loperamide abuse, sobrietyland | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Doo be doo be doo…

operFor those of you relatively new to my blog, back in the day, I used to sing. I was pretty good too, at least according to those who told me so. Occasionally, I even impressed myself (but only occasionally). I wasn’t professional per se, though I had been paid for a few performances. Most of the time, I simply sang for my own amusement.

I started by singing classical jazz (think Frank Sinatra, Ella Fitzgerald, etc.), then from there, I progressed to opera. I didn’t particularly like opera right away; it took some time to earn appreciation for it. But took to it like a duck to water, and I so enjoyed being surprisingly good at something, I kept doing it.

oper2I took lessons for years while in my 20’s, studying for a time under a rather Prestigious Tenor, learning the classic bel canto technique (he said I’m something like 6th in direct line to Nicola Vaccai since he studied under someone who studied under someone back to the master). I learned so much from that tenor, but was intensely frustrated at being boxed in by a particular vocal type.

Allow me to explain. Regarding vocal types, most people know that, in choirs and such, you have your basic altos and sopranos, tenors, and basses. In opera, however, there are multiple sub-categories of vocal type. With women, you have your contraltos (and their various sub-categories) which are the lowest voice. Then you have your sub-categories of mezzo-sopranos (mid-range) and all the various categories of sopranos (top range). Ultimately, I sub-categorized myself as a dramatic-coloratura soprano — which is vocally akin to “jumbo shrimp”. It basically means I had a darker, more powerful sound combined with the agility to glide through all the vocal roodle doodles of the high sopranos. I had about a 4-octave voice which is pretty unusual and helped me sing all types of music.

However the Prestigious Tenor preferred light lyric sopranos (a more delicate, pleasant tone), and did his damnedest to cram my big dark voice into a simulation of that popular timbre. We worked at it for years — in time, my voice and technique became lighter and brighter which is much more desirable within the opera community.

Prestigious Tenor didn’t want me becoming involved in community theater projects lest I might become distracted from my studies of the compendium of Italian opera. I thought it was ridiculous, but the man sang with Callas and many other famous singers — obviously he knew more than I did.

I parted ways with Prestigious Tenor after we got into a row about whether or not I should expand my vocal abilities into other types of music. He said no, I said yes, he said he couldn’t teach me if I fought him on this. So… that was it. We parted friends, but it was hard on me. From there, I studied under another tenor who was wonderful in a different way, and when he left to take a job in Washington DC, I “retired” from studying vocally.

rlphThen, about 7 years ago, I got it in my head to take piano lessons again. I studied piano for eight years as a kid, but didn’t remember much more than the basics. As an adult re-studying piano, everything came back to me quickly. I excelled and became pretty accomplished after a year of study. During that time, I had mentioned to my teacher (we’ll call him Grant) that I could sing. After hearing me sing, he encouraged me to do something with it. I got involved in a choir (which wasn’t the best move), and then I got involved in that dreaded community theater that Prestigious Tenor warned me about.

The first show I did was a rare Gilbert and Sullivan. I loved it — really loved it. I was chosen for one of the leads when the producer, director, and cast heard me audition and were absolutely stunned (like I said, sometimes I was pretty impressive). It was hard work, but completely worth it. I made a lot of friends — a lot! — including Grant.

Grant became something of a best gay friend for a while (no, not the one who f’d me over). He was a good kid, about 15 years younger than I am, but mature for his age. After he went back to college to earn his Master’s degree, we fell out of touch.

With regard to opera, I did a few more shows after that only to become deeply disenchanted with the community theater ethos. Too much infighting, goofing off, unpreparedness, pettiness, and backbiting for something I wasn’t even getting paid for. Then my ex-friend (not Grant) f’d me over and pretty much scotched any chance I had of doing it again even if I wanted to.

Then, there was the whole near-death-by-loperamide-overdose thing. When I was on life support and intubated for three days during “The Incident” a few years back, my vocal cords became paralyzed. Eventually I could talk, but singing was nearly impossible. For the first time in my whole life, I couldn’t sing a note without croaking like a frog. It scared the crap out of me. I was afraid to even try to sing for a very long time. Only lately, these years later, have I had the courage to try again with any gusto.

Yesterday, I’d heard that Grant returned to my crummy Burg to open a music studio, so I  reached out to him to see if he’s still teaching voice. I need to get a hobby desperately. If I write another long post about a stupid doctor’s appointment, I’m going to shoot myself.

Turns out, Grant does indeed teach voice (as well as piano), and of course, he remembers me well. Lessons are generally about $40/hour, and since I’m on seriously limited funding, I may only be able to make a lesson once every two or three weeks or so. It won’t be like the last time when I thought one lesson per week was too few!

ritaI sang a bit over the weekend and discovered much to my delight that my top notes seem to be coming back. I started with the classical jazz stuff that I love so much, then progressed to a couple of opera pieces. I can only imagine what my neighbors were thinking! Singing was something I always did without much thought — and I’ve been without music in my life for so long now. I’m not sure how I’m going to approach lessons since all of my sheet music is gone. ALL of it. I can download sheet music online, luckily, and re-order some of my classic books. Without a piano, I’ll have to rely on online sources too. It’ll be much harder, but maybe it’ll be worth it.

Grant texted me after I contacted him yesterday and will text again later. It’s really nice to hear from him again. I’m looking forward to seeing him and maybe getting some lessons that will keep me out of my own head and worrying about stupid things that don’t matter.

**UPDATE: I heard back from Grant and it seems he might be able to fit me in for some lessons in the evening and costs are $45 per hour. Scheduling might be a challenge though. He actually referred me to the person across the street if he can’t fit me in. Well if I wanted to do that, I would have already. So we’ll see. If it doesn’t work out, no biggie.

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Ah, pray make no mistake,
We are not shy;
We’re very wide awake,
The moon and I!

– The Mikado

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Maybe I Should Talk About This In Therapy

shrinkoffice.jpg

I guess in some ways, I’ve always had ridiculously high standards, both for myself and others. Even as a child, I went above and beyond on anything I was handed — swimming classes, spelling bees, homework assignments — you name it. Maybe I was trying to impress my teachers, or maybe I just really, really, REALLY had to be the best at everything. Driven by inattentive and alcoholic parents, I was always trying to find a way to shine so maybe someone would pat me on the head and tell me I’m good.

Not much has changed.

I mentioned previously that the Square-jawed NP has changed practices. His new office is a bit farther away, and a whole lot harder to contact. I worry now that I won’t be able to get in to see him for months.

shoshan

More successful at getting away than I thought.

I went into immediate panic mode after he told me he was going somewhere new, and called his new location to get the ball rolling on switching over. It has turned out to be much more difficult than originally thought. Even though I started early — which, as you know, people who like to excel at things often do — I’m still without an appointment. I knew this was probably going to be a convoluted process, but I had no idea how bad it would be.

I called to start the ball rolling about 6 weeks ago, and I’m still not in. It’s insanely ridiculous. In order to be accepted into this new practice and see NP regarding my meds, I had to have a phone interview (already done), and next up, I need an intake appointment (which is, generally speaking, just a medical history). I started right way because I wanted to prove to myself and the world that this would be no big deal. Even with all that planning, it’s not working out.

Last week was my intake appointment. I showed up at the location, and the office wasn’t there! They’d moved without telling me. I called and discovered they were now halfway across the city — impossible for me to get to without a vehicle. Nice that they told me that, right?

I was promised that they’d get back to me with a new intake appointment, but no one has called yet. Nothing like the frustration of doing what you’re supposed to only to get the raw end of the deal.

I called the main number on Friday, and again this morning with no response from the intake people. I asked the receptionist if I could just get an intake appointment and immediately (same day) follow up with my buddy the NP, but was rebuffed. “That can’t happen,” she informed me, “You have to have the intake appointment before you can see NP, not at the same time.”

I was crushed. I mean, seriously crushed. This is not turning out so well.

And who do I blame? Ultimately, me. I could have double-checked the location. I should have made sure I was where I was supposed to be, not at an old address, but at the correct one. I made assumptions, and I failed.

I expected to get all my ducks in a row on this thing and beat the system. But I couldn’t do it. I lost. And that’s where I sit with this thing right now. Blaming myself, feeling like crap, anxious, and nervous.

Failure is not a thing I deal with terribly well. Being that I did everything I should have done, I expected success, only to find I was skunked again, by my own hand. I beat myself up about it. “I should have double-checked the location! I should have made sure I got there anyway, begging a ride from someone, even if I was late. I should have… would have… could have…”

I am my own worst enemy when it comes to things like this.

At our last appointment, NP prescribed a new med, Abilify to replace the Risperdal that was keeping me calm but making me fat. I don’t think it helps; in fact, I think it makes me more nervous than I felt before. But being that NP’s literally gone — and I can’t get hold of him without that stupid intake appointment that I can’t get anyone to schedule — I don’t know what to do. I will have to make some executive decisions on my own, and, should I ever get to see him again, I’ll confess to NP that I monkeyed with my medications.

Then again, at this rate, I feel like I may never see him again, so it makes little difference.

I’ve actually thought about stopping all the medications. I’m not sure why. I know it’s the wrong thing to do, but I feel helpless here. Maybe it’s because I want to punish myself for not excelling at this “changing practices” thing. Or maybe I just don’t care anymore. I guess without NP to keep me honest, I just want to drop out of the whole thing. I know that’s idiotic, but I can’t help feeling that way. Right now, my plan is to discontinue the Abilify since it doesn’t seem to be helping at all (and I’ve been on it for several days now), and maybe discontinue the Wellbutrin, but keep the Viibryd and the sleep meds.

I don’t know. I know it seems self-destructive, but I feel so damned helpless.

I’m extremely disappointed in myself and in the whole process. The way I see it, if — and this is a very big if — if I get an intake appointment, it might not be for two to three weeks from now. Presuming I can’t see NP that day, and I was told that I absolutely cannot see him, it could be another month before they consult with each other and allow me to come in. That means, I won’t have any prescription care until maybe September.

How crazy is that?

So I called the old office this morning to confirm my appointment with some idiot stranger on August 5th. If I can’t get in to see NP before then, at least I’ll have someone handling the medications, even if he/she is an idiot.

I become very self-punishing in situations like this. I truly do. I don’t deal well with feeling helpless. I’ve been walking around in a serious nervous funk, carrying my cell with me just in case they call.

Now, you might be saying to yourself, “Damn, girl, get a life!” And I would agree with you. This should be the least of my worries, truly. I mean, after all, would it be the worst thing in the world to lose the Square-jawed NP? Not really. But he’s been a big part of my recovery — he’s important to me — and I feel like I’ve lost a friend, and somehow, it’s my fault.

I’ve also noticed, interestingly enough, that lately I’m experiencing a lot of transference. Every time I start feeling abandoned in all this, my feelings intensify. I keep trying to figure out how I’m going to fix this mess. I obsess on it. My brain links it to all the times I’ve been abandoned before — parents, lovers, friends — and I respond in kind.

But this situation of losing him hits every button on my control panel. Lights start flashing, alarms sound, and I’m a little kid alone at home and crying because my mom is in the hospital and might die. Again.

The situation also recalls when my ex-friend screwed me over, broke up with me, left my music “career” dead in the water, took all our friends, and how I crumbled into a pile of Vicodin-popping suicidal shambles for months, barely able to function. I was warned about him, and I was warned here. Abandonment. Too many similarities to ignore.

Transference is a pretty scary thing if you ask me. Powerful in therapy, but desperately destructive in the absence of it.

I hold myself to pretty high standards, so failure, for me, isn’t an option. But sometimes it happens anyway.

My appointment with VESID (the NYS education program for poor disabled people) was last week. I missed it. Yes, believe it or not, I was a day late — how does this keep happening?? I had to reschedule, so now I won’t get in to talk about a new career until mid-August (probably sooner than I’ll get to see NP). This new date likely means there’s NO WAY I will get to take any fall classes. I may have to wait another year.

My fault. I did this to myself.

So after I hung up the phone with the VESID people, I was so upset and embarrassed by my own screwup that I broke out in hives — only on the left side of my face. It went bright red and hot and intensely itchy, so bad I had to check the mirror. You can imagine how weird that must have looked. Can’t say that’s ever happened to me before. I’ve broken out into hives under stress, usually on my chest and neck, but never on one-half of my face.

That, my friends, is some serious stress.

FQueeneeling like a massive failure, and wanting to relieve some of my stress, I downloaded some of the classic jazz and opera music I used to listen to so I could sing along with them. I used to do that all the time, back before everything crashed and burned. Alone in my hovel apartment, I relaxed and sang along to my favorites, feeling free to sing as loudly as I wished. I discovered that my voice isn’t, in fact, ruined. I can still sing. I can even hit the top notes if I relax enough. I need to practice technique of course — my breathing needs work  — but I was thrilled to discover that yes, in fact, I can still sing.

Next step, try to do something with that. Within reason of course. It will take a tremendous amount of bravery on my part, but maybe it’ll be worth it. And maybe that’ll help get me out of my own head and stop worrying about the stupid medication and appointments and shit.

In the face of so much recent failure, it felt good to excel at something again.

*********

UPDATE: I finally heard from someone and have an intake appointment for August 14 — another month away. I was also told that I cannot just ask to see the Square-Jawed NP when I want to anymore — the therapist has to make that call. How fun is this going to be? This sucks ass.

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Sit there and count the raindrops
Falling on you
It’s time you knew
All you can ever count on
Are the raindrops
That fall on little girl blue.”

– “Little Girl Blue”, Richard Rogers

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EXCERPT — The Strawberry Shortcake Incident

I was re-reading some of the old articles on this blog, and thought I’d share a piece of one that really cracked me up. Even in the midst of a crippling, untreated depression, I found the absurdity in the situation. I’m glad I did — it’s especially enlightening to be able to look back at some of these essays with the 20/20 hindsight of the present day. Hope you enjoy as much as I did!

straw

From June 27, 2011:

Yesterday (Sunday) I went to church — the Presbyterian church I’ve been attending — since the people were so friendly, I thought it would be nice to spend some time with God and community. I’d find out the latest goings on and maybe even get my mind off my troubles for a while. Well, that really (REALLY) didn’t happen. None of the girls I had gotten to know fairly well were there.

After services, they have coffee and donuts in one of the meeting rooms — it’s normally a pleasant diversion that I’ve enjoyed going to. This time? Not so much. I was starving; I hadn’t had breakfast since I had no money for food, so I was looking forward to diving into a big donut and hot cup of coffee. Normally they ask for donations, and normally I give a dollar or two in the kitty, but I didn’t have any money this day. I felt a little guilty, but figured I’d make it up the next time. They were serving strawberry shortcake in these little styrofoam bowls. I was one of the first people in the room, but I waited to be the second to dive into the dessert tray, piled with shortcake, bright red strawberries and topped with homemade whipped cream. My mouth is watering just thinking about it. Taking my bowl, I went to the coffee table and chatted as I poured the coffee into my mug. The first sip was heaven. I went to sit down along the row of chairs — figuring since I didn’t know anybody there very well, I’d stay out of sight, eat my cake, and head home. As I walked to my seat, I heard a crack under my right thumb. The styrofoam bowl was breaking! I moved my hand to support the bowl when it cracked in half — the strawberry shortcake AND my coffee went flying. Right onto their antique chair and white carpet. Oh yeah, you can guess what I was thinking.

Fortunately, I caught the coffee before it totally went over — it only splashed a little. But the shortcake went ass over teakettle right onto the chair and floor. Stunned, I didn’t know what to do for a moment, but I reached down, grabbed the mass of cake from the chair and the floor with my bare hands and plopped it back into the broken bowl. I assessed the mess and figured I’d better get a cloth and some water to clean it up with before someone saw me. But it was too late. The man running the breakfast came over and said, “You need to put a cloth on that so no one sits in the mess.” Thank you Captain Obvious. I told him I was looking for something to clean it up with, asking where I might find a cloth or some water. I grabbed the broken bowl holding the remains of the cake — which was now dripping bright red strawberry juice on the white rug — and looked everywhere for a trash can, where I eventually chucked it.

“Oh no!” said someone else stating the obvious, “What happened?” I replied that the bowl had broken, to which the person replied, “Too much deliciousness, huh? Well, you’d better get something to cover up the mess on that chair before someone sits in it.” I put my mug of coffee on the chair in the hopes no one would sit there, but was told not to do that. “Someone will sit there anyway not seeing the mug then it’ll be a bigger mess.” I asked yet again for where I might get a cloth and some water to clean it with, and someone finally pointed me to the kitchenette.

Down the hall, I grabbed some paper towels and was handed a cloth to lay over the chair, and went back to the meeting room to clean up the damage. I was told yet again by two MORE people that I’d best not leave that mess for someone else to sit in. I was starting to get grumpy about it because it wasn’t like I made the mess on purpose! told them I wanted to remove the chair to the hallway to clean it, and everyone stepped aside so I could carry it away. In the hallway, away from the madding crowd, I hummed as I scrubbed to cover up my embarrassment, but I was completely, totally, and hopelessly beyond mortified. My hungry stomach growled. There would be no shortcake for me. I placed a clean cloth over the damaged chair (which, since it was a dark red color, actually cleaned up pretty well), but couldn’t do anything for the carpet. I reached in stealthily to grab my purse from the meeting room corner, returned to the kitchen to throw away my used paper towels, quickly gulped down as much of my coffee as I could, and snuck out the back door. I just kept thinking, “God doesn’t want me here!” It’s a horrible feeling thinking that the divine presence has rejected you.

I hung my head in shame and walked home thinking how pointless and worthless I was, not even worthy of coffee and cake. What a shame, too, because I really liked that church.

Original post: “The High Price of Depression”

Posted in depression, Humor, memoir, remember when?, sobrietyland | Tagged , , , , | Leave a comment

Bleak House

jabThere’s a sensual, seductive quality to depression. It’s magnetic. Perhaps the dark seems like a comforting place to hide and disappear from the world. Or maybe it’s just so familiar. It’s a lie that you don’t sense that until you’re in far into the thick of it and long for the light again.

It’s like sleeping with an old bad boyfriend who’s handsome and says all the right things, but is actually a horrible human being.

(Only with depression, you don’t get up in the morning and do the shame walk back to your apartment. Instead, you move in, and try to make yourself comfortable on bad boyfriend’s brokedown lumpy couch, then start whining that everything sucks, smells, itches, and there’s something black and sticky growing in the corner that you swear is staring at you.)

For me, it was bound to happen sooner or later with everything that’s been going on. The first test of my depression meds perhaps? I’m unprepared for a barrage of tests for my melancholy.

My weight hasn’t budged much this week — at least I don’t think so — so I didn’t post anything special about it. I’m still continuing Atkins though. I’ll know for sure tomorrow when I weigh in at my very last meeting ever with the Square-Jawed NP before he transfers to the new place. It still feels like an ending even though I know where he’s going and have an intake appointment at that place in about two weeks. Like it’s all bound to get skunked, the refills I have on my meds will run out, and I’ll have nothing and no one again.

And with depression and that darkness, I’d like to fight, but… meh. Too much bother.

It convinces me that my making any effort toward success is like Charlie Brown running for that enticing football only for Lucy to pull it away at the last minute. What did you expect, fool?

I’m still waiting to talk to NY State about getting back into college (that appointment comes in a couple weeks), but I have very serious doubts it’ll happen. I’ll be doing this one without NP to help defend me, and I strongly suspect they’re going to put the kaibosh on it before we even get started. If I can get them on my side, I have decided to go for a graduate nursing degree — sort of a compromise, mainly because I don’t think I’ll survive the length, breadth, and depth of medical school demands.

Of course, they’ll still probably say no, so there’s no point in worrying about it or being prepared or anything. Isn’t that what I’m supposed to say and do? Let God take the lead? Trust in God? Whatever will be will be? Tra la la?

At the core of my depression this time is a sense of pathétique. I’m not the person I used to be, and I’m not terribly proud of the person I’ve become. There’s no worth nor treasure here, not that there was much in the first place. My hair is frizzy. My fingernails are chewed down to the nub. My feet have calluses, a bunion, and two toes on each foot have developed (I think) a fungal disorder. Great.

I ran into someone on the bus a few days ago — a guy that I knew way back in grade school. While he wasn’t a good student, I was. He had nothing but a torrent of questions all at once. What I’m doing these days. I was so smart and top of my class! What happened? Why am I still in this crummy burg? Moreover, what am I doing on a bus?? Why didn’t I go be a doctor or a lawyer or some kinda astronaut or something?

Yep, you can imagine how great THAT meeting felt. While my face might still be somewhat recognizable, the rest of me isn’t.

mmjnSomeone took a picture of me on their cell phone the other day and sent a copy to my email. I was wearing what I thought was a lovely long empire-waist summer dress in a floaty black and tan fabric that catches the breeze and feels so good in this hot weather. Instead I look like Mama June if she was dragged through moldy mud.

Which is funny because when I look down at my body from my perspective, I just see me. I see a pretty, floaty dress. And when I think that other people see what was in that camera, a sort of cognitive dissonance results.

On the topic of relationships, I have mentioned to my therapists (both Marshmallow and NP) that I don’t date because nobody’s gonna want this mess. Who in their right minds would want this? Anyone worth their salt? Hardly not. (Of course I can always attract the bums outside the bus station who proposition me every day.) Undeterred by logic, both Marsh and NP see “no reason” why I shouldn’t be with someone. They say I’m thoughtful, intelligent, and witty and those are all very good qualities.

Yes, I’m sure the first thing on a man’s mind is getting himself a chick who’s intelligent and witty and looks don’t matter. Oh yeah, of course. Silly me. All men aren’t at all libidinally shallow, wanting a young, thin, beautiful girl with big, perfect boobs, and a sweet name spoken with a giggle like “Heather” for their spousal prize? Gimme a break! Stop trying to make me feel better. I’ve seen the pictures. The jig’s up, so they can give it a rest.

Running into problems along the way, no matter how small, convinces me that the world is scummy and fickle and as stinky as I am right now in this heat. Every person — even the beautiful and supposedly kind people — are secretly lowlife scum. A lady who seems like an interesting easygoing person, turns out to be a temperamental narcissist with serious anger issues. If I see them screech at someone like a wild banshee, it’s time to run the other way or be the next victim.

Just when I feel safe, it starts to break apart.

But I’m not supposed to let any of it bother me. Let go and let God and Kumbaya-my-Lord. I don’t know how to not let it get under my skin. My whole life has been spent trying to survive until the next opportunity. Until I can lose enough weight to be worthwhile (the trick of it is, it’s NEVER enough; something’s always wrong.) Or to work twice as hard as everyone else, be the best, and prove myself a success so that those who know me won’t think I’m a dork anymore. It’s because of ultimate failures in all that, I seem to have come to the conclusion that I will never be happy. The clouds will lift for a while, sure, but they’ll always return. For everybody else, this doesn’t seem to be a real problem. I don’t know why it is for me.

I was sad when I was a child. Not always, but when it hit, I couldn’t come out of my room. Then I was a maudlin, dangerously depressed teenager just waiting to escape from under my parents’ thumbs so I could prove my independent worth. And as an adult, I remained miserable. Until recently, I distinctly remember only two times in my whole life that I felt happy. One walking home one day among the yellow leaves on the autumn trees, and once for a few minutes riding in the car going by pastures and beautiful woods on a gorgeous blue-skied summer day.

Depression and I have been together as long as I can remember. I don’t welcome its return, but I sure do understand it.

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“Thou canst not think worse of me than I do of myself.”― Robert Burton, The Anatomy of Melancholy

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