Cymbalta and fibromyalgia, my experience

Since being diagnosed in 1992 I’ve tried quite a few medications hoping they’d help the symptoms of fibromyalgia. Only two have made the cut; most of the others had no effect, or (like pregabalin and Lyrica) were too sedating to find out if higher doses would work.

Currently I take only two medications for fm: a very low dose of trazodone, an old (generic and cheap!) anti-depressant, to help me sleep, and a new anti-depressant, Cymbalta. The Cymbalta is actually for depression. I began it after the previous anti-depressant, Celexa, stopped working. I didn’t know it had stopped working, I thought I was just feeling how I felt. Dark horizons closed in on me and I saw that life really was merely a period of pointless suffering, so I told the doctor who prescribes for my depression that I thought I might as well quit taking anything and just experience reality. Afterwards I was embarrassed at my lack of insight into my own mental processes, but by its nature depression’s a condition that disables self-analysis and replaces it with the exquisite existential pain of being alive and aware. This is why depression thrives on the isolation it so effectively induces.

To be honest I must say I still feel there’s a strong intellectual case to be made that “life is merely a period of pointless suffering”… except that the medicated me retracts the word “merely”. And knows that the intellectual perspective is not the whole picture. Like an extremely protracted wait in an airport, life can be viewed as just something to endure, or you can notice what’s going on around you, help out some other travellers, go explore a different part of the airport, meet other people, and so on. Then, indeed, you die. But in the meantime, why not make the most of where you are? There are pleasures to be found, skills to master, a marvellous natural world of birds and bugs and clouds, and considerable satisfaction in doing something that lessens the overall quotient of crappiness and suffering. It’s even possible to find other people whose company you enjoy, people you love.

But without a functioning anti-depressant, I did not feel this way. So is it the “real me” speaking now, or just a chemical? Or was it a chemical imbalance that made me feel even worse than this guy (Joe Btfsplk, from Al Capp’s Li’l Abner)? Irrelevant hair-splitting. Unproductive line of investigation. Phooey on it.

Okay, so, Cymbalta works for me (for now) as an anti-depressant, but what about the fibromyalgia connexion? It’s touted as a drug that helps with fm pain, which is why my doc and I agreed on using it despite its expense. At first I noticed no difference. Pressure is still pain, it hurts to hold onto the steering wheel or lean against a wall or sit or stand. Then the doc asked me, after using it for the better part of a year, if it had helped the fm. Didn’t really think so. Later, I looked back over what has changed in that period and there’s one huge thing: I have been able to stick with an exercise plan of walking, to the point where I could walk 2 miles with the first mile being all uphill. And when I challenged myself after a while to walk the uphill mile without stopping I found I could. Always before, no matter how gradually I increased the exercise, within a couple of weeks (or less) my pain and exhaustion would spike so much I’d have to stop for 5 or 6 days. You never get any “training effect” that way. You’re always struggling and always being knocked back to the starting point. This fantastic feature of fibromyalgia (and of chronic fatigue syndrome) is called post-exertional malaise.

Unlike my previous anti-depressant, Cymbalta (Duloxetine) doesn’t just increase the amount of serotonin available in my system, it does the same thing for norepinephrine. What does this mean? Here’s a clue: norepinephrine is also called noradrenaline. It’s secreted by the adrenal glands and, along with adrenaline, it has actions throughout the body and also in the brain, mostly aimed at revving you up—increasing heart rate, blood pressure, and blood sugar; raising the metabolism; in general, preparing the body “to take immediate and vigorous action”.

Since even the researchers aren’t sure exactly how anti-depressants “work”, I’m not going to delve into it any further here. Suffice it to say that some part of norepinephrine’s action enables my body to deal with exercise more normally, and adapt to it. My walking muscles have gotten stronger, my aerobic endurance has increased, and I’ve even gotten to where at the top of the hill when I branch off onto a level road to cool off before the descent, I feel really good! Like I could walk for hours! That’s something I never thought I’d experience again, the enjoyment of physical exercise and of getting a little fitter each time. It’s probably partly the oft-mentioned endorphins that those smug runners get, and partly personal satisfaction at achieving the goal once again.

Each time it gets a tiny bit easier. At first when I started doing the uphill half without stopping I was flogging my body onward, unconscious of anything around me, totally absorbed in persevering. I had to sit down at the top, out of breath and exhausted. Now, I walk on for another 15 or 20 minutes (not uphill—yet!) without difficulty and then head back. Sometimes I have minor muscle soreness that lasts a day or two, and one knee protests that it is too old for this, but I’m not in pain and drained of energy for days as I used to be (prior to Cymbalta) after doing short level walks.

The catch about Cymbalta is the expense. I take a high dose, 160 mg/day, and it costs about $10 a day. (Last quarter the manufacturer, Eli J. Lilly, made profits of $1.2 billion on total revenue of $6.25 billion; 20% profit, not bad.) My insurance, the Medicare Drug Plan, covers most of it and so do some regular health insurance plans. It’s prescribed for depression, fibromyalgia, neuropathy, and some forms of chronic pain. There will be no generic version until the patent expires in 2013. Online ads for generic cymbalta should be regarded as scams, as if someone wanted to sell you $20 bills for $5. It can’t be the real thing from the manufacturer, and you have no idea what it might be.

There is an organization, The Partnership for Prescription Assistance, which “helps qualifying patients without prescription drug coverage get the medicines they need through the program that is right for them. Many will get their medications free or nearly free.” This organization is sponsored by America’s pharmaceutical research companies. There is no charge for getting help from the PPA. You can find more information about them here. Your doctor may know about other ways to save money on prescriptions; ask! Also, inquire about free samples to get started and see if it helps you.

For the first time ever…

My blog has been dormant since early this year. During this period my husband went through four shoulder surgeries, and is now facing spine surgery. In a later post I’ll describe parts of all this which may be useful to others. But for now I am going to ease back into blogging with a short simple post.

As an older adult, I feel it’s not too often I do something for the first time ever. But Friday, while pursuing the sedentary pleasure of reading in the shade on our deck, I got to sit in the shade of trees I helped plant! And it felt good.

Over the years I have planted trees here and there, even sprouted acorns and popped them in the ground, knowing I would not be around to admire them when they got really big. I remember thinking once that I hoped someone somewhere was planting trees for me. Of course it’s true, “someone else” (including a host of squirrels, bluejays, and other animals which transport and hide seeds) has planted all the trees we gaze upon, eat the fruits of, and climb. But now, thanks to fast-growing seedlings from our two old birch trees, I sat in shade my husband and I had planted. It really did feel different, quite satisfying.

Birches make lots of little seeds which glide on the wind, sprouting wherever they encounter a moist spot. The slender trees now shading me started as little guys that I potted up to adorn the front deck; after a few years they outgrew their pots and were planted as a group. They’re prettier that way, and because the nature of birches, it takes several to make a sizable area of dappled shade.

We also have planted our own aspen grove, five that we bought in big pots, and they are doing well. Our hot dry summers and fast-draining soil (that’s a flattering term for it) aren’t ideal for either aspens or birch so I water them once or twice a week in the summer, and that seems to be enough.

I always marvel when I see houses without any trees: no shade, no windbreak, no fruit, none of the other comforts that trees offer us.

If your surroundings are lacking in trees, don’t wait for Arbor Day next spring. Plant some this fall and they’ll be ready to grow in spring. Get some advice on what does well in your region (use natives as much as you can) and what fits your needs with regard to questions such as year-round shade or not, growth rate & eventual size, likes to be in a lawn or not, species that provide food for birds or butterflies, blooms or fall color, amount of leaves and seeds to be raked if that is an issue, and so on.

Look for nursery sales as they pare back their holdings before winter; you can get some good deals. Or, just start your own. Some trees are pretty easy to grow though you’ll wait longer to sit in their shade, of course. Willow cuttings will grow readily if they get water; acorns can just be pushed into the ground and some will grow. There’s an inspiring short tale (The Man Who Planted Trees, by Jean Giono) about a shepherd who over many years revivified a desolate area by planting acorns each day as he followed his sheep. It’s fiction, but full of truth. Tree roots help stop erosion, their leaves cause the rain to fall more gently promoting absorption by the soil, their shade cools streams for wildlife and shelters other seedlings, their flowers, leaves, and seeds are food for many animals, and their presence gives birds, insects, and mammals places to live, breed, and hunt.

As Thomas Jefferson wrote, “I never before knew the full value of trees. My house is entirely embossomed [embosomed] in high plane-trees, with good grass below; and under them I breakfast, dine, write, read, and receive my company. What would I not give that the trees planted nearest round the house at Monticello were full grown. “ (in a letter to Martha Jefferson Randolph, July 7, 1793).

Two months before his death, at the age of eighty-three, he designed an arboretum for the University of Virginia. Such an epilogue to years of planting at Monticello was perhaps inspired by Jefferson’s own adage: “Too old to plant trees for my own gratification I shall do it for posterity.” (This and more about Jefferson and his tree-planting here; the aerial photo is of Monticello.)

To which I add: Leave the soil at the bottom (that will be beneath the root ball) undisturbed to avoid settling. If the tree is bare-root, gently spread out the roots over a cone of soil. Don’t stake unless really necessary, for instance when planting on a slope. Finally, water it in, and water regularly for the first couple of years or more depending on your weather. More tips here.

Bin Laden’s death, a different point of view

The American media’s orgasm over the reported killing of Osama Bin Laden is unseemly and ill-advised. Here is why I think that.

Unseemly

Our morning newspaper had a single-word headline in huge black type, over Bin Laden’s photo:

At least they put quotation marks around it, appropriate to indicate a mis-applied word. And such an important word, too, concerning which we Americans have a particular pride. The United States: nation of laws.

The killing of Bin Laden was, of course, no more “justice” than a lynching is. What was it? Justifiable, yes; revenge sweet on the tongue of Americans, yes; necessary, perhaps—if only to tie up a politically embarrassing loose end.

I recognize that it was an impossible situation. There is no place on this planet, except perhaps Antarctica, where this man could have had a safe and reasonably public trial. Even if the trial were held at Camp McMurdo, there would predictably be suicide bombers elsewhere, mass murders of the innocent, just because.

So it had to be death, not capture. But having done it, let us not revel in it. And we might have done it better.

We could at least have pretended that we killed Bin Laden “during the fire fight”. The President in his address said “After a firefight, they killed Osama bin Laden and took custody of his body”. And Obama is a famously careful and considered speaker. Admitting that it was a deliberate killing, not one necessitated by combat, is honest, but it will enrage Muslims even more.

Ill-advised

The more we gloat, the more payback we will receive. No one should imagine that we have in any way made the US or the West safer by this deed. Islamic extremism is not a snake with one head to be cut off, or even two heads; as terrorism experts have endlessly told us, al Quaeda has for some years been a “franchise” with branches in many locations, and there are Muslims everywhere capable of low-budget, virtually impromptu, attacks. This is not like killing the political leader of an enemy nation; the root of the strife is no nation, but a religion.

Having killed Bin Laden we quickly disposed of his body to avoid the martyrdom issue; it might have been wiser to capture him, film his execution for later broadcast, and then drop the body in the ocean. He’ll be a martyr to many anyway, without doubt, and filming him alive and then showing his death would undermine the inevitable rumors that it’s all a hoax.

In matters concerning survival, clear thinking must be chosen over pleasing though misleading emotion. This is my effort.

Siskiyou wildflowers – 4/10/11

The wildflower season is beginning here, during a strange spring with early warmth and late snows, but truth be told the first wild flower to bloom at our place was back in February, and it was this one:

Look familiar? It’s the much-maligned dandelion, Taraxacum officinale. If it weren’t such an invasive and persistent plant, we would find the flowers quite attractive: they’re numerous, vivid yellow against a basal rosette of dark green leaves, and have an attractive seedhead. The seeds exemplify a smart strategy too, in that they don’t require pollination to develop. You may have noticed this when looking into a container where you have discarded dandelion flowers or plants that you uprooted. The buds—even if not open when the plant was pulled—often go on to open and develop seeds via a process called apomixis. The seeds will be viable.

The first two showy blooms of what we usually call wildflowers began a couple of weeks ago with Henderson’s Shooting Star, Dodecatheon hendersonii

and the Trout Lily or Fawn Lily, Erythronium hendersonii.

It is a good year for the erythronium, with many having 2 or even 3 flowers, and both leaves and flowers often larger than we’ve seen them in the past.

The darkly mottled leaves give these plants their common names of Fawn Lily or Trout Lily, and I find them quite beautiful though hard to photograph. The surface is never quite in focus; perhaps there’s a covering of microscopic hairs that interfere with my camera’s auto-focus function.

Individual Trout Lily blooms have a short life; in a week they’re fading and withering. But we will be able to find them for a few weeks longer as they bloom at higher elevations or in shadier spots. Mixed sun and shade seems to be their preference.

This plant on a steep sunny slope in scree has, I think, been the “victim” of aggressive wildfire fuel reduction efforts about a month ago that removed most shrubs and small trees and caused decomposed rock from above to come down the slope. Few plants of any sort appeared through the scree, and I’d be surprised if the several erythroniums I saw today are there next spring.

A plant with four buds, more than we have ever seen before.

Both of these native wildflowers are named for “The Grand Old Man of Northwest Botany“, Louis F. Henderson (1853-1942). You can read more about him here, and even see a photo of him with a smile on his face. Nineteenth-century scientists maintained grim demeanors for their portraits (perhaps just conforming to the expectations of their time, but of the people I see on television these days the ones who look truly happy are mostly field scientists like geologists, palaeontologists, and botanists. Cosmologists and astronomical scientists also look cheerful and absorbed in their future work. Zoologists generally look concerned, as they’re usually asked to talk about how the creatures they’ve studied are threatened by human activities.

Previous posts (2009, 2010) about E. hendersonii.