i suggested to resident doctor #4 that he should send me home with topamax (topiramate), a prescription anticonvulsant which is notorious for its weight loss properties. in doing so, we could see if there is a benefit as a mood stabilizer and also test his theory that anorexia has truly adapted the way i respond to cues of hunger and appetite. if one considers my severely underweight body and knows he refers to my anorexia as "impressive" then one can understand how this was an odd place to take the conversation. he trusts me and trusts his theory-- and wrote out the prescription.
the eating disorder's influence and desire for hunger is clear without confirmation, but resident doctor #4 keeps soft balling me with ideas of trying out zyprexa (olanzapine). a notorious joke floating around about zyprexa suggests that people gain weight from merely standing in line to fill the prescription. zyprexa offers substantial sedation and, from the patient reviews i have read, has stimulated a lot of appetites.
so, he mentioned zyprexa again.
uh, no.
why would he focus on zyprexa when i do not have a psychotic illness? in my case, using traditional ssri antidepressant medications are useless prior to body weight restoration. after carrying around an underweight body for the majority of my life, i neither have intention of ever aspiring to a normal weight, nor the desire to stress vital organs with any additional mass.
as a low weight anorectic patient, i lack sufficient central 5-HT available for release and reuptake-inhibition of ssri antidepressants. this explains why the 'zoloft, prozac, paxil' branch of the psychotropic family tree offers grief rather than a reduction in symptoms. the essential amino acid precursor (l-tryptophan) availability, which i lack, is required to continue 5-HT-synthesis. the side effects from those particular ssri medicines trumped any elevated mood.
zyprexa shows potential because it functions differently. zyprexa does not depend on l-tryptophan, bypasses the presynaptic apparatus altogether, and acts via postsynaptic 5-HT2-antagonism. for me to endure a trial of zyprexa would be very exciting for resident doctor #4 because 'it will work immediately and i will experience something much different than normal' or it will not.
how could i ever accept a prescription for a medicine which lists carbohydrate cravings and substantial weight gain in its list of adverse effects? even my invalid friend chuck is scared for me to try it out. the stress standing behind the mere thoughts of taking zyprexa would kill me, even if nothing noticeable was changing with my body. i lack faith i could handle any amount of that medicine without immediately expanding into a gigantic, swelling fuss. why do this? why invite more hell when the objective is to alleviate it? the odds are not in my favor.
in the case of anorexia nervosa, agreeing to try out anything with a side effect of weight gain and edema could stir a profound weight loss. noting that a tremendous gain in weight is expected will summon my rigidity. consider how i may instead unexpectedly drop pounds due to the intense fear. this is resident doctor #4's biggest concern-- that i finally accept a trial of zyprexa, reluctantly, and *lose a lot of weight* in the process.
i am screaming inside to start sawing apart many problems being held in a no-win suspension, but i also don't want to venture out of the zone of my own familiar hell. that's right-- i am about ready to face uncomfortable changes with my eating disorder, but on the other hand, this current hell is tolerable. this life is what i know. i am scared of the different hell that any change will bring, even if it is only a minor or temporary discomfort. how does one rock the boat only sharply to the left, without having it overcompensate when it rebounds to the right? i can only see 'worse' replacing 'bad' and nothing positive.
long story short, resident doctor #4 is confident that medications with both 'appetite suppressant' or 'increased appetite' side effects will not influence the way my eating disorder functions. i should neither lose weight with an appetite suppressant, nor gain if my appetite is driven. he wrote the topamax prescription for a one month supply-- not only trusting me with what i think is a huge potential for weight loss -- but he has signed for three additional refills.
consider the negative voice of anorexia and how i can never win. the voice gnarls sentiments of 'how fat a person needs to be to score this topamax prescription which i have folded in my bag.' the anorexia is somewhat 'offended' and 'suggests' it must not be offering my body enough peril if i can access a potentially damaging 'weight loss' medicine. "you must be so fat, and if you aren't, your doctor apparently understands that you do have a pound or two of leeway. you aren't thin enough to warrant the strongest sentiment of 'you have absolutely NO weight to lose.'" now, in the opposite spectrum, any medicine known for its weight gaining properties would grant an appalled opinion from anorexia, too.
consider how resident doctor #4 sees me regularly, and that familiarity affords us a security. this prescription for my topamax heaven is not a grand error on his part, rather, this is an indication of trust.
why didn't i press him to write out a prescription for amphetamine salts or another stimulant? neither of us would want me to take a medicine which lowers the seizure threshold. this topamax will not hurt me alone-- it is a tool which should only work in relation to weight loss for those who live with uncomplicated eating or with ordinary dieting scenarios. he may be right-- it may not work. then again, he may have more faith in the way he can convince me topamax will not work. perhaps his confidence is merely a face?
so, there it is: resident doctor #4 states he honestly doubts i will automatically lose weight even though it is common and occasionally dramatic side effect. should this medicine prove not to render a reduction in weight or any type of physical experience, it will strengthen his argument for an upcoming trial of zyprexa. or, at least it strengthens an argument toward trusting his decisions.
the real answer is that if he trusts me with just about the worst thing in the world, which would be these pills, then i can do more than spit on his prescriptive suggestions.
but... regardless of everything written, philosophy is not fact. i know i will lose weight on topamax and gain considerably on zyprexa. if this topamax offers even a slightly positive experience for anorexia, a future trial of zyprexa hasn't a chance in hell.
the eating disorder's influence and desire for hunger is clear without confirmation, but resident doctor #4 keeps soft balling me with ideas of trying out zyprexa (olanzapine). a notorious joke floating around about zyprexa suggests that people gain weight from merely standing in line to fill the prescription. zyprexa offers substantial sedation and, from the patient reviews i have read, has stimulated a lot of appetites.
so, he mentioned zyprexa again.
uh, no.
why would he focus on zyprexa when i do not have a psychotic illness? in my case, using traditional ssri antidepressant medications are useless prior to body weight restoration. after carrying around an underweight body for the majority of my life, i neither have intention of ever aspiring to a normal weight, nor the desire to stress vital organs with any additional mass.
as a low weight anorectic patient, i lack sufficient central 5-HT available for release and reuptake-inhibition of ssri antidepressants. this explains why the 'zoloft, prozac, paxil' branch of the psychotropic family tree offers grief rather than a reduction in symptoms. the essential amino acid precursor (l-tryptophan) availability, which i lack, is required to continue 5-HT-synthesis. the side effects from those particular ssri medicines trumped any elevated mood.
zyprexa shows potential because it functions differently. zyprexa does not depend on l-tryptophan, bypasses the presynaptic apparatus altogether, and acts via postsynaptic 5-HT2-antagonism. for me to endure a trial of zyprexa would be very exciting for resident doctor #4 because 'it will work immediately and i will experience something much different than normal' or it will not.
how could i ever accept a prescription for a medicine which lists carbohydrate cravings and substantial weight gain in its list of adverse effects? even my invalid friend chuck is scared for me to try it out. the stress standing behind the mere thoughts of taking zyprexa would kill me, even if nothing noticeable was changing with my body. i lack faith i could handle any amount of that medicine without immediately expanding into a gigantic, swelling fuss. why do this? why invite more hell when the objective is to alleviate it? the odds are not in my favor.
in the case of anorexia nervosa, agreeing to try out anything with a side effect of weight gain and edema could stir a profound weight loss. noting that a tremendous gain in weight is expected will summon my rigidity. consider how i may instead unexpectedly drop pounds due to the intense fear. this is resident doctor #4's biggest concern-- that i finally accept a trial of zyprexa, reluctantly, and *lose a lot of weight* in the process.
i am screaming inside to start sawing apart many problems being held in a no-win suspension, but i also don't want to venture out of the zone of my own familiar hell. that's right-- i am about ready to face uncomfortable changes with my eating disorder, but on the other hand, this current hell is tolerable. this life is what i know. i am scared of the different hell that any change will bring, even if it is only a minor or temporary discomfort. how does one rock the boat only sharply to the left, without having it overcompensate when it rebounds to the right? i can only see 'worse' replacing 'bad' and nothing positive.
long story short, resident doctor #4 is confident that medications with both 'appetite suppressant' or 'increased appetite' side effects will not influence the way my eating disorder functions. i should neither lose weight with an appetite suppressant, nor gain if my appetite is driven. he wrote the topamax prescription for a one month supply-- not only trusting me with what i think is a huge potential for weight loss -- but he has signed for three additional refills.
consider the negative voice of anorexia and how i can never win. the voice gnarls sentiments of 'how fat a person needs to be to score this topamax prescription which i have folded in my bag.' the anorexia is somewhat 'offended' and 'suggests' it must not be offering my body enough peril if i can access a potentially damaging 'weight loss' medicine. "you must be so fat, and if you aren't, your doctor apparently understands that you do have a pound or two of leeway. you aren't thin enough to warrant the strongest sentiment of 'you have absolutely NO weight to lose.'" now, in the opposite spectrum, any medicine known for its weight gaining properties would grant an appalled opinion from anorexia, too.
consider how resident doctor #4 sees me regularly, and that familiarity affords us a security. this prescription for my topamax heaven is not a grand error on his part, rather, this is an indication of trust.
why didn't i press him to write out a prescription for amphetamine salts or another stimulant? neither of us would want me to take a medicine which lowers the seizure threshold. this topamax will not hurt me alone-- it is a tool which should only work in relation to weight loss for those who live with uncomplicated eating or with ordinary dieting scenarios. he may be right-- it may not work. then again, he may have more faith in the way he can convince me topamax will not work. perhaps his confidence is merely a face?
so, there it is: resident doctor #4 states he honestly doubts i will automatically lose weight even though it is common and occasionally dramatic side effect. should this medicine prove not to render a reduction in weight or any type of physical experience, it will strengthen his argument for an upcoming trial of zyprexa. or, at least it strengthens an argument toward trusting his decisions.
the real answer is that if he trusts me with just about the worst thing in the world, which would be these pills, then i can do more than spit on his prescriptive suggestions.
but... regardless of everything written, philosophy is not fact. i know i will lose weight on topamax and gain considerably on zyprexa. if this topamax offers even a slightly positive experience for anorexia, a future trial of zyprexa hasn't a chance in hell.
