Praise then darkness, and creation unfinished

The advice the GI doctor gave me on Monday seems to have done the job: my gut has been behaving since the visit, which is five days so far:

The doctor told me was to take the imodium (anti-diarrheal) twice a day whether or not I have symptoms, and start taking psyllium (metamucil). I was surprised, because psyllium is generally referred to a laxative; I suspect that's why Carmen didn't think of it. Assuming I'm still fine on Monday, I'll be sending her a MyChart message

I've taken one/day for five days, which seems to be enough. The package instructions are not to take it within two hours before or after other medication, because it can interfere with absorbtion. I'm already taking other medication on something resembling a schedule, which means this one has to be at or a little after 6 o'clock, unless I want to fiddle with the timing on something else. The schedule includes "right after I wake up" and "after breakfast." )

I just talked to Carmen. Based on the signs of inflammation in my bloodwork, she is prescribing a burst of steroids--five days of pills. Carmen said they have figured out they don't need to taper patients down from a short course of those pills.

Also, my gum has been painfully tender and I think a little swollen for the last couple of days. I mentioned that, and we decided that I should also have an antibiotic, because with my current MS drug, there are no antibodies in my bloodstream. So, I will take both sets of pills, and check back with Carmen next week, probably on Monday.

I had an easier time getting to sleep for the last couple of nights, because it's easier to find a non-painful position to lie down in. That is a good sign, but this is not going away quickly, and even with the cane, walking or standing for long hurts, so we definitely need to treat this, not wait for it to get better on its own.

On Carmen's advice, I just called the nurse at the MS clinic, and left a message briefly describing the situation, saying Carmen wants me to loop them in, and offering to send them the test results.

ETA: I now have the prescriptions, and having read the instructions, I will be starting them tomorrow morning: the doxycycline is twice the first day, then once daily, and the prednisone is daily, "before 9 a.m." but to be taken with food.

Carmen said the doxycycline "works best on an empty stomach, and either an hour before, or two hours after eating and other medications." I already have one medication I take first thing in the morning, and two others that I take in the morning, with food. Given that sleep matters, and that I have to leave here a little after ten tomorrow to see my pulmonologist, I may take the doxycycline and ritalin at the same time, and the prednisone around 9:30.

My mood and focus are both up and down unpredictably these days, significantly moreso than pre-pandemic*.

This morning I did some proofreading while cattitude was still asleep, and rescheduled a grocery delivery for this coming Thursday instead of Sunday: and a couple of hours later playing Scrabble seemed too mentally difficult. (Between the hand brace and the MS, I am going to drop tiles occasionally, and don't let this stop me from playing.)

We went for a walk this afternoon, and successfully completed a Scrabble game. I idled for a bit, cut up more cardboard for recycling, and even did another half hour of proofreading.

I have no idea what we will do for dinner, though it's likely to involve leftover chicken.

*Putting in that comparison, I feel like noting that it's not as bad as before we increased my dosage of one antidepressant and started me on a second. I am *very* glad we got that sorted out, at least mostly, when the only difficulty in seeing a psychiatrist was finding room in her schedule.

I saw Dr. Segal this morning, and told her that yes, I want to add a second antidepressant. She couldn't remember, and hadn't written down, which atypical antidepressant she had been thinking of the last time I saw her, so we discussed options starting with what I'm on now (welbutrin). After considering which antidepressants I've tried before, and likeliest side effects of the different drugs we were considering, we settled on mirtazepine, to be taken late in the day because one of the commonest side effects is sedation. ("Side effect" is an interesting term; the pharmacist asked if I was taking it for sleep.)

I asked if I can add that to the evening meds I currently take around 9-9:30 p.m., and she said yes. One dose a day, starting at 7.5 mg (half a pill) to be increased to 15 mg in a week or so if I don't have bad side effects other than sedation. Oddly (not my adjective) it is more sedating at the lower dose, so if the only problem is excess sleepiness, increasing to 15 mg could fix that. Dr. Segal also said that if it's helping, but not enough, the dose can be increased up to 45 mg/day.

Dr. Segal recommended this in part because it may help with my sleep, though I noted that part of why I'm not sleeping well is the tennis elbow, which is still at the point where my wrist hurts every time I wake up, making it harder, and less appealing, to go back to sleep.

I also filled the prescription for the diclofenac (NSAID) gel; twice a day, but I'm waiting until evening for the first dose because I had naproxen this morning.