The unwelcomed journey back to the land of the damned wasn’t apparent at first.
Having escaped the world of the damned and back on a clumsy, but effective seizure prophylactic, I waited until my brain healed from the neurosurgeon’s saw and scalpels. Once the swelling receded and the scaring was set, I was given an EEG that, if clear, would let me say goodbye to phenytoin, be drug-free once again. As I had been for seventeen years before the rude growth under my temporal lobe slapped the epileptic label back on me.
In the neurologist’s office, electrodes were pasted to my scalp.
Then, I laid down and listened to the scratchings of spider-leg pens on a roll of paper moving slowly across the bed of a machine.
For a bit, I had a strobe light flashed in my face, and well: nothing.
Not even an aura (the recognition by the I part of the brain that there is a storm brewing someplace, and it just might erupt and knock I out).
Off drugs again! No longer an epileptic. I’ve swum across the ocean once again.
Except that was a fleeting victory.
At lunch a few weeks later, I felt the violent urge to throw up. I got up from the table and booked to the bathroom.
Then, I woke up in bed with a gash across my forehead.
Seems that as I knelt before the porcelain god, I’d had a seizure and got my head stuck between the toilet and the sharp corner of the cabinet under the sink.
Piss me off.
Frightened wife. NYFD showed up to extract my head from the jam it was in.
At least I was flattered that they were surprised at how old I was—seems I looked over a decade younger, even with a bloody face. Tiny consolation.
This meant that the scars from the surgery not only left tracks across my forehead and around my right ear but are so thick under the temporal lobe that they press on my brain, causing seizures. Just like the meningioma.
At least scars don’t keep growing.
Still, they relabeled me an epileptic for the third time and had me taking phenytoin. For the rest of my life.
Except for a few days about a decade later.
In the summer of 2017, I was on vacation with family and took a bad step on a catamaran.
One hand holding flippers, the other holding a mask and snorkel, I took a step off the last of two stairs, intending to make a sharp right toward another set of two steps on the other side of the boat. Planting my right foot pointing the way I wanted to turn, I lifted my left. Full weight now on my right foot, my heel decided to keep its forward momentum, sliding on the wet floor straight ahead. The rest of my body remained turned to the right. The fibula gave under the torque. I had nothing left supporting my body and collapsed into a loud pile, including a vulgar cry.
So, instead of eating our last dinner in Aruba together in a nice restaurant, we sat in an ER and nibbled what we could find in a vending machine. After an hour or so, I got x-rays showing clearly I’d snapped off the head of the fibula—a clean, spiral fracture with minimal displacement.
Hurrah for me!
The guy in the ER put a plaster of Paris cast on and gave me a set of instructions.
Back in Brooklyn, the orthopedist left that “temporary” brick of a cast on my leg and thus my summer was spent on a kneeling scooter—so much the outdoors.
Annoyingly, the bone, in spite of being in place and needing nothing but time for the reknitting had been taking rather too long to heal. My neurologist had been concerned about bone density for some time—seems that the sodium channel that phenytoin works on also deals with the calcium re-uptake in bones. So, off to a bone density scan.
Diagnosis: Osteopenia in multiple locations.
Not so hurrah for me.
My longtime friend is harming me. Lovely.
Usually, with osteopenia, a person just monitors it; but I broke a bone, which means action. So my choices this time:
- Various pills or injections directed at the bones and calcium
- A change in my seizure meds. To a newer, more sophisticated one, which is processed by the kidneys, not the liver.
(An aside, the same enzyme that metabolizes phenytoin is used to metabolize alcohol. In the past, alcoholic epileptics were given phenytoin and a stark choice: keep drinking and have seizures, or stop drinking and control them. Had anybody bothered to tell me this, my college years might have been seizure-less—I drank an awful lot of beer back then, especially as a freshman….)
This fancy new drug was Vimpat™, lacosamide, which treats partial onset seizures, like the kind caused by scar tissue in the meninges pressing on the temporal lobe. The sodium channel it affects doesn’t interfere with calcium reuptake. Plus no liver issues. Less drug but twice a day, which is a slight drag, but overall…
Sounds damned good to me.
Unfortunately, it also came with return tickets to the land of the damned, complete with brand new views.
Next, Part 6 of 6: the Meanings of Nausea
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Only recently has the concept of decision fatigue as a form of mental exhaustion become a subject of psychological study— decision fatigue acknowledges that
- decisions take mental energy
- that any given person has only a certain amount of mental energy
- that each decision a person makes uses some of this limited resource, and
- once this resource is exhausted, decision making turns to avoidance—
choosing the least effortful action in every case regardless of possible outcomes.
A recent study (2011) looked at boards granting parole in Israel.