bitter pill

When I was taking doxycycline for my acute Lyme infection many years ago, I developed a serious aversion to it. I had to force myself to swallow each twice daily dose. So great was the desire not to take it that I sometimes gagged on it and had to spit out into my hand, take a moment to visualize that it was a large tic tac, and then pop it in for another go. I often forgot to take it when I was supposed to. There were many, many nights when I had to get up out of bed, eat some crackers, and take the damned pill because I had totally “forgotten” to take it before I brushed my teeth and settled down for sleep. How did I remember after I got into bed? I had finally taped a sign to my bedroom ceiling to remind me to take the pills.

Why was it so bad? Because within two hours of taking it, I would feel HORRIBLE. It wasn’t an upset stomach. It’s hard to describe…I felt like my brain had been scrambled. My head felt like I had taken a blow from a 2×4 right dead center on the forehead. My eyes ached. I couldn’t stand light and sitting up or standing made me feel like I was going to puke and pass out.

This happened every single time I took a pill. The time frame on it might be off. It’s been a while since I was on the doxy and I tried so hard to forget the details. Some of them will stay with me for a while I’m sure but stuff like “did it start in two hours or was it peaked and falling off by two?” is information I can and therefore do forget.

When I was on the IV rocephin a year later, I had another sort of odd psychological reaction. This one wasn’t based in any physical aversion training. It was the creepiness of knowing that little port not far above my elbow was the leading end of a line that went smack into the superior vena cava. The exact placement of the end of the line was quite apparent to me since for a few days after I had it placed, every time I crossed my right arm over my chest – say to brush the teeth in the left side of my mouth – my heart would go “ka-chu-u-unk” instead of the usual “ka-thunk”. I had them pull it back some. (Yeah, like I said, I’m that patient.)

Point is, I knew it was there and I sometimes had to think really hard about not thinking about it so I wouldn’t get skeeved out. About the second week in, I noticed that if I successfully accomplished this goal, I’d forget about the line maintenance routine. So it’s flushed twice a day, once after the drug and once again about 12 hours later. On the days when I’d managed to not be thinking overly much of my PICC and where it went, I’d forget to bring my supplies with me if I was out. It was sort of a catch 22 – think about it and fret but remember to be prepared to take care of it or not think about it and be so blissfully unaware that I got caught more than once without my syringes.

These days, when I miss a pill or forget if I took one, I can’t help wondering if there’s some kind of aversion issue happening. The ones I forget now have none of the obvious displeasures associated with the doxy or the PICC line, but there are two in particular which I consistently forget to take or forget if I’ve taken. Unlike my elavil, which I seem to hardly ever forget to take and never forget if I have taken, I far too often find myself standing there looking at the package of PPIs or bottle of NSAIDs in my hand and wondering “crap…did I take one of these already?” or realizing many hours later (usually when the symptoms get raging) that I can’t remember having taken one.

I’ve considered that there may be some regularity to this pattern. The one which has worked the best and without which have an eventual visible, marked effect (weight loss) is the one I am good about taking. It’s not a simple cause and effect thing though. I don’t feel immediately or even directly better after I take the elavil. It’s a cumulative thing on a much longer time scale than I would have thought necessary to induce such an association. So what’s going on with the others then that makes them so readily forgotten?

I was thinking about this today after I got off the phone with a friend who’s been doing chemo every other week for about many months now. She’s been switched to a once every three weeks course now, but says it still sucks a bunch. I also thought of another friend who had to administer Hepatitis C treatment to herself at home (this woman hates needles) and my brother who’s taken various HIV and psych meds, all with various side effects and the occasional adverse event.

How the hell do they face each dose?

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