Taking Ownership

“I don’t believe you have epilepsy.”

I was afraid to look too excited at what the neurologist said, afraid to want something so much that I’d make it happen. I pushed the heels of my hands down into the vinyl seat of the chair. I looked at the oatmealy floor. “I don’t?”

“You don’t.”

A year ago, I took ownership of epilepsy. That word. My diagnosis didn’t change my reality, but it sure as hell changed my feelings. It changed my routine. More sleep, no booze, less stress. It changed my future. This was my new life.

Two months ago, I stepped out of a Sprouts market and into the sun. I’d only been inside for five minutes to use the restroom. I stalled on the sidewalk, blank. I had no earthly idea where I’d parked my car. It didn’t take long for fear to settle into the spot where a simple memory of my parking spot should have been. Did I park on the right? The left? How far back? Was I even parked in the lot? I was scared. How could I not hold a thought for five minutes? If I stood there, would it come to me? It did not.

Three months ago, I sat down at a table under the redwood in our yard to review a novel for Kirkus. I’d read the book. I’d made notes. I had opinions. I’ve written countless reviews. Pull quotes from the text. Fight through frustration. Explore. But that day, language failed me. Every tenth or so word felt like it was behind a cloud, inaccessible. I just couldn’t remember them. Not complicated words. Words like ordinary. Words like compare. Words like implication. Being unable to conjure your own language is terrifying.

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Fall 2017: Struggling so hard. Headed for a seizure.

A year ago, I woke up from a nap with my face covered in blood. My tongue was split on the side where I’d mashed it between my molars. I felt misery, head to toe. Stiffness, a cold dread. I submitted myself for prodding and scanning: EEG. MRI. Neurology. Referral. After that seizure and a series of subsequent episodes where I bit my tongue in my sleep, my doctor prescribed Topamax to address my dual brain issues: epilepsy and chronic migraines. Topamax is no joke. It requires gentle ramping up; it makes the patient lose weight, and it affects cognition more than a little. Soon after beginning the drug, I was plodding around, dazed. I was tired all the time. My thoughts were unclear. My doctor assured me that the fogginess would settle.

It didn’t settle.

First to go were names. I would be telling a story, and I’d forget the name of a coworker I’ve worked with for over ten years, someone I talked to daily. Was I good at covering and laughing it off? I didn’t want to think about that for too long. I developed tricks to mask my blank memory. “Tell me your last name?” I would say as a student of six months came up to ask me about her grade. I relied too heavily on the class seating chart. Thankfully, none of my students called me out. My friends kindly ignored my pauses. After names, I lost chunks of text. Stories I knew and had taught for years disappeared from my mind. When my students would ask about something they read in the chapter the night before, I’d say “show me where in the chapter that is?” and hope (again) the moment would pass. I struggled to pull my thoughts together about a book. My ability to connect anything was gone.

Topamax affects speech and memory in the brain. Aphasia–difficulty with speech and language–is just one of its side effects. So are memory loss and confusion. After months of Topamax, I was “losing farther, losing faster…” like some fucked up “One Art.” I tried to write that review for two hours in our backyard, then I went to find my husband. “I can’t write,” I said, feeling the prick of tears in the corners of my eyes. “Not like I don’t want to, or I don’t know what I want to say. I can’t find my words. I can’t get to them.”

I was sad and confused. I tried to continue with both of my jobs: teaching English to reluctant high schoolers all day, reviewing books in the wee hours of every morning. But I couldn’t concentrate–not on my own narrative or any story. I define myself entirely in terms of comfort with language. Everything I do involves words. The phrases we own and the stories we remember become our personalities. I’m wary, when I write, of my syntactical habits; I’m suspicious of what writes easy. But I know I have to write to survive. Both of my jobs require fluency, ownership, and memory. I love to find patterns, to connect disparate ideas. What does a novel mean? How can I capture the diction of a passage? Does this book do what it sets out to do? How do we access the world it describes? What questions does it ask? Topamax blurred those thoughts. Every page I read was separate. Each sentence, its own thing. Teaching was exhausting. Reading and writing were near to impossible because the Topamax moved into my head.

People in epilepsy forums call it “Dopamax.”

Two months ago, after losing my car, I told my neurologist I wanted to wean off of the drug. I wasn’t living if I couldn’t write or speak. “I’m done. I can’t take this anymore,” I told him. He gave me instructions to stop taking the drug. But to my horror and surprise, he also told me flatly that if I stopped, I was at risk of dying suddenly in my sleep. People with nocturnal seizures are at risk for SUDEP: sudden unexplained death in epilepsy, he said. Off the drugs, the risk increases. At no point in the last year did he bring up SUDEP; it only came up now as a threat to make me take the medication. My feelings about sleep became complicated, which isn’t good for someone trying to avoid nocturnal seizures. I did a lot of crying. I took Topamax for two more weeks, but I didn’t feel like myself. I talked to my husband and finally decided that fear of dying was keeping me from living. I weaned myself.

Off the Topamax, things brightened. I found words. Clarity returned to my brain like blood through a sleeping limb. It was time for a second opinion.

This Thursday, I sat in an office at a local epilepsy center. I recounted my story to a different neurologist who specializes in epilepsy and seizures. He’d already reviewed my record. He listened patiently for a half hour as I gave him dates and symptoms, my story of observations and lists. He asked specific questions about each episode where I’d bitten my tongue. He agreed that my initial episode was a seizure, caused by sleep deprivation and stress. But he had a different opinion than my original neurologist about my subsequent episodes of tongue-biting.

“I don’t believe you have epilepsy,” this new neurologist said.

A year of Topamax. A year of fog, and panic, disordered memory. A year of teetotaling. A year of consternation. Laconic speech. Panic about death in my sleep.

“I don’t?”

“You don’t. I believe you had one seizure, but the rest of these ‘episodes’ aren’t actually seizures. I think you damaged your tongue during your seizure, and now it’s sensitive. I think the biting is caused by your tongue resting between your teeth. We know your seizure’s cause–sleep deprivation–and if you haven’t had another one, you don’t have epilepsy.”

I don’t have it. That word. Now I’m hoping to take the rest of them back.

What’s in a name?

I have Epilepsy, and I feel a little weird about it.

You will remember that I had a rough autumn of bad health: headaches and insomnia and tongue-biting in my sleep. I felt like I couldn’t control my stress, and I was on the verge of tears all the time. My doctor thought I might be having nocturnal seizures, but he didn’t know for sure. My EEG was inconclusive, even though I bit my tongue in the middle of it. He gave me a long list of things to do to improve my health, and that was overwhelming and hard. Many of those things were for the migraines, and a few were for the seizures: cut out all caffeine, make sleep your new religion, cut the stress. Plus the old medical standard: wait and see.

I started taking Topamax to treat both problems: the chronic migraines I’ve had since my twenties, and the [maybe] seizures. If I stopped biting my tongue, that would tell us something. Well, I stopped biting my tongue. I started feeling way better. It’s amazing how groovy you can feel when you’re not biting your tongue all the time. About three months into the meds, I had another appointment with my neurologist, and he said that we could assume it was seizures, and I should stay with the meds.

Then as is always the case in the spring, I started having discussions at work about next year’s teaching schedule. Immediately, my stress level was through the roof. My health was better, but barely. Worrying about it getting bad again was going to make it bad. I tried to be honest about my health issues and take things off my own plate, but I struggled to say no because I’m a wimp. I felt like I should have a doctor’s note on file so it would be clear that I wasn’t making this stress/seizure stuff up. It’s hard to explain something that you can’t see. It felt like dumb excuses. I asked my neurologist for a letter that explained my condition. I didn’t know how to convey what it was, anyway. Did it have a name? Was there something more specific than nocturnal seizures? Could he put it down on paper in a way that would make sense so people wouldn’t have to Google what was wrong with me?

He did. It took about a month, but he finally sent me a letter, which said, “Heather has nocturnal seizures caused by Epilepsy.”

What.

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The funny thing is that I wanted the letter so nobody else would have to Google anything about me. But the letter sent me Googling. What the Google Machine told me is that Epilepsy is what they call repeated seizures without a known cause. So: me. I think my neurologist didn’t use the word at first because we didn’t know, and then he was just being more specific, referring to the specific type of seizures.

This is what I tell myself, anyway. Because he just hadn’t used that word at any time before.

But I feel better than I’ve felt in a long time. For at least the last 15-20 years, I had a terrible daily headache, and I woke up every night in the middle of the night with anxiety and insomnia. That’s not happening, anymore. I still get headaches, but they’re rare, and they usually have a specific cause. I’m still sad I’ve had to cut so many things out of my life–don’t get me wrong. I’m pretty much off caffeine, soda is gone, and I haven’t had a drink since October. I don’t take OTC pain meds more than twice a week. But I’m at a point where decaf tastes like real coffee, and the amount of uninterrupted sleep I get has made a notable difference in my energy, anxiety and migraines. The meds help, but I think that all the lifestyle changes were huge. Damn it.

And I’m not having seizures. To my knowledge, I’ve only had two since October. One, about a week after I started on the meds, and another a few weeks ago. Both times, I was up way too late, and I was unusually stressed. That tells me that what I’ve been doing is working. Sure, it stinks to leave our friends’ houses early, or to go upstairs when my whole family is still hanging out, but I’m better.

Not having seizures all the time is great. I can recommend it.

What we call things doesn’t give them any more power than they have on their own. I know this. As Eric says, nothing is different in my body now that I have that letter. And yet: feelings.

My 60 Day Caffeine and OTC Pain-Med “Wash-Out”

I hate my neurologist.

Of course, this isn’t a static emotion. What was first a panicky hate for his long list of changes has grown into an affectionate grumpiness for the smart man I wish hadn’t been right. Damn him.

In September and October of last year, I kept waking up to bite marks in my tongue. Bad ones, ever-worsening. Besides being confusing, they made teaching difficult. One day I woke up from a nap with my face covered in blood from a deep wound in the right side of my tongue. I didn’t wake up when I bit it. I felt like shit: heavy, weird, and confused. Every muscle ached. Fearing I’d had a seizure, I made some doctor’s appointments.

I was worried because there is something in my head. This isn’t a figure of speech. Midway through getting my MFA a few years ago, when my migraines increased, I had what seemed like a cursory MRI before I could be put on Topamax, a daily migraine medicine. During that MRI, the technician slid me out of the tube and asked me a bunch of questions that were too pointed to seem normal. Have you ever had an MRI before? No. Have you ever had any head trauma? No. Are you sure? Yes. Has anyone ever told you that you had any abnormalities in the left side of your head? No. And at that point, the technician told me she needed to push me back in and do the MRI all over again because she couldn’t be sure of what she saw. My Ativan had worn off. I couldn’t reach my ears through the head cage to get the earplugs back in. I lay there and I cried through the booms and clangs, in full panic attack. What was in my head? An arachnoid cyst, just behind my left ear. My general practitioner wasn’t great about helping me understand it. She sent me an email. She said they’d keep an eye out, wait to see if I had any neurological symptoms. And that was that, for a few years. So when I bit my tongue, when I suspected this might be a seizure, I was terrified.

I promise you, this is about coffee, too. I’m getting there.

My tongue-biting episode led me to the neurologist, which is where I should have gone after that first MRI. He asked me if I wanted to see the last few MRIs of my head. He showed me the surrounding, healthy, brain tissue. He told me I was probably born with the cyst because my brain had grown around it. He said that it couldn’t be causing either my migraines, or the episodes I was having now because of both where it’s located and how it hasn’t changed in several years.

See? I told you he’s smart. He’s kind and comforting, too. That made it hard to ignore him when he told me that I needed to give up caffeine and all OTC pain meds for two to three months if I wanted to make my headaches better.

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“How often do you take over-the-counter pain medication?” he asked.

“Oh, I don’t know. Probably four days a week?”

“How much?”

That answer was too high.

“And how many cups of coffee a day?” he gestured to the cup in my hand.

“Oh, this? This is green tea.”

“Green tea has caffeine in it, too.”

“I know. But, uh. Just one cup of coffee a day.” His fingers fluttered across his keyboard.

Diagnosis: rebound headaches. People like me who have chronic migraines can get them from being too used to caffeine and over the counter pain meds.

Prescription: cut out all over the counter pain meds, any use of Imitrex (a migraine medicine I take when I get one), and all caffeine for two to three months. A “wash-out.” After the “wash-out,” I could return to these things, but in an irregular pattern. Caffeine was okay, as long as it wasn’t every day, and I had to do one week a month with zero caffeine. Pain meds no more than twice a week. The hope was that it would lessen my headache frequency.

“It’s going to be hard,” he said. “Your headaches are going to get worse before they get better.” No Tylenol, or Motrin, or Excedrin. Nothing. No coffee, or green tea, or black tea.

Cool.

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He wasn’t wrong. The two weeks I cut caffeine were awful. I weaned myself with decaf (first three quarters caffeinated, then half, then one quarter, etc), then decaf for a few days, then nothing. Water and herbal tea only. It sucked. When I say “it sucked,” I mean that I had headaches and I was tired and I hated everyone and my body ached. And I wanted to murder my neurologist a little bit.

He also cautioned me that in order to stop the seizures, I needed to get at least eight hours of sleep, and I needed to “reduce my stress.”

Sure, Buddy.

This is my sixteenth year of teaching high school, but it feels like my first. We have all new curriculum–entirely new anthologies–as well as new novels at each grade. I teach two grade levels, which means I am teaching something new to me four times a day, every day. Not to mention learning one hundred and fifty personalities and trying to accommodate each soul as it needs to be taught. We also have an entirely new, entirely confounding computer database this year (and in the fall, I was a trainer for our staff), and the combination of new computer system and 180 days of new literature–times two grades–proved to be more than I could fit into my brain. By the second month of school, I wasn’t sleeping. I would wake up at 3:00 AM, worrying, and I’d think, well, that’s an extra hour of work I can get done. I’ll just get up and create a user guide for the computer system. I was borrowing sleep from both ends of the day, falling asleep late and getting up early. Usually I would wake sometime in the middle of the night to go to the bathroom and I’d lay awake trying to make lists of all the things I needed to do.

Sometime last fall, my friend Lizi sent me this podcast from NPR, with scientist Matthew Walker. It inspired me to start harassing my children by telling them that “sleep is the Swiss Army Knife of health.” I believe it, though. The podcast is wonderful, and I can also recommend his book. Cliff Notes version: if you ain’t sleeping, you gonna die, friend. I was putting myself at risk every day. The real science behind how much we need a real chunk of sleep is pretty scary, and my recent brush with nocturnal seizures is proof that I need to stop messing around.

Robbing my sleep was the worst thing I could do. I just didn’t know. I’m a morning person because I like the peace of a quiet house. I like the sunrise and the sound of the coffeemaker. But that means I need to be an early-to-bed person. I like knowing that I’ve given time to the most important task on my list so I won’t have to worry about it for the rest of the day. But I was taking so much time from sleep that my body was shutting down. My neurologist diagnosed me with nocturnal seizures. (Biggest contributing factors: sleep deprivation and stress). Since I left his office in November, I’ve been religious about sleep. I’ve set an alarm to get in bed (not to sleep, but getting in bed about an hour before I want to be asleep makes a huge difference). I try for eight hours, but I usually get about seven and a half. You know what’s happened since I started getting all that sleep? I haven’t been sick once.

Giving up coffee was emotional, in a surprising way. I didn’t realize how it was linked to writing and reading, entirely a part of my routine. I got past the caffeine withdrawal after a few weeks, but I never made it to a point where I didn’t miss the emotional pull. I gave up soda, too, but I couldn’t care less. But at 8.5 half weeks, when a bad day finally sent me over the edge and I gave up on this “wash-out,” it was because I needed a cup of coffee. For my feelings. This process has taught me both that I have a serious lack of vices, and that I am tied more to a daily cup of Joe that I thought. More than once as I tried to muscle through, I thought, maybe it’s just worth it to have headaches, because I really, really love coffee so much.

But of course my doctor was right. After the initial miserable pain, my headaches lessened. I still have them, but more more infrequently. Not being able to take even a Tylenol made me pay attention to headaches before I got them. Before, I’ll admit that I’d just get a headache, and then worry about it later. Now, I’m more likely to try to prevent one before it starts. I’ve found that a lot of my headaches are from bad posture: specifically, sitting badly in bad chairs. I sit to read or type for long periods of time. I need better neck pillows and desk chairs. My tension headaches often turn into migraines (I had three migraines during my “wash-out,” and I couldn’t take anything for them. That was fun.) An added side effect of cutting caffeine was that I slept better.

I found that without coffee, I ate more. I had less of a reason to get out of bed. (Who gets up for tea? Not me.) I realized I drink coffee when I’m bored, rather than eating. I also found that I had to be more honest with myself about how much caffeine I’d been consuming before. Sure, I only drank one cup of coffee when I was home, but if I was out, one “cup” meant a Venti black coffee, and usually a large iced tea somewhere else in the afternoon. Oh, and when I was stressed last fall? I’m sure I was also pounding down the Coke Zeroes. So if I really think about that answer I gave the doc? It wasn’t honest because I wasn’t telling myself the truth. No wonder I had headaches, and no wonder I couldn’t sleep. The other thing this taught me is that most people are completely stupid when it comes to how much caffeine they’re consuming. Decaf is not caffeine-free, dummies. Now I know that herbal tea is just gross water (I never really got on the herbal tea train, although I will say mint tea and chamomile are the least offensive of the herbal teas), and it’s not good, but most people are just downright ignorant about what they consume.

I made it 60 days without coffee or pain meds. I couldn’t do the full three months, but I’m still glad I did it, and I do feel like it had a positive effect on the number of headaches I’m having. For now I’m sticking to decaf for as long as I can, and I’m still not drinking coffee every single day. More importantly, I’m still trying to sleep close to eight hours, and I’m practicing saying no to the constant demands on my time. That’s the hardest part of all of this. It feels like my health is under control, but barely. I need practice.