Too Damned Hot Already!

95°F=35°C= too damned hot for the month of March, even in Southern Arizona.  But wait, “there’s no such thing as climate change.”  That must mean that it’s now normal to have temperatures >15 degrees above normal, in a sustained fashion, two years in a row.  OK, I’ll try to squeeze yet one more incongruity the size of Texas into my pea-sized brain.  

For reasons that are well explained by Ayurveda, my tongue got the word about the heat wave first:

That thing that looks like a small liver on the underside of my tongue is an aphthous ulcer.  It’s the classic “punched out” kind.  Makes me feel pretty damned punched out, let me tell you.

That was a few days ago.  The ulcer kind of propagated into the back of my mouth and throat.  I’ve been literally living on aloe vera juice and coconut water, which I leave in the freezer and sip on.

It occurred to me that this was rather more ulcer-ness than I’m used to.  I get them every few weeks or months.  A Crohn’s thing, you know: it’s a “mouth-to-anus” disease.  Meaning that, lesions can occur anywhere in there.  And do.  

My brain survives and at times even thrives, by continuously scanning for outliers.  That’s how the prey animal survives.  That ripple in the tall grass that wasn’t there earlier?  Lion.  That shadow in the water?  Crocodile.  

Those bizarre mouth ulcers?  Could be just the ol’ Crohn’s monsters.

And on the other hand…there’s lamotrigine (Lamictal®).

Ever since I landed in the hospital in 2001, and ever since the amateur psychiatrist who tried to kill me with every antidepressant under the sun nearly succeeded, and ever since she thankfully went on vacation and left her on-call beeper with the brilliant neuropsychiatrist who correctly identified my brain as bipolar, I have faithfully taken my “L&L cocktail” every day.  Lamictal in the morning, lithium at night.

It’s worked better than anything else.  It’s been my staple.

There’s a problem, though.  It’s been a theoretical problem, till now.

Lamotrigine has one major potential adverse reaction.  It doesn’t happen often, but when it does, it can be devastating.  It’s called Stevens-Johnson Syndrome.  (The linked article downplays what the syndrome really looks like….)  It’s a known and much-feared adverse event that’s associated with Lamictal.  That’s the reason for the very slow dose buildup, if you’ve ever taken it, and the huge black box warning that says if you ever get these nasty lesions, stop taking Lamictal immediately.

My tongue up and turned completely white, then started peeling.  I put my Lamictal away.  Increased the lithium dose by 25%, got out some high CBD cannabis to help with the transition.

If you take medicine for brain stuff, you just naturally deal with side effects.  How not?  Most of this shit we dump into our bodies, no one has any clue what they actually do, outside of the one thing they have to look at for the studies.  Beyond showing that this does or does not increase dopamine levels in the brain, for instance, researchers are not able to predict every single one of the thousands of other chemical interactions a medicine may set into motion all around the body.

Fortunately most side effects are merely unpleasant but not life-threatening.  Stevens-Johnson is extremely unpleasant and also life-threatening.  You just don’t want it!

Lithium has its bad side too: kidney failure holds down the position of real bad actor.  But lithium won’t kill you today.  It might take decades.

On the other hand, Lamictal’s dark side will put you in the burn unit…or the grave.  Right quick.

It’s a terrible choice to have to make: my sanity or my life!  There’s no percentage in trying to gamble with Lamictal, once these mucous membrane lesions appear.  There’s no guarantee that a break from the drug will fix the problem.  For me, this is the red line.  No more.

So what am I gonna do now?

Well, I’ve increased my lithium dose.  That means I have to be incredibly careful in this heat, because lithium can become toxic via dehydration.  And since lithium has a diuretic effect, that makes it even harder to stay hydrated.

I’m making plans to move to somewhere cooler after the end of the month, when I have my hand surgery recheck.  Oregon is sounding good to me….

And yes, my medical cannabis is once more doing yeoman’s duty.  I read an abstract of a study that looked at using CBD to treat psychosis.  Holy crap, the stuff holds up alongside conventional antipsychotics, with absolutely zero side effects!  I’m on that bus.