Trazodone Withdrawal & A Swim

For more than a decade, I have been on some kind of psychoactive medication to help me to sleep. One of the horrible things about depression/PTSD/etc, is that the sleep-wake cycle can go completely haywire. When I was most ill, I was on a combination of tranquillisers and sedatives just to get some kind of sleep at night. The alternative was long, anguished night's, wide awake and feeling increasingly tired, ill and desperate for relief. Anyway, I was later put on Trazodone, a sedating anti-depressant, which I take just after getting into bed. I have been on that for, well, who knows how long, perhaps just under 10 years.

In my attempt to figure out what on earth is causing my disabling mental fatigue, I looked up the side-effects of Trazodone. I also reasoned that on gym days, I feel tired through the afternoon but rally and feel fine/alert by the evening. It's only after I have taken the Trazodone (and other daily anti-d) that I feel utterly drained/rubbish etc the following the day. It occurred to me that it might be the Trazodone which is causing the daily mental fatigue. Over the past 11 days, I have first reduced the dosage (by emptying some of the contents of the 50mg capsules) and then finally stopped taking my nightly dose.

The main side-effects have been great difficulty in sleeping and emotional instability (i.e. crying/laughing easily). The problem whilst trying to get to sleep is that my body and brain feel wired. It's like my nervous system is raw and heightened and every nerve fibre is primed. There's also a kind of horrible feeling through my body, the sort of feeling you get when you know you're going to be sick but it hasn't happened yet. Almost like you've been poisoned and your body hasn't yet expelled the venom. The whole body feels uncomfortable and twitchy and horrible. Finally, the biggest issue is hypnic jerks (Link) or sleep starts. I've had these the whole time I've been on anti-depressants but during this withdrawal they have been awful. Every single time I'm just about to fall asleep, my body does a shocking startle response and I'm zapped awake again. It's like being hit with an electric shock. And this happens over and over and over again, for hours as I try to fall asleep. Last night, it was beginning to feel a bit like torture. I was aching for sleep but my nervous system would not allow it.

So far, I have done 3 nights without Trazodone. The general pattern is to be kept awake until between 2 and 3am, then sleep fitfully for about an hour or so, then perhaps get another 2-3 hours between 5 and 8am. It's a very unpleasant sleeping experience but doesn't seem to be adversely affecting my days. I actually feel more awake and alert during the day.

The only thing I've found to help with the hypnic jerks is paracetamol. It seems to have something of a calming effect on the nervous system. Not sure if that's scientifically possible but, even if it's just a placebo effect, it's helping. The problem is I don't want to have to take paracetamol long term. It does make me angry that when they stick you on these drugs they don't say that getting off them is going to be a nightmare! When I reduced my Venlafaxine dose right down, it took a good year before my nervous system really started to feel more 'normal' again. I was an emotional wreck for months simply due to the withdrawal effects on the nervous system.

In terms of physical rehab, I hit the pool this week. With all the heat, I fancied a nice cool swim. Having not swum since January, I wasn't sure how I'd cope. But, it went well. I did 32 lengths (0.5 miles) in about 35 mins. No cramps in my feet or calves (for the first time ever) and no pain through the front of my left shoulder (for the first time ever). I also seem to have recovered well physically, managing a good 2.5-3 mile walk this morning. The gym work and running are making a difference! 

Right, I've run out of steam so will leave it there....

Physio Attempt & Another 2km

I apologise in advance if this post is poorly written etc. My head feels drained and thinking clearly is something of a challenge.

After last week's gym session, I decided I needed to take action regarding my right hip. It has improved but at the same time, it's still a daily problem. It's a significant limiting factor. I also realised that I can't deny any longer that the post-exercise fatigue and general daily exhaustion is what's holding me back from making real progress. Every week, I hope it'll get better. Every month that ticks by, I hope that I might have improved my resources by even a small amount. I have to admit that, on balance, they haven't improved anywhere near enough. If I'm honest, I feel pretty rubbish most days. Most days, I don't have enough energy to do even the simple things. I push against that. I dissociate it. As I've said before, if I waited until I felt up to doing the things I enjoy, I'd spend my life sitting and waiting. Often, it's a case of taking a couple of paracetamol, dissociating from how cr*p I feel, and then doing the thing I enjoy (mostly birding)....and worrying about the cost later.

Anyway....so, I booked an appointment with a private physio to get some advice on my right hip. Unfortunately, it didn't work out. Someone, somewhere had made a clerical error and I was booked in to see the chap but no-one actually knew where he was. No-one even had a phone number for him. They apologised etc etc...and I went away to think about it...not sure if I'll try again or just head to the GP (NHS). My plan was to get it properly assessed, go to my GP fully armed and then tackle both the hip and fatigue at the same time. We shall see.

This week's gym set. It was all a bit of an effort this week - I felt tired/washed out all week, including when I woke up on Friday to head to the gym. The 2km run isn't getting any easier. It always takes maximum concentration/perseverance. Everything in me just wants to stop.This week it definitely felt like I was flogging a dead horse.

• 5 mins exercise bike
• Hip/lower back stretches
• Glute bridges (10 secs hold) 3 reps then with 7kg dumbbell across hips 10 reps, 10 sec hold. 5 single leg glute bridges (each leg), 5 sec hold each.
• Press ups-plus (at 45 deg angle) 2 x 10 reps
• Run on treadmill (2km at 9.5km/hr in 12:45 mins)
• Seated rows 10 kg 3 x 10 reps.
• Wobble board 4 mins (5 squats)
• Trunk twist using cable weights 6kg 3 x 10 reps 
• Chest fly with cable weights 4kg 2 x 10 reps, 6kg 10 reps
• Tricep extensions using cable/rope 8kg 4 x 10 reps 
• Side slides using cable weight (for oblique muscles) 8kg 2 x 10 reps
• Combo lateral/front shoulder raises whilst sitting on exercise ball 4kg 2 x 5 reps, 3kg 10 reps
• Lying on the floor, starting with elbows by my side, arms bent 90 degs, then pushing weight upwards against gravity, straightening the arm (modified front raise) 4kg 3 x 10 reps.
• Stretching: hips/lower back, hamstrings and chest/pecs/lats.

The right hip pain/ache kicked in after lunch. I took painkillers again last night to be able to sleep. I felt tired after lunch yesterday but, by tea-time, I'd rallied and felt fine/alert. Actually, I felt better yesterday evening than I have all week?!? Today, I've felt tired/washed out/headachy. Took paracetamol this morning cos I just couldn't be bothered to deal with the headache and hip ache.

I suppose the next step is an appointment at the GP....

Right hip problems & A better week

Spotted Flycatcher (one of a pair nesting locally this summer)

Ok, so I had better start with a word about Andy last Sunday. I thought he did fantastically well. For the first set and a half it looked like he might just pull off the win. He rose to the occasion, played aggressive, thoughtful tennis and put his heart and soul into it. Federer, however, was just too good. When it counted, he was able to play sublime tennis. I don't suppose there was a dry eye in the house during Andy's closing speech and it was hard not to focus the admiration and celebration on the vanquished rather than the victor. It was, after all, the best a British man has done at Wimbledon for 74 years! Wonderful stuff Andy!

For me, it's been a better week in terms of energy. I wasn't totally wiped out after last week's gym session. I had a mildly stiff left calve and the usual right hip discomfort but all in all, it was 'back to normal' thankfully.

This week's gym set:

• 3 mins walking to warm up (there weren't any bikes free)
• Hip/lower back stretches
• Glute bridges (10 secs hold) 3 reps then with 6kg dumbbell across hips 10 reps, 10 sec hold. 5 single leg glute bridges (each leg), 5 sec hold each.
• Easy Press ups 10 reps on hands and knees (didn't have access to where I normally do the press ups)
• Run on treadmill (2km at 9.5km/hr in 12:50 mins)
• Seated rows 10 kg 3 x 10 reps.
• Wobble board 4 mins (5 squats)
• Trunk twist using cable weights 6kg 3 x 10 reps 
• Chest fly with cable weights 4kg 3 x 10 reps
• Tricep extensions using cable/rope 8kg 3 x 10 reps 
• Side slides using cable weight (for oblique muscles) 8kg 2 x 10 reps
• Combo lateral/front shoulder raises whilst sitting on exercise ball 4kg 4 x 5 reps, 3kg 10 reps
• Lying on the floor, starting with elbows by my side, arms bent 90 degs, then pushing weight upwards against gravity, straightening the arm (modified front raise) 4kg 3 x 10 reps.
• Reverse abs crunches 10 reps, Plank 2 x 30 sec hold
• Stretching: hips/lower back, hamstrings and chest/pecs/lats.

Generally, I felt like I didn't have much stamina this week. When I got to 1km on the run, I wasn't sure I was going to manage the next 1km. It was really hard going. Doing the weights, the first 8 reps were fine but the last 2 were often a struggle and in some cases I lost 'form'. I've no idea why my endurance was so low but anyway, I was pleased to achieve what I did.

When I left the gym, I felt good. I'd had some mild pain through my right hip when running (and it had actually been aching when I woke up that morning) but otherwise I was fine. I iced my right butt/hip through lunch as I could begin to feel the pain kicking in. I felt tired through the afternoon but by evening, I felt alert and fine again. I took painkillers for my right hip before bed.

Last night, I dreamt I went to an old outdoor, tennis court. Like the ones you find in parks - often run down and a little mossy. I had my old tennis racket but I'd bought some new balls. And, I started to just hit forehands across the net. Soon, children came to play and I began to knock up with them. I didn't have the energy to move much, and my shots lacked skill, but I enjoyed hitting the ball when it came to me. As the dream progressed the courts filled with people/children and it became clear there was a coaching session going on. I had to leave. I woke up from that dream this morning with the feeling and sense of joy of being able to play tennis again! I got out of bed and my right hip gave way on me. As ever, no idea what's wrong with it but it's painful and difficult to walk on. I might have to bite the bullet and head to the docs.

Of course, the disappointment of the right hip problems is magnified today with the longing of wanting to play tennis/sports again (writing that causes tears to well up). I love sport. I used to play tennis to a pretty high standard as a youngster/teenager. I played just below County level, going to two hour indoor coaching sessions once a week and matches at weekends. My sister and I used to always knock a ball around in the holidays and we'd talked about maybe trying that gently this summer....

We shall see.

A Tired Week but Andy's Through...!

Last weekend and most of the following week were a write off due to feeling completely and utterly drained after the gym (irrespective of taking Pharmaton). I've no idea why. There doesn't seem to be any pattern, rhyme or reason to it. Thankfully, I had Wimbledon to enjoy...

Yesterday, I didn't really know whether to risk the gym again. The thought of a repeat of last week's total wipe out was somewhat off-putting. However, the potential positives outweighed the likely negatives and I took the plunge. My Friday gym sessions really are the only 2 hours of the week where I get to feel strong, powerful and free and like a 'normal human being'. I get to do what 'normal people' do. The whole routine of getting ready, heading to the gym, working out, coming home, showering, changing and eating a good lunch is completely life-affirming. For that period of time, I feel normal. I feel relief. I feel like a solid, powerful human being.. I don't care that it takes days to recover or that each week I have to take painkillers for my hip for 2-3 days afterwards. That feeling of normality and empowerment is worth it!

Anyway, yesterday's gym session went well. I pushed myself to do the 2km run again at 9.5 km/hr with a sprint finish for the last 100 metres. I did that in 12 mins 45 secs. That's the part I most look forward to. Running. And the sprint finish is the icing on the cake. I think naturally, I'm a sprinter rather than a distance runner, and especially so since the mental and physical breakdown. I lack endurance in every way. I tend towards wanting to get things over and done with. It takes discipline for me to stick to a steady pace and not just sprint/walk/sprint/walk etc. Everything in me wants to push hard whilst I have energy then slacken off entirely only to then push hard again. It's probably very good for me to teach my body/brain that doing things at a good steady pace is possible.

The rest of the session was the usual weights/stretches etc. I didn't push too hard as I was a little worried about how I'd react afterwards. However, when I left the gym, nothing in particular hurt and I felt good. During the run, I'd not felt any pain in my right hip and my calves had coped better this week.

The right butt/hip pain kicked in during lunch so I iced that. The other issue last week was that the left butt/hip ache/pain and LHS lower back tightness, which I thought had resolved, came back as bad as before. Very disappointing. The right calve was mildly effected during running yesterday and is stiff today. The left butt/hip pain was still there through the afternoon (and today).

Surprisingly, I didn't feel too tired yesterday afternoon and, by evening, I felt alert and fine. I wasn't aching for sleep/bed. I do feel tired/drained today. I guess I'll know tomorrow how big an impact yesterday's gym session has had.

Of course, the thrill of yesterday was seeing Andy Murray reach the final of Wimbledon. I am a big Andy Murray fan and follow all his matches through the year. To have achieved a place in the final, under the enormous weight of hope and expectation of the British public/media etc, is an outstanding achievement. I don't know how he holds his nerve or withstands the phenomenal pressure. As for Federer in the final....well...I know Andy can beat him but on Centre Court, in a Wimbledon final...that's about as hard as it gets for a British player. It's a massive ask....here's hoping for a little magic...

(image courtesy of the internet!)

2km Run Non-Stop

After 2 weeks of feeling downright rubbish, I started to take Pharmaton* on Wednesday. It seems to have had the desired effect although who knows why or how or if that's a good thing or not!

So, back at the gym today. I was really chuffed to do a 2km run without any walking breaks, in 12 mins 55 secs. I set the pace at 9.5 km/hr which seemed just right. I think my muscles actually prefer to move faster but in terms of energy use, that speed worked. I upped the pace for the last 100 metres to 12.5 km/hr, which is a comfortable sprint. The right butt/groin pain was intermittent and mild. I knew it would hurt later but at the time, it was manageable. Since coming home, I've iced my right butt (the pain kicked in fairly quickly).

The rest of the session was the usual weights and stretches. I didn't push my abs as they felt a bit twingey and I reckon the running places good demands on my core.

All in all, a satisfying workout. If only my right hip would resolve, I'd be very pleased.

Edit 14/07/2012: * I stopped taking Pharmaton on the following Monday when it was clear that it wasn't having any positive effect and was in fact causing digestive problems. I suspect it's good for people whose vitamin/mineral levels are low but I know my diet etc is very good these days so no need for supplements like this. I guess my energy problems have another cause.

Rung Out

I'm not sure what's been going on with me over the past 10 days. I was particularly tired/sleepy/worn out after last week's gym session and took the usual painkillers for the right butt/hip/leg discomfort to be able to sleep on Friday, Saturday and Sunday nights. Monday, I was taking painkillers for a headache and generally feeling rung out. And that theme has continued and continues....

I've basically felt like all my get up and go has got up and gone. I feel drained mentally. Physically, I actually think I've recovered from the gym session, but my head/brain is completely fatigued. I went out birding on Tuesday and Wednesday, when the sun shone, but mentally, it felt like an up-hill climb the whole time. All I really wanted to do was crash out. I haven't had any patience or tolerance for anything that requires effort/thought. By Friday, the task of figuring out what to feed myself for the day was as much as I could manage. Needless to say, I skipped my gym session and had a very quiet, still day at home. And, it genuinely felt like it took all day to figure out what to eat for the next meal.

My hayfever has been really bad too, which doesn't help. And, I've been getting momentary episodes of vertigo on a daily basis. Most often, it's whilst propped up in bed, reading, before I go to sleep but I've also had them whilst watching TV or working at my PC. Interestingly, the week before I had the last severe attack of vertigo/vestibular neuritis, I felt very drained/exhausted. The other issue which dogged me for a few weeks was daily and almost constant severe scalp tenderness around the back/sides of my head. Basically, my scalp suddenly gets extremely painful when palpated and, if I rub/massage the areas, the relief I feel through my whole body is immense. I guess it's excessive muscle tension or something.Cause, unknown; solution, unknown....as usual!...but today, it's fine.

Furthermore, I look as pale as I feel, which never helps. All in all, I look and feel like death warmed up and I've no idea why. I took an iron tablet on Friday in the hope that was the problem but it had no effect. Yesterday, I wondered whether maybe I needed to do some exercise to kick start my system. It was a kind of kill or cure solution. In the afternoon, I got on my exercise bike and did 30 mins (7.5 miles) at varying levels of difficult and speed. I followed that with 10 minutes of stretches, glute bridges and general hip strengthening. I felt no better for it. I still felt completely mentally drained. I had no sense of any energy or adrenaline. Within about an hour of finishing, I felt even more tired and drained than I did before and the usual right butt/hip/groin discomfort had kicked in. The only bonus was I slept well last night!

Today will be another quiet day, doing nothing. I feel so completely mentally fatigued. My brain feels fried and I've got no capacity to cope with any demands etc. I don't feel like driving anywhere to go birding. At the slightest sign of effort, I want to give up and go home. I guess it's depression....due to the continuing social isolation and grind/pain of rehabilitation. Generally, I find ways of coping but every so often, it gets too much and my head says enough is enough....

Ah well....

Another week at the Gym

Back at the gym today after missing a couple of Fridays due to other commitments. However, I did do a couple of sessions on the exercise bike, 30 mins, varying difficulties/speed, 8 miles, to make up for missing those gym days.

So, today's set:

• 5 mins exercise bike
• Hip/lower back stretches
• Glute bridges (10 secs hold) 3 reps then with 6kg dumbbell across hips 10 reps, 10 sec hold. 5 single leg glute bridges (each leg), 5 sec hold each.
• Press ups (plus) (at 45 deg angle) 2 x 8 reps
• Run/walk on treadmill (2km in 13:30 mins)
• Seated rows 8kg 10 reps (kept arms extended so just worked scapular muscles), 10 kg 3 x 10 reps.
• Wobble board 4 mins (5 squats)
• Trunk twist using cable weights 6kg 2 x 10 reps 
• Chest fly with cable weights (4kg 2 x 10 reps) 
• Tricep extensions using cable/rope 8kg 2 x 10 reps 
• Ab crunch machine 20kg 10 reps, 25kg 10 reps 
• Leg Press 41kg 10 reps
• Combo lateral/front shoulder raises whilst sitting on exercise ball 3kg 5 x 5 reps
• Lying on the floor, starting with elbows by my side, arms bent 90 degs, then pushing weight upwards against gravity, straightening the arm (modified front raise) 4kg 3 x 10 reps.
• Reverse abs 2 x 10 reps, Plank 2 x 35 sec hold
• Stretching: hips/lower back, hamstrings and chest/pecs/lats.

As ever, the limiting factor on the run was my right butt/hip. Pain kicked in after 3 mins running. Painful/sore through this afternoon in spite of icing it. Generally tired this afternoon, as usual. My right calf muscle coped a lot better with the run today, which is an improvement.