28 December 2006

Xanax and the Diet Dilemma

"Food is an important part of a balanced diet."~ Fran Lebowitz

My psychiatrist finally got back to me today. I left a message for her on Tuesday, explaining that my therapist thought I'm being a bit overwhelmed by anxiety. She suggested upping the ante of my regular Xanax dosage. I told Dr. W. (psychiatrist) that my appetite never returned after I finished chemo. I'm aware of that unpleasant empty stomach feeling when I haven't eaten in too long, but I'm never hungry. Dr. W. thought maybe it could be a thyroid thing. I actually like that answer more than the Xanax answer. I have serious misgivings about raising the amount of potentially addictive substances in my life. I have addiction problems on both sides of my family. Very dangerous.

Dr. W. considered raising the amount of Elavil that I use to help me get to sleep (post traumatic stress disorder caused me to wake up many times every night before I was medicated). That would improve the appetite situation, she said. Somehow, we decided against that. We decided to stay with the current level of Xanax, but I'm supposed to get the extended release version. Maybe this will help the jittery feeling I walk around with all the time. I didn't even have to develop a closer relationship with any addictive substance. The conversation was a roaring success, as far as I'm concerned.

The food thing is beginning to make me a little nervous. I've always flirted with a potential eating disorder problem. So far, I've managed to sidestep anorexia. Bulimia will never be a problem. I just don't do the finger down the throat thing. So unattractive! This morning I had a whole bagel (it's a very large bagel) and six prunes. For lunch, two pieces of toast. And a cookie. I also ate most of a bag of popcorn. I find myself worrying about the calories contained in all of that non-nutritious food. It's not a good sign.

The only reason today's diet is so lacking in nutritional value is that I didn't manage to get apples and oranges this past weekend. I usually have two pieces of toast, a large apple and a Clementine orange. That doesn't sound like much, does it? My therapist pointed out to me last week that I'm not eating enough. It was she who raised the specter of anorexia.

If you're never hungry and you always feel bad after eating, it makes it hard to know what constitutes enough. When I finish my usual lunch, I feel pretty full. My therapist thinks that's because my stomach has shrunk. Once I establish the amount of food I'm supposed to be eating, I'll still have the problem of feeling crappy afterwards. It's not much of an incentive to eat, period. I'm very clear about the necessity of eating, though.

Dr. W. said that I should just treat food the same way I would medication. Got to do it. No skipping doses. I'm fine with that, but I'm seriously going to have to figure out how much food to add. At the moment, I'm thinking about adding a container of yogurt to my regular lunch menu. The only problem with that is that I haven't been able to get through an entire container of yogurt. I can do half. My therapist is stunned by this lack of capacity. That gets my attention.

I've been trying to maintain a low-fat diet because there's strong evidence that less fat equals a lower chance of getting breast cancer in the remaining girl. I can't do chemo again. I have to do whatever I need to do to ensure I won't have to try to endure it again. On the other hand, I don't have a lot of fat in my diet at the moment and I could probably add some without danger.

This is when thinking about myself as my best friend is helpful. When I'm trying to determine the best course of action or when my nasty little inner voice starts beating me up, I always just think about what I would say to a friend if she were in the same situation. I end up being much kinder to myself when I do that. As I said before, I've always had food issues. I'm just going to have to find a way to eat more. Damn.

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