The Effects of Sleep Deprivation on Cognition Without Chemical Stimulants: A Mini-Case Study

And lo, there was insomnia.

I think sleep deprivation plus uppers may kybosh some key writing processes in my brain, so I’m going to try to ford ahead sans meds today. Then again, sleep deprivation alone may in itself be enough to mangle my brain’s word production capability. But I’ve been wondering for a while whether the Adderall—while giving me the energy I need to stay motivated and productive—may actually be impairing some of my creative ability. I’ve got the verve, but the words seem lodged somewhere in my head that I can’t access with anything like the same fluidity and ease that I use to. I can still do routine and very technical wordsmithing, like copyediting and, well, editing in general—those skills may actually be enhanced by the meds—but my ability to create new prose feels diminished.

‘Course, I can’t write if I’m passed out and drooling on my desk, either. So I’m keeping the shiny capsules close to hand in case this doesn’t work out.

And now: coffee.

Brain Still Fizzing; Novel Still Progressing

And sleep issues still plaguing me. Too much or too little, can’t seem to find a happy medium. At this rate, I’d be glad for a so-so medium. Yesterday I was in such a daze that I left the gingerbread muffins I baked for the office potluck at home.

Remembered to bake them the night before and remembered to get them out of the ‘fridge and stick them in a carry bag that morning. But between putting on my coat and walking out the door, the static in my head wiped out the all-important “bring muffins to work” step. Urg.

Fortunately, I have a forbearing and magnanimous hubby. fosteronfilm drove into town to deliver them for me. Isn’t he a sweetie?

   


Writing Stuff

New Words on The Stupid Novel:
• Tuesday: 150 – They kept wanting me to edit bills instead of write fiction at my day job, the nerve .
• Yesterday: 800 – Realized I need to split Part III into Parts III and IV as it has sprawled to a greater length than anticipated.

Quickie Update and More Novel Progress

Been wrestling with mood issues which I’m pretty sure are due to a formulary switch in my HMO which stopped including Adderall XR (extended release) in the list of covered meds, forcing me to switch to Adderall IR (instant release). The IR isn’t as effective at combating my lupus/MCTD related fatigue, and it’s also harder on my stomach. Been trying to offset the difference with caffeine with limited success. Slept for 12 hours on Saturday, which is very, very bad.

So logy, cranky, and melancholy is me—or else I’m entertaining three dwarves in my brain.

Apologies to folks who I’ve neglected and/or who are waiting on me for something. One of the coping mechanisms I’ve established when I’m drained and scraping bottom on the energy/motivation bucket is to withdraw and triage to-do items into “essential, life and death, red alert now!”—like paying bills and going to my day job—and “meh, what’s another hamster on my toe?” categories. Most things end up as the latter. Sigh.

   


Writing Stuff

Received:
• 54-day “lively and interesting but…” rejection from Strange Horizons with invite to submit again (!@%#%^ I’m never going to break into them, am I?)

New Words, uh, lessee, since last entry:
• Wednesday: 1,300
• Thursday: 600
• Friday+Weekend: 500
• Yesterday: 1,700

Total: 4.1K.

Racing to hit zero draft by the end of the year.

At least getting words on the page is great therapy. A productive day of writing makes the world brighter and shinier. Of course, the correlary is that a day of no writing just piles on the suckitude.

State of the Human Suit

Had a follow-up with my rheumatologist. He’s not only the best specialist I’ve ever had, but the best doctor, period. He pulled me out of a miserable, two-month long flare-up (my doctors back in Illinois were well-meaning but inept) going on four years ago and has kept my lupus/MCTD stable ever since. And he’s the only doctor (and I routinely see quite a few) who actually remembers anything about me or my condition*.

He always inquires about my writing, sometimes asks after Hobkin, and is generally interested and engaging. He’s also got an incredibly appealing bedside manner—stern in a grandfatherly sort of way—and has a charming Italian accent. And I actually believe he cares about my health; when I first saw him, he scolded me for not seeing a rheumatologist before for my lupus (I mentioned the ineptitude of my previous doctors, didn’t I?).

He’s also the reason I haven’t wanted to switch to a different HMO despite the fact that it’s the most expensive HMO option offered and some egregiously terrible experiences—bordering on (possibly crossing into) malpractice terrible—not to mention the general bungling, incompetence, and inability to provide basic customer service I’ve suffered at the hands of my HMO. But it seems that the state is making that decision for me. Due to budget issues, my place of work is dropping my current HMO as a benefit option, so come 2010, I’m going to have to switch.

When I first heard about this, I was appalled. My rheumatologist is specific to the particular HMO I’m currently with, so I won’t be able to keep seeing him. But, after our follow-up on Friday, I’m a little less dismayed. Not ’cause I like him any less or anything, but ’cause he said that “I’ve graduated” (his words, hee!) and don’t need to see him as often since I’ve been stable and flare-up free for so long. He suggested we decrease the frequency of our follow-up appointments down to once a year—with, of course, a stern admonition to call him immediately if I start evidencing any signs of a flare-up. And then he teased me about missing him.

Although y’know, I actually will miss him, ’cause I rather enjoy our visits.

But with me only seeing him once a year—and the fact that, at best, I won’t mind replacing my other doctors, at worst, I’ll be glad to swap them for another one since I can’t imagine their replacements being much worse—it’s less distressing.

Still, I remain miffed that I don’t get a say in this matter. ‘Cause in the end, I find any amount of aggravation and incompetence from the rest of my HMO to be a fair trade for seeing my rheumatologist. So even though I can contemplate this mandatory service provider switchover somewhat philosophically, I remain very unhappy that I have to give him up come 2010.


*My p-doc still thinks I have ADD even though I remind her every single time I see her that I’m taking Adderall to combat lupus/MCTD-related fatigue, not to treat ADD. Not to mention that I have no (and have never had any) symptoms of ADD and have never been tested for or diagnosed with ADD. Not impressive. I’d be raring to switch p-docs and would have way before now, except that pretty much all she is to me is a signature on a ‘scrip, so it doesn’t really matter to me how incapable she is as a doctor.

   


Writing Stuff

Writing accomplished this weekend: none. Glargh. Move along, folks. Nothing to see here. Sigh.

Adventures in Psychiatry

Announcement: We’ve done away with our land line. In lieu of it, we got another cell phone so now have “his” and “her” phone numbers. For folks wishing to call me, use our “cell phone” number. For folks wishing to call fosteronfilm, use our old land line number. Please do not text message us as we’d rather get an email or voice call (and don’t want to pay the additional fee).

Saw my (a new one, actually) pdoc and got my Adderall prescription upped from 20mg to 25mg. At first the doctor was puzzled as to why I was concerned about tolerance symptoms and striving to take weekly Adderall holidays, and then I realized she thought I took it to treat ADD. But I don’t have ADD; I take Adderall to counter Lupus/MCTD-related fatigue.

Seems the colossally incompetent nurse practitioner I saw last year, who bullied and lied to me to get me to take Celexa, hadn’t bothered to determine the reason the doctor had prescribed Adderall for me originally, and had simply entered in the usual diagnosis for said script. And it’s lingered in the computers all this time . This is the same woman who told me–after a single, Likert scale questionnaire upon which I indicated that I was stressed (being unemployed at the time) and sleeping erratically–that I’d end up in a hospital if I didn’t get back on antidepressants.

I still get irked when I think of the hubris and presumption of that woman! I mean 1. She wasn’t a doctor; 2. That was the first time she’d ever seen me, and she hadn’t even exchanged more than a couple sentences with me before proclaiming me on the verge of institutionalization; 3. She never asked why I was prescribed any of the psychotropics I was on or had been taking, when a single question would have informed her that I’ve never been diagnosed with or suffered from severe depression*; and 4. Telling a patient that they’ll “end up in the hospital” after less than five minutes of in-person interaction is egregiously irresponsible unto malpractice.

And now I discover that she entered in an incorrect diagnosis, too. That woman’s a menace. I hope someone gets her out of patient care and puts her someplace safe, like dish washing or ditch digging or something, anything which doesn’t involve anyone’s health, welfare, and/or wellbeing.

But, anyway, we got me straightened out in the computer. Finally. Haven’t really noticed much change between 20mg and 25mg. I’m still relying on caffeine to boost me up to productive energy levels.


*I have suffered from borderline mild depression–diagnosed by an actual doctor who talked to me and discussed my emotional state with me before jumping on the “give her antidepressants” bandwagon–but there’s a huge difference between feeling unmotivated and irascible (mild depression) and needing to be hospitalized (severe depression with psychotic features). Glargh.

   


Writing Stuff

Much and many things to accomplish in the next few weeks. terracinque, fosteronfilm, and I are helping dire_epiphany out by editing the guest bios for the Dragon*Con program book. Deadline: Monday. I need to write/complete two stories by month’s end, preferably three although I’ve got more of a deadline on that one. And then there’s Dragon*Con. Eep.

Received:
- Hold request from new podcast ‘zine, PodCastle (sister to Escape Pod and Pseudopod).
- Note from Jetse de Vries that the story he held from Interzone‘s May electronic submission period for a second read made the cut and is being sent on to the editorial horde for discussion and debate. Crossed fingers galore!

New Words:
- 1700 words on the short story I’m writing for mroctober‘s anthology project. Working title: “Hollow.”


Zokutou word meterZokutou word meter
1,687 / 4,000
(42.2%)

Hamsters, hamsters, everywhere!

The Dragon*Con staff meeting was Saturday, whereupon I bolstered my Daily Dragon staff, bringing myself up to fully loaded (I think), and dire_epiphany asked me to adopt a hamster. Or rather, a third of a hamster. bevlovesbooks and sara1221 have already agreed to co-adopt the other two-thirds. Of course I agreed to be responsible for the care and juggling of my hamster segment ’cause I can deny dire_epiphany nothing . . . or almost nothing.

Also got a note from a computer gamer person in Poland who writes fan-variety gaming modules. Seems he’s working on a diary for a female character on the project he’s currently working on, and is using my blog (tone, I gather, rather than content, although that part is a bit fuzzy) to imbue it with realism. He asked if I’d be interested in reading and providing feedback on it. While I continue to be up to my ankles in wayward hamsters, I have to admit I was both flattered and intrigued, so I agreed to be a consultant. I’ve never worked on a computer gaming project before. I think it’ll be fun.

And lastly, I’m battling a lupus/MCTD flare-up. My own fault, this one. I haven’t had a flare-up in a couple years, due in large part to the daily dose of Imuran I’m taking. But while in Illinois, with my comfy routine thrown off, I forgot to take a dose. Of course I took it as soon as I remembered, but I began feeling kind of blah within 24-hours. I could have probably staved a flare-up off by keeping on a rigorous Imuran-taking schedule. But when we got back home, I forgot again–daily routine still in uproar–and last night, I fell asleep early, at around 6PM and slept for twelve hours straight (another indication of an impending flare-up), and fosteronfilm didn’t realize he needed to wake me up to take my Imuran. As a result of three missed/late doses in as many weeks, I’m tottering on the edge of a full-blown flare-up. I keep flashing hot and cold, on the brink of fever, my body is all stiff and achy, and my throat’s sore. Not good. I simply do not have the time to get sick now. Crappity crappity crap. It’s probably some hamster-mutated plague . . .

And just now, I started coughing, and I heard Hobkin suddently start making these rasping, coughing sounds too. The cuteness of him coughing at the same time as me is way overshadowed by my anxiety. I hope I didn’t get the little guy sick!

   


Writing Stuff

New Words/Editing:
- 600 on my “Writing for Young Readers” column article for Writing-World.com, a bunch of editing passes, a squint or two, and it’s off. Big, grown-up columnist, me.

Received:
- 209-day personal “Although we discussed it exhaustively, I regret . . .” from Cricket. Waaah!! *sobs*

To make matters worse, the next market I want to send this story to is closed to submissions until Mid-August. Snartleblast! Also, that again drops my submissions to the bug ‘zines down to one. Urg. Must send them something else soon.

On hyperthermia amd dehydration in skunks

Discovered the limits of Hobkin’s heat tolerance yesterday. We’d set the A/C to 81, trying to save energy and money, but it seems that’s too warm for the lil guy. Yesterday morning, he had a bad tummy and then wasn’t interested in breakfast. Loss of appetite is extremely worrisome in a skunk, so much fretting commenced.

fosteronfilm suggested that Hobkin might be dehydrated from his bad tummy, so, feeling rather dubious, I scooped him up to see whether I could force some water into him.

Normally, Hobkin doesn’t drink water. And I mean at all. The closest he’s come to drinking out of his water bowl is dipping his paw in and then licking it, and even that’s pretty rare. We still leave fresh water out for him, just in case, but he’s knocked the bowl over more often than he’s drunk from it–and it takes quite a bit of effort to tip it as it’s secured to his pen. In the past, when I’ve tried to feed him water out of a syringe, he’s batted it out of my hands and spat or shook what little fluid I could get into his mouth back out. He just doesn’t like water, the goofball.

But yesterday, although he whined and glared at me, he readily swallowed something like 12ccs. It seems the heat had dehydrated him, and he wasn’t hungry because he was thirsty. But figuring out the problem didn’t get us much closer to a solution. How does one re-hydrate an animal that doesn’t drink and won’t eat? We could take him to the vet’s and have them inject fluid into him subcutaneously, but that would’ve stressed and freaked him out. Plus, I didn’t think he was that badly dehydrated. We could try buying some flavored Pedialyte or Gatorade, but that’s a last-ditch sort of effort as I don’t like the idea of him having all that sugar. Also, there’s no guarantee he’d like that any better. When we had to force electrolytes and fluids into the ferrets they were quite underwhelmed by the stuff (as I am–Gatorade, yuk). Also, last I checked, fresh watermelon wasn’t quite in season, and again, re-hydrating him with watermelon would’ve involved more sugar than I’m comfortable with him having.

After some brainstorming and much anxiety, I came up with the answer: A cottage cheese smoothie. I used a fork to mush up a teaspoon of cottage cheese in about 18ccs of water and added some diced bok choy, and Hobkin lapped it right up! Three servings of cottage cheese smoothie later, and he’s himself again–running amok, stomping at shadows, and begging for treats. Whew. I kept pushing liquids the rest of the day; his lunch was more smoothie along with bok choy and celery, vegetables high in liquid, and I added enough water to his dinner lentils and rice mixture to make it a pudding.

Definitely going to keep that in mind for future need. My next plan had been to make him a veggie shake–cottage cheese, a bit of milk, plenty of water, and various vegetables in a blender. But fortunately I didn’t have to break out the blender.

And yes, we’ve now cranked on the A/C.

   


Writing Stuff

Got an email from Lynne Jamneck–a writer who I’ll be sharing a ToC with in mroctober‘s So Fey antho–asking for an interview and inviting me to contribute to an anthology she’s editing, Lesbian Sleuths & the Supernatural, to be published by Regal Crest Enterprises. Of course, I said yes to both. The anthology also has an open call for submissions:


An Anthology of Lesbian Sleuths & the Supernatural
(Women Writers Only)

Word Length: 7,000 – 10,000 words
Payment: $100 Flat Fee Per Story
Submission Period: July 2006 – November 2006
Reading Period: December 2006 – April 2007

Ghosts, haunted castles, and things that go bump in the night. A trip to Egypt; the mummies and the pull of a primordial tomb. Ancient Aztec ruins and the burning fever of a jungle. Is a sinister cult operating in a small town near you? Do you feel the pull of something otherworldly just beyond the veil of everyday? The supernatural have existed in cultures for thousands of years, all around the world.

I am looking for stories that explore these and other weird happenings, and are centered around a ‘whodunit’ type conundrum. The sleuth of the story-whether amateur or professional-must be a lesbian character. No excessive violence. Humor is welcome. No fan fiction. Character driven stories with strong emphasis on storytelling essential.

If you’re looking for a reference/indication of the types of stories I’m looking for, you should familiarize yourself with the following authors:

H.P. Lovecraft
Agatha Christie
Ray Bradbury
Arthur Conan Doyle
Harlan Ellison
Kim Antieau
Kathe Koja

Submissions should be unpublished, original short stories. If you feel you have a story that does not fit that word count but would be perfect for the anthology, please query to (superantho@gmail.com) superantho (at) gmail (dot) com. Be sure your submission includes your surface mailing address and phone number in addition to a valid return email address.

Submissions (disposable copies) should be sent to:

Lynne Jamneck
129 Layard Street
Invercargill, 9501
New Zealand

Exceptions can be made for email subs, but query first to: (superantho@gmail.com) superantho (at) gmail (dot) com


New Words:
- 1100 on the article for Writing-World and it’s at zero draft. It needs a few editing passes, but I’m hoping to send it off today.

Received:
- 60-day “although it’s a really fun concept and a wonderfully creative POV choice, this one doesn’t quite work for Escape Pod” with invitation to submit again from sfeley on a reprint. Snartleblast. But I’ll show him! I just launched two new submissions his way, mwa ha ha haaaa!

Erm, yeah. My wingstubs have been really hurting these last few days. I popped two Tramadol, and they’re not helping the pain, but I think they’ve made me a loopy.

Club 100 For Writers
      25

500/day
      37

On shaving a skunk and Tramadol

And it’s back to the daily grind.

After hearing how much happier yukinooruoni‘s cats are in summer after being sheared, I wondered if Hobkin wouldn’t prefer to carry less fur weight around during the hot months. And then I remembered how much he hates being brushed and having his nails clipped (although, oddly, he doesn’t have a problem with me cleaning his ears), and I’m thinking we’d lose digits if we tried it. Ergo, skunk shall remain fluffy.

Wingstubs giving me some major grief, so I took a Tramadol last night. And not only didn’t it knock me out, but it seems to have given me a bit of a zing. I was up until 4AM, working. Huh.

   


Writing Stuff

In an effort to continue spring-boarding more paying work off my psych. degree, I went on a guidelines spree. And, of course, I found an ideal market right under my nose. The Cricket folks put out a Parent’s Companion publication as accompaniment to their ‘zine for 2-6 year-olds, Ladybug. They’re looking for articles written with “a thorough, up-to-date understanding of child development.” Bing!

Went through my old grad. papers for inspiration–which were stored in Lotus’s Word Pro, of all applications, and I had to scour the Internet looking for a freeware program that would let me open them before I could read them. So I spent most of last night compiling notes, references, and checking out new research, and I hope to get an article written this weekend. This one’s on spec rather than of the query–>greeen light variety, but I’m thinking the topic matter is such that it should be sellable to other venues if they turn it down. Assuming I don’t totally botch the job and write gibberish, of course.

Also put together a query/pitch for a nonfiction article for the China-themed issue of the kid ‘zine, Faces, and sent it off. They’ve got a pretty formal process for queries that includes a word count, an outline, and a reference list, with the end result being that I’ve all but written the thing by the time I finished putting together my query. It should definitely make writing it a no-brainer, should I get the green light.

Initially I hesitated about querying them because their guidelines specify that they buy all rights, and I’ve been assiduously avoiding selling all rights to my work, but I realized I’m far less possessive about my nonfic stuff. After all, I’ve been ghostwriting routinely since I started picking up more freelance work, and haven’t had any qualms about the “all rights” nature of that. Of course, they’ll probably send me a “thanks but no thanks,” which would make all this waffling moot.

Received:
- Contrib. copies of the June issue of Spider with “The Tax Collector’s Cow” in it. I was delighted to see five illustrations (by Jennifer Hewitson) for my story. Very shiny.
- Contract and payment from Best New Fantasy: 2005 for “Returning My Sister’s Face.”
- Payment for my last freelance gig.
- 1-day rejection from Escape Velocity on a reprint; they don’t take reprints. Oops.
- Comment at MySpace from the MechMuse folks that their audio production of “The Storyteller’s Wife” is proceeding apace. Quite looking forward to that, I is. I’ll be sharing a ToC with Kevin J. Anderson!

Club 100 For Writers
      23

500/day
      35

You get what you pay for at the Pdoc’s

Went to see the pdoc nurse practitioner to get my Adderall refilled yesterday. When you go in for a meds checkup with the nurse, they have you fill out this checklisty form in the waiting room where they try to concise a DSM diagnosis into one-word categories–”mood,” “sleep,” “appetite,” “interest,” “anxiety,” etc.–with 1 to 10 (bad to good) rankings.

I’m thinking, okay, this is subjective, and surely she’ll ask me questions and we can discuss it if she has concerns. Because, y’know, that’s what a doctor would do. So I fill it out based on how I’ve been sleeping and stressing this last week, giving “sleep” a “3″ since my circadian cycles have been wonky, and mood a “3″ as well because I’ve been juggling too many hamsters. And I also put down a “4″ for appetite because, well, I’m taking an amphetamine, and it’s an appetite-suppressant. (Which, by the way, is an excellent way to lose weight.)

When I go in, she informs me that “I’m not doing good,” which I thought was a wee bit presumptuous since she’s exchanged all of two, maybe three sentences with me. And she pushes hard for me to get back on an antidepressant. I ask her what she’s basing her assessment on, and she says the 3 I gave “mood.”

Okay, so nurse lady doesn’t subscribe to my “it’s subjective” interpretation and doesn’t realize that that 3 is a 3 for me across the board, and that my board has never been profoundly depressed or psychotic. I try to explain this to her and that I didn’t think “mood” was an effective descriptor for everything that encompasses a person’s mental state, and I’m not suicidal or homicidal, and I’m really not all that depressed either; I’m mostly cranky and stressed.

Her response? “You keep going like this and you’ll end up in the hospital.”

WTF? First of all, I was diagnosed with mild depression–not a hospitalization caliber ailment–and I feel tons better now than I did when I was diagnosed years ago. Second, how can she find it in the least bit appropriate to tell anyone, especially someone who may be feeling emotionally frail, that if they “keep going like this you’ll end up in the hospital” based solely upon a 1 to 10 scale of a one-word descriptor? This woman hasn’t spent fifteen minutes talking to me in the three months she’s been aware of my existence!

I tell her, “No, I really won’t.” And explain to her how hard it was to get off the Effexor and that I would rather not go back on an antidepressant.

She continues to push and suggests I try Celexa which is a “more pure” SSRI than Prozac and isn’t an SNRI.

I try to point out that it wouldn’t take effect for six or so weeks in any case (by which time I fully expect to have selected the hamsters I want to keep in the air, and to have volleyed the rest of them over the fence), and she interrupts me and says “two weeks.”

Huh. Okay, my grad. school Psychopharmacology class was a loooong time ago. Maybe they’ve made strides in the antidepressant field. Might be worth trying.

As I make speculative noises, she rattles on how I should “take this at night before bed.” Since I took the Prozac in the AM, and I don’t want to take something that will make me tired because that’s the whole reason I’m on the Adderall–fighting the fatigue and all–I ask her “so this will make me sleepy?” And she says “no, you just take it before bedtime and when you wake up you’ll feel better.”

Do you get that she was talking to and treating me like a refugee from the short school bus?

Yeah. By this time I’m annoyed, upset, indignant, and doubting myself. Maybe I should go back on an antidepressant. After all, I was dwelling upon it before, and I’m going through a lot right now. But mainly, I just want to get my stupid Adderall refill and leave. So I give her the go ahead on the Celexa.

She enters prescriptions for both meds into the computer and off I go to the pharmacy. But Adderall is a controlled med and requires a hard-copy script, which nurse-lady should have known. I’m forced to go back and wait 45 minutes to get a stupid piece of paper, ensuring that I get caught in rush hour traffic, making an already upset-Eugie extremely unhappy.

After languishing for over an hour in Atlanta’s lovely traffic, I got home and looked up Celexa online. Length of time until effective: 6-8 weeks. May cause drowsiness.

In addition to bullying and coercing me, she lied to me.

I’m obviously sympathetic to the mental health profession, having that MA in Psychology and all, but I’m feeling pretty mistreated by it right now. And I have to wonder, how exactly is the sort of conduct she displayed going to be of benefit to anyone’s mental state?

Because I have indeed been stressed to my eyeballs, I took the Celexa last night. When I woke up this morning, I was groggy and light-headed. And I feel a headache coming on. Oh yeah, so helpful.

Now I’m debating whether it’s worth staying on it, because I was, after all, contemplating going back on an antidepressant, or if I should just pitch the stupid pills out the window.

I’m trying to base my decision not on my experience in getting them, but my overall mental state.

Right now, the window’s looking pretty enticing.

Feh. And she wants to see me back in six weeks. I’d say “no way in hell” except my alternative is to follow-up with a doctor to get my Adderall refilled, which has a co-pay. Seeing her, at least, is free.