At work I'd been getting progressively more stressed due to usual work things, and after a particularly bad few days two weeks ago I felt like what I really needed was some sort of medical intervention. So I asked my doctor, and he put me on Prozac, which I started taking on Saturday (the 3rd).

At first it wasn't too bad; it just made me sleepy and made my dreams way more intense. But over time I started to feel more and more effects from it. The big one was that I always felt like I was swimming through molasses. Thursday I felt depressed and worthless because of a pet-related issue. Friday (the 9th) I had the biggest panic attack I can remember ever having, and I ended up taking the day off work because it screwed me up so bad. All weekend was pretty stressful because of the issue the attack was about, and then Monday morning I had another (smaller, but still pretty big) one, so I called my doctor, and went to work because it felt less stressful than missing another day (and having to be home while my kitchen remodel kept going on around me).

Anyway, in the evening, he finally got back to me and said to stop taking the Prozac, so I did. One of Prozac's more pernicious issues is that it has a very long elimination half-life, though, so my current serum level is probably a lot higher than it was when I first started on it, but still, even right now I'm feeling a lot better than I did this morning, and even with some of the stressy antagonistic Meetings Of Doom today (which always get me a bit panicky) I managed to hold it together for the most part (although I did have to shut out all the constant arguing and just breathe deeply a few times).

One of the weird things about Prozac is that I sort of 'taste' something that's like licking zinc except it's throughout my body and not in my tongue. It was especially prominent during the Prozac-induced panic attacks, but it's still pretty persistent otherwise. But it's fading.

I still feel like I'm swimming through molasses though.

So, it's looking like my ongoing health problems have really been a stress disorder. Considering that I've been under one form of extreme stress or another since the time that this crap started, that makes a lot of sense; I think the aspect that made both me and my doctor consider this as the most likely possibility is that I'd actually been doing pretty okay for the last month (after returning to work and no longer being stressed about health issues per se), until early this week when work suddenly got VERY stressful VERY fast, and the problems all came back in spades.

So, for now, he's putting me on a low dose of Prozac to take the edge off while I try to figure out how to reduce my stress levels. I did have a good long talk with one of my coworkers who had gone through something similar a while back and he said he learned to just let other people make decisions and to just go with the flow and do what he's asked (and nothing more). I'm not sure I can make myself not care enough about what I'm working on to do that. But we'll see.

I have been a lot less stressed ever since making the following changes in my lifestyle:

• Installing Comment Blocker on Firefox (and Shut Up on Chrome, although I'm back to Firefox full-time)
• Turning off all email notifications for general-purpose comment systems (Disqus, TypePad, etc.) that I can
• Sending all emails from comment systems that can't have notifications disabled (YouTube, Blogger, etc.) directly to the trash
• Blocking/ignoring/gagging people on IRC and MUCKs who infuriate me
• Not following blogs, LJs, etc. that have turned into nothing but whining or trolling
• Not following webcomics that have stopped being entertaining
• When something still manages to get me angry, taking a deep breath and thinking about how little it matters

So after getting home and getting the aforementioned bill, I was very frustrated. I called the billing department, which of course had an overly-cheery answering machine that just said that the office was closed and to please call back during business hours, but to leave a message I could press 1. I pressed 1 and it just replayed that message. So I hung up.

Then I sat down to type up the angry blog entry previously, and Werner jumped on my lap and as always started getting "playful" with my mouse. I lost it and yelled at him, and he was completely shocked and ran off in fear. I felt like the worst person in the world.

A few minutes later he came out and I decided I'd play with him again with his favorite toy (a stick with a long swatch of multicolored fabric) to try to calm down, and then I just got another twitch while thinking about the stupid bill and everything else, and I just felt like I needed to let out a lot of anger and just started whipping at the ground and I guess I started swearing louder and louder, and then Werner ran off, completely frightened, yet again, and it was several minutes before I calmed down enough to find Werner and pet him and apologize and calm him down.

Right now he's sitting next to me, and I know that I wouldn't do anything to actually hurt him (and that if I did hurt him I don't know what I'd even do) and I just need to pet him and talk softly to him and not think about the things that make me so angry.

I need a healthier outlet.

So I just got a gigantic (thousands of dollars) bill for my CT scan a month ago, with an "uninsured discount." This means that Sutter's billing department has most likely either forgotten to bill my insurance, lost the information outright, or made a stupid data-entry error which has caused them to believe that my insurance isn't valid. Either way, this is going to be another giant headache that takes another fucking year to take care of. All for a test that found nothing.

And this is why I should just stop caring about my health.

I guess I haven't posted about my butt in a while. I had a CT scan a couple weeks ago, and a colonoscopy a week ago, and neither found anything, so the gastroenterologist is calling it Irritable Bowel Syndrome (which is just code for "we have no idea what's going on but a lot of people have it") and put me on a medication that will supposedly help but so far it just makes me dizzy and tired. (I only started it this morning thanks to a mixup at the pharmacy, though.)

On the plus side I've been back at work most of the time (aside from time off for procedures and doctor followups) and am actually being really productive lately. I mean in the work sense. In addition to the butt sense, I guess.

Butt butt butt.

The differential diagnosis only points to a single possibility: diverticulitis.

The specific tests for diverticulitis do not find it. Or anything else that could be related. The only thing even slightly abnormal that showed up on my CT scan was fatty tissue in my pancreas, which is a benign condition especially when it isn't coincident with anything else.

And yet I'm still having stool issues (tarry chunks in a torrent of undigested bile) and dizzy spells, and palpating my lower left abdomen still freaking hurts.

At least I have my appetite back, and my doctor has cleared me to eat foods that aren't too high in fiber, fat, or spice. I'll probably regret going out for shabu-shabu with out-of-town friends tonight, but I'm hungry, frustrated, and willing to put up with a morning of diarrhea and stomach cramps if it only means I can just freaking eat something (other than white bread, vegetable broth, and Jell-O).

CT came up negative for diverticulitis. Meanwhile, I'm still having a bunch of symptoms that are best explained by it. What the hell, body? Stop sucking.

I'll be getting an endoscopy sometime soon, so maybe that'll find the issue.

So on the plus side, my current bowel issue isn't due to infection or whatever. On the minus side, it's probably, well, see the title.

I'm getting an abdominal CT tomorrow, and will be getting an appointment with a gastroenterologist in the near future, but I am likely to be pretty much out of commission for a while longer.

I'm mostly over the cold/bronchitis that started nearly 4 weeks ago, but right now I'm on the seventh day of diarrhea and stomach cramps. I'm so sick of eating nothing but chicken broth and rice. I'm sick of drinking ginger ale and 7Up. I'm sick of being tired and dizzy and nauseous and unable to care for myself. I'm sick of not being able to go to work or work on my hobbies, and I have so many commitments that I'm unable to follow through on.

I really wish I could just get over whatever this is.

Hopefully my lab work has come back by now and the doctor can tell me what's going on.

My bronchitis is clearing up but I've had diarrhea for the last four days, and the cause isn't clear. It's quite likely I might end up needing hospitalization due to this, since there's probably something in my gut that needs antibiotics that I'll need administered under doctor supervision (due to my long list of drug intolerances).

For anyone who was hoping to see me at Further Confusion this year, I'm sorry, but at this point I'm expecting I won't be able to make it.

Basically I've been sick and unable to work on anything for the last three weeks and it's very frustrating.

The year began just hours after my grandmother died.

Just because I have a working theory for what's going on doesn't mean I don't have a lot of ridiculously high (post-insurance!) medical bills from the ER visits I had earlier. Sigh.

So, when all is said and done, a fairly likely diagnosis for what's been going on with me is that I have labyrinthitis (an inflammation of the inner ear, usually due to viral infection). It certainly fits the symptoms, at least — bouts of dizziness which turn into anxiety attacks, occasional tinnitus (more than baseline for me, anyway), and so on. My working theory right now is that the stress of Chris' death made it easy for me to get very dehydrated and therefore rather constipated, which turned into an impacted bowel, and somewhere along the line I also got labyrinthitis (I don't recall exactly when the dizziness or anxiety attacks started but they were I think around the time that I passed out on the 2nd). The stool softeners I've been on for the impacted bowel (and the discontinuation of spironolactone) have helped immensely on the bowel (I'm pooping normally and regularly again, yay!) and the remaining symptoms are all just explained by labyrinthitis and a re-emergence of Raynaud's syndrome, which I've had in the past but haven't had trouble with for a while. And of course, anxiety is a pretty major Raynaud's trigger, which explains how one thing can lead to another (and the progression of an attack really does strongly imply that it's labyrinthitis → anxiety attack → Raynaud's attack).

I don't know the underlying cause of the Raynaud's but I know my mom has it chronically and so there might just be a genetic component, and I just need to learn to relax when I'm having an attack. For a while I had been just meditating (usually while lying down) although I'm not always in a situation where I can do that, and the times that it's gotten out of control have been when I've been in a situation where I just plain couldn't take a break, or just when I was getting better some concerned friend would come over and make sure I was doing okay which would of course just make everything come right back (such as during Chris' funeral, where I'd go lie down in the car and things would be getting fine and then someone would knock on the window, bringing everything right back; of course, Chris's funeral had plenty of NON-dizzy anxiety as well).

Anyway, hopefully if that was the case then I can go back to normal life and be more confident that I'm not going to just die unexpectedly or something, and that in and of itself should help to keep things from getting bad to begin with.

My understanding is that viral labyrinthitis usually takes a few weeks to a few months to clear up on its own, and my bloodwork doesn't support it being bacterial labyrinthitis. My doctor seems to think the labyrinthitis theory is plausible (per a brief email conversation) so I guess I'll just stick with that for now, until something else happens to make me think otherwise.

Maybe the Internet people can figure out what's going on here.

Symptoms

Normally I feel fine (aside from being somewhat constipated), but when I'm having an attack the following occur:

• Dizziness
• Weakness
• Numbness (esp. in hands and face, sometimes in feet)
• Anxiety attacks
• Dry mouth, feeling dehydrated
• Lack of water retention/frequent urination
• Feeling faint (and actually fainting a couple times)
• Loss of appetite

Attacks seem to occur most often after exertion or eating/drinking certain things (I haven't narrowed down which things yet).

Lab tests

WBC: 8.5 (high normal)
RBC: 4.8 (low normal)
HGB: 13.0 (low normal)
HCT: 36.9 (low normal)
MCV: 77 (low)
MCH: 27.1 (low normal)
MCHC: 35.2 (normal)
PLT: 181 (normal)

GLU: 112 (slightly elevated)
UN: 13.7 (normal)
CRTNN: 0.81 (normal)
NA: 138.8 (normal)
K: 3.7 (low normal)
CL: 102 (normal)
CRP: 1.09 (rather high but not considered extremely elevated)
TP: 6.1 (low)
TB: 0.3 (low)
LDH: 136 (normal)
AST: 22 (normal)
ALT: 27 (normal)
AMY: 40 (low normal)
CK: 84 (normal)

This is from my Japan ER visit last night. I don't have actual lab numbers for the American visits.

Contributing factors

The slightly elevated GLU is likely because this measurement was taken a couple hours after I'd had a sweet mixed alcoholic drink.

The high CRP is a sign of inflammation. I have persistent inflammation in both wrists due to chronic RSI issues.

What it isn't

Diabetes

It has a lot of the superficial symptoms of diabetes, but none of the labwork supports it. My doctor has categorically stated that there is no way it could be diabetes, as has a friend of mine who is medically-inclined as well.

Anxiety disorder

There seem to be too many physical symptoms for this to be the case. It's possible that my recent anxiety attacks have been caused by whatever the underlying cause is, or that generalized anxiety attacks are causing whatever this is to trigger.

Medicine intolerance/sensitivity

The only medication I'm taking now is a prescription stool softener, and I only started that well after these problems started. Before the problems started I was taking spironolactone, which was certainly contributing to the dehydration, but probably not the root cause of it.

What it could be

Food sensitivity

This one does seem like a distinct possibility, especially since it sometimes comes on after eating. A wheat or gluten intolerance would seem the most likely. I really hope this isn't the case because holy cow do I love me some pizza. I'll try avoiding gluten foods today and see if that helps.

Some sort of autoimmune disorder

"It's never lupus." Except for when it is. But it seems unlikely.

Raynaud's Phenomenon

I guess that's more of a symptom complex caused by vasoconstriction (which could also be caused by an autoimmune disorder) but a lot of things fit. Numbness in the extremities brought on by cold, exertion, or cigarette smoke (and caffeine doesn't seem to help any, either), and during attacks my hands to seem to get a bit more pale although I could just be getting pale everywhere and I just don't know it. I do have a family history of this (from my mom), and she said it started at around my age (and has only gotten worse over time). Obviously this isn't a disease on its own but it's not exactly a symptom, either.

In Tokyo, the emergency room is staffed with enough people that everyone has multiple attendants always taking care of them, whereas in the US it can often be hours between check-ins by the staff.

In an American emergency room, it is up to the patient to undress themselves and put on a gown; if they are unable to do that, the staff will cut the clothing off. In Japan, they do as much as possible without removing any clothing, and are exceptionally conscientious about the patient's comfort.

In a Japanese emergency room, the language barrier is something they attempt to overcome and make sure that everyone knows the same amount of information; in an American emergency room, the attending staff tends to not communicate or even listen to the patient.

In an American emergency room, regardless of what's going on they always hook you up to a saline drip, while in a Japanese emergency room, that is considered a treatment that they only perform when it appears to be necessary.

In an American emergency room, if you have to use the bathroom it takes quite a lot of time before an attending nurse even finds out that you need to, and they just give you a jar to pee in before disappearing. In a Japanese emergency room, they accompany you to the bathroom and make sure that you're doing okay.

An American emergency room bills you later, via the convoluted process of American medical insurance. A Japanese emergency room either bills your insurance directly and asks you to pay the difference (if you have insurance), or just bills you directly and has you pay before you leave (and provides receipts for reimbursement with foreign insurance claims later). Fortunately, the overall uninsured bill of a Japanese emergency room is less than the copayments involved in an American emergency room, so even if one doesn't get reimbursed you still end up ahead.

An American emergency room is doing good if they keep track of your name and mailing address. A Japanese emergency room issues you a personalized smart card that keeps track of your medical history with them for easy access later.

On the other hand, an American emergency room understands that people come in all sorts of sizes and shapes, whereas in a Japanese emergency room, the beds are very small and cramped, the slippers they give you for going to the bathroom (you don't wear shoes!) are tiny, and the adhesive on the tape sticks exceptionally well to a hirsute-American's arms.

Neither one can figure out what the hell is wrong with me.

The last week or so has been an endless cavalcade of health problems and ER visits which have led to absolutely no resolution or anything feeling like recovery. Instead of trying to re-explain this to everyone individually I'll try to piece together a timeline here, so maybe that'll be useful.

12:27 PM So, after I wrote this I went to the grocery store and bought some smoothie fruit and some easy-to-make-small-portions-of food. I had a smoothie and felt a lot better, and now I actually have a decent appetite again, and I am able to eat and I'm feeling a hell of a lot better. But I'm keeping this here in case things get worse again.

So I got an ear infection about a week ago, and when it didn't clear up on its own I went to my old doctor Monday morning (I haven't yet had an intake appointment with the new doctor so it seemed easier to just go to the old doctor even though the old doctor has screwed up enough times that I am looking forward to switching away from him, why no this isn't foreshadowing in the slightest).

So Monday morning I got in as soon as I could ("How long's the wait?" "No wait." "Great!" An hour and a half later, "The doctor will see you now.") and after five minutes of the doctor rambling at me about things that weren't at all relevant for the situation he prescribed me "a really good antibiotic, no penicillin so don't worry about that" as well as some Allegra, and told me to just take one every night before bed.

Monday night I didn't sleep very well but I figured it was just the infection.

Tuesday night I didn't sleep at all.

All day Wednesday I was feeling tired and drank caffeine which had no effect and was feeling tired and depressed and worthless and suicidal, and I was desperate for sleep so I took my antibiotic and laid in bed and still couldn't sleep, and I got up and checked the warnings for the Allegra, thinking it might have pseudoephedrine in it, but it didn't, so I checked the warnings for the antibiotic and it said that if you experience sleeplessness, nausea, dizziness, joint pain, depression, hallucinations, or suicidal thoughts, call your doctor immediately. (That's just the list of the stuff I was actually experiencing. The actual list of counterindications is much longer.)

So I called my doctor immediately and left a message (marked urgent) and read up on levofloxacin (fun facts: it prevents caffeine from being metabolized fully, it can cause sudden and debilitating spontaneous tendon ruptures, and it has a huge number of severe side effects, has been banned in several countries due to safety concerns, and the FDA indicates that it is only to be used as a last resort!), tried going to bed, and then two hours later gave up on sleeping and got online and started ranting about how if I die overnight it's my doctor's fault and just generally illucidly ranted a bunch. My friends convinced me to go to the emergency room, which I did.

I learned the following:

• St. Luke's emergency room still has patients put on their own gown even if they come in presenting with suicidal thoughts (and the thought of tightening the neck straps crossed my mind more than once)
• Levofloxacin is pretty much not the right thing for my doctor to have put me on, because of the side effects
• Levofloxacin also wouldn't have even treated my ear infection anyway, what with it being fungal, which the ER doctor saw right away
• Levofloxacin will also still be in my system for a few days (and as I later read online, apparently it can cause problems for as much to a year as it's been taken, if I'd taken the complete course)

The ER doc prescribed me some heavy sleeping pills to counteract the sleeplessness, and an appropriate antibiotic for my ear.

Meanwhile I'm still having occasional hallucinations but I'm at least tired enough to fall asleep tonight, I think, and generally feeling better anyway. Also just one day of the appropriate antibiotic (a topical drop that I apply 3-4 times a day) has helped my ear quite a lot.

Oh, and the doctor never returned my call. Thanks, Dr. Lim. You fucking suck and I hope you lose your medical license. Asshole.

So which hospital administrator and/or accreditation board should I contact about this? (This, incidentally, isn't the first time he's prescribed me an inappropriate treatment for a partial solution for a potentially-life-threatening problem and failed to actually handle any sort of followup with anything remotely approaching good medical care.)

So I've been having some minor hearing trouble with my left ear, and last night it became pretty obvious that it's due to an infection or the like. So I figured I'd go to a Saturday clinic to get it looked at (I am between doctors right now). Of course, St. Luke's Hospital (whom I've ranted about so many times in the past) no longer lists their clinic hours on their website, and only provide a phone number; calling that phone number just results in a message that says, "Our office is now closed. Please call back during business hours." They never state what those business hours are.

My health insurance provider's website also doesn't provide hours of operation for any of the doctors in their directory. Searching the Web is an exercise in futility; San Francisco has so many special-purpose clinics that those dominate the search results for any search on "clinic" (Saturday or otherwise), and searching Yelp for "doctor open Saturday" finds a bunch of restaurants which have one or more reviews including the word "doctor" or "Saturday" (e.g. "went here for brunch on Saturday") and plenty of other non-doctors (e.g. chiropractors).

It's like this xkcd, except about things in real life.

I thought I'd had all the bills settled from my endoscopy last year. So of course today I just got another bill from St. Luke's for $713.72 with no reason given aside from "balance due," saying that there is no more insurance payment forthcoming on this account. The only contact option given was either calling their toll-free number or "access your account online." Knowing that the online access is useless I called the number. I was greeted with an endless cavalcade of data entry, which ended with "our office is now closed; please call back during regular business hours." They could have said that BEFORE I spent 5 minutes entering every bit of information they wanted. Ugh.

Meanwhile, I have no idea what this amount could be for. I am pretty sure that I have paid every bill that came to me. All this shows is: Service date June 24 2010 (the endoscopy), total charges $6430.07, $4044.56 in payments, a $-1671.79 "adjustment," and a balance due of $713.72. I am pretty sick of this whole stupid situation.

And of course my employers moved me over to a new insurance provider this year so who knows what the hell the status is of my previous insurance vis-a-vis handling this issue. Obviously my new insurance company wouldn't be held accountable for this.

St. Luke's billing department is the embodiment of failure and a shining example of what is wrong with the American healthcare industry.

Or, in short, St. Luke's hospital FUCKING SUCKS.