Bad anxiety is probably the single most miserable emotional state humans can experience. It is truly a living hell.
Dr. Charles Raison, Psychiatrist, Emory University Medical School.
My stroke experiences in 2017/2018 took me back to June 1974:
I was in trouble, and I knew it.
I sat on the edge of the hospital bed and smoked Marlboros—one after another. I was alone in the chilly room. My hands shook. My second night was a lonely Friday night at St. Mary’s Hospital Extended Care Center near the West Bank of the University of Minnesota in Minneapolis. The third floor was an adult alcohol treatment center reputed to be one of the toughest and best in the country—a boot camp of human development for broken lives. I normally got drunk on Friday nights. I was cold sober on this June night and I didn’t feel at all like the Marlboro man.
I had just finished the book, I’ll Quit Tomorrow. The book described the dynamics of alcoholism. Each page was a sharp-edged piece of a shattered mirror that reflected my life. I was shaken to my core—until that moment, I did not know I was an alcoholic. I was defenseless: my denial penetrated, and my delusions about my life exposed to me. I saw the impact of alcohol on my life, my work, and my relationships. What I saw hurt. The person I saw was not the person I started out to be.
The father of three young children, a Phi Beta Kappa graduate of the University of Minnesota, and a 3-year special agent in the United States Secret Service, I was now 28 years old, unemployed, and broke. I was 6’3” tall and weighed 150 pounds—down 20 pounds from my normal weight. I was alone, scared, and depressed.
I stared at the sterile and indifferent wall across from me. How did I fall into this abyss of despair, addiction, and self-betrayal? Could I find the courage and strength to save myself? Was salvation even possible or had I gone too far? Could I redeem myself? Could I again realize my possibilities?
I could change or die, and the choice was mine alone. My “bottom” wasn’t as low as some, but it was as far down as I wanted to go. I chose life.
Treatment—the most difficult and most spiritual experience of my life— challenged me more than any other event of my life; I had to look at myself honestly under watchful eyes. I was humbled by the experience, and by the power of authentic human connections. I felt anxious although I didn’t know it then. I was determined to rise above this setback in my life.
I left St. Marys with a profound sense of commitment, albeit more than a little shaky. Treatment began my conscious life of self-development and my vow to live my values to the best of my imperfect ability.
My existence depended on an authentic and value-driven life.
As I described in an earlier post, my five strokes were painless with no permanent loss of function. My days in the hospital were easy.
But the next three months (January-March, 2018) were as difficult as or harder than my month at St. Mary’s. As I went through the weeks of TIAs, new spots on my brain and a cancer scare, I felt anxiety and fear that may have been greater than what I felt when I was in treatment almost 44 years ago. I was anxious about dying, the unknown, potential disability, and simply losing myself. And probably many other things.
I had never thought of myself as an anxious person. I was never treated for it. Sure, in the hours before I gave a speech I wanted to run away. Didn’t everyone feel that way? When I began to talk, I immediately went into my flow mode and I had fun and usually got high marks.
Once, anxious about being confronted, I didn’t go to a post-treatment growth group session long ago at St. Mary’s. But I showed up an hour later and took my lumps. In my last year or two at the Star Tribune, I felt anxious. I feared people with more power than I wanted to neutralize my success. The thing is, they did.
I asked Melanie if she thought I was anxious. She smiled and said if she were to list three top characteristics of mine, anxious would be the first one. Daughters Cari and Becky thought the same. I did worry and sometimes catastrophized outcomes. But I figured that was my job as a leader and consultant: Figure out the future possibilities and put scenarios together to avoid unanticipated and negative outcomes.
Whatever the past, I knew I felt a dark anxiety after the strokes.
My doctor prescribed me Zoloft for depression and low dose (.25 mg) Xanax for anxiety (both common after a stroke). I was proud of my long sobriety and did not want it threatened. I resisted Xanax. I thought of Xanax as a highly addictive drug and I feared going down the path of addiction again. My mind flooded with memories from my 10-year journey into the darkness of alcoholism and my first years of recovery as I faced life without alcohol. I did not want to go through another recovery from addiction.
I felt anxious about taking a drug to reduce my anxiety.
Melanie pushed me to take Xanax anytime I felt anxious. So did my daughters. I considered Xanax to be a worst-case drug so I would tough out the day and only take a Xanax as a last resort. The doctor prescribed up to two tablets (.25 mg) twice a day as needed. I took no more than one tablet a day. After a few weeks of going around and around about how much Xanax to take, my doctor said, “Let me worry about addiction. You will not develop tolerance or addiction taking one .25 mg of Xanax a day.” I never took more than one tablet a day. Many days I took none. Xanax also helped with my hand tremor, worse after the strokes and my moderate voice tremor (called Essential tremors). As the weeks passed, I came full circle from resistance to acceptance of Xanax as a drug that could help me where other drugs had failed, when taken as prescribed.
I’m sure many recovering alcoholics and those who struggle with addiction to other drugs, have had the angst I had felt. My friend, Bruce Nelson, wrote to me and I share a long quote of his so wonderfully written:
I can particularly relate to your mixed emotions over the Xanax. I started my 39th year of sobriety yesterday, and have wrestled a lot with the same dilemma you faced over those decades of recovery. I religiously avoided anything stronger than Advil for 30 years.
Then I went through a hip replacement in 2009. I couldn’t tolerate any of the physical therapy I needed to do after the surgery and my doctor persuaded me that opioids would dull the pain so I could do the exercises necessary to get my new metal hip to work with the rest of the body. I was really frightened, but what he said made sense. So I used them for two or three weeks and everything worked just fine. Yeah, I felt a little high from the drugs. But my then 30 years of recovery had also changed me. I wasn’t desperate for an escape or eager to shut down my feelings, like I was back in my active alcoholism days. The opioids served a purpose, and I used them for that purpose and then quit taking them.
I went through a similar episode with them in 2011. I had a huge malignant tumor on my chest, between my heart and lungs, on something called the thymus gland. They split my chest open just like they do for open heart surgery and yanked the mass out. Full recovery after radiation. But I went back on opioids as I recovered from the surgery, with pretty much the same effect as they had after the hip replacement: [I] took them until the pain subsided and then stopped.
My real opioid challenge came in 2014. I slipped on the ice and broke two bones in my back. The pain was incredible, so I went back on the drugs. Unlike surgical pain, the back pain seemed to be without end. It turned out that I also have spinal stenosis, a chronic pain condition. Well, I quit the opioids two months after I fell. The pain had subsided a little but was still bad but I was damned if I was going to take those things for the rest of my life. They were dulling my brain to the point where it was really hard to focus on anything.
My primary care physician saw me a month or so after I stopped taking the pain meds. I thought I was doing pretty well, but she said she could see pain all over me, from my face to my movements and even my voice. She was keenly aware of my feelings on opioids. “What would you say if I could give you something that is not a narcotic that would take the pain away?” she asked. I told her masochism wasn’t my thing, and that I would be glad to try whatever she was talking about. She prescribed Tramadol. Amazingly, it did exactly what she said it would do. Most of my pain was simply gone, and there were absolutely no feelings of being high or in any way mentally dulled.
Several months after I started taking it, Tramadol was reclassified as a narcotic and a controlled substance. My doctor swears she didn’t know this was coming! It was a combination of two pressure points, one out of corporate greed and the other well placed. Whatever company markets Codeine put all sorts of heat on the DEA because the non-narcotic status of Tramadol was giving it an unfair competitive advantage. The growing opioid crisis was another source of the change. Apparently there is some low-grade opioid in Tramadol and addicts were taking it in huge doses. I’m still taking it. My lifestyle would be greatly reduced without it. When I don’t take it, I have several hours during the day where the pain overrides everything else. I can’t think, focus or even begin to carry on a conversation. The Tramadol reverses much of the pain and allows me to feel more human.
I also keep a very limited supply of Percocet on hand for very special occasions like when I try to insert my 6-foot-8 body into an airline seat or have to go through a CT scan or a two-hour dental procedure. Those kinds of things bring the pain way past the Tramadol level.
When I started this email, I had no intention of going on this long with my medical stuff. Sorry about that. It’s just that your story about your trepidation over the Xanax really resonated with me, in a way that only those who are in recovery can understand. Taking these drugs can be an agonizing decision. But in the end, I think we both did the right thing. We both used drugs at one point in our lives to detach from life, to not feel or think or focus. Now we carefully use them to make all of those same functions possible. It’s a careful and delicate balancing act.
See Bruce’s blog: Let’s Think This Out for some wise, smart and well-researched commentary on our crazy world.
I’ll end with another quote from Dr. Raison:
“The vast majority of people who take benzodiazepines for extended periods are highly compliant and follow doctors’ orders closely. Indeed, in my experience many anxious patients who would benefit from benzodiazepine treatment are so worried about addiction and other problems that they deny themselves an important potential pathway to well-being. But the other extreme is even more problematic. Although in my experience benzodiazepines do not have the addiction potential of something like opiate pain pills, they can cause significant trouble when abused. Hence the importance of taking exactly as prescribed.”
More to come in future blogs.