Meditation for the Mentally Interesting

Well, the grand experiment with the diabetes drug Rybelsus is over.  I was in the middle of trying yet another workaround when I suddenly asked myself why I was trying to work around what was essentially the problem instead of just, you know, solving the fucking problem.  And it in no small way helped that the wife, the good friends and the psychiatrist had all said essentially the same thing.  So I quit taking it, but I still had to break the news to my Regular Doc.

For reasons I'm a little fuzzy on, my Regular Doc seems to think that this medication and the others in this family hung the moon and the stars.  She wants all her diabetic patients on this stuff.  And once in a while I do something smart, like take my wife to my doctors' appointments.  I think if Joan hadn't been sitting right there, she would have tried everything I could think of to keep me on it.  I was actually prepared to go in there and fire her, if necessary.  But that didn't happen, though she did sigh rather theatrically and say, "Well, at least we tried."

Yes, and we also managed to upend every facet of my life, almost get me fired, and make me mildly crazy.  But sure. We tried. Heck, maybe I'm the only one who even noticed.  

Anyway, there are lots of diabetes meds and they make new ones every day.  The latest is called Januvia and it seems to be mostly harmless. I think it maybe does make me a little sleepy, and the weird vivid dreams are a new thing.  I can't find anything about vivid dreams in the literature, though, so maybe that's Just Me.  My other meds are slowly starting to work again.  (It takes any semaglutide drug about 5-6 weeks to work your way out of your system, so I won't be normal until like mid-to-late April.) And as long as nobody sneezes or anything, everything should be fine.

Which brings me back to the whole point of this blog: Buddhism.  Or at least Buddhism with a sense of humor.  I don't exactly advertise that I'm a Buddhist, since it's not an evangelical kind of thing, but some people do know this.  And I get this a lot:

"You meditate, right?"

Right.  I'm a Buddhist.  We do that.

"Well, like how? Because I've tried it and I can't sit still and my brain is racing around from one thought to the next and I can't focus on anything."

Oh, honey.  I have three (count them, three) neurological pathologies, for which I'm medicated.  A lot.  My brain acts like a highly emotional cocaine-crazed weasel at a rave.  

Now, in most blog posts, the author would say, "And if I can do it, anyone can do it" but this is not most blog posts and I try not to say stuff like that. The older I get, the more I see that however typical you think your experience is, it's really not typical at all.  It's a big mistake to think that "everybody" knows about the Constitution or continental drift or evolution, or believes in science or vaccines or even that the President of the United States should maybe not be a raving criminal madman with advanced dementia who's ready to sell nuclear secrets to anybody who'll pay his legal bills.  It's too big a world and there are too many of us.  Besides, not all of us grew up bipolar/ADHD in a Scandinavian Lutheran family in Salt Lake City in the 1970s.  (And if you did, my sympathies, and we should really compare notes.)

That said, however, most people can learn to meditate, one way or another.  And did you know there's more than one way to meditate?  You don't have to sit crosslegged on the floor and chant om mani padme hum for an hour.  You can even get up and move around.  Yes, I'm serious.  Read on.

Really quickly, the benefits of meditation:

• Reduces stress
• Helps concentration
• Helps with depression and anxiety
• Bolsters self-confidence
• Improves sleep and brain health
• Helps with pain
• Helps with addiction issues and cravings
• Decreases blood pressure
• Makes you look cool 
• Helps you pick up girls

Okay, I'm not sure about those last two.  The rest are backed up by science, though.  Here's a nifty Web site from the National Institutes of Health that links to some of the major studies.  

Now, for most people, meditation does mean sitting on a cushion or a chair, getting comfortable, and focusing your consciousness on a single point.  That's usually a chant, like om mani padme hum, or if you're Christian, maybe Christus mecum est or even Jesus loves me.  If you realize you've drifted away and are lost in thought, you just gently come back to your point.  Yes, you will do this over and over again.  But over time, like a long time, like probably a year, it does get better.  Your mind will be quieter and the other benefits of meditation will start to appear, too.

But: A lot of people don't like sitting still.  Or they can't sit still.  Or they maybe could sit still, but they'd be basically forcing themselves to sit still, and kind of the point of meditation is that it's supposed to be gentle and not forced.  (Which is why I can't figure out in some of those kung fu movies why the meditation master whacks you with a stick when you start falling asleep.  I mean, that's kind of the antithesis of meditation.)  So here's something else:  Walking meditation.

In walking meditation, you walk a slow path from one side of the room to the other, or one side of the yard or the other, and back.  If possible, go in a circle.  If also possible, take your shoes off so you can feel the earth beneath your feet.  (Please don't do this if you might step on an ant hill or a Lego.  Being in pain or needing an Epi-Pen is not conducive to meditation.)  Take slow steps, not fast ones, and take the time to actually feel the earth under your foot.  What does it feel like?  Is it cool? Warm? Hard or kinda soft?  How does it press into your foot?  How does your foot feel after touching it?  What's the space like between one footfall and the next?  Hopefully you are getting the idea.  The meditation focus in this case is not the chant but the sensation of your feet touching the earth. 

Thich Nhat Hanh, who was my guy, once wrote that he practices walking meditation in airports.  Yep, he said airports.  Speaking of antitheses to meditation.  Airports are full of stressed-out people having the worst days of their lives trying to get from one point to another point, sometimes for fun but sometimes also for really icky reasons. Anybody who can practice walking mediation in an airport is definitely a Zen master.  (Did I mention Thich Nhat Hanh was a Zen master?) I'm not saying you should try meditating in an airport, especially if you're new to it, but maybe, if you are not late, you could try not walking as fast.  Taking a little more time to appreciate all the different people and the stuff that goes on.  Look at the colors and the different kinds of lights and especially the kids.  The great thing about kids is that they always are who they are no matter where they are, at least until they turn five and have to start being like all the other kids.  In I think 2002 I was at an airport in New York City to catch a flight to London and there was this advertisement that was shining colored lights all over the floor.  This three-year-old boy from I think China chased the lights around and stepped on them for like forty-five minutes.  This still makes me smile.  Especially since his parents didn't grab him and say (in Chinese) "Come on, we're going to be late" but just let him keep doing it until he got tired.

Another way to practice meditation is by doing yoga.  Yoga gets a lot of press and it's sometimes kind of pricey, but check out your local Y or LA Fitness or equivalent.  What yoga basically is, is stretching exercises, but they are exercises done mindfully, with all of your focus.  In this case you'd be focusing on the particular body part you're stretching, how that feels, how to push the stretch a little bit farther if it doesn't feel right or rein it back in if it's gone too far.  Disclaimer: I can't stand yoga.  Too slow-moving, too much holding still and I can't get into a lot of the positions because of my knees.  That said, though, I know people who swear by it.  And I will grudgingly admit that I've had some success at chair yoga or yoga classes for disabled folks.    

Other forms of kinetic meditation include things like doing the dishes meditation, or if you like, sewing or knitting meditation.  Any simple activity that you can put your whole mind into works great for this sort of thing.  Knitting and sewing are particularly good because the repetitive hand movements are very soothing.  (I'll bet you didn't know your grandma was a Zen master.)  Doing the dishes meditation is also good, and it gets the dishes clean too.

Sports meditation is something I do when I'm swimming.  (I haven't talked about swimming much in a while but I swim.  A lot.  I used to be a marathon swimmer, and who knows, maybe I can be again.)  I put the focus on the swimming muscles, usually one at a time because there are a lot of them and I can't concentrate on all of them at once.  Maybe for the first lap I'll focus on how my shoulders come around.  Then next time the leg muscles and the extension of the feet.  Then the third time maybe hand position or head position or something like that.  Not only is this meditative, it makes me a better swimmer, too.  I've also heard of runners, cyclists and other kinds of athletes talk about doing this sort of thing.  I mean, I guess you could go out there and just, you know, let your mind drift around, too, but if you're working on your focus, it's gonna help you in every area of life.  And it's not like there's plenty of time to drift around later.  You know, like during that 9 am meeting.  

The point of meditation, though, is that it's a practice.  If it's something you do every day, for ten minutes a day, you're going to have a better experience than if you do it once a week for an hour.  But hey, if all you have is once a week for an hour, do it then.  All meditation is good meditation.  Bad meditation is good meditation.  Once, manic as hell, I went bouncing into a retreat led by the late great Brother ChiSing.  I boinged down the aisle of this church like a grasshopper, dropped onto one of the cushions, and said, "Hi!!" I could see him trying really hard not to roll his eyes.  Believe me, there was no good meditation that day.  But because bad meditation is good meditation, I got something out of it anyway.  

This I promise you:  If you meditate every day for a year, even if it's only for ten or twenty minutes, you will be a different person at the end of that year.  Fewer things will bother you.  Your stress will be lower.  You won't freak out so much about small things.  People around you will notice that you are nicer to other people. That you will do weird things like ask them how they're feeling.  I know this is true because I've seen it happen, both to myself and other people.  

So, anyway, I'm going to send you to Thich Nhat Hanh's how to page.  There are plenty of other ones if this one doesn't do it for you.  There are also some apps.  My favorite is Insight Timer, but there are also calm, Ten Percent Happier and many others. It doesn't really matter where you go or what kind of instruction you get, though I do think instruction is a good thing.  What's important is that you do it at all.  Yes, even if you are mentally interesting.  Cheers!

Guest Post: Chicken Fat and Me!

"Chicken Fat" and Me, by J.C.

I have a love-hate relationship with the "Chicken Fat" song. If you're of a certain age, you at least know the chorus "Go, you chicken fat, go away! Go, you chicken fat, go!" Yeah. That one. (And if you don't know it, click here.  Warning, it is loud. )

It played very often in my 1st? 3rd? grade classroom. And on the playground, all the mean kids would start singing that chorus when they saw me. Fun times. At least it was a musical interlude amongst the general fat-bullying. So, yeah. I hated it. Except that I love the song and still do.

There are a plethora of reasons why I love "Chicken Fat."

I love musicals. I blame "The Music Man". When I was 6 or 7, I went to a high school production of it. My first live theater experience of any kind. I was completely captivated. And when Mayor Shinn was berating the River City-izens for falling for Harold Hill's chicanery, and bellows "He promised us a band. Where's the band? WHERE'S THE BAND??!?!!???", the high school's marching band came down the aisles playing "76 Trombones" full blast.

Mind. Blown.

(Hang on, I will get to "Chicken Fat.")

I imprinted on "The Music Man" like a baby duck on its mama. I have seen the movie so many times I can do the dialogue as well as sing all the songs - and both parts of the ones in counterpoint. Robert Preston's voice will grab my attention like a tornado siren. (Loved him in "Victor, Victoria' as well - his drag version of "The Shady Dame From Seville" is pure gold.) So here we get the first connection to "Chicken Fat": Robert Preston. How can I not love a Robert Preston song?

Not only that, guess who wrote "Chicken Fat?" If you clicked on the YouTube link to it, you know the answer: Meredith Willson. And who wrote "The Music Man?" Yup. Same guy. Composer, flutist, radio & television musical director, etc. etc. etc. Very talented man. Very fond of counterpoint. The Christmas song "It's Beginning to Look a Lot Like Christmas/Pine Cones and Holly Berries" ought to ring a bell. That's him, too.

On top of being a HUGE fan of Meredith Willson, I've got a 5th-degree connection to him. My grandfather--his father--Arthur Pryor--John Philip Sousa--Meredith Willson. (And then on to Arturo Toscanini, according to Willson's Wikipedia bio.) A pilgrimage to Mason City, Iowa and the Meredith Willson Museum is on my bucket list.

Finally, to put a big ol' bow on it:  Willson and Preston recorded "Chicken Fat" while making the movie version of "The Music Man" which is why it sounds like it's being sung by Harold Hill.

I can't not love this song.

But I hate this song because it was used by bullies as a weapon against me.

Conflicted, me.

dis-MISSED!! 

Fun with Drug Interactions

 First of all, for no particular reason, here's a video of my happy feet.

Secondly, here's a video of one of my finish line dances.  Whenever I swim 1600 meters or more at a swim practice, I post one of these, though it's happening so often now I'm probably gonna need to up it to 1700.  So if you like fat chicks dancing or you wanna see updates. follow me on Threads @J3ninDallas. 

Thirdly, let's consider for a minute our nation's pharmaceutical companies.  These bold pioneers make wonder drugs so that their shareholders can make lots and lots of money.  Oh, and to cure diseases and treat conditions and whatnot.  This is a cautionary tale of what can happen when two prescription drugs collide with each other and make a big mess.

I think I told you guys I was diagnosed with Type 2 diabetes and a rare neurological condition the same week.  Which doesn't take into account that I already had ADHD and bipolar disorder and was being treated for those. Four conditions to monitor at the same time is a little flipping ridiculous, especially considering that two of them require testing and worksheets and, in one case, drops of blood.  Eesh.  Sure, years from now I'll probably also have heart disease and need three surgeries, but anyway, It's A Lot.  And finding a combination of medications that treat diabetes without also killing you is kind of like finding a combination of medications to treat bipolar disorder without killing you, only with some luck it only takes like six months instead of (in my case) three years, not counting lots of adjustments since.

Anyway, the first drug we tried is like the standard drug for diabetes, Metformin.  500 mg of this was fine, but it Did Not Do The Job; my numbers were still too high.  So my doc upped the dose to 1000 milligrams.  This was a mistake.  I had crippling nausea, not like minor stomach pain but as in I stopped being functional and had to go lie down on my side for half an hour.  A couple of times this happened in traffic and after the second time I called my doc back and said, "This is not safe."  I was being stubborn and trying to make it to three weeks, after which it (usually) gets better on its own. 

So back down to 500 we went.  Again, fine but not effective.  The next likely culprit in the arsenal is one of the semaglutide drugs, made somewhat famous (and infamous) for being prescribed off label for celebrity weight loss.  We're talking Ozempic, only I wouldn't take Ozempic because I didn't want an injectible that lasted for two weeks after my Metformin experience.  No, if it was gonna upset my stomach (which happens to me with basically every prescription drug made, never mind those that are  particularly known for that sort of thing) I wanted to be able to stop taking it Right Then.

Fortunately there is a pill version of one of these, which is called Rybelsus, and it starts out at a very low dose, just 3mg.  So we tried that and it worked great.  That plus the 500 mg of Metformin brought my numbers down where they should be.  There was, of course, some nausea, but nothing like Metformin.  It was a little like morning sickness.  It usually wore off by around 11:00, sometimes flaring up briefly later in the day. So I hit up all my friends who had ever been pregnant to find out what their go-to nausea treatments were. The surprising answer: Ginger.  Ginger tea in particular but also ginger candy and dried crystallized ginger (a little bitter but you get used to it, and Grayson likes it, too.)  So I lived on ginger and saltine crackers for a while, and the morning sickness gradually went away.  

Unfortunately, something else went away at the same time:  My ability to do my job.  I began falling asleep at my desk.  Like, routinely.  I can fall asleep just about anywhere, and in just about any position, but concentrating deeply on something and then suddenly startling awake and realizing that 20 minutes had gone by and I didn't know where I was or what was going on because I had, uh, been asleep was kind of a new thing.  Also, that deep concentration?  Disappeared. Kind of gradually but once it was gone, it was gone.  After two weeks I was going in to work and just kind of taking up space until I could go home.  Which is, you know, kind of bad when you manage a large number of complex things that keep the revenue generating machines chugging along.  

Right about this time, my doc was going to up my dose of the new diabetes med to 7 mg, but fortunately we had a problem with my health insurance. 🙄 The Ozempic class meds, in addition to being known for weight loss, are also expensive. The problem, apparently, is that I don't have T2D and you have to have T2D to take Rybelsus.  I of course have T2D, and we've sent them records showing this a couple of times, but I don't think an actual human being has looked at them.  So I have to appeal and so on, which should prompt an actual human being to look at them.  But I haven't done that yet because I got this text from a good friend.  I paraphrase:  "Hey, have you heard that those new diabetes meds can interfere with medications for ADHD and bipolar disorder?  Something about dopamine receptors and poor absorption?  You might want to check that out."  

WELL, HOLY CRAP.  

That was exactly what was happening.  It was like not being on meds at all.  Apparently the problem is particularly acute with extended-release meds, which my most important one is.  It's called Vyvanse and it's the one that keeps me awake in the face of the two or maybe three other meds (I lose track) that want to put me to sleep.  I went without Vyvanse for a month last summer during a national shortage and it was kind of like trying to rouse myself from a coma.  My psychiatrist ended up prescribing Adderall temporarily, which did the job, but it was like using a bulldozer to find a china cup, if I can quote Rene Belloq.  I mean it was harsh. I still take Adderall once in a while but it's a desperate times/desperate measures sort of thing.

Anyway.  The problem is that semaglutide disrupts absorption of certain substances by the stomach and intestines.  If you're not taking any other meds, this isn't a big deal, but if you are, it can be a real problem.  You're supposed to take the diabetes med right when you wake up and then not eat for 30 minutes so it can get going.  (This delay in my morning coffee has only been mildly dangerous for the population at large, though Joan has the Joint Chiefs of Staff on speed dial just in case.)  So I was doing that and then taking everything else when I got to work.  Which meant I was taking everything else right when Rybelsus was at its strongest.  No wonder nothing else was getting through.  There's also some problem with disruption of dopamine receptors in the brain that I'm not quite sure I understand, but that didn't seem to be my biggest issue.  My biggest issue was that the stuff couldn't get in. 

So I notified my Regular Doc about this and called my psychiatrist.  He called me right back (he usually does; he's a rare specimen of the breed) and said that he had an idea.  Try taking the Vyvanse about an hour before the Rybelsus and -- you'll love this -- take the capsule apart and pour the contents into a glass of water.  Then drink the water.  I bet you always wanted to know what the inside of a capsule looks like, right?  Well, sorry to disappoint, but it's just kind of this plain white powder.  

So that's what I've been doing.  My Regular Doc is holding off on increased doses and fighting with my insurance company before we find out if it works, but so far it seems to be.  I was going to take a whole week off work but instead I took half-days, and I was able to work the half-days (though I seem to be crashing and burning about 2:00 -- not surprising if I'm taking the Vyvanse three hours earlier.)  And the other meds seem to be working better, too.  I'm taking them all at the same time, before the Rybelsus.  This would not work with Ozempic or any of the other injectables, so I dodged a bullet there. 

There are, of course, some wrinkles in the plan.  Firstly there's the crashing and burning early part.  That might be solvable with a suitable application of Adderall; again, desperate times desperate measures.  Then there's the problem of waking up basically in the middle of the night, slamming down the powder for a strong stimulant that's supposed to be in a time release capsule, and then trying to go back to sleep.  Yeah, that's not working very well. And probably contributes to the 2:00 crash and burn.  There is a chewable version of Vyvanse, for little kids, that might also work.  It's absorbed in your mouth and bypasses your stomach entirely.  But it's kind of not as strong, so my psych doesn't want to do that unless the drinking the powder doesn't work.  And then there are the empty capsules themselves, left on the night stand after I swallow the powder and try to go back to sleep.  Guess what makes a great, rattly cat toy and makes a bunch of noise at 5 am? 

By the way, how cool is drinking powder?  Think Maria de Medici tipping her poison ring into your glass of water.  Sometimes it tastes bitter and sometimes it's kind of mildly sweet, so there must be two different components in there, at least.  Of course, it tickles my throat and makes me cough, too.  Nothing is ever perfect.  

I've reported this whole mess to the drug companies involved and I told my psychiatrist that he needs to Tell People.  Neither he nor my Regular Doc saw this coming.  I mean, there is one tiny line on the Rybelsus warning label that says something about malabsorption.  But it's awfully arrogant of Rybelsus, really, to act like it's the only important medication anybody out there is taking. This could be a big problem.  What if you're being medicated for schizophrenia and you start hallucinating because you also have T2D?  What if you're depressed and you go from mildly unhappy to actively suicidal?  I mean, people should know about this. I'm sure all of you know at least one person with ADHD and/or bipolar disorder and/or schizophrenia who also has T2D.  (If you don't, you're probably not hanging around with the fun crowd.)  So, like, tell people.  Thank you for coming to my TED talk.