Repeats are Never as Good as the Original

I had the second ear surgery last Thursday, and I went back to work today, though I’m still not fully functional. This surgery has proven much more difficult for me than the first one, and because the doctor took a skin graft from my hip this time, I have that added pain. More positively, given that I’m now fairly used to all that this surgery entails, I’ve been much less disoriented this time. I’m not having the trouble locating sounds that I did after the previous surgery. I’m getting quite used to having only one working ear. And the pain, on my hip (where it looks like he used a cheese grater to take a three inch long strip of skin) and around my ear, is subsiding as it should.

As planned, the doctor did the surgery differently this time, taking advantage of all that he’s learned since the previous surgery. As I’ve mentioned before, he’s using the one large skin graft, rather than several smaller pieces, and he’s also tried to more effectively address the issues caused by my previously unidentified TMJ. He didn’t discover that until more than two months after the previous surgery, so he didn’t take it into account the first time. It’s not clear to what extent that contributed to the replaced tissue becoming mucosa, the ultimate reason the surgery had to be done over, but the more he addresses up front, the better our chances are. This time, he tried to address it in the surgery. He tried various things, and opened and closed my jaw like a ventriloquist’s dummy’s during the surgery to see how they worked. He tried putting some cartilage between the jaw and the ear canal, but the bone pushed through that. What he finally settled on was replacing almost all of the skin with a single graft, and then replacing the skin directly over the bone protrusion (only a few square millimeters) with a separate graft. He’ll then keep the ear well-packed to ensure that the protrusion is scarred over as it should be (and as it was eventually last time). If there are any problems with that, the rest of the graft should still heal correctly, and that specific problem can be addressed by an oral surgeon. I hope that doesn’t prove necessary.

But the real difficulty this time has been emotional. I don’t know how much that’s related to the surgery and how much it’s just an accident of timing. Certainly any surgery is traumatic, as is the related starting and stopping of very powerful medications, no matter how much less I dread it than most people do. And the prospect of having to wait weeks, possibly months, before we know whether or not this will even work isn’t conducive to peace of mind. But I think the larger problem is a coincidence. All of this is happening while I’m still trying to recover from having been, for lack of a better term, emotionally overwhelmed. I stopped taking the clonazepam about a week before the surgery, in part because I felt better and didn’t think I’d need it any longer and in part because I thought it would be best not to have to account for that among all of the other medications I would taking. And for the first three nights, I felt fine. But the Monday before the surgery, the anxiety returned. I thought it might just be a symptom of withdrawal and figured I’d tough it out, but it kept getting worse. By the day before the surgery, it was clear that this wasn’t from withdrawal and I was just anxious, but at that point it didn’t make sense to re-start the clonazepam.

I didn’t sleep the night before the surgery. Even the night after the surgery, with no sleep the night before, the general anesthesia, the intravenous painkiller, the Percocet, and a few hydrocodone, I didn’t so much sleep as nod on and off. And that’s the way my sleep remained into this week. On Saturday, when it seemed I was no longer in pain, I stopped the hydrocodone, and gradually the pain emerged all over the place–stiffness in my jaw and neck, soreness in my hip, and a general feeling of being beaten with a stick–but worse was the depression. I just felt hopeless, and I couldn’t think of anything I’d even want to hope for. After the recent return of my anxiety, this marked the return of crushing depression, the other half of the cyclothymic experience. I started back with the hydrocodone, which helped, but not enough. Finally yesterday, I pretty much stopped with the hydrocodone and started again with the clonazepam, and finally, I slept well. Today, I could even imagine hoping for things.

With all of the things that have happened over the last month or so, it’s hard to tell what’s causing what, but it’s reassuring to know that I can feel better. I’m going to see the psychopharmacologist tomorrow morning, and we’ll discuss what the long term plan will be, but I suspect I’m going to be on an SSRI for a while. The clonazepam isn’t a long term solution, but I think I’m going to need something for a while. Though I’m not entirely pleased with this situation, I have to do something, for myself and my wife–it’s not fun being around me right now. We probably won’t be able to make any final decisions tomorrow, given how up in the air my condition is, but we’ll start formulating a plan. The other thing that’s reassuring (perhaps) is to learn that however bad (or good) I feel, it’s temporary and it’s caused. I know that in a cognitive sense, but I still haven’t fully absorbed it experientially–I don’t yet have faith in that truth. Once I do, I suspect I’ll suffer less. Perhaps the worst aspect of depression is the inability to remember ever having felt differently or to imagine ever feeling differently again. I suspect that once I’ve genuinely absorbed the truth about that, depression (or anxiety) will be less overwhelming, but until then medication is likely to be an intermittent reality.

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