St Croix River Road Ramblings

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Saturday, February 23, 2013

Anhedonia and Euphoria -- a Phantasmagoria

Spock of Star Trek
Did he suffer from
My neighbor just down the hill says he will tap his maple trees today!   I stopped to visit as we came back from Margo's daily trip to Mayo and caught him with the blower clearing the 6 inches of  fresh snow at the end of his driveway.

"Last year I tapped February 1st through March 1st, a whole month earlier than normal for me," he   told us.  "Got about half of my normal yield."   He is a physical therapist and his wife a school teacher.  They have a 10 acre woods around their house, full of large sugar maples--quite rare in our mostly prairie area of SE Minnesota.
My neighbor's father, Dr. Walters, a physician who had an old style family practice in Wanamingo, had the 10 acres and a small A-frame cabin on it for 40 years and every spring took some time from his medical practice to put out 50 pails and cooked some syrup.  When he passed away 15 years ago or so, his son and wife built a new house there and have continued the annual syruping--making 10-20 gallons of syrup each spring.  They are the only folks around this neighborhood who make syrup as far as I have seen from driving through the area.

Our home is between two branches of the Zumbro river that meander in from the west, cutting deep broad valleys in the prairie lands meeting in Pine Island.  The two valleys make a wedge of land that is about 1 mile wide and 6 miles long, an area that escaped the prairie fires, heavily wooded when the settlers came in 1850s.  Where the rivers joined was the island of Pine.  Where we live, on a high hill midway between the two valleys was an island of hardwoods; maples, basswood, elm, oak, butternut, ash and cherry trees.  The 10 square miles of forest in the midst of a thousands of acres of treeless prairie was (and is) an oasis for wildlife and forest products. Although much of it has been converted to farmland, the steeper valley sides, and as in the case of my neighbor and my forests, pieces of land never fully cleared.     My piece has not one mature maple on it--just a few young ones too small for tapping. We own a 5 acre woodlot strip -- 1/4 mile long and 166 feet wide, sold to a prairie farmer in 1900 for his wood supply.

Maple syrup season appears to be out for us this season.  Margo has cancer surgery March 11th followed by daily radiation April and May.   Mid March to mid April is the maple syrup season most years at Cushing, where our 60 acres of maple woods and lake cottage are usually open for business on March 1st.   I have almost no motivation to tap the maples this season, so I am not too bothered about skipping it this time around.

Which brings me to a health update.  Margo is gradually regaining strength lost from chemotherapy that completed January 14th. Since then she has had daily treatments for lymphodema (swelling) of the left arm and hand.  That means a 50 mile roundtrip to Rochester Mayo five days a week for light, massage and compression treatment. It is helping, but we can't help but wonder what will happen when she has the lymph nodes removed on that side.  Just have to wait and see.

Margo has a dozen tomato seedlings ready to transplant into their own containers this weekend as well as 30 geranium seedlings--all under lights in the basement.  She was so tired and sick from chemo, that December and January were months where just eating, sleeping and getting to medical treatments were as much as she wanted to do.  Now, life is becoming interesting again.  We are told that the left breast mastectomy and lymph node removal surgery and the following radiation is much less of a problem than chemo, so that sounds good.

My own condition is pretty fair physically and rather strange mentally.   I take large daily doses of prednisone to keep my immune system from producing antibodies that attack my nerve-muscle connection and make me weak. It works pretty good and I am mostly functional physically.  However, my mind has gone wonky.  I have developed anhedonia (this is a self-diagnosis at the moment--have to try it on my doctor next week).

For those of you for whom anhedonia doesn't ring a bell, -- hedon is a root word from the Greek meaning pleasure.   Anhedonia means "without pleasure."   Prednisone has this side effect in some small number of addicts-- it takes away the feelings of pleasure that are part of a normal life.

The technical explanation:  when we anticipate doing something we like. when we do something we like, and when we complete doing something we like to do, we get a feeling of pleasure.  This actually comes from our brain releasing dopamine into itself.   When something stops this, we lose our enjoyment in doing things--just a bucketload of chemicals being dumped underlying it all.  This includes not only our hobbies, our jobs, but eating, sex, exercise or whatever gave us pleasure turns into just a flat non-emotional, non-enjoyable dullness.

 Anhedonia is found as a side effect of some medications, is present in some folks with depression and some folks with schizophrenia, and can be found in former drug addicts.  Many abused drugs give their high by bathing the brain in dopamine (i.e. oxycodone/oxycontin pain killers gave me euphoria when I took them after knee surgery) turning on the pleasure response artificially.    However, too much of that can burn out the pleasure areas that dump the dopamine.   Prednisone, in some folks, seems to limit the amount of dopamine produced in the pleasure part of the brain--leading to lack of motivation and enjoyment until you quit taking it   Prednisone can cause other mental problems including confusion, irritation, mood swings, and so on, so folks taking prednisone may think they have strange mental conditions that are really just part of a mental confusion produced.  

My regular doctor, when I complained that I didn't have any motivation nor enjoyment to do anything, said I was surely depressed and stressed, with Margo and me both haviing health problems, and I needed to go on depression meds or seek counseling.  As I am not in the least bit sad, or down, just unbelievably lethargic, I disagreed and went to Dr. Google.  Depression without sadness search led me to pages describing anhedonia--which, I thought, pretty much fit my condition, and gave me an explanation that prednisone probably was the culprit.  

There are alternatives to prednisone for keeping the immune system running on low. So my next step is to switch to one of those as a trial--none work for everyone and some have even harsher side effects.  The process of getting unhooked from prednisone is several months -- it shuts down the adrenal glands and you have to gradually bring them back to life--and the alternative medicines take 3-6 months to take effect.   So, somewhere in March I will being trying to switch over with the goal autumn to be addicted to something else and have the thrill and agony of discovering a whole new set of side effects.    

In the meantime, if I seem to be quite lazy and accomplish little, I would hope you blame the prednisone rather than me.    Although I can force myself to do something because it is my duty, it is surely not as motivating as enjoying it.  That is why I haven't been writing much for the past few months and in fact barely doing anything other than what I must do.  

 To give you an idea of what this is like,  think of what it would be like if sex was always just a duty like shoveling the sidewalk.  I suppose I could be a good Catholic anyway!

  I call my condition "Spockification."   I have the cold, logical, unemotional, unjoyful pure rationalism of Mr. Spock from the Star Trek series.  I am in the tapering down process with prednisone, and I noticed I got irritated with a dodging and weaving driver yesterday while driving through the snowstorm to Margo's appointment--a good sign that some emotion is stirring again.  Now if ice cream started giving me pleasure again....