Less Anger, More Irritation

Today was more placid than the past several days. The book sale was over save for the cleanup. We made more money than we projected we would. Even though not nearly enough people showed up to help with the load out, it still managed to get done without driving any of us to total exhaustion. Close, but not quite all the way there.

The inner dialogue today was primarily one of irritation and disgust instead of rage and fury. That is a big win from my perspective. Even though none of the dialogue ever reaches spoken form to be judged by others hearing it, it still makes me feel better that, were it to slip out, it would not sound quite so insane as it would have this past weekend.

I still set up an appointment with the difficult Dr. K, my primary care guy to sort out the thyroid situation, as it could not hurt to know the score on those meds. He can check assorted plumbing as well so we will all know just how things look from the bottom up.

Still keeping the knives sequestered and the ammo separated from the firearms by stairs, but the trigger finger is much less itchy today…

Anger Management Revisited

I have noticed that anger management issues are cropping up once again as my chemotherapy drags on. In an earlier post, I talked about the first bout of it I had several weeks into the RO5024048 study. It’s coming back again, though with a decidedly different twist. I am not having problems dealing directly with irritating people, but I am having extended arguments with them in my head. I think this could be attributed to one of two side effects or a third cause that is due my current circumstances.

The first would be depression. I am on Celexa and do not feel that I am depressed. I remember what I felt like before I started on the antidepressants and this doesn’t feel like that. I am a bit tenser than I have been and I have a theory about that I am going to check out this week. I noticed that once I started on levothyroxine for my low thyroid function, I became more jittery than I had been before. There was a bit of an adjustment period when I started on antidepressants but that had leveled out a bit by the time I started on the thyroid meds. I then noticed a definite step up in nervousness when I started taking the thyroid meds. I wonder if my thyroid is working better now and my dose is too high and whether the thyroid meds might be interacting with the antidepressants to make me a bit too edgy. I am calling my primary care doctor tomorrow to set up an appointment to test my thyroid hormone levels and perhaps adjust my dose.

The second possibility is the mental problems that can be caused by interferon and ribavirin themselves. It is a known side effect of this combination of drugs that can include irritability, depression, aggressive behavior, suicidal behavior and suicidal or homicidal thoughts. I have not been thinking about killing myself or anyone else. I have indeed thought about letting a few individuals know what I really think about their attitude and behavior and doing it in no uncertain terms. I have imagined these (admittedly one-sided) conversations in vivid detail. I have not, however, actually done any of this and I have not noticed that my behavior towards others has become more aggressive. I am trying to keep a close watch on this and am going to wait for the results of the thyroid tests and any dose adjustments before I address the issue of whether my antidepressants need to be adjusted.

I do note that my behavior has become more decisive, but no one has mentioned that I have been abusive or angry toward them, and I have been asking for feedback if that happens. I find that in situations start to degenerate into indecisive dithering, I am becoming more apt to step in and tell people what to do. This does not seem to me to fall under aggressive behavior in the way they mean in the side effects description, but I am definitely wary of my reactions and behavior.

The third possibility is that some of this is the result of a long hard seven days of dealing with our organization’s biggest event of the year. I have been working longer hours than usual, in more crowded and chaotic circumstances than usual, doing more stressful work than usual. There is nothing like dealing with the sort of obsessive, picky and occasionally barking mad people that populate a used book sale to drive stress levels to the stratosphere. I don’t believe it is entirely due to this circumstance that I am noticing my inner dialogue moving more to “that stupid little prick” sorts of expressions than usual, but it must have something to do with it.

So until I get to see all my doctors about my meds, the knives stay in the drawers and the guns and ammunition on separate floors of the house…

World Cup Manifesto

We take a break tonight from our regularly scheduled disease-ridden maunderings to discuss the most important event occurring in the world today, the 2010 World Cup of Football (or soccer to most US citizens). And we dare to ask the question, “Why is this World Cup so disappointing to the world-wide television audience?”

We are not talking about the football. The play has been interesting and even compelling for the most part. Both of the finalists from 2006, France and Italy, did not make it out of their groups. Combine them with England (also a casualty of group play) and all three looked old, slow and as if the game had passed them by. The upstart nations of Asia displayed quality play and two advanced to the knock-out round. South America reasserted its historic dominance and had the highest percentage of its entries make it clear of group play. Africa fell prey to disorganization and bad luck and sees only one team still alive in the tournament. The USA did as well as it should have winning clear of its group only to go down in defeat in the round of 16. There has been interesting attacking play, the usual number of terrible mistakes by players, refereeing both wonderful and woeful, and a fast-brewing controversy about the intransigence of FIFA regarding the role of instant-replay in international football.

All well and good, but when we are standing amongst a group of strangers in a tavern at 7:00 a.m. on the west coast of the USA, many of whom clearly came directly from their bed without a hygiene stop along the way, we want more than mere great football on the big screen as our reward.

We want cheesecake (and beefcake too for that matter).

What are we getting instead are endless shots of coaches pacing the sidelines, players grimacing after tackles and missed shots and the occasional celebrity fan close-up. Does anyone alive today honestly believe that we want to see a wrinkly Bill Clinton standing next to an even wrinklier Mick Jagger (who is beginning to look like he goes to the same life extension center for the undead as Keith Richard)? Hell No! We want to see beautiful Spanish women agonizing over a missed goal opportunity. We want to see muscular Ghanaian guys with six-pack abs waving their shirts over their head. We want to see bronzed Brazilian babes doing the samba after the best team in the world scores yet another goal. In order to prevent this travesty of television justice from ever happening again at the World Cup, two major areas of concern must be addressed in the most forceful terms.

The first is that the World Cup must never again be scheduled to occur in a country that has cold, or even cool, weather at world cup time. Beautiful young women and cute young guys are still beautiful and cute even when bundled into down jackets and knit beanies, but if that is what we want to see we can tune into the winter X-Games on ESPN. In warm-weather venues we can see the most beautiful men and women in the world in all their skimpily-attired glory. We can see them in the extremes of the agony and ecstasy that sports fans can experience and for this World Cup we could be seeing them in High Definition TV. Instead we see only the faces of the beautiful and handsome peeking out from beneath their wool hats and over the collars of the jackets they are huddling inside. Never Again!

The second is that any television director who allows a stoppage of play to go by without either a beefcake or cheesecake shot should be dismissed from directing the video of any further world cup matches. We are not talking about an out-of-bounds ball that results in a relatively quick throw-in or a foul that allows for a quick replay followed by the free kick, these may continue to be covered in the same way. But when a player is writhing endlessly around on the ground after a trivial foul, or a player is strolling slowly over to the sideline to be replaced or we are enduring the agonizingly exact preparations for a set piece off a free kick, we must be given beauty as a reward. Above all, we must be shown the celebrations in the stands after a team scores a goal. As it is now, we see the players celebrating the goal. Watching yet another striker run to the corner flag, slide on his knees and be mobbed by his teammates without also being shown young women shrieking in joy and young men dancing in the aisles and the celebration of fans who have followed their country’s teams longer than that striker has been alive must never be allowed to happen again. If FIFA will not address this, we need a new international governing body.

Here it is: The Heprat Manifesto for the perfect World Cup:

Warm Weather Venues and Compulsory Cheesecake.

Anger Management: Walk On By

Friday I blew up at a co-worker over a relatively minor incident at work. She was repeating a question she had been asking several times over the past few days and had been unhappy with my answers. She blindsided me with the same issue as I was dealing with another individual and she made it clear to me through non-verbal cues that she believed I was lying to her. I was tired, I was unprepared to be dealing with her and I went off. It was a brief exchange that involved the use of profanity on my part.

She did not attempt to clear the air with me, but instead went to our boss the next day with a complaint that I had been yelling at her and then he had to come to me and admonish me for my unprofessional behavior. It was an unpleasant situation all around.

The reason I bring this all up is that anger management is a major component of successfully negotiating Hep C treatment. One of the known side effects of Interferon (Pegasys) is a measurable increase in irritability in the patient. Given that the standard therapy also can cause low energy, exhaustion and along with those things, depression (which can have a side effect of bouts of rage) and you have the potential for serious issues cropping up both in your personal and your professional life.

There are a number of ways to deal with this. Try to manage your interactions with difficult people to times when you are prepared to deal with them. Try to deal with personal and professional problems during times of the day that you have more energy and mental focus.

A tactic that my wife recommends (she has worked in many different organizations and office environments in her working career) is to memorize a few responses to people who do blindside you with issues or problems when you are unprepared to deal with them. “I am in the middle of something right now, but perhaps we can get together later to discuss this.” “I’m sorry, but that does not fall within my area of responsibility, perhaps we should meet with our boss to work out how this will be handled.” “The issue is a new one that needs to be more broadly discussed, perhaps we should bring it up at our group meeting.”

The final recommendation that came from AVB our study coordinator, is to Walk Away. If you feel that you are becoming upset, Walk Away. If you feel the other person is not respecting your wish to deal with this later or in a different manner, Walk Away. If you feel you are getting angry definitely Walk Away.

As AVB points out, walking away from someone can bring its own set of problems as they might view the behavior as disrespectful but dealing with that is always easier than dealing with the aftermath of having an angry exchange with someone. That someone can be either a professional colleague or a family member, but it is always easier to explain that you walked away to avoid an unpleasant incident, than to explain your way out of the angry, unpleasant incident that happens if you don’t walk away.

Definitely Walk On By.