The benefits of a young, new doctor

After several years in the wilderness, I finally found a doctor who may have a solution to some vexing (although totally non-fatal) problems.

I’ve been a Kaiser patient for the past 30 years, and it’s been a good relationship. I’ve also suffered from one chronic problem throughout that time: chronic migraines, something I inherited from both my parents. My migraines were bad enough that I ended up in the ER a couple of times. About 15 years ago, though, a neurologist put me on a maintenance medicine called Nortriptyline to block the migraines.

Nortriptyline is one of the original antidepressants. The dose for depression is 150 mg per day. For my migraines, I’ve been taking 20 mg.

Mostly, Nortriptyline has worked to keep the migraines at bay. Instead of having them weekly, I might go three or four months without a migraine, which was huge! That was the status quo for about 13-14 years.

Of course, there’s always a fly in the ointment. In my case, it’s that I hate the Nortriptyline side effects.  Even though I’m not taking the “antidepressant” level of the medicine, I still feel it flattens my emotions. My range of lows is diminished, which is fine, but so is my range of highs, which is a loss. (Thankfully, at this stage in my life, things have fallen into place so nicely that I don’t have lows.) The drug has a few other niggling side effects that I could also do without.

In the past few years, I’ve developed another problem: high blood pressure. It’s not very high, and medicine controls it but, ideally, you can lower your blood pressure without drugs by losing weight. I would benefit from losing about 10-15 pounds.

Since I’d prefer not to stroke out, and the blood pressure medicine has some wacky side effects, too, I promptly took dieting seriously. I’d tried dieting before over the past decade but couldn’t shift the post-baby weight. I figured that was my metabolism. When I was young, I couldn’t gain weight, so it made sense that, now that I’m older, I couldn’t lose weight.

But this time around, it wasn’t vanity driving me; it was fear. Instead of my past desultory efforts, I slashed my caloric intake by about 40-50%, gave up ice cream (a huge sacrifice), stopped snacking, etc. I also stopped talking about getting back to exercising (which I’d given up a few years ago because of several martial arts injuries) and actually exercised.

After eight months of this (with every bite and motion carefully tracked in my dieting app), I’d lost 5 lbs. I was also hungry all the time. Moreover, I could only exercise for 15 minutes at a time. At 16 minutes, I was getting migraines that lasted for days, precluding further exercise. In other words, everything seemed to be conspiring against my losing weight.

To say I was frustrated doesn’t begin to describe it. Also, I was tired of the migraines, with the only solution seeming to be to kick up my Nortriptyline dosage — and to live on Motrin. Now, I adore Motrin, which I call my favorite sleeping pill because it takes away the nagging joint pains that interfere with sleep and helps with migraines, but it’s really bad for your kidneys and liver. Whether I adore it or not, I try to minimize using it.

So, here I was: high blood pressure, migraines, still overweight, and very frustrated.

When I went to Kaiser yesterday, because I couldn’t see my regular doctor, I ended up randomly assigned to a new doctor, a young man (by my standards). He listened as I described my frustrations and then said, “Of course, you can’t lose weight.  Nortriptyline makes people gain weight.”


I’ve been struggling with my weight for years, and it turns out there was no way I could win that battle? Aargh!

So, we’ve got a new plan. I’m ending the Nortriptyline (slowly because you can get seizures if you stop drugs in this class too quickly) and switching to a new medicine that will (a) treat my migraines; (b) improve my sleep; (c) attack some neurologic pain I have from old injuries; and (d) not block my weight loss efforts. The doctor also gave me a secondary medicine that’s not Motrin to take whenever I exercise to stop that migraine trigger.

That was yesterday, so I have no idea whether this new regimen will work. (Which is why I’m not naming the new medicine.) All I know is that, for the first time in a long time, I feel hopeful, and that’s a wonderful feeling. It’s an especially wonderful feeling today because it offsets my anger and despair that Jack Smith has effectively fired on Fort Sumter by indicting Donald Trump for exercising his free speech to challenge an election. Monica Showalter puts into words what I was thinking.

Image by DCStudio.