Ever-so-diligent about getting the proper and timely care for my injuries, I went to see my family doctor and a new physical therapist the day after I arrived from California.
At the doctor’s office that morning, the receptionist realized that it was me, Minerva jacket in tow, who had all my California medical records sent to them and requested for a referral for a neurosurgeon. I don’t know how it works elsewhere, but in Ontario your family doctor must refer you to a specialist before you can see them. The receptionist, whom I had met many times before, was incredibly sorry to hear about my accident. She led me to the examination room to see the doctor.
I had been seeing Dr. K for less than a year. My problem then was lower back pain from my running and intense workouts. Now it was a tad more serious. She came in the examination room was just absolutely shocked to see me. “Oh my God honey, it was you,” she wailed. (My doctor’s a bit dramatic.) Like the receptionist, she didn’t realize that this tragic accident, an accident that they’ve read about only on paper, had befallen me and hadn’t put a face to the name until now. I told her the whole story like I had done tens of times over by now. She probed me question after question as she wrote her notes, and all of a sudden I felt so sorry for myself.
In tears, I continued to tell her the plan for my current neck brace. I was to wear it for another five weeks and then get a CT scan to confirm full healing in my neck, as my neurosurgeon in California advised. Practically sobbing by now, I asked her if I could get it off earlier, but she said that she didn’t want to mess with my neurosurgeon’s plan.
“Are you depressed?”
“I don’t think so,” I said.
“But you’ve been through so much,” she retorted. “I really don’t think so,” I countered.
“Honey, it’s like when your house burns down and you’ve just realized all you’ve lost. I think it’s like that for you. I’m going to give you Cymbalta, it’s a very nice medication that’s definitely going to help. This is what I would take if I were you,” Dr. K told me.
Duloxetine (cymbalta or other generics) belongs to a class of medications called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). It is used to treat depression and generalized anxiety disorder. It can also be used to treat diabetes-related nerve pain, fibromyalgia, chronic low back pain, and chronic pain from osteoarthritis of the knee.
For depression and anxiety, duloxetine works by affecting the balance of chemicals in the brain and other parts of the body. For certain types of pain, duloxetine works by affecting the balance of chemicals in the brain and spinal cord that are involved in the experience of pain.
She prescribed with me a month’s supply at a low dose of 30 mg once daily. I left the doctor’s office startled and confused. Was I actually depressed? I know I had always been a very emotional person, but depression was a different thing all together. An anxiety disorder was more plausible, given the last few weeks’ events. My husband was surprised by the doctor’s quick judgement too. Should I actually take these pills?
My husband and I grabbed a quick lunch and off I went to see a brand new physical therapist. The clinic was much smaller and low-key than my previous one in California. While they had mostly positive reviews online, I chose it mainly because it was walking distance from my parents’ home. By walking distance I mean 30 minutes of walking. Every other clinic nearby was more or less that far from me.
I met my new physical therapist who was also the clinic’s director. The receptionist assigned him to me because of the complex nature of my case. He was extremely warm and friendly. We sat down in his office and I recounted the whole story over again. And again, my emotions took over and I began to cry quietly. I showed him my progress reports from my previous physical therapist and he quickly glanced over them. We then both got up and began taking baseline measurements of the range of motion in my left wrist and shoulders. At the time, my main issues were that 1) I still couldn’t achieve the full range in wrist supination, and 2) I had so much pain in raising my shoulders up and sideways.
“Taking any medication?” he asked as we completed my medical history.
“Umm, my doctor just prescribed me Cymbalta but I’m not sure if I should take it.”
“Okay, well some people think it helps. But it’s totally up to you.”
We proceeded with him working on mobilizing the joints and tissues around my shoulders as I lay on a table. We talked about lighter topics like our respective adventures climbing mountains overseas and completing running races. While I was happy to engage in such a conversation, I teared up at the thought of not being able to do these things for a little while longer.
“Oh I’m sorry, I’m not making it easier, am I?” he said. We both laughed it off and carried on with the treatment.
Like at my previous physical therapy clinic, I received heat at the end of my treatment. I continued going to this clinic twice a week.
Skeptical yet curious, I spent a good deal of time reviewing the product information sheet for Cymbalta that night (here is a more comprehensive version online). While a substantial number reported side-effects like nausea, headache, and constipation in clinical trials, I considered these side-effects minor. And though I was terrified of the possible insomnia and withdrawal issues, I began taking my Cymbalta that night. Whether it would help me or not to deal with my emotions, only time would tell.