25 September 2009

Mental Health, or "Hey! If my kidneys are the problem, why do I need my head shrunk?"

You may have read my recent references to trying to go off steroids after 18 years. I've taken oral prednisone during that whole time, and also had occasional high doses of IV steroids as well.  The reason I take steroids is of course so I can compete at a nation level in weightl...actually, no. The reason I take them is because steroids have an anti-inflammatory effect; specifically, they depress the immune system. Normally, depressing the immune system is a Bad Thing, but in my case it prevents my immune system from attacking my donated kidneys.  But because of advances in medicine, immune suppression no longer requires steroids; the doctors would like me to discontinue them because they do have nasty side effects like diabetes and osteoporosis, especially over the long run. They also can cause your adrenal cortex to stop working. But either starting or stopping steroids has its effects too, one of which is "the crazies".  OK, you've all heard that already.

I spoke with the psychologist at my transplant clinic, who confirmed that, yes, discontinuing steroids can certainly make one cranky. She said that my regular shrink would certainly have encountered this issue before and should be able to handle it. Sure enough, at my psychiatrist appointment earlier this month, we brought this up with him, and he was very familiar with it. Evidently this is a common problem, and patients discontinuing steroids often need adjustments to psychiatric medicines at the very least.

So the outcome in my case was to increase my anti-crazy pills, to take it slow on the steroid discontinuation, and to be patient. It will pass, it will take time. This is excellent news, since with this new kidney, I have plennnnnnty of time :)

I'll editorialize now:  this has direct bearing on the current American health insurance debate. Coverage for mental health conditions by health insurance companies is not comparable to coverage for other conditions. But as my example above should show, you really can't separate the two. Physical health and mental health are so intimately related as to be indistinguishable.   The body and the brain are both biology. In my opinion, if it is not medically or scientifically defensible to totally separate mind from body, then it is not morally defensible either:

Diseases of the brain are diseases of the body. 

Mental health coverage should be on a 100% par with coverage for other health conditions.