Welcome to my stupid blog

Also! Stress tolerance is such an important skill that having a learning disability in that area is a major symptom of a whole lot of other disabilities/mental illnesses! Struggling with it is a huge part of life! It sucks!

Am I saying everyone with misophonia needs to listen to chewing noises all day? No. But you need to find ways to tolerate it enough that you don't treat others like shit if they make a mouth noise near you.

No, you don't have to read the fic with your trigger tags. But you do need to be able to handle scrolling past the tags without being upset.

It is hard! But not having it also makes you so so so easy to manipulate. That grandma is racist AF because her mom raised her to be uncomfortable around black people and she never fought that discomfort. Trans people make so many cis people uncomfortable and that discomfort turns into bigotry real fast.

i used to work at a Local Organic Produce store that's popular with the lefties in my city who are interested in food justice. i quit for a lot of reasons, mostly the boss, but something i will always remember is one of our suppliers coming in to drop off produce, being told her check wasn't ready, and her laughing and responding it didn't matter -- even a low bank account was more than enough to pay the migrants who picked her produce. i am not filling in any blanks here. she said this.

after quitting, this was a common story i told people about my time there. some then became annoyed at me, acting like i was a wokescold trying to undermine the store's "eco" mission with unrelated "ethical" concerns. but, like -- if food justice isn't for the people making food, who the fuck is it for?

these are all really good and important things to be aware of and I recommend gathering that info for any new meds. i don't say this to like, blame people who were not given this info by their doctors and who took meds without being given this information, but rather to give people resources for being more in control of their own medical treatment going forward 💜

CYP450 is a family of enzymes in humans. enzymes are chemicals that speed up chemical reactions; in this case, in our bodies, CYP450 enzymes process the vast majority of currently available medications. because of that, they're responsible for most drug interactions.

different substances - including medications, supplements, and even foods - can affect the CYP enzymes in different ways.

a CYP inhibitor blocks the CYP enzymes from working to process the medication. that means you can end up with more of the medication in your body than you expect. that can cause mild, moderate, or severe side effects. good examples of CYP inhibitors are St. John's wort, grapefruit, and isoniazid (a tuberculosis medication).

a CYP inducer encourages the CYP enzymes to work faster. that means you can end up with less of the medication in your body than you expect. that medication may not work as well. this can be especially dangerous in cases where, for example, you're suppressing a dangerous effect (like autoimmunity or transplant rejection). some examples of CYP inducers are insulin, tobacco, prednisone, and in some cases, St. John's wort again.

a CYP substrate is just a substance/medication that is affected by an inhibitor or inducer. birth control is a very common substrate, and its effectiveness is affected by many medications.

each substrate is related to a different family of CYP enzymes, like CYP3A4 or CYP2D6. each one responds to different inhibitors and inducers.

you can see why they often don't tell patients this stuff: It is complicated. this is pharmacokinetics! it's difficult stuff. but i really, really believe it's important. knowing how your medications affect each other can save your life. doctors and pharmacists often do not check medication interactions. sometimes it really is up to us to understand what we're putting in our bodies.

at the very least, i urge you to check drug interactions with the drugs.com interaction checker. this checker automates some of the work of cross-referencing CYP relationships. if you have an account, you can save your drug list and cross-check all of your meds at the same time. keep in mind that not all "severe" interactions will necessarily apply to you; i recommend reading the "for professionals" version of the warning to make informed decisions about whether or not you want to be concerned. (this is also something you can discuss with a good doctor if you have the good fortune to have one.)

but, if you have the capacity, at a certain number of medications (i am taking 20+) it really is worth getting to know how they interact with CYP enzymes, what effects you might need to be watching out for (more intense effects from a higher concentration of medication? less intense effects as the medication can't attain high enough concentrations to work as it normally does?), and what meds might be the culprits of new problems as you add more medications.

to cross-check CYP relationships directly, i recommend the flockhart table. search for a medication (ctrl+f helps) and you can see all its documented CYP relationships. (they also have a mobile friendly version, but i find it slightly harder to interpret.)

here's how i do it.

start with a medication or substance. let's say i'm about to start celecoxib (Celebrex), a non-steroidal anti-inflammatory drug (NSAID). on the flockhart table, it's listed as an inhibitor of CYP2D6. (ctrl+f is helpful here.)

think through what the words mean. it's an inhibitor, so it makes the enzymes not work as well. it might increase blood levels of medications that are processed by CYP2D6.

what medications are processed with that enzyme? the flockhart table lists them if you click on the name of the medication you're curious about. CYP2D6 substrates include amitriptyline (Elavil), aripiprazole (Abilify), atomoxetine (Strattera), duloxetine (Cymbalta), oxycodone (Oxycontin), and propranolol, among others.

what effects do i need to be watching for based on the affected medications? for an inhibitor, we're looking for stronger effects; for an inducer, we're looking for weaker effects. let's say i take oxycodone daily. i want to keep an eye on the way i feel when i take oxycodone. am i feeling "higher" than usual? am i feeling dazed or dizzy or numb? or let's say i take propranolol. am i feeling dizzier or more lightheaded? am i having nightmares that i wasn't before?

here's another example. what if i want to check for a substance that might not be listed on the flockhart table? grapefruit is a good example.

wikipedia is actually a great source for this (though in some cases i recommend just searching "[substance] CYP" and seeing what pops up).

head to the list of CYP450 modulators on wikipedia. ctrl+f finds three instances of grapefruit: naringenin (a CYP1A1 inhibitor), generic 'flavonoids' (inhibiting CYP2A6), and bergamottin (a powerful CYP3A4 inhibitor).

think through what the words mean. any substrate medications processed by 1A1, 2A6, or 3A4 enzymes might be dangerously increased in my bloodstream if i consume grapefruit (or anything containing those substances; earl grey tea actually contains bergamottin, too!)

what medications are processed with those enzymes? this i can check on the flockhart table, or i can stay on wikipedia. atorvastatin - a cholesterol medication - is a substrate of 3A4. so is diazepam (Valium). valproic acid, an anti-seizure medication, is a substrate of 2A6. i'm having more trouble finding substrates of 1A1. it's not listed on the flockhart table. there is a paper published that mentions theophylline (an asthma medication) and difloxacine (a fluoroquinolone antibiotic).

what effects do i need to be watching for based on the affected medications? at a glance here, i'd be worried about having too much valium or valproic acid in my system (if i took those meds) - those could have pretty serious effects on my central nervous system. likewise, having too much of that fluoroquinolone antibiotic (if i took it - and i wouldn't, because if you have hEDS you should not take fluoroquinolones unless it's a matter of life or death!) could increase my risk for serious musculoskeletal side effects like tendon rupture. it could also disrupt my bacterial microbiome.

the physician who created the flockhart table, the late dr. david flockhart, was an exemplary physician who truly, truly cared about patients - a rare treasure. everyone's CYP-related genes are different, and it affects the way we respond to medication. we know that, just as we know that CYP relationships can cause serious and harmful drug interactions. but we don't put it into clinical practice. dr. flockhart wanted to change that, and he did pave the way towards that future. we're not there yet. but i do recommend his table.

i hate that this is not something that is widely taught and widely understood. i hate that we have this knowledge about how people metabolize drugs and how drugs work with each other and we often just do not talk about it at all. i hate that i was not instructed on the risks of taking clonazepam (a benzodiazepine, in the same class as Valium) and hydrocodone (Vicodin, an opioid) simultaneously. i experienced central nervous system depression - difficulty breathing, dizziness, confusion, fatigue - multiple times as a teenager before i figured out that i shouldn't take them close together. needless to say, mixing those two drug classes can be extremely dangerous. i got lucky and just felt awful. but at certain doses or under certain circumstances, taking those two simultaneously could kill someone. Does kill people, in fact!

a responsible doctor - one of my favorite doctors! - prescribed me those medications. he just wasn't thinking. it happens all the time.

we should not have to be doing all this work. but often doctors and pharmacists simply do not think about it. and the literature they hand out with medications, while helpful, is not going to cover all possible interactions, especially for polypharmacy patients or people on unusual medications.

likewise, you should know what medications interact with your conditions - like i mentioned fluoroquinolones and hEDS earlier. or how morphine tends to activate mast cells. that's something i can't cover here, though.

Anyway I wrote a whole comic about Cyborg Franky.

The substance I was addicted to was heroin. While I was actively addicted, it absolutely came before everything else. My life shrank around it. I kept using despite very real, very obvious negative consequences. If you’re looking for something that fits the “compulsion + harm + loss of control” model, that was it.

But what’s always sat strangely with me is what happened when that context changed.

Once my abusive relationship ended and I was no longer in an environment where it was readily available, it was shockingly easy to stop. I’m not saying it was physically comfortable. My body was pretty pissed off for a while. But psychologically, it just didn’t have the same hold anymore. I wasn’t spending my days white-knuckling cravings or constantly thinking about it. It dropped out of my life in a way that, according to the 12-step model, is not really supposed to happen.

And that’s where my issue with that framework starts.

Because 12-step ideology tends to assume that if you have ever had that kind of relationship with one substance, it reveals something fundamental and permanent about you. That you now have a generalized “addictive nature” that will attach itself to other substances or behaviors if you’re not constantly managing it. That you are, in some essential way, always on the verge of transferring that pattern onto something else.

And that just hasn’t been true for me.

I was a near-daily cannabis user for years. When it started consistently making me feel physically uncomfortable instead of good, I stopped. No drawn-out battle, no existential crisis, just “this isn’t giving me what I liked about it anymore” and I moved on.

I drink occasionally, in social or celebratory contexts, and I genuinely find alcohol kind of boring outside of that. It doesn’t have much pull for me.

I tried gambling once, got annoyed at how tedious and overstimulating it felt, and left the casino in under an hour. I have not felt remotely compelled to revisit that experience.

I use the internet a lot, and I play a handful of video games, but I can also go on a camping trip with no signal and be completely fine, unless you want to try and find something pathological about nature photography, in which case you can blow it out your ass. If anything, I generally enjoy the change of pace. There’s no sense of panic or withdrawal or “I need to get back to my computer/consoles immediately.”

So when I hear the idea that addiction is this broad, transferable trait that will latch onto anything with quick reward or low friction, I just don’t see it reflected in my own life.

What does make sense, looking back, is context.

When I was using heroin, I was in an abusive relationship. My environment was unstable, stressful, and honestly pretty bleak. The substance didn’t just exist in a vacuum. It fit into a specific set of conditions where it functioned as relief, escape, and regulation.

When those conditions changed, the behavior changed with them.

That doesn’t mean there was no dependency. There obviously was. It doesn’t mean there were no consequences. There very much were. My grades suffered. I dropped out of college. I lost my apartment because staying out of withdrawal and numbing out from the abuse felt more important than paying rent.

But it does suggest that what we call “addiction” might not always be this permanent, identity-level trait that needs to be managed forever. Sometimes it looks a lot more like a relationship between a person, a substance, and a specific environment.

When that’s the case, then a framework that assumes universality - “if this happened once, it will always be waiting to happen again, with anything” - is going to miss a lot of variation.

I’m not saying 12-step programs can’t help people. Clearly they can, or they likely wouldn’t exist in the way they do. But I do think they’re often treated as the model of addiction rather than a model that fits some people and not others, and when your experience doesn’t match that model, many people who swear by them will assume that you are misunderstanding yourself, in denial, or “not taking it seriously enough.” This paternalistic attitude only serves to make me even more skeptical of the framework.

For me, what mattered wasn’t declaring myself permanently “addictive” or treating every pleasurable behavior as a potential threat.

What mattered was getting out of the environment where that pattern made sense in the first place.

sleep issues can make people sleep all day and be awake all night no matter what they do. they can make people sleep for over half the day every day. they can make people stay up for over 24 hours frequently - and it just goes up from there. being up for days at a time just unable to sleep.

they can make people have a completely unpredictable sleep schedule too. not everyone is capable of going to bed and waking up at generally the same time, or maintaining it.

all this could be more temporary, or it could just be indefinite. like. having to live your life not knowing if you will or will not be conscious at any given time. you can't plan for fucking anything. you can miss almost every plan or event or obligation.

and everyone just hates you for it pretty much, thinking you're irresponsible and lazy.

Future you will thank you for not pinning your ability to enjoy and get any sense of achievement on having the base energy levels of a teenager.