Crazy Or What

I remember the first time I walked into my psychiatrist’s office.  There was a huge sign on the wall with an arrow: Psychiatric Ward.  Am I crazy, or is that a demoralizing introduction to adult mental health?

As I’ve mentioned, my shrink is currently on maternity leave. As I haven’t mentioned, because I haven’t gotten around to writing about it, my replacement shrink is too far away and also I missed my last appointment with but anyway, she’s not the type of shrink I want to be seeing. I want to see a shrink who knows ADD like I know the inside of my closet.  I want an expert.

Such an expert does exist within the same department as my temp-shrink but in the same building as my shrink-on-leave, which is much closer, and cheaper for parking.

A few months ago  I wrote a (very good, I think) post on how hard it is to accomplish things when people don’t get back to you, especially when you have ADD.

I want to switch doctors. I very, very badly want to switch doctors, and I have been taking action towards that goal. I have been calling the department of mental health (that’s the true name, and not the one on the sign. Clearly, the clinic needs some updating) every week but to no avail. I simply can not  get in touch with anyone in my department.  That is, I couldn’t get in touch with anyone until a few days ago when I tried all the numbers that they had listed and actually got to speak with the secretary (who sits, I kid you not, in an office with a sliding window like in a Boston gas station, presumably to protect her from psych cases like me.)

Well, she remembered me from my previous visits and sympathized with my plight, though of course she was not able to help me.  The best thing to do, she advised me, would be to call my temporary shrink and ask her for a referral to the desired shrink.

So I called, and guess what? NOTHING HAPPENED. Nobody called me back. I had no response whatsoever.  Am I crazy, or is it completely irresponsible for a medical clinic to completely ignore the calls of it’s patients?  Especially, dare I say, if it’s a psych ward.

NB: I stand corrected. The temp-shrink’s office did reach out to me. By snail mail.  They sent me a bill charging me for my missed appointment.

 

 

Image: https://pixabay.com/en/users/Counselling-440107/ 

Isn’t it a good one? My compliments to the photographer.

 

 

 

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C(K)eeping Up With The Concertas

I saw my new shrink last week.  She was nice, friendly, positive, and generally affirmative (affirmational? She affirmed what I said) but, as she pointed out before we even sat down, it was a bit of a mismatch.  She deals with palliative care patients, and not at all with ADD.  She was only handed my file* because they needed people to take over for my regular shrink, who is now on maternity leave.

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Not My Shrink.                         …ok now tear your eyes away and go back to the blog post…

I was a bit disappointed because I had been imagining this new doctor-patient relationship as the one that would complete me, mental health-wise.  Alas.  I need a Tinder for psychiatrists.

She asked me, at one point, probably because I was rambling at high speed and holding a Grande Pike Place, whether I was self-medicating with coffee. I am not, and I told her as much. I usually have one coffee in the morning and one, if I am desperate to stay awake, around the kid’s bedtime.

She also told me, as my last shrink told me, and probably everyone in the medical profession will tell me, that I need to get on the meds and just stay on them if I want to have a good idea of whether or not they’re having any effect. As you may recall, this is one of the great questions that surround my decision to medicate.

Since taking them intermittently, as I have been doing (sometimes intentionally and sometimes unintentionally)  for more than a year, is not a viable option for me at this point, I have a problem.  Even if I ‘set an alarm on my phone’  (which everyone thinks is the answer to everything ADD), taking them on a regular basis has proven to be much more difficult  than it would seem.  It’s not that I don’t remember to take them. It’s that if I remember, and I am not seated at my desk (where I keep the bottle) or in a position to get the ‘travel pack’ out of my purse immediately, then the task will get put on an indefinite ‘snooze.’

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The Elusive Travel Pack              Writing About it made me remember to refill it!

At the behest of Dr. Affirmational, I decided to try once again. She asked if I could commit to two weeks straight and I told her, without much confidence, that I would surely try.  My appointment was on a Thursday, and I decided that the following Monday would be my first day. I took a pill on Monday. I took one on Tuesday. I took one on Wednesday. I forgot them on Thursday and Friday and then didn’t bother over the weekend.

Correction: I did not forget them on Thursday and Friday, Rather, I remembered on Thursday but I was in the car, driving. And I remembered on Friday but I was in the supermarket, and I  was in a rush to get out.

Today is Monday, the start of a fresh new week.  I took one this morning. It made me jittery after an hour. I calmed down. I am finishing my blog post that I’ve been meaning to write for 11 days.  Thanks to the shakes, I know it’s having an effect on me, but I don’t know if it’s actually fulfilling the intended purpose.  Hopefully, if I can keep up with the Concertas,  I’ll be able to tell you in two weeks. Wish me luck.

 

*Interestingly, she was actually NOT handed my file.  So most of my visit consisted of me recounting all the things I do and the things I don’t get around to doing and how I feel about it all. What else would we have talked about, really?

Book Review: Hyper

Book Review: Hyper: a personal story of ADD                                                                              Timothy Denevi,  Simon & Schuster, 2014      

Timothy Denevi introduces all of his characters– historical and contemporary — with a description based on memory, jacket cover, or photograph image and also on his personal impressions of the person. I’ll do the same for him.

Denevi looks out at you from the back flap of his book with a gaze that belies his tenacious relationship with authority.  The three-quarter view of his face, with a neat beard softening his  tight-lipped smile,  sharp nose, and trendily ‘squinching’ eyes, is a story in itself;  a hard-won adulthood emerging from a long battle with mental health and self confidence.  His forward-facing torso, draped in a bookish professor jacket, leans casually against a wall as if to invite either challenge or earnest inquiry.

Part memoir, part review and critique of the history of ADHD, Hyper is ambitious in trying to intersperse Denevi’s personal experience with the story of ADHD’s changing and expanding scientific, medical, and pharmaceutical paradigms.

Denevi’s recounting of life from toddlerhood to university is compelling. He is as successful as one can be in helping the reader understand what is going on in the mind of a child who, at various points throughout history, might have been institutionalized, imprisoned or otherwise segregated, corporeally punished, and called repressed, hyperkenetic, or minimally brain damaged.  One early thinker, we learn, might have even threatened him with execution.

Denevi takes no hostages, and calls out those who helped and hurt him along the way– an act that also reveals how crucial  good mentors and friendships were to him and to those whose growth and development are similarly tumultuous.   His parents, though they struggled alongside him, were ultimately his biggest advocates and supporters as he went from being Goomba to Timmy to Tim. His psychologists were trustworthy and nonjudgmental, and a teacher’s cooperation, understanding, or lack thereof was highly correlative to the degree of academic and social success that Denevi would achieve throughout his years in school.

The nearly 120-year-old history of ADHD as described by Denevi, and the development of associated treatments and medications, does not exactly parallel Denevi’s experiences. However, the information in the book is well researched and interesting in it’s own right. Along the way, we encounter the jerky and meandering trajectory of research, and the confluence of psychology, educational philosophy, and pharmacy which have brought us to today’s standard of diagnosis and care for people with ADHD.

As a mother, what struck me the most as I read this book was how much time energy Tim’s mom devoted to the wellbeing of her eldest.  While, on one hand, devotion and motherhood tend to go hand in hand,  I can tell you, based on my own experience, that Mrs. Denevi’s standard of care went above and beyond. Perhaps it’s the ADD in me talking, but the commitment to weekly psychiatry sessions and teacher correspondence, monitoring, and medicating, not to mention her perseverance through some of Timothy’s more rueful behavior as a young adult, on top of the usual homework and extracurricular duties and taking care of her other two children, working a full time job, and keeping house, is an amazing accomplishment.  Even when suffering from her own newly diagnosed and debilitating arthritis while Timothy is in middle school, Mrs. Denevi is a pillar and a guide to her child.  Denevi also describes his father as being supportive and loving throughout the challenges they faced as a family.

Of course, the degree to which it was necessary for Denevi’s parents to persist in advocating for him also reinforces the degree to which Denevi is affected by ADHD, and how severe his condition was. One shudders to think what happens to children whose parents or teachers do not have the resources to deal with the disorder,  especially in a form as extreme as Denevi seems to have experienced.

I also felt connected to Denevi for the fact that he and I are just about the same age.  Although I did not seek a diagnosis until adulthood, I was aware of my differences in the same way as Denevi describes. I remember the growing awareness of ADD in the school system from the time I first became conscious of it and until today when at least half the families I know are affected by it.  As an educator, I have learned so much about it.  I hope that books such as Hyper will help policymakers, educators, parents, and society at large understand Attention Deficit Disorder and develop strategies to maximize the potential of those with ADHD while minimizing the detrimental effects it can have.

Twist of Fate

When I last saw my shrink, she was apparently pregnant. She did not bring up the subject and so, according to protocol, I did not bring it up either, though her condition was quite… pronounced.

Well, in addition to ADD-dar, I apparently have preg-dar, because this week I got a call from the hospital informing me that I’d been transferred to a new doctor due to my own psychiatrist going on maternity leave.  I felt it safe to enquire if she’d actually had the baby yet– she hadn’t– and asked the caller to pass on my congratulations for when the time comes.

What my radar didn’t pick up on until just now was that her pregnancy was a graceful solution to a conundrum I’ve been avoiding.

For a while now, I’ve been debating doing a shrink-swap.  Although I am fond of my psychiatrist, I wasnt’ sure she was the best one for my specific needs. I want someone with experience in my specific area — Adult ADD– and I felt, at times, like she was winging it a little bit.  I mean, I’ve been on this road towards intentional correction for close to two years now — or more?  But I am still not 100% sure of my diagnosis.

The appointment they offered me with the new doctor is still two months away.  I guess that lack of availability is one strike against her.  Still, I’m in no rush. I haven’t been updating, but I also haven’t really been taking my medication for over a month now. I took it today for the first time in ages.  The only definite effect was hunger pangs at about 4:00.

If I am brave and strong and play my cards right then this can turn out very well. I tried e-stalking the new doctor, but there isn’t too much online about her, at least on the first couple of google pages.  I’d asked the administrator about her when she called to set up the appointment. I learned that she’s not new; she’s been around for many years. Well, that’s something.  And if I realize that she is not for me, I will be bolder this time and ask to be re-referred. I will.

P.S. If you scroll up and down over the square in the image on top of this post, you’ll see why the two doctor characters are doing the twist.

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I saw my Shrink again last week, and here’s what I had to report:

When I first got this new round of prescription after our last appointment and  I started taking the medication,  it was the week before winter break.  I took it the first day and the second day, but on the third day I felt all cloudy and disoriented.  I think I skipped that day– or the next.  I had started a list so that I could keep track and maybe chart the effects of the medication on my productivity– because, ultimately, increased productivity is my goal.  At least, I think I started a list. I have one attached to my pill bottle with an elastic band but it has some very random dates on it. Seems I haven’t been keeping track very well.

Strike one against the effectiveness of medication, I guess.

I wasn’t sure if the cloudiness was due to some side effect of the medication or a withdrawal from it.  All I knew is that I was barely functional. I could hardly prepare school lunches– something that is usually rote for me and doesn’t require a whole lot of thinking (though I still hate doing it and it sill takes me waaay too in the morning.)

On the other hand, i also had a cold, and this could have led to the cloudy feeling as well. Coffee helped. Napping too, though how much of an opportunity do I really get for that?

For me, the problem with being in a fog goes even deeper than zombie-like, purposeless wandering.  It reinforces a deep fear of mine, which is that I will become dependent on meds in the way that people are dependent on glasses, or that they will permanently dull that region of my brain because I’m not using the muscle behind it.

I decided at some point that week–  I believe I’d had 3 out of 5 of the intended doses, to postpone the big experiment until after winter break.  I still had work to do in the intervening weeks– I was preparing for a new business initiative I’m hoping to get off the ground, not to mention all of my regular duties.  But I didn’t want to do this medication thing haphazardly– because then what would be the point? I want to know if the stuff is working and if it’s worth all the soul searching and departure from my long-standing resistance to medication. As I had discussed with the shrink at or last encounter, I need to stick it it consistently for long enough to figure out whether it’s worth sticking with at all.

I started taking the medication regularly – Concerta– when the kids went back to school after winter break when my routine, theoretically resumed.

As I mentioned above, I am working on a new program that I hope I can develop in to a business.  I am hesitant to mention it here or even tell people around me about it because it seems that every few months I embark on a new project with great enthusiasm, and sometimes at great expense or personal investment, only to abandon it a little while later — always with a different excuse ultimately forming a pattern of failure associated with ADHD. I guess it’s important that I keep trying to find success– but the process can be disheartening.

In this case, however, I gave myself a deadline. I set up a date to present my project to a local organization, and that date was last week.  Even though I so far have only that date and two subsequent ones (it’s a series) booked at the same venue, I put a ton of work into it, hoping that the investment will pay off with further bookings and that, by the end, I’d have a program I could market more broadly.

As it happened, my weekly ‘protected time’– the one day each  that I arranged with my husband would be my own time to work on my own projects without interruption when he’s responsible for picking up the kids and being with them late into the evenings–  got compromised the first week after winter break because of a job-related commitment that there was no way for him to get out of. I tried to put in time that day anyway, but then my DS called home sick from school , so that day got cut short.

On the second week’s protected time, DH was desperate for me to help him out with a few projects that he regularly relies on me for, and they also really couldn’t wait. So last week I also lost a good half day from my protected time. I did manage to get a lot done in the late afternoon and evening, however, so it wasn’t a total loss.

Throughout the past two weeks I have been taking my meds pretty faithfully. One exception was last Thursday when I did my presentation. I find that the medication can make me shaky, depending on what other elements are happening (whether I’ve eaten, slept well, etc) and just today I noticed that they actually make me a little emotional the way that Adderol did– not to the point of being crazy, but enough to cry over some sad and/or heartwarming articles I read during my brain-warm up this morning (aka acceptable procrastination time– but that’s another blog post for another time.)

I guess that the pattern I’ve found so far with these meds is that the benifit– the drive– that is (most likely) supplied by the meds, is accompanied by a degree of stress. With this med it is to a lesser degree than the last, though I don’t remember feeling it at all before last week. I wonder if it has to do with the fact that they say it can take several weeks to start working.  Is it going to get worse now? Or is this as bad as it gets, because I can handle it at this level.

There was also another day the week before that I forgot or neglected to take the meds.  Let’s say I took them for 8 our of the 10 intended days.  I was supposed to only take a break from them on Saturdays but I haven’t been taking on Sundays either.

For me,  a deadline is the best motivation to get working, and I really pushed myself to get all everything done on time, and done well. It’s hard to say whether the pills were working or not, but I felt very motivated, and I spent a lot less time ‘getting into’ the work, and a lot more time actually working on it.  When I got distracted, it was a lot easier for me to get back on track, whereas sometimes it can take me half an hour or more to ease back  in.

Also, this is work that I really love to do, and I know that I’m good at it because I have done it for years, though not lately. So again– hard to say if it’s because of the drugs.

My program went well, though I only got through about half of the materials we’d prepared. I thought the participants really enjoyed it and that it got their wheels spinning. I’ll find out when I get back the evaluations.

After telling the doctor all this, I was surprised to hear her say that she was concerned about the fact that I was feeling cloudy.  The meds are supposed to make you more functional, not less, she said.  With regards to that, and also to my fears of long-term damage, though, she didn’t tell me to stop.  She just said again that I need to do a risk/benefit analysis.  Are the meds helping me meet my goals, overall? If so, are the risks and/or side effects tolerable?

The idea behind the medication, she reminded me, is not to provide a cure, but to provide a higher level of function.

Also, we discussed how I’m effectively doing three jobs at once if I take on this new venture.  Mothering, working the equivalent of part-time for DH, and now this.  Honestly, I don’t mind putting the work in to see if I can get this started, even if it means a couple more late nights.  Granted, it also means I’m pushing off some of the mothering stuff (nothing significant) and also some of the paperwork I’d otherwise be doing, which means it’s building up faster than usual.  I guess I’m ok with that too.

 

 

 

In Psych I… uh… Trust

It had been five months since the last visit with my shrink.  To be specific, my shrink is a psychIATRIST– a medical doctor who is licensed to prescribe medication, as opposed to a psychOLOGIST who is a person who studies human behavior and the human mind. Both may or may not practice psychoTHERAPY, a method for remedying  what ails the  psyche.

I’m not sure what kind of doctor BeetleJuice’s waiting room buddy there was waiting to see…  Is there such a thing as a head un-shrinker?  (Better call in Rick Moranis. Now THERE’s a movie mashup just waiting to be made. rick_moranis

The reason I make the trist/gist distinction is that the function of  my psychiatrist, as I see it, is mainly oversee my rotation through a series of ADD meds until we find the right one which will, in combination with my own efforts and personal growth and strategic planning, release me from the perils of  distraction and impulsivity that my brain, unaided,  keeps leading me towards. As a result I will, in theory, begin– or resume — my climb on the ladder of success, self-fulfillment, and fortune.   For this purpose alone has Dr. C. spent a decade in medical training. In contrast, a psychologist might try to work with me on strategies and techniques… I think.  I have never actually heard of one who deals with ADD.

My shrink laughed at me last week. I told her that I’d only called her after such a long spell because I’d run out of the prescription she’d given me in June — a 28 day prescription. It’s now the middle of December.  I told her that I was trying to take it as needed, but since I hardly had any time between July and November to sit down and do any work, I hardly took them. Also, when I did  sit down to work in that period, I neglected to or forgot to take them. I admitted that, shortly after I called her, I found another stash of about four doses in my purse where I knew I’d have them with me in case I forgot to take them in the morning.   That was the part that got her laughing.

“That’s so ADD!”

An astute, and timely observation.  I laughed along. It was a good moment; We bonded a bit, I think.

I told her about how I was not really sure about the effect of this round of medication. I am pretty sure it led to a crash on at least one occasion. I was in the supermarket on the day  after I’d taken it.  I hadn’t had a dose that day. I started to feel really over-caffeinated and jittery, and acutely aware of all the chaos around me…. which had never felt like chaos before. The supermarket is always a busy place but I don’t usually feel like I am at the centre of some storm. It was odd and unpleasant. I felt weak as well, and would have liked to sit down, but since there was no opportunity to do so, I just pushed on.

Honestly, I am not sure it was a crash or that it was at all connected to the meds, though I did notice a coming-down at other times on other meds.  This is one of the things I was afraid of.

The Doc told me that the meds certainly may have played a role in my odd experience at the grocery store, and that if I’d been taking them every day as prescribed, it might have not happened. She says I misunderstood about taking it as needed and that until I figure out what meds, if any, work for me, I should take them consistently for a few weeks.

I am always afraid that I’ll become dependent on medication. I am afraid I won’t be able to ‘get back’ to where I was before– back to my  brain baseline.  I am afraid that the medication will cause permanent changes– if not damage– to my brain. I’m afraid I will lose my ability to be creative. I am afraid I won’t see inspiration all around me.

She said I could take a medication break on Saturdays.

I dutifully took one dose the first Monday after my visit. I don’t know that it did anything.

Actually, I know it  did something because I was ravenous in the evening, which meant I hadn’t eaten enough in the day, which is not the worst side effect, in my case.

Let’s see how the rest of this stash goes.  If I really like them, I have four extras in my purse…