Wednesday, November 9, 2011

Partially Compensated Metabolic Acidosis

The human body is amazing....for more reasons than I can count, but one of which is its ability to physically compensate. Whether you know it or not, there are all kinds of autonomic functions (the kind you don't have to think about, like your heart beat) that are constantly changing to accommodate everything you throw at it. One such "situation" is called partially compensated metabolic acidosis.
For my non-medically oriented audience, stick with me. Under specific conditions of duress your body can develop something called acidosis, the cliff notes on the subject are that the pH in your blood drops too low. If it drops too low it's incompatible with life, in in reality, the tolerated range is really quiet small. Nature was kind in our evolution and created autonomic functions that try their very best to "right" things before we crash and burn. In fact, you can go on for a fair amount of time before your ability to compensate is worn out...or the problem that caused the acidosis in the first place overwhelms the ability to compensate. Still with me? Any idea where I am going with this?
My current state of being is the cerebral equivalent of partially compensated metabolic acidosis. My brain has, for years, recognized the scattered disordered thoughts, the inattentiveness, the restlessness and has created ways to compensate, to accommodate it all. I makes lists down to the minutest detail so that I don't miss anything (but then usually lose the list or don't fully follow it). I use having to pee as a socially-acceptable excuse to get up and move (whether is is leaving a class, on a plane, a movie--makes no difference). I think in black and white because it gets things done--I don't know what to do with grey (it actually overwhelms me). There are set places in the house that a few select things go so I CAN'T lose them (like my wedding rings). This is, apparently, how I have compensated. There are things I have actively done to organize my life (not knowing why, mind you, other than the fact that is decreased my anxiety) and there are things that I have just done but seems to make a helluva lot more sense in hindsight. Now, this all works fine and dandy until something tips the scales and suddenly I can't compensate anymore. The expression of the loss of the ability to compensate has been panic attacks and shut down. I flap, as in my hands. And wring them too, and pull on the hair on my arms and really, everything just goes haywire--in fact, I look something akin to a schizophrenic poodle (yes, I realize its not proper English to start a sentence with a conjunction--bite me). Complete meltdown = feeling broken. I feel guilty for having lost it, incompetent for not having been able to prevent it, berate myself--then I try to pick up the pieces. Rinse and repeat--over and over again. Its exhausting--and until now, there has never been an explainable "cause." Cue entrance from stage left: ADHD!
Its hard to explain to someone who has never experienced severe anxiety what it is really like. I have tried to tell my husband that its like that moment of shock you have after a near car accident - except it lasts for hours, days, or even weeks. Its not something that you can "just stop" or choose to not have happen--its a symptom! Problem is--if you don't know what is causing the symptom, you are screwed! By now it must make sense to someone why this whole ADHD diagnosis is such a revelation??
In partially compensated metabolic diagnosis you do a number of things: figure out what the cause is, take over the role of compensating or assist the body in doing so, treat the root cause. When applied to my brain and life...well, it starts to make sense! It might have taken 20+ years to figure out the root cause (there were a lot of red herrings in there!!) but finally there is a diagnosis that actually makes sense and accounts for all the random bits and pieces: ADHD. Check. In terms of assisting my brain - treatment of ADHD should be multifacted--it's not something that magically goes away--you have to learn a way to accomodate and live with it. I started vyvanse this past Saturday--a little baby dose that will inch up slowly if I need it to (really, its a trial and error thing). I go to therapy once weekly to talk through things (there is alot of sorting through the past and unlearning some bad thoughts about myself) and for cognitive behavioral therapy. I do homework at home. For the record, those who believe that you simply fix ADHD with medication you are crazy--its something that helps you manage life but it doesn't fix anything permanently--just like tylenol doesn't permanently fix a fever. Excuse me as I clamber off my soapbox (I'll probably trip and fall anyway--I'm clumsy like that).
Don't know if this was more to try and explain things to the world or rationalize it to myself in a language I trust. In any case, its undeniable progress in the march of acceptance.
Sarah

Saturday, November 5, 2011

It's Been While

Admittedly I have lost track of time, of myself, of the original impetus that brought me to blogging. For the few of you who used to read this, a long while back I decided to find myself, to gallantly (and somewhat blindly) delve into the human experience of actually living in your own body, and with your own thoughts, brain and head. It was (and is) a magnanimous undertaking--one that got lost for awhile. Ironically, it was lost in the process of grad school and truly following what I thought was my dream and the first real step I've ever taken that is truly an honest interest of mine. Oh how the mighty have fallen. Suffice it to say that a lot has happened since the "beginning" - maybe realization is a better term - of my quest. Its time to start again.
I was diagnosed with ADHD this week. For me, its life changing. It is not that I am am suddenly some radically different person (at least not to the outside looking in)...its just that things are beginning to make more sense. I finally feel like I can truly figure myself out. Have you ever worked on a puzzle and as you get close to the end there are only a few more pieces and your heart races in excitement (as fast as it can anyway when you are working on a 2000 piece picture of kitten and puppies with bows tied around their necks)? As you realize that you have it almost figured out, you know where those last pieces are and where they are supposed to go? The little kitten after all this time finally has both eyes (and the eyeball puzzle piece is no longer staring at you from the coffee table) and doesn't look so creepy anymore? I'm about halfway through the puzzle - in true Sarah style, the pieces are all over the place, half organized, mostly flipped upright.
ADHD. It's a pop-culture term these days--everyone flippantly says, at one point or another, "I'm so ADD" when they are having trouble focusing, can't get something done or are trying to spread their time and attention to thinly. I agree--there is reason to be skeptical. I'm slightly skeptical--my husband is more than "slightly" skeptical. At the same time, I am neither a novice or a layman (nor am I an expert for that matter)on the subject. I am a pediatric nurse practitioner. ADD and ADHD are one of the most pervasive diagnoses in a pediatrician's office--there isn't a day that goes by that you don't get asked by a parent about "it"--maybe passively think that the child you are trying to examine might have "it" or are questioning families about how their child is doing on the new medication for "it." Now I'm the one diagnosed with "it."
The point of my blog is to document my journey of self-exploration, acceptance and understanding. This is not intended to be technical--but I feel like I need to clarify something. ADHD and ADD are not diagnoses that you just suddenly "come down with" like the common cold--its a pervasive mental health diagnosis for which symptoms must have presented prior to age 7. Those who are diagnosed as adults have had symptoms for a lifetime - they may have waxed and waned depending on the situation, changed over time, or been crowded out by co-morbid diagnoses like anxiety and depression--but they have always been there. Regardless of whether ADD/ADHD are identified as a child or an adult--it is rarely a clear-cut picture and is never a simple diagnosis. There is no single test that gives a definitive yes or no--no blood test or single physical finding. There are a number of screening tools, questionnaires, checklists and observational tools that have been thoughtfully and scientifically developed that have high sensitivity and validity for detecting ADD/ADHD symptoms and correlating them with the DSM criteria. Its just as valid a diagnosis as a "physical" problem, like diabetes, high blood pressure or a broken leg--but more based on qualitative data. Which DOESN'T mean its any less real--just saying. I think I have lost track with where I was going with this (what the real end goal was)--in fact, I know I have...I guess the point is that while it may seem that "everyone" has ADHD, in fact, everyone doesn't.

Explaining Myself...
You know, I will openly admit (and have no problem doing so) that I have had my fair share of mental health issues in the last 28 years of life. I don't have any problem talking about them--anxiety, depression, anorexia, self-mutilation. I am having trouble talking about the ADHD (at least with my immediate family and friends--clearly not with the "anonymous" world wide web). I think that, in part, it has to do with the following responses (that I have either received or I am anticipating): "Oh, I do too!" or "That's not possible - you have done so well" or "That's just the diagnosis du jour" or other less supportive than things. I get it--I get the skepticism, the suspicion--don't you think I have those feelings?? I am a relatively accomplished person for being 28--I went to a prestigious undergraduate program, have successfully attended graduate school, matriculating with a dual master's degree and 4.0GPA. I live in a single family home that we "own" (I only say that since no one "owns" their home anymore--the bank is really just letting us pretend we all do), a wonderful husband, some excellent friends and relatively successful career. I don't fit the (stereo)typical profile--so clearly I can't have ADHD. I think that is why I don't feel like talking to anyone close to me about it--because I feel like I have to argue or prove the diagnosis, explain my whole life and how it supports the diagnosis, and then wonder if they believe me. Its easier to just not say a word for now. Funny that no one ever grilled me about the "other" mental health diagnoses I've had. I feel defensive. It doesn't help that my husband is one main people questioning it...Here's the thing-- I was diagnosed through a series of medically validated qualitative tests by a board-certified and well-respected psychiatrist whom I trust. I have agonized over the possibility--spent hours mentally reviewing my past, scrutinizing different parts of my mental-self, facing the things I despise about myself head-on and actively ignore whenever possible. And you know what--things finally make sense. I can finally see how the puzzle fits together--and for ONCE in my life I finally feel like I have some answers. Its like putting the 3D glasses on in the movie theater 30 minutes into the film--the images finally make sense as opposed to some red-blue double image that gives you a headache. Does it mean that you instantly understand everything you missed? No--you have to go back and think through and process all that you saw in the purple diplopic fuzz so that you understand why the main character is now standing nude in a ball-pit with a sombrero on and why that is funny. It also doesn't mean that you will fully understand the plot now that you have the right glasses on (though you do have a better shot for sure) or that you will know how it ends. I finally have my 3D glasses on. I'd prefer being offered tape to keep them in place as opposed to being told they don't fit and I should take them off and find some other pair.
This has been long winded--I realize--but honestly, its not for you--its for me. In fact, its apparently one of the coping skills I have culled over time--I work though things by writing them out, arranging and rearranging them until they make sense--its an "active" coping skill. In anycase, my brain is tired, a little jumbled, and honestly I am having trouble focusing at this point. So off I will flit to any number of other things I am actively working on but never actually finishing. One day I will. Not today...and you know what? I'm okay with that.
Sarah

Tuesday, January 5, 2010

Reality and Epiphitamous Moments

Okay...yeah, last semester handed me my ass is a brown paper bag. NO JOKE! I am serious--it is pretty bad that I cannot account for August-December of 2009. It doesn't so much bother me that I cannot account for my time (although that is distantly disturbing)--but rather that I cannot account for what I learned. In 130 days I will graduate and take a test and be charged with young, beautiful, innocent lives--ACK!!!!! I will take a test that will say that I am qualified (yes, my 4.0 average will testament that I will likely pass the test the first time around) but will I really feel that way.??
There is a lot that has happen, mainly in the last 2 weeks when I have actually had the time to think about my life and course of action. There are a number of books that have guided my thoughts...including The Happiness Project and How to Unclutter Your Life in a Week.....admittedly I have yet to read either cover to cover. I am mildly obsessed with the DVD the Secret. In the end, I have to wonder whether it really matters what the impetus for change is as long as change occurs...I wrote this in an email to my bestest friend in the whole wide world today (and I might have been a little drunk...I'll admit):
"You are the only person who has every really understood these moments in time...the only one who has taken them for what they are and raced me to the finish line with them whether they are real or true or not--my inspiration. You cannot fail at something if you never do it. If you fail to try then you cannot fail--but you cannot do anything. What is the worst thing that happens if you fail? Typically you worry that someone will laugh or ridicule you--sometimes there is money at stake. But how will you ever know that you have failed if you never try? How will you ever know what you are good and amazing at if you never attempt it? Will you spend your life forever fantasizing about the things that you could be and want to be? If you never do it then you never have the opportunity to fail, to grow, to succeed! Failure is not the end point, it is the learning point. It means that there is opportunity for growth. If you had fun doing it and learning it then why does failure matter? It doesn't. Anyone can succeed successfully....its takes a special person to fail successfully. I will write a children's book and be published. I will learn to play the French horn. I will sky dive and walk the great wall of china....I like epiphitamous moments...tooo bad epiphatamous isn't a real word. Thank you for not rationalizing them. xoxo
S"
I think that is good for the night....stay tuned for more!

Wednesday, November 11, 2009

Tired...and a little defeated

I have to say that it is tiring never being able to be right about anything. Exhausting, actually. In reality, it has nothing to do with being right--it has everything to do with being heard. I could care less about being right (unless I really am SURE that I am right on the FACTUAL level)--there is really no right and wrong with feelings I don't think. That is the problem with a thinker and a feeler being married--1/2 the time it is also the problem between men and women. I don't necessarily have logic or rationale behind the way I think and feel--and just because I can't provide the rationale or logic, well, it doesn't mean that I am wrong. I can't "win" no matter what route I take, however--and it isn't even winning. If I "argue" my case, I have to provide rationale for everything that comes out of my mouth--which isn't always there--and even if I am able to put up some sort of "reasonable" defense, I am never right and can never defend myself. Not "arguing" my case is not an option either, however--I am not allowed to just sit and listen--and it isn't even about winning--just like its not about being right--what I have to say is never taken for what it is and digested--its argued and battered about--like a cat playing with a 1/2 alive mouse--eventually for self-preservation the mouse just plays dead--I can't even flippin' play dead! Why is it that I always leave the conversation feeling like the villain and feeling like I should apologize? With a relatively reasonable person (I did say relatively) such as myself, it really is not statistically possible that I am "wrong" EVERY SINGLE TIME WE "TALK." I wish I had found my voice before I got married.

Saturday, November 7, 2009

Hello My Friend

I have not been here in 2 months.....and I am not really able to account for the last 2 months of my life. Truly laughable that I thought that I would be able to "work on myself" while in school, much less blog about it. I should have known that there was a snowball's chance in hell of that working out. That being said, my current mission is to merely survive.
This semester has worked me over in a way that I could never have imagined. I mean, seriously kicked my ass--and I am not done yet. I am still waiting for that point that I just don't care any longer and can just "let it all go" and not have to get straight As or worry about doing everything perfectly and right. I have a sneaking suspicion that that day will never come, at least not without some serious therapy first....one thing this semester has been good for it teaching me the value of a few free hours--although that doesn't really exist in my life.
I got to thinking the other day--what exactly happened during my childhood to screw me up and make me the way I am? That sounds as though I am not owning the mess that makes up me--but that is not really it at all--I would just like to pinpoint what started all of this. Surely there is some genetic susceptibility here, but nature is not alone in shaping humans--nurture counts too! I wish desperately that I could remember what exactly changed things. I remember being a happy kindergartner--I think. I remember the not-happy times too....like having to make my own lunch when I was in the 4th grade---that I either made my own lunch or I had to buy lunch....I remember envying all the kids whose mom's packed their lunches and wrote them nice notes on the napkins...no one ever wrote me notes after the 3rd grade. I remember my parents being unhappy and my mom being miserable. I remember trips to home depot with my dad early on Saturday mornings--I didn't really want to go and I don't think that he really wanted me there with him, but it was like some sort of routine--he had to act like he actually wanted me around when he really wanted to be alone and I had to act like I wanted to go to home depot when all I really wanted was for my dad to like me. I remember waiting at the bus stop in the dark waiting for my dad to get off the bus from the pentagon, just so I could walk 2 blocks home with him before he was angry with my mom and my mom mad at him. I remember the day he told me that I didn't need to put cheese on my hamburger because I was already heavy enough and when my mom showed me the movie 'Circle of Friends' just to prove to me that boys liked fat girls too. I remember doing things to earn my parent's praise so that they would like me....I never really thought they did...but they seemed to like it well enough when I got good grades and didn't make trouble.
The first time I thought about suicide was in the 6th grade. I think that I was 12. I wrote a note, decided who was getting what of my personal posessions. I don't remember now how I was going to do it--but I remember the feelings. I remember the night that I wrote the letter, under the covers with a flashlight in hand---emotional hurt beyond anything I had ever known--I can still feel that pain. I gave the note to a boy, who either gave it to the teacher or it got confiscated, one of the two. I don't really know what happened after that--I remember being sullen at lunch, bursting into tears on the platform that went upstairs to the classroom and then my mom being so angry with me. That sealed the deal---my emotional pain brought on disapproval and anger--I wasn't allowed to feel those feelings--it made my parents dislike me even more. I dropped it. They tried to get the guidance counselor to talk to me--I shut down. I got made fun of in school for a long time after that. It didn't matter. I had always been an outcast and different.....a loser of sorts. I think that is when I learned that it was not okay to feel the way I felt--that it only meant people would be angry with me. Was that when things really changed?

Tuesday, September 1, 2009

Dread

And thus it has begun--a semester that I have dreaded from afar, the semester that guarantees to hand my ass to me in a brown paper bag, without so much as a courtesy bow. I wonder whether I have made in out worse mentally than it will really be--I have a tendency to do that. I imagine the worse, make it my reality, and then live it regardless of the actual situation. It is really quite silly, actually. There is part of me that just wants to be in the thick of all of it--to be in a "routine" of school that is comfortable. I hate this beginning period--where everything is up in the air and there is this muddling sense of disorganization that plagues everything and just makes it harder--and just makes me anxious. Oh the common theme. Anxiety. I used to say that I would give anything to eat normally again--to be a normally functioning "human being" again--this is what I said when I was anorexic. Now I am an axiectic (yes, I made this word up--it is my self-description for a person often paralyzed by anxiety--also known as me). I just wish that it didn't pervade everything I do and everything I am. It dominates me--like chocolate dominates some women. It makes me worry about things that haven't happen and may not necessarily happen. It makes me act stupid or silly or paranoid or not in my right mind. I suppose that it is part of me....but I don't particularly like it. I am not anxious all the time--like at work--I am not anxious when I am not floated (being in a strange place with an unfamiliar charting system, on the other hand, is very anxiety producing). Yet, I digress. I just want it to be 3 weeks from now. Not only because it means that I will be 3 further weeks into school, but also because I will be comfortable in my routine, in how it is going to work and how I might possible be able to function. I am still struggling with getting up at 0430. I think I have mentally made this my cornerstone--I have placed some blind faith in the idea that if I get up at 0430 and exercise for an hour that somehow my routine will be solidly in place and all will be well with the world. Maybe I am wrong...maybe I am right. I have yet to explore this--or rather, I have yet to drag myself out of bed at 0430. It is just so early....so middle of the nightish. Routine = control = less anxiety = fanatacism = god knows what. There is a fine line between motivated and obsessed. On a random note, I am mildly disturbed by the fact that I will be working with the doctor that treated me for my eating disorder....seeing as I feel like I am on the cusp of the divide between normal and not. Then again, I have to remind myself that I never chose to be anorexic--I just realized one day that I was. I don't think that it was something I could have accomplished if the situation wasn't just right--how else does someone eat 300 calories a day and run 5 miles? I am not sure. It was in some ways super foolish....and in some ways superhuman. Something to fear and to be proud of. It is no longer my "badge of honor" but rather a part of my past. It doesn't mean that I don't peruse the occasional pro-anorexic website...I wonder whether it is an activity I don't participate in when I am in such stressful situations because I don't want to or because I don't think that I can. I will never know....

Monday, August 24, 2009

A Father's Wisdom

Mountain Dew Ultraviolet is gross. Fact. Not the real point here though. I love my Dad--though I don't get much time to spend with him. He is very different now than how he was growing up--though I didn't get much of a chance to know him then either. It was a bad combination of lifestyles, I guess you could say. The upshot of all of it is that I am just now really getting to know my pops. Making it that much harder is that we live 2000 miles away...it makes me sad. Very sad. When Ross (my husband) and I were visiting recently, my dad and I were talking about grad school and graduation and everything else in life. Correction. I was complaining about school and lamenting it starting again...blah blah blah. Anyway, in his wise wisdom he opened my eyes to something--something that, if I can take it to heart and live my vague understanding of it, might make the next 9 months (finishing school, not baking a baby) a little easier. "Boo, its always something else. There will always be something else. You will finish one thing and there will always be another. It isn't about the 'what' of what your are doing, but rather, the 'who'". Huh? Yeah--its not the easiest to explain in a blog--nor is is quite as easy to digest without a side of Dale's Pale Ale--but the theory behind it is that you will continue to feel as you do, no matter the task, as long as you stay the same. Again--clear as mud. Maybe if I explain it in real-life terms....
I am counting the days down to May 15th. It is my graduation day. Mentally, I feel like everything will be better if I can just get through the next 9 months--that suddenly life will be fixed. I will be happier--Ross and I will be happier. (Kind of like when I thought that being less than 90 pounds would make boys like me and my life would be perfect--no, not so much).Life will just be better. But as my dad pointed out, however, something will just take school's place. I will have something else to complain about or be anxious about or to "get through." The only way that things will really be better is if I change my view on things--my perspective--my outlook. This is daunting but give me hope--and fuels my pink high heel project. It is daunting as it takes a profuse amount of energy to change one's perspective. Hopeful, however, because it makes the next year of school potentially less scary. I am a little late in discovering this--school starts tomorrow. Or rather--I should have visited my daddy a little earlier in the summer. Nonetheless, it is a glimmer of hope.