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
Wednesday, November 9, 2011
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
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
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