Wednesday, November 9, 2011
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
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
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
Saturday, November 7, 2009
Hello My Friend
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
Monday, August 24, 2009
A Father's Wisdom
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.
Tuesday, August 11, 2009
CAGE
1. Have you ever felt you should cut down on your drinking?
2. Have people annoyed you by criticising your drinking?
3. Have you ever felt bad or guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
If you answer yes to 2 or more of these, you are at risk for a drinking problem or alcoholism. I scored a 2...it is true that I have often thought that I needed to cut back and I have often felt guilty about drinking. This scares me--it scares me to the core. It is a hard concept for me to grasp though. I don't feel abnormal--it is more that I really enjoy a glass of wine or two in the evenings after a long and stressful day at work or school or clinical....when I "drink alone" it is not hard liquor nor am I trying to hide it from anyone--I just so happen to have a glass of wine in the evenings when my husband isn't home yet. I don't hide my drinking, I don't lie about how much I drink. I certainly don't need to drink to get through the day and have never needed an eye-opener. I drink wine and beer--never hard liquor...though I don't suppose that matters. My drinking has never interfered with any of my responsibilities...but I do crave a glass of wine or two, or a beer at night. Am I an alcoholic? I wonder. I drink to relax me, to let go, to relax. I feel guilty when I have had too much to drink because I feel like crap and I act stupid. It doesn't happen too terribly often, but more often than I think is right. "Just stop" you might say--but that is where I get hung up--I am having a hard time doing that...just stopping. I don't know whether it is because of dependence or habit. I don't know if it is because I feel so stressed beyond belief half the time right now that I don't otherwise know how to chill out. It is social. It is personal. I am scared. I think that somewhere in my history there was an alcoholic...there was certainly a great grandparent addicted to gambling. Maybe I just need to get pregnant--I certainly would never drink during my pregnancy...I write this as I sip a glass of wine, alone on my couch. Hypocrit. I failed the CAGE....
The Irony of A/C
Monday, August 3, 2009
Mold, Marlin and Fear
I caught one of the beginning portions of Finding Nemo this morning and it dawned on me that I am much like Marlin. Scared of everything--always wondering the what-ifs and letting them paralyze me. I really am not scared of everything--but I am scared enough that it changes how I live my life. There are risks that I wish I had taken, choices that I wish I had made, opportunities that I lost--all based on my fear. There are lots of fears. Fear of not being prepared, of not knowing how to do something, of being wrong or looking stupid, of the unknown, of anything different. I do really well with routines and changes from that make me anxious. It is anxiety too--I am anxious as that damn fish--and look where it got him! Nowhere! His mini-flippered son disappeared and it wasn't until he manned up and grew a pair (if fish even have a pair) that things turned out okay. Is that what I need to do? Grow a proverbial pair?
Fears. The fears. I would be an airline pilot right now if I hadn't been scared. I would also not have gone to UVA. I would be able to get rid of my paper bank and credit card statements. I would be able to be honest all the time without fear of being left and abandoned. I would be able to "stick to my guns" and not be resentful and frustrated for giving up my convictions. I might be able to stand up for myself (or maybe not) and I might even be willing to put my neck out and write the children's book I have always wanted to write. Fear and anxiety. Fear and anxiety.
I feel pathetic. I am a semi-grown woman (I will never be a real grown up) and I am dominated by fear and anxiety. I am expert and playing out in my head all the possible scenarios in any situation. And I let those scenarios stop me in my tracks--freeze me. FUCK! Even my career (though I love taking care of my kiddos with cancer and would never in a million years take it back) is based on SOMEONE ELSE'S hopes and dreams and aspirations. Not my own!
Wow--never said that out loud before. Feels a little odd...maybe some sense of freedom...though I probably won't ever really feel that until I apologize to the person whose dream I copied. I am struggling to believe that it doesn't make me a bad person. Struggling and failing. If you read this--you know who you are--I am sorry--and someday maybe I will be fearless enough to actually say it to your face.
I am sorry world. I am a coward. A fake. Is that why I want to do daredevil things? To prove that I am fearless? Is that why I want to find myself? To prove that I am not a fake?
Friday, July 31, 2009
Reading and Rockstar
If you want something done, do it yourself
Comment: Obviously true, and doing it is usually very good for your self esteem. A surprising amount of work can be done this way, and experts are not always necessary. However, there is a risk of becoming overworked if you try to do everything yourself - we all need other people after all.Never procrastinate anything you can do right now
Comment: Very powerful. There are many things that can be fixed or solved with a minimum of effort, but are often pushed aside as unimportant. Unfortunately they won't go away, and in time the feelings of guilt for not having done them will make you even less likely of fixing the problems.When you have several things you could be doing and don't know which to do: Just do any one of them!
Comments: If you cannot decide between two or more possibilities, then there is a good chance that the differences don't matter. However, most people begin to hesitate in this kind of situation (Fredkin's paradox). If you are conscious of this, you can just choose one choice randomly or according to some standard method.Always assume that you will succeed
Comments: If you don't expect to succeed in an endeavor, then you will not do your best and will not notice possible solutions, while if you feel that you will eventually succeed you will concentrate all your power at the problem. Of course, there is no point in attempting what you cannot do, a certain amount of self-knowledge is always needed.If you can't find a solution, change the rules.
Comment: Remember that there are no no-win scenarios.If you cannot do anything about something, there is no point in worrying about it.
Comment: Worrying is stressful, and in most situations doesn't accomplish anything - it just wastes energy. Instead of worrying about things, either do something about them or find ways around the problem. One useful idea is to write down your worries on slips of paper, and then put them away in a box. Regularly, once a week or so, you open the box and see what you can do about the worries that are still relevant.Do not rely on conscious decisions for speed - Just Do It
Comments: The conscious mind is surprisingly slow, conscious choices and actions are delayed for a significant time (a reflex acts within some tens of milliseconds, an unconscious reaction to external stimuli circa 100 milliseconds and a conscious choice several seconds). The duty of the conscious mind is usually to inhibit rather than start action, and if you become too conscious of what you are doing in a tense situation you will hesitate or slow down.It is a good idea to learn to rely on your non-conscious mind, since our conscious mind is slow and has very low bandwidth while the other systems in our brains have a tremendous capacity and actually do most of the real work anyway.
Don't try to explain away your actions for yourself
Comment: While we often do things we do not want to explain our real motivations for before other people (out of fear of embarrassment, anger or loss of image), it is a bad idea to try to convince oneself that the motivation was anything different from what it was. It will only reduce your self-knowledge with deliberate misinformation, and it is often valuable to understand what motivations you have (even if you dislike them or would never admit them in public).Listen to your intuition, but do not believe it unconditionally
Comments: Intuitive or emotional thinking, analogies, "gut feelings" or "flashes of inspiration" can sometimes give fantastic new insights or show problems from a new direction. Unfortunately such thinking isn't always reliable, and quite often completely wrong! Such insights should never be accepted because you admire their beauty or they are intuitive, only because they fit with reality.And with that...I am off to do something productive
Wednesday, July 29, 2009
Me
- One of my pet peeves is when people don't call when they say they are going to call. WTF. We all have cell phones--its not like you aren't close to a phone. Fine, I understand if you n't talk, but its still not hard to say that to a person when you call them. Either way--call like you say you are going to. Or send a voice mail--you don't even have to call for real! Or text! C'mon people--its a common courtesy. I am less annoyed by people who don't call you back when you leave them multiple messages, but I can forget about that more easily.
- I am very texture-sensitive about foods--which is why my mother in law's leftovers scare me. I don't like onions on pizza or in lasagna. All the yucky parts in chicken should be taken off PRIOR to cooking. If I bite into something that crunches or is rubbery when it shouldn't be, the meal is over. YUCK!
- I drink my milk with ice cubes in it and I like any food that is supposed to be hot to be ATOMIC hot
- I love thunderstorms and blizzards.
- I have my first cavity this year:-(
- I have an older brother--he once rolled me down the stairs hogtied wrapped in a flannel blanket--we are friends now. We look nothing alike and people are confused about who is older. I am 3 years younger.
- I am the spitting image of my father but I can feel when I am making the same faces my mom makes
- I never lost my Moro reflex as a baby--I startle with even the slightest noise and it gets to me sometimes
- Loud noises really bother me occasionally (another reason my MIL gets to be sometimes)
- I love the smell of pine-sol, rain on hot asphalt, and fresh baking bread.
Signs
There is something spooky, romantic, mystical, amazing about the idea of following the signs. Maybe because it is an excuse to not have to make decisions, to ride on the whims of the universe. Some might see it as a way to live freely...others as a way to avoid taking responsibility for anything. Ask yourself, do you believe in signs?
Tuesday, July 28, 2009
ESB, Breastfeeding and Aggressive Driving
Shadows on My Thighs
Needless to say, my motivation and irritation was renewed by said discovery and I am blogging from the damn elliptical machine now. Jeez. Here is where I am supposed to have some insightful and deep comment about loving my body and person within as part of finding myself. Fuck that. I will be there someday, but right now is not it. I was much more inspired after my Yuengling Black and Tan yesterday--maybe I will have something deeper after my Redhook ESB--AFTER I get off the freaking elliptical. ARGH!!!!
Monday, July 27, 2009
Yes--Pink High Heels
I am new to this blogging thing...but I like the idea of being held accountable for what I am trying to do. Altogether too often we make decisions to change and then they fall by the wayside, shoved behind grocery shopping, laundry and aggressive driving. So here I am world--openly declaring my mission, thinking that perhaps pursuing my mission publicly will somehow commit me to truly change. We will see...Just so we are all aware of what I am doing here--for any of those who somehow fall across my dreadful blogging--I am on a mission to find myself. I am not entirely sure whether I am trying to find myself or recover myself. I have long contemplated this question. Did I ever know who I was? Maybe, maybe not. Do I know who I am now? No--I don't think I do. I know who I think I am supposed to be and I am pretty damn good actress and portraying that role. This begs the question, however, whether who I am trying to be now if who I really am or who I think I am supposed to be...oh the confusion. In the end, it doesn't really matter. I am not my genuine person right now, at least not fully. No to say that I am lying...just not being true to myself. Which is why I will wear pink high heels. That is something genuine. I know this--there is no question--I just haven't ever had the courage to wear them and do so proudly. So that is my goal--so proudly wear pink high heels, among many other goals that is--many more important goals--but the high heels are something tangible.
So, this is my journey. To find myself. To find who and what I am, and to embrace it. I am scared. What if I find out that I am a bad person or someone no ones likes? What if I fall off the wagon? What if everyone I know and love leaves me because my genuine person is some evil ogre and awful and ugly? But what if I live my whole life not being who I am supposed to be--merely acting a role rather than living it? Today I am choosing the scarier option--the road less traveled. Thank you Robert Frost.