Monday, September 19, 2011

'Process' is a Dirty Word

M2 and I visited the therapist last Wednesday.  We visited the psychiatrist today.  In both appointments, I got to hear the word 'process.'

I'm coming to really dislike the word... and all that it stands for.

Last week, we had a really productive appointment with the therapist, assuming that by the word 'productive' you understand that she got really sassy and announced point-blank that the only reason she hadn't bitten me during a rage is that she hadn't thought of it.

Alternatively, productive might mean that I now know how to properly put my child in a therapeutic hold instead of just trying to make do... for the record, I had been pretty darn close the way I'd been doing it already. I just needed to be told to stick a pillow against my sternum because apparently I'm not intelligent enough to figure that one out myself.  DUH, Sarah.

I also know what to do in case biting jumps to mind next time.

Oy and effing vey.

Either way, the therapist and I then discussed the whole process scope of what we've accomplished (anxiety seems to be under better control), what we want to accomplish, and what is even POSSIBLE to accomplish with a girl whose mood switches more often than Oklahoma weather... and that's saying a lot.  The long and short of the appointment was that we now have another mood gauge chart (since M2 systematically destroyed the first one during one during one of her moods) and we're trying to see what we can do to motivate the girl to try to help herself.  I'm on the fence as to how much it'll actually help, but the only thing we can do is persevere.

It's a bloody process.

Today we visited the psychiatrist, whom we hadn't seen since school began.  The visit didn't encompass so much in the way of treatment as the diagnostic side of things.  I'm trying to hold off on medication for as long as we can, until we can get as firm a diagnosis as possible.  Plus, the psychiatrist is extremely reluctant to make certain diagnoses - pediatric bipolar disorder being one of them.  I'm okay with that, too, but it means that I get to deal with more and more in the way of going through the diagnostic process.  When we first visited, the doctor was hesitant to diagnose anything other than anxiety (generalized and separation), which means we tried Lexapro, which ended in ULTIMATE FAIL.  Since then, he's watched and listened and tried to work out if there actually are any other diagnostic possibilities that fit her slew of symptoms other than bipolar disorder.  Two sessions ago, he admitted the possibility of a mood disorder, NOS.  Last time, he added depressive disorder to the list of probabilities.  Today, though, he admitted he's pretty darn close to giving up the ghost and said that he really can't figure out anything else other than bipolar disorder, NOS.

Heh.  Heheheheheheheheh.  I have triumphed over the processing process!

I didn't actually want to win that one, though.

Anyway, because M2 isn't consistently up or down for days and days on end (she'll have two or three good days, then two or three bad, then another one or two good and another one or two bad), we're still holding off on formal medication.  We're doubling her melatonin each evening, and M2 is going to keep a sleeping log, writing down the times she wakes up each night.  If she's not consistently sleeping at night, the doctor wants to add some clonidine or trazodone and see if that helps.  After that... well, after that we head to Lamictal, assuming she doesn't get extremely manic since Lamictal is primarily used for patients who tend toward the depressed side of things rather than the manic.  I wouldn't be surprised, though, if the doctor actually begins to recommend medication soon rather than agreeing we should hold off... he tends to agree with the 'kindling' theory that young people who have untreated bipolar tend to become more difficult to treat over time.  However, if she doesn't have bipolar, then maybe we could try another SSRI and see if she reacts as negatively as she did last time.

Mostly, it's all a crap shoot.

A process.

Sometimes even processing it takes too much effort. 


Next time, a funnier post!


farmwifetwo said...

Med's are litterally "a crap shoot". My eldest is nearly 12, now mild (passing for normal) NLD from mild non-verbal PDD. He's moody, miserable, and discovered the joys of head banging at the age of 18mths. At school he fears the office so he actually behaves. He has a full OT movement program and enough pieces of paper (so the school has to do their stuff at their end) he can cope. When he was 6 to 8.5 he was on Risperdal. Worked well enough we got ahead on the speech/behaviour but then it rebounded. See, they don't tell you to remove the drugs every 18mths to a year for 2 to 4 weeks... no, they just increase them. We had a child psych who told us to pull them.

He currently has lorazapam for emergency use. In the last 5mths that's been one half pill. He has severe claustrophobia, toss in a good dose of anxiety, a traffic jam and.... meltdown. The child psych also told his he is a child for whom it'll "never be his fault" and the "whole world is against me"... sigh... he's right of course.

We're waiting for the school to do their psychometry testing - spring - then requesting a return to the child psych. We don't anticipate he'll manage puberty without a return to meds. The moods are slowly driving me batty and I refuse to be one of those parents when the worst happens to their children and they say "I never noticed".... As long as he can manage we are trying to wait for full puberty due to med reactions and to find a right one, and hopefully not have to keep changing them.

His younger bro is on the severe end of the autism spectrum. We tried Adderall and Risperdal to deal with the sensory - his is a need to move not sounds/lights etc. Neither worked. We've stuck with the melatonin - back to one pill a night from 2 last winter but making certain he gets more exercise - for sleeping. Have no plans to put him on anything now or in the future.

I don't see the point in not medicating for mental issues. Many people won't, but I don't understand that since you will if anything else is hurting your child. But, that's just me.

Amy said...

We are on the verge of meds. My girl is almost 10, with conflicting diagnoses. (The whole diagnostic "process" - blah! - is an interesting ride, isn't it?) Her rages are getting harder to manage, and that therapeutic hold is getting tougher as she gets older. Therapy is helping, but only in a limited way. And so here we are.

My big issue with meds is, really, MY issue. With years of chronic depression and panic attacks behind me, I know the good & the bad that come with meds. I also know how hard it is to find that right combination, and the right dosage. I hesitate to start the whole process with my dd, but I don't know that there's much of a choice.

I wish a whole heap o' luck for us all with this effing crap shoot.

Beth said...

You know where I stand on meds and how long we held out for wee girl and how once we finally got a good mix for the girl how she was FINALLY able to make progress. It's not what I WANTED to do, but she needed it. She's a much happier HER without thinking everyone is laughing at her or having 5 hour attack fits. You've been dealing with this issue for a while, you'll come up with the right solution for you and her, just hang in there.