On the ADHD Radar

Playing catch up here, trying to get to the present point in my adventures.

I was tested for ADHD on June 16th, and Dr. L told me I did indeed have ADHD, Predominantly Inattentive Type, on the first of July.  I was giddy about the news and had to keep myself from jumping up and hugging her!

She referred me to a psychiatrist in Franklin whom I lovingly refer to as Dr. Nyquil.  I had a great session with him and left that visit feeling more optimistic than ever.

First it was Tina at the allergy clinic.  Then Drs. L and Nyquil.  Just having a few medical professionals listen to you and actually hear you is amazing.  Feeling validated.  It's incredible.  Yes, my problems are all in my head, but not the way my primary care physician implies.  I had a wicked sinus infection and a brain chemistry issue. So there!  Neener, neener, neener!

Dr. Nyquil.  He's very professorial, glasses riding low on his nose.  He uses a bean bag desk on his lap behind his massive wooden desk.  He's got your folder on one side, your current list of medications on the other.

He'd tell me this patient vignettes, peering at me over his glasses, speaking low and methodically.  "I had a patient, 37 years of age.  Male.  Did well on medications."  or "I had a patient, 33 years of age.  Female.  Was fine until she had a child.  The stress of dealing with a newborn was more than she could cope with having ADHD.  Responded well to medicine and is thriving."

This is what he told me:  basically smart people with ADHD come up with a lot of coping mechanisms on their own.  They usually end up in a mental health professional's office because some stressful life event has elevated their stress and anxiety to a level where they've simply run out of effecting coping skills.

Aha!

Last year, when I begged the doctor at work for testing, I was dealing with an aggressive puppy that was picking fights with my other dogs.  I was incredibly stressed and couldn't get anything done in life.  Even getting to work was a struggle, until I finally took her back to the breeder and the stressor was eliminated.

This year, I was dealing with the whole weight loss frustration.  Yeah, I had surgery.  Not that you can tell.  What do I do?  Revision?  Suck it up?  Diet? Scream?

Also, I'm really bored at work.  Though I love where I am, it's not challenging in a way that I like, and it doesn't use my skills and talents very well.  I like to work with people!  Now I spend most of my time holed up in my office.  That had been eating at me subconsciously.

The push it over the edge thing was the chick with flip flops.  Well, actually they're high heeled plastic, plexiglass and silver lamé sandals, but her frantic scampering around the office might as well be Ricky Ricardo playing a ham with a couple of ping pong paddles!

I'm really sensitive to sounds (the psych testing confirmed it), and her frenetic scurrying was driving me nuts!  I couldn't block out the annoying sound and she wouldn't sit the hell down!  I spent a lot of time with my office door shut, eye twitching.

And that's how I ended up sitting in Dr. Nyquil's office, on the ADHD radar.

He said that about 85% of his patients respond well to medication, and I was gung ho to try.  Looking closely at my current medications, he decided we'd start with a low dose of Adderall and titrate up until I had a robust, therapeutic response to it.

The next day, when I took that first pill, my life changed forever.

Yikes! Where have I been lately?

I'll try not to make this post horrendously long, but I will preface it by saying a lot has happened since November of last year.

Where to begin?  I got ridiculously frustrated by my aftercare at the hospital where I had my Lap-Band surgery.  I ended up following in the footsteps of several of my other friend-patients and transferred to Centennial Medical Center, which I love.

I had another fill and my new doc is really good!  Even though my port has nearly flipped completely, he was able to get in and out faster than anyone that's ever tried to give me a fill to date.

Since the fill, I've been struggling.  I go from starving to stuck and sliming, which is not the ideal way to live.  What gives?  Why is this band such a beast for me?

Spring was quite fun for me, with travels to Texas and Boston, where I met up with many of my SWL friends.  But after the floods of May 2010, and getting back to reality, I realized I was sick of dealing with my band.  I want a revision to sleeve!

But . . . there's always a big butt.  I mean but.  I told myself that there would be no talk of revision until I made sure that I left no stone unturned when it came to my band.  Yeah, I know I'm having issues--is there anything I can do to fix them?  Give it the old college try and if nothing changes, THEN revision, here we come.

I went to a psychologist led group at Centennial, where I really liked the doc.  I signed up for private counseling sessions with her and within 20 minutes into the first session, she cocked her head and said, "Have you ever been tested for ADHD?"

(Brief pause where I smacked myself in the head and said I went to the psych clinic where I worked and BEGGED to be tested for ADHD, but was ignored and told I probably had some kind of underlying medical condition.  I hate doctors sometimes.)

One meeting with Dr. L and I was getting psych tests scheduled the next week, and two weeks later I was told some important things:

1.  I have Very Superior Intelligence™
2.  I have ADHD, Predominantly Inattentive Type
3.  Did I mention I was really smart?

Okay, I'm just goofing on the inflated ego from my IQ testing!  And the VSI is not really trademarked. It just looks more profound that way!


Long story short, the Lap-Band (or Realize Band) is NOT the ideal surgery choice for ADHD patients.  Who knew???  I found this out the hard way, after 15 months of struggling with essentially no significant weight loss after my surgery.  And a lot of sliming and puking.

Now that I know this and am getting my ADHD treated, things are changing.  And so will the direction of my blog . . . not just about surgical weight loss, but dealing with obesity and the ADHD brain.

Dealing with this has been a pain in the ass, but yet it's also fascinating.  I am more enthusiastic about life and my future now than I have ever been!

More stories to come . . .

Success and Failure

In spite of the awful time I've had dealing with my surgical clinic and the fact that I ate a lot of garbage to spite them (yeah, that's smart on my part!) over the holidays, my health continues to improve overall.

It's been 10 months since my surgery and I still do not have restriction.  I will get stuck if I don't chew well, but other than that, I cannot really tell I'm banded.  The clinic has now determined that since I'm further out from surgery, my fills should be farther apart.  Even though the band is not doing it's job yet.  Yeah.  Protocol says so, therefore it must be true.

So now I sit, frustrated, with two months between appointments, banging my head against the wall at my ravenous hunger.  Yeah, if follow up care for band patients is of this caliber across the board, no wonder why band failure rates are so high.

Despite my lack of success of weight loss at this point, I have turned a corner.  My last few months of feeling like crap is resolving with the treatment of my sinus infection.  I have a little bit of energy.  I've got some great events coming up in the next few months, like my Texas trip with Debra, and Carolyn and Anne's wedding in April, and all the great friends I'll get to meet at both events.  So emotionally, I am energized.

Anyway, my head is feeling better mucosally, and my mental health is feeling better as a result.  The two of those are dragging my body along for the ride and now I actually care about refocusing my fallen efforts at weight loss.

Yesterday, I had a follow up visit with my endocrinologist (ooh, I'm actually getting to the point!).  It went surprisingly well and my test results were a pleasant surprise because I really felt crappy and frustrated in December and was completely non-compliant as a patient.  I just didn't care.  Because I felt so bad, I was incapable of caring.

But the numbers were encouraging and now I am inspired to care.  Two helpful doctor's appointments in a week--this is a record!  HA!  Here are my numbers:

• Old HbA1c 8.0, new 7.2, down 0.8!!!!  
• Old total cholesterol 210, new 201
• Old HDL cholesterol 76, new 102 (happy cholesterol, higher = better)
• Old LDL cholesterol 117, new 76 (lousy cholesterol, lower = better)
• Old triglycerides 84, new 114

I am most pleased about my HbA1c dropping and how my HDL and LDL have changed for the better.  One significant thing is that I don't do fast food any more.  It's just nasty tasting now.  So I attribute that to playing a role in the improvement of my cholesterol.

Now it's time to focus.  Patients generally say that with the band and weight loss, it's 80% you and 20% band.  In my case, it appears to be 99% me and 1% band.  So until I can persuade my clinic to listen to me and have my band do something, it's all on my shoulders.   At least I finally feel human enough to have the desire to start taking care of myself again.

Oh, have I said today how much I adore Tina, the allergy nurse practitioner??? : )

Back to the Land of the Living

The past several months I have felt miserable.  Exhausted.  Unable to think or concentrate.  Couldn't breathe (but thought that was just a result of my chronic allergies).

I have to thank one of the nurses at the allergy clinic for taking care of me and actually believing there was a problem and addressing it.  My shot nurse Lisa suggested I go upstairs and talk to someone when I complained to her about my stuffy nose and ridiculous fatigue.  I had talked to my primary care's office in December (exercise more and maybe we should sign you up for a sleep study!) and my weight loss clinic (we'll do blood work on your iron when the Protocol says we can...that'd be February!), to no avail.

Tina at the allergy clinic is MY HERO!

I sat in the chair next to her last Wednesday morning, mouth breathing defeatedly.  She took one look and said, "Oh!  Something here is not right."

Huh?  You mean I'm not crazy?  What?

After taking a thorough history, she looked up in my snoot and the next thing I know, I'm heading to the CT scanner.  Thank GOD!  Turns out I had a raging sinus infection and that was the beast behind my exhaustion.  Who knew?  I was under the assumption that because my drainage was clear, it wasn't an infection.

But it was.  My maxillary sinuses were so blocked that nothing could get in or out.  Just sealed off festering pockets of goo.  Lovely!  No wonder I felt like crap!

She made a To Do list of aggressive therapy:  steroids, Afrin, antibiotics.  Within hours I was feeling better and after a full night's sleep, I was feeling significantly better.  I started to realize just how crummy I was feeling, once I began to improve.

I just wanted to say thanks to Tina and her expertise. It was so nice having someone who listened to me and helped me.  Unfortunately, half the time my docs just up my antidepressants when I go in with complaints.  It was refreshing to have someone validate that it wasn't in my head (even though technically it was), and that there indeed was a reason that I felt bad and yes, I really did feel bad. Not faking it.

When it feels like so many doctors just push you through assembly style, don't listen and don't even seem to care, it is so exciting to have someone step up to the plate and do what they were trained to do.

Who knows, now I might actually have the energy to exercise!  Dear Diary!

My First ER Visit, EVER!

The ability to swallow my own saliva was a short lived ability.

I got up Sunday feeling okay, but tired and weak and a smidge dizzy. My poor brain was jonesing for some Lexapro. Well, maybe I could take one after some warm beverage. I nearly got stuck taking one Saturday before the trip to the vet's office. So I wasn't looking forward to it.

Because I hadn't had much of anything in days and I was down 10 pounds since Wednesday afternoon's weigh in, I thought I would do hot cocoa again. Yeah. Not a good idea. Two small sips was enough to wake the Slime Monster.

This attack started about 9:15. By 11:30 I was still sliming and it showed no signs of stopping. I was anxious, jittery and worried. Enough was enough. I had to go to the hospital.

Here's a word to the wise: make sure you have an emergency contact number for off-hours for your surgical clinic. I assumed I had one, but I didn't. I emailed my nutritionist, Jessica, and my surgeon, but wasn't sure if they checked work email on the weekends. Lord knows I don't! I tried calling the hospital but got nowhere, there. I asked the guy who answered the phone if I came in, could they page the on call surgeon? "Ma'am, that's hearsay. If you need to come in, come in."

WTF? Hearsay? I asked you a question dude, I didn't tell you a rumor. I just want to know if the ER can get me my doc!

I gave up and decided to go in, spit cup in hand.

The time to go to the ER is 11:45 on Sunday. I was called back in less than a minute and in a room within 5. I curled up on the gurney and the emotional relief of being seen by medical staff helped me calm down and the sliming finally stopped. I slept for a few hours while they were paging the on-call doc, periodically interrupted by ER docs.

I had to laugh--one of them compared me to Goldilocks. This fill's too loose. This fill's too tight! My bandy is not very easy going. Very picky. Not enough, not enough, not enough--OVER THE TOP!

I'd say why me, but hell, why not me? Nothing in life has been smooth sailing, so why should this be an exception? I believe things happen for a reason. Obviously there's some lesson I'm supposed to be learning. I just have to figure it out. And make the most of it. Shit happens, and I'm not immune. I can either whine, or I can learn.

I was giddy to be awoken by Dr. Foster! Have I mentioned yet how much I adore her? She reminds me of the pediatrician Arizona on Grey's Anatomy. Like when Arizona gets in there with her patients and relates to them (last week where she had the kid with the bowel problem go on rounds with her and practice his algebra by calculating meds). So I was excited when she came in and 100% confident she'd take good care of me.

Dr. Sexton helped her out and he was great, too. Whew. I was terrified they were gonna just send me some ER doc who knew nothing about Lap Band ports that would make things worse. But my great team came to the rescue.

Unfortunately, though fortunately for my ER bill, they were not able to get me to a fluoroscopy suite. So they numbed me up with some lidocane and went on the hunt for my port.

I'm the Atypical Bandster for many reasons. One of which is my challenging port. Twisted 20-odd degrees (in spite of being anchored to my abdominal wall on a piece of surgical grade screen door fabric!) and covered in scar tissue. It's not easy to access for an experienced surgeon with visual access (x-ray). But Dr. Foster did a great job of getting in there blindly. It took awhile and involved sit-ups on my part. But she did it.

She pulled off the 1.5 ml she added earlier in the week and I felt immediate relief. They brought me a cup of ice with a dash of water and the first sip went down perfectly. Ahhhh, the best water on earth! I was able to drink 1/4 cup over a few minutes with no adverse effects. That was the most fluid I'd had in awhile! Glorious! Then I had a cup of apple juice! JOY!

While I drank, we chatted and she said she was hoping this wouldn't happen! Me too! But at least it was fixed. And she's amazing. The normal protocol after a problem like this is a complete unfill. But she only took off that 1.5 ml because she knew how frustrating my band has been. It took 7 months and 6 fills to get me just overshot. The first 6 months, NO restriction.

I told her I had a trip coming up to Chicago and a hectic week at work prior to that. So to be on the safe side, she took off another 0.5 ml before removing the needle. So I was up 1.5 ml and now I'm down 2. Which is okay. I can drink fluids again!

Long story short, the bandster existence is not always straightforward. For a vast majority of patients, they have surgery and a few fills and viola! They're at restriction and life is good with the steady pound or so a week weight loss.

Then there are the complicated people like me. It can be very frustrating at times. But I am losing and at least the docs are learning how to deal with challenging ports. And I had a really nice 2 hour nap, too. No barking dogs or anything!

Like I always say, it could be worse. Of course try asking me that after I get the bill. I'm sure I won't be so chipper then!