June 13, 2010

Day 10 on Strattera - Burst of Energy, Got Lots Done. Drank Metamucil.

Today was my 10th day on Strattera - at 10mg daily. It isn't working very much yet on my memory - I keep forgetting what I was supposed to be doing, and kept returning to locations without having done what I'd started off to do... Or maybe it is that I am more and more aware of this habit of mine. To think that I've been doing this most of my life without being aware of it. Holy crap.

But I suppose I need to listen to my own counsel and be patient - and keep with it.

While my wife and little toddler went out today, I got some chores done:
  1. Half-mowed the lawn (lawnmower kept sputtering - I think there is water in the fuel, so I added some methanol to absorb it overnight) - I'll finish it off tomorrow
  2. Cleaned kitchen
  3. Did dishes
  4. Drank orange flavoured Metamucil fiber powder in cold water to keep my ol' system running smoothly - my primary side-effect while taking Strattera is akin to what happens when only one escalator out of three is working at the top of the subway platform and it is rush hour and everyone is trying to go down the same escalator and of course things get rather congested and someone hits the red button at the top of the escalator stopping the device and compacting the pedestrian erstwhile commuters and then you have to telephone the Metamucil man - ifyouknowwhatImeanbecauseifnotreaditagain
  5. Put up veranda tarpaulin in backyard
  6. Dug out compost heap and put some nice aged dark compost on front lawn to fill in an open spot in the grass
  7. Cemented a loose flagstone in the front pathway into place, and chinked in some broken gaps with mortar cement.
  8. Did two loads of laundry, and folded towels and put them away
  9. Took the winter insulating blankets off of the dog's indoor tent which serves as his bed - something I've been thinking to do for ages - he will thank me
  10. Cleaned toilets in the house with scrub brush - awfully satisfying
  11. Put out garbage - not all that satisfying
  12. Edited a host of new photographs for my camping blog and created a draft post - will write text tomorrow
  13. Posted yesterday's entry on this blog (I was too bagged after the hike yesterday to write one) and on my military intelligence news aggregation blog
  14. Organized the baby dishes section of the kitchen
  15. Stuck to my diet
  16. Vacuumed the house with our amazing new hand vacuum cleaner to get rid of obvious dust and bits and pieces
  17. Dug out weeds in the garden, the nasty spiky ones I've been meaning to deal with for months - nasty spiky things
  18. Played my guitar and recorded some of it on my camera, hoping that a blues record label will pick me up and make me a bazillionaire - a pipe dream given my lack of range and paucity of talent
  19. Read some of a book on relationships (ADHD can wreak havoc in marriages)
  20. Cleaned out the gutters in the front of the house
  21. Got a big splinter in my finger and unsuccessfully tried to carve it out with a Swedish carbon-steel hunting knife I use for camping
  22. Put a band-aid on my finger to fix the small hole I made to remove the splinter which is still there
  23. Updated my to-do list in my personal carry-around notebook, bringing past entries forward and making sure I did a brain dump to update it
  24. ...and a few other miscellaneous things that make up a normal Sunday, including feeding the toddler, bathing the little monkey, and lulling him to sleep with some ingenious and highly sophisticated songs about things like tummies and ears and chickens and parks and anything else that came to mind, along with a bottle of milk
Come to think of it, I did a lot of things today. But I still have a lot on my to-do list to get crossed out. I wish I had a day off this week to keep on crossing off items like I did today.

Cheers,

Mungo

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June 12, 2010

Went for a Hike as a bit of Nature Therapy

I went for a hike in woods in a valley behind our house on Saturday afternoon with a buddy. It was fun - we had a fire, and ate some food over our camping stoves. It was a fairly quiet day.

My weekends are not very structured, and I wonder if this is something I might consider to help me manage some of my symptoms. I mean, it is the weekend, so most people would say 'just kick back and relax, maybe get some home chores done whenever', but I'm not sure if that's right for me.

Maybe a schedule of some kind or at least a checklist that would ensure I get the right things done. For example on Sunday, I'd need to iron some shirts for the work days ahead, and prepare lunches etc...

Anyway - hope you're having a good weekend.

Cheers,

Mungo

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Daily Twitter Posting Roundup from @MungosADHD

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Cheers,

Mungo

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June 11, 2010

How To Make Diamonds In Your Lower Digestive Tract - Writing & Reading

I'll keep this nice and short. I have been sitting in the backyard reading and watching birds with my binoculars this evening. The beagle has been wandering about burying, digging up and re-burying a bone. He finally consumed it.

Today I had another round of one-on-one performance evaluation meetings with my staff, and found my focus was exceptional. Then spending time writing up my notes afterward worked out well also. I wasn't all over the place, up and down, left and right. If Strattera is helping now, or if this is what I am to expect to a much greater degree - then I am preparing a big thumb's up for Strattera.

The side effect that is bothering me is my lower digestive system compressing certain by-products of my digestion with such pressure and heat that I think I may be forming diamonds in my colon. While this may benefit me in the long run (diamond prices are high at the moment), it is a bit uncomfortable. Time to up my fiber in my diet. These stool softeners are not doing the job. Sorry. I felt uncomfortable writing that, I can only imagine how uncomfortable you are feeling right now, having read it and trying to shake the imagery I've implanted in your mind.

Have a good night - it is FRIDAY!!!

Cheers,

Mungo

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Commentary & Notes About How Fast Strattera Takes Effect

I thought a comment trail on a recent post was really noteworthy. I am repeating it below because it echoes something I've been thinking about as I have been reporting on my course of treatment with Strattera:
Reader Comment:

"I thought that unlike stimulants, Strattera did not take effect until after a few weeks. Do you have any comment on that from research or what your prescriber has told you?"

Mungo's Reply:

"Yes, that's my understanding that it doesn't [generally] really work for a few weeks. I am noticing something, and I'd likely attribute it to either (or some) of the following:
  1. a cognitive bias i.e. I'm looking for something and seeing it and disregarding other contradicting evidence
  2. there is a small effect at first which will vanish before the normally therapeutic effect takes place once the neurotransmitter and loop equilibrium effects establish themselves
  3. placebo effect which could genuinely be improving my focus and attention in the short term
  4. my ADHD was so bad, that it took only a little of the Strattera in my blood to give it a kick - e.g. your car is out of gas, and all you need is a cup of gas to get to the gas station down the street
  5. aliens manipulated my brain while I slept
I think item #5 is the most unlikely.

I'm thinking it is probably mostly expectation bias (noticing the good stuff, not the bad), and maybe the sense of agency I have [developed] now that I've made steps to get on the meds... that alone could [ameliorate] my anxiety which in turn could improve my attention etc...

It's a tough one, but I should tell all readers [the point which you] are bringing up:

Don't expect significant improvements [on Strattera] for at least 4 to 6 weeks, and know that not all meds work for all patients. Sometimes you have to try out a few - including at various doses - to find something that works for you."
Another comment was an addition to this conversation:
Reader Comment:

"[Mungo:] I think that you might be on to something with the sense of agency you get from just starting treatment improving your concentration. I think that improvement might be from the decrease in the scatterbrainity that comes with anxiety. I know that is part of what's been helping me and that was without changing my medication. You might be on to something there."
If anyone has something else to add to this conversation, feel free to use the 'comment' feature at the bottom of this post.

Cheers,

Mungo

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Daily Twitter Posting Roundup from @MungosADHD

Here is a roundup of my most recent Twitter posts from @MungosADHD.com:
  • Dr. Atila Turgay Dr. Kenny Handelman ow.ly/1WE3I
  • 3 Tips to Better ADHD Shopping | ADDaboy! - HealthyPlace ow.ly/1WN6f
  • ADD'ing it all up: Murphy schmurphy ow.ly/1WN6v
  • What Is It Like to Have ADHD? - HealthyPlace ow.ly/1WNvH
  • So I Married an ADDer: For Partners of People with AD/HD: Where Have All the Flowers Gone? ow.ly/1WRuM
  • Pinball Cognition: Help, I need an adult! Or rather, I did.... ow.ly/1WRvv
  • #ADHD New Blog Post: Day 7 on Strattera - Focused in Meetings and No Side Effects ow.ly/17GYX3
  • Stephanie Sarkis, Ph.D.is the author of 10 Simple Solutions to Adult ADD ow.ly/1X1MK - I highly recommend this book for all ADHDers!

Cheers,

Mungo

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June 10, 2010

Focused in Meetings and No Side Effects from Strattera

Well, nothing especially dramatic today happened.

I had 18 separate meetings today, most of them being brief annual employee evaluation one-on-ones where I asked questions about and discussed my staff's roles and all that sort of stuff. They're pretty tiring, especially when I booked most of them back to back. But I was able to focus on them completely. I'm normally good in one-on-one meetings because I find interacting with individuals really interesting.

But I also had group meetings. While I'm focusing really significantly better than I was a couple of weeks ago, I am more and more noticing my impulsivity trying to burst out with 'funny' comments. I don't think I'm more impulsive than before, but simply much more aware of my tendency. Now, some of my comments are funny.

At one point yesterday I explained to an ebullient and generally inappropriate sexist male director (who was hitting on one of my staff and asking if she likes to drink vodka because she is Russian) that "I have a feeling that the more vodka that you consume, the more attractive I would likely appear to you..." (Now, for full disclosure, in university one year my buddy and I dressed as hookers for the Halloween party and we were very unattractive as women. So basically, it would take a LOT of vodka for anyone to find me attractive, at least one looking for a woman...). Everyone chuckled. He back-pedaled, and I was able to regain control of the meeting. But there is a time and a place for everything. Perhaps that was okay, because it pushed him back, but in some meetings at my company, there are brutal undercurrents of rivalry and pettiness, and I need to stop being sensitive to that and trying to act as stand-up comedian referee, attempting to defuse the tension.

I don't think I can notice any side-effects today related to the Strattera. I think my anxiety has increased slightly because I find myself bruxing my jaw and teeth during the evening. But that too could be due to the change in the benzodiazapene from lorazepam to clonazepam, with its more gentle effect and softer time course of drug action. But I'm not shaking or quivering or trembling or wobbling or having a paroxysm (I'm running out of words here), so I guess the anxiety isn't all that bad.

I got a whole bunch of yard work done this evening. A bunch. A big ol' bunch. As my wife remarked after the fact with a look of awe and confusion in her face, it seemed due to an uncharacteristic 'burst of energy'. I also spent about 2 hours last night (until nearly midnight before I collapsed of exhaustion) cleaning the basement. The dog watched me from his supine position. He was trying to will me to go the hell to bed and shut the hell up. He's a good dog.

Maybe Strattera will make me clean stuff. Not obsessively, but from the already crazily messy state that I leave things in. Now THAT would be cool. Soon they'd be selling Strattera along with Mr. Clean Magic Erasers and those Swiffer floor cleaners:

"Take a tablet one hour before using our cleaning products and you'll be cleaning like you have never cleaned before."
I worked in advertising for a few months. You'll now understand why it was only a few months.

Anyway, enough of this. I have some Tweeting to do with my @mungosadhd account.

Plus I have some updates needed for my Mungo's Military blog which I opened recently (hyperactive enough for yah?!)...

Cheers,

Mungo

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Daily Twitter Posting Roundup from @MungosADHD

Here is a roundup of my most recent Twitter posts from @MungosADHD.com:
  • #ADHD New Blog Post: Daily Twitter Posting Roundup from @MungosADHD ow.ly/17FNuq
  • RT @drkenny: New blog post #ADHD: Generic Concerta in the US www.addadhdblog.com/generic-concerta-in-the-us/
  • RT @SplinteredMind: ADHD Meltdown: Ever get so busy that you forget a deadline or errand? How do you f... bit.ly/a1NKJN
  • RT @frankcoppola514: #adhd New Book About Adult ADHD: So a lot of you know that my husband has ADHD bit.ly/aMMeRF
  • New Book About Adult ADHD « My Crazy Story…In A [Perfect] Nutshell ow.ly/1W6ur
  • Positive effects of repetitive transcranial magnet... [World J Biol Psychiatry. 2010] - PubMed result ow.ly/1W6Uo
  • Attention deficit hyperactivity disorder in adult s. [World J Biol Psychiatry. 2010] - PubMed result ow.ly/1W6UH
  • ADD'ing it all up: It suits me. ow.ly/1W6Vx
  • Experiencing ADDvantages: What To Do When Hyperfocus Works Against You ow.ly/1W6VT
  • What you may be doing that keeps you from making friends ow.ly/1W6WF
  • 18 Channels - my ADHD colored life...: This was supposed to be an improvement... ow.ly/1W6WX
  • My ADHD Meltdown | ADDaboy! - HealthyPlace ow.ly/1W6YA
  • Generic Concerta in the US Dr. Kenny Handelman ow.ly/1W6YW
  • ADD'ing it all up: Seeing through the pain ow.ly/1WdVh
  • 18 Channels - my ADHD colored life...: Assault on my senses.... ow.ly/1Wwf5
  • #ADHD New Bl og Post: Day 6 on Strattera - Focus in Group Meetings, Noticing Those Who are Not the Sharpest Pencil in... ow.ly/17Gthp

Cheers,

Mungo

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June 9, 2010

Focus in Group Meetings, Noticing Those Who are Not the Sharpest Pencil in the Box and Road Non-Rage

Day 6 zoomed by today. I had lots of meetings and lots to do. I noticed I had nearly continuous focus during group meetings, and during one-on-one meetings. I just hope that isn't a blip or caused by something else, like cosmic rays, the position of the stars, my astrology sign, homeopathy, or other such scientifically-validated theories.

My desk remains cluttered at work, but differently cluttered than yesterday as I pulled out all sorts of stacks of paper from storage cabinets to go through them thusly:
  • recycle bin (60% of sheets)
  • garbage bin (20 % of sheets)
  • filed away to be recycled or disposed of later when I'm feeling braver (10%)
  • filed away to be referred to later (9%)
  • folded and placed in my pocket for later perusal (1%)
I was feeling irritated today. I felt like about 50% of the people with whom I work would benefit from a brain enlargement or at least a reverse-lobotomy, if there is such a thing...

I found myself shaking my head over and over again when I saw the responses people made to me and others. One way I coped with a particularly irritatingly blunt object that I met with for a while was to draw a small mark on my notepad everytime I noticed them being utterly unimaginative, intellectually dull and incurious. That is, denser than lead. At the end of my meeting, my page had 12 thin marks blended in with my notes. I think that is a healthy way to cope with stupidity, rather than zoning out and wishing I were among people who weren't big believers in folk psychology, and who weren't incredibly internally inconsistent in their attitudes, beliefs, opinions and responses to questions. Or zoning out and thinking about camping instead, while nodding enthusiastically at their expressions.

But I got through that. John Le Carre once wrote about a protagonist who used a mental trick to insulate him from an interrogator's intimidating questions - he simply imagined the interrogator wearing diapers and with a soother in his mouth. This gave the protagonist some mental distance to allow him to avoid becoming overwhelmed or confused during the interrogation. For me, I instead noted - or 'flagged' - instances of the person being stupid (I have high expectations for folks I work with - we do some very high level stuff sometimes) and recorded these occasions dispassionately.

I also noticed that driving to work this morning, while I was tempted to honk at road-idiots, I declined calmly and got back to my task at hand - guiding the vehicle in the general direction of work. This is interesting - as though I am getting control over some of my impulsive behaviours.

Anyway, it is almost midnight and the little boy wakes up at 5ish. So I must sleep and/or pull an all night write-a-thon. I'd prefer the former option.

Sleep well, my readers.

Cheers,

Mungo

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Daily Twitter Posting Roundup from @MungosADHD

Here is a roundup of my most recent Twitter posts from @MungosADHD.com:
  • #ADHD New Blog Post: Daily Twitter Posting Roundup from @MungosADHD ow.ly/17EVBP
  • 5 Gifts of Being Highly Sensitive | World of Psychology ow.ly/1VAic
  • Your Brain on Computers - Attached to Technology and Paying a Price - NYTimes.com ow.ly/1VXIp
  • #ADHD New Blog Post: Day 5 on Strattera - Focus and Continuity in Group Meetings ow.ly/17FBJ2

Cheers,

Mungo

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June 8, 2010

Focus and Continuity in Group Meetings

This post will be brief - it has been a long day and I am good 'n tired.

No negative side-effects noticed. I had 3 one-hour-long group meetings scheduled today where I needed to pay careful attention to each and every participants' discussions and presentations. And in each of them, I was able to maintain my concentration for the whole hour. I caught myself looking out the window at one point, but noticing it sort of happened at the same time that I did it.

I find this to be promising. I found myself working the whole day at work - not spending too much time fiddling about or wandering about.

I think the Strattera is beginning to take effect. We'll see though - it is very early still, and I would like to see consistency around any possible positive effects, and certainly a much more powerful or shall we say deeper effect. I'm still skating on the surface of what I think I can do with this medication.

My desk started getting messy at work, but I realized it wasn't because I'm slipping back into crazy multi-tasking and disorganization - but that all the papers and folders on my desk were there because I was actively tackling my work. My to do list is still long, but I'm getting there!

Cheers,

Mungo

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Daily Twitter Posting Roundup from @MungosADHD

Here is a roundup of my most recent Twitter posts from @MungosADHD.com:
  • #ADHD New Blog Post: Daily Twitter Posting Roundup from @MungosADHD ow.ly/17E2MR
  • RT @PeterBrownPsy: (6/2010) Thich Nhat Hanh: A Leader In Mindfulness bit.ly/ahuRDL #mindfulness
  • ADD'ing it all up: The Bane of Chaos ow.ly/1V5VC
  • ADHD Medication: $4.2 Billion? Dr. Kenny Handelman ow.ly/1V5Xs
  • #ADHD New Blog Post: Day 4 on Strattera - Subtle Signs of Memory Improvement ow.ly/17EJiF

Cheers,

Mungo

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June 7, 2010

Subtle Signs of Memory Improvement in my Adult ADHD

I'll start this post off with pure excitement! I seem to be managing my constipation with stool softener (Docusate Sodium tablets) and so no return of the signs of the Venusian Tapeworms.

Phew. You can open your eyes now. It's okay. Sit down, have a sip of your milk and relax. Read on:

I think one of the more salient effects of ADHD for me I've noticed over the past couple of months (since I've been paying very close attention and reading a lot about ADHD) or so is feeling like I'm struggling on a journey from day to day, from hour to hour - bewilderingly wandering around a darkened building, moving from room to room, not quite sure where one ends, and where the next one begins. It's like I'm going on blind faith. No preparation, no carrying my calendar with me, no arriving early to make sure I'm ready to go. How can I if I can't even figure out the next location? It is like getting caught in a riptide, just struggling to swim, to get somewhere, anywhere. And constantly frustrated at myself for not preparing, for not getting anywhere, for repeating the same gosh-darned mistakes over and over again. Frustrating myself, and frustrating others - my closest friend, my wife. My friends, my family. It's like one of those anxiety dreams where you end up somewhere where you are supposed to be, but either late or way too early, and without the necessary items or without having prepared or studied for that exam etc...

You might notice the flowing nature of my previous paragraph. That's because this stuff is so familiar to me. I own it, it owns me - it is an easy habit. It reminds me of the etymological source of the word 'habit' - i.e. a habit was clothing monks wore, a piece of clothing they inhabited. A condition, demeanor, appearance, or dress.

Colleagues and friends could look at me and say 'Uhm, you seem confident, you seem certain, you seem experienced and okay' and wonder what all this struggling stuff is about. But - you see - I've learned over the decades to be very camouflaged. My impulsiveness was draped in a clever (or bizarre) sense of humour. My forgetfulness was managed with excuses and frantic catch-ups, and the not-so-occasional Hail Mary pass. My lack of preparation was mitigated by years of learning how to read subtle cues in language and body language so I could bullshit my way through stuff. Unfortunately, bullshitting myself through stuff is the perfect way to erode my self-esteem, my pride, of diminishing the possibilities of developing a sense that I am getting through stuff using honest, healthy, and ethical methods and means.

Today, and over the last couple of days, I found it it easier to decide to hold my tongue and avoid making a crack during a tense meeting to reduce the pressure on a colleague, to distract the attacker, or to fill an uncomfortable moment with humour or to interrupt someone with an impulsive non-sequitur. I'm finding myself more frequently saying 'alright, let's move on' to myself and breaking out of perseverative hyper-focusing.

Today I was imbued with a subtle sense of confidence and optimism. At work I am generally quite busy. Mondays are especially so, I find. I'm going from meeting to meeting, I have one on one meetings with staff members, and work on my own projects and deliverables. I observe my staff with the eyes and ears of a psychologist, and approach work as though I am in university learning new things and also enjoying sharing my knowledge and skills and working with colleagues towards the goal of education and learning about their skills and knowledge. Sharing. I enjoy my job.

But when I'm overwhelmed with all of that toxic stuff, it is hard to enjoy my job, and to be an effective listener, collaborator, educator, sharer.

Well, I don't know if it is the Strattera (in only 4 short days - not all that likely), but I feel like the light has come on in the darkened building a bit for me. I made my way through the day without anxiously consulting my calendar and to-do list and making notes with wide, worried eyes lest I forget things. I still caught myself a few times going places and having forgotten something, but I'm seeing those occasions as being more accidental or explainable due to factors other than working memory deficits.

It's like I just know what to do next. It's the weirdest thing to describe, such a subtle and odd sensation. Not quite confidence, and not quite certainty, but almost like that sense of freedom a kid gets when their bicycle's safety wheel is removed, and they find themselves riding about in zig-zags without falling or faltering.

So - a good day all in all. I know good days come with bad days, and I'll always have to work at this. I'm not being a Pollyanna, or succumbing to the Valence Effect - but I'm okay to feel good and confident today, knowing that tomorrow may bring something different.

Hope y'all had a good day, and are enjoying your evening. My wife is sleeping, recovering from a bad cold and a throat that she says feels like she's swallowed razor-blades (ouch). My little boy is fast asleep hugging his little teddy bear and looking cuter than anything in the whole universe. My dog is snoring gently in his doggie tent a few feet away. And it is time soon for me to go to sleep.

Cheers,

Mungo

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Daily Twitter Posting Roundup from @MungosADHD

Here is a roundup of my most recent Twitter posts from @MungosADHD.com:
  • #ADHD New Blog Post: Day 2 on Strattera - Very Minor Side Effects ow.ly/17DCFo
  • #ADHD New Blog Post: Day 3 on Strattera - Minor Acid Reflux & Expectation Bias ow.ly/17DNhW
  • Melatonin for Sleep: Dr. Kenny Handelman - ow.ly/1UOQz
  • How 'The Hidden Brain' Does The Thinking For Us : NPR ow.ly/1UPfa

Cheers,

Mungo

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June 6, 2010

Minor Acid Reflux & Expectation Bias Now That I'm on Strattera

Today I experienced an brief instance of acid reflux. Nothing I would normally note, except I used to suffer from it, and haven't for a couple of years. So - maybe it was because we had folks over yesterday and I ate foods which didn't agree with me, or maybe it was due to the Strattera.

I have not noticed any significant positive effects of the medication. I say 'I have not' because my expectation is that I won't actually notice anything for at least a week or two or three or four. But there have been several moments today when I've felt clear and my sense of continuity in time (i.e. related to working memory) seems to be more acute, and I find myself remembering things that normally I'm quite sure I'd have forgotten, but I think I will ascribe that to the cognitive bias known as expectation (or Experimenter's) bias.

But those brief moments were counterbalanced by a long period of time this morning where I perseverated and hyperfocused on reading news and couldn't for the life of me get away from my computer.

Had my 10 mg dose at 7:10 PM. To remember, I have an alarm set on my BlackBerry that beeps over and over and over and over again until I am tempted to shred the loathsome beeping device. To wit:



I also have set a calendar event in Google Calendar to send me an alert by e-mail.

Anyway, that's Day 3. No hair loss, no suddenly finding myself in Wisconsin, wondering who I am, and no bed wetting. So far, so good.

Cheers,

Mungo

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June 5, 2010

Very Minor Side Effects of Strattera for Adult ADHD

I woke up in the middle of the night with my bed side light still on, so maybe the Strattera made me fall asleep the moment my head hit the pillow, before the 2 second interval that I normally wait before turning off the light. Or maybe I'd just had a long day.

Today I didn't experience any urinary retention (as in difficulty in 'watering the geraniums' as noted yesterday).

I did experience a slightly shocking moment when I saw blood in my stool (yes, I just wrote that, and you just read that). But I suspect this is simply due to the constipation that Strattera can induce as a side-effect (hey, if you didn't want to read that, then you could have stopped after the previous sentence...). But that was only once, and after a brief flurry of reading medical sites, I've determined it is not something scary like Venusian Tapeworm infestation or something worse. Just a little internal distress.

Now, somewhere between side-effects and positive effects are the 'I wonder where that came from?' effects - for example, my subtle ability to levitate small objects from a distance for example. But that just might be something I've always had, but never noticed before.

I took my 10 mg dose at 7:30 PM. I'm trying to figure out a good time to take it - this is right after the toddler goes to bed. Seems a convenient time.

Anyway - more tomorrow. So far I'm feeling fine, overall.

Cheers,

Mungo

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June 4, 2010

Day 1 on Strattera for Adult ADHD & Why I Have Decided To Change my Family Physician

Yesterday afternoon I went to my family doctor who works about an hour or so away from where I live - in my old hometown. I left a little early in order to make it on time, and dropped by my folks' house to say hello first.

Off I went shortly afterward to my appointment, and after waiting for 30 minutes, he walked into the little room where I was sitting with my notebook and pen.

He asked me how I was doing, and took a seat. I told him that I was feeling pretty good. I had been taking the Clonazepam (an anxiolytic in the same class as Valium and Ativan) instead of the Ativan, and that it was far milder, and that I preferred the longer, gentler effects. I told him that I was planning on seeing a psychologist for counseling and that I was glad to be there to find out the results of the tests I took a couple of weeks back (blood tests and ECG).

He looked a bit flustered, and then slowly went through the blood tests and ECG. He went over each item of the blood tests (and on a few I had to ask him 'so what does that mean?')... the bottom line is that my blood tests seemed to impress him considerably. It was as though I had given him a nice watch for his birthday. He kept grinning and saying how good the results were. My blood pressure was 120/70, better than my last one of 120/80.

He seemed so excited to have a healthy person in his office, I guess. I said that I figured losing over 30 pounds might be contributing to my good results. He didn't say anything, but just closed the folder.

He then said that he would then give me a longer prescription for the Clonazapam as it seems to be working for my anxiety, and 5 minutes after he arrived, he got up to leave.

I fretted my brow and reached down for my notebook and asked him "Uhm, so I imagine you will be giving me a prescription for Strattera as per the recommendations of the assessment and evaluation report - the reason I'm here today - right?"

He frowned and absentmindedly flipped through the folder again. He stopped on a page and squinted at it. Then he asked me in a sort of quiet, doubting sort of way, "So you want a prescription for it?"

At that point my inner voice replied "Yes, you genius. That's why I spent nearly a grand on the evaluation, and spent the last fucking three months going to appointments, and ultimately received an authoritative and bona fide psychiatric diagnosis of ADHD Combined Type after attending long sessions with two eminent and very experienced psychiatrists, one who died right after I initially met with him, and with a clinical psychologist and a psychometrist - each of whom specialize in both child and adult attention deficit hyperactivity disorder. And your obvious due diligence as reflected in your unusually thorough understanding and expression of understanding of the report you hold in your hands only serves to strengthen my opinion that you are only being facetious and that indeed you are completely in control and are exceedingly competent and commanding control of this session with your patient whom you have known for nearly 30 years. No actually I'm just kidding. I'm here because I am fond of the smell of this doctor's office. And I especially like the decor. It was nice to see you, I'll now go on my way and not bother you anymore."

Shortly after my inner voice settled down, I took a deep breath and I actually (in real life) responded, using my managerial tone that I use at work to get stuff done.

I locked my eyes on his and said that my understanding was that the assessment he was holding recommends that I am to be put on Strattera, at an initial dose of 10 mg, once daily, and that I was to be titrated up while he monitored me periodically for side-effects, and until I reached an effective dosage. I said that it was indeed my expectation that this is why I had attended the appointment today, so as to review the test results that he had ordered I take, with the express purpose of ensuring I was healthy enough to be put on Atomoxetine (Strattera). And that Strattera was the recommendation contained within the consultation notes, because my comorbid anxiety precluded or at least weighed against my taking any of the stimulant medications for ADHD. I said that my understanding was that The Canadian Attention Deficit Hyperactivity Disorder Resource Alliance also specifically recommends this regime, and that I might potentially eventually end up - once titration ends - on 40, 60 or more milligrams daily, depending on my ability to tolerate the medication, but more importantly depending on when it began to effectively help me manage my ADHD symptoms. And that I expected that I would be meeting with him periodically until the dosage is working.

He looked puzzled and shuffled the papers around a bit, and then wrote out a prescription for both the Clonazepam and the Strattera and told me that I should come back in two weeks and that we would continue from there.

I thanked him for his time, and wished him a good weekend.

On my drive home I decided that once I have gotten through the titration and initial monitoring, that I will change my family doctor of 30 years to someone more local - in Toronto. I'm done. I used to put up with his chit-chat because I believed that he might be using it as a therapeutic mechanism to monitor my behaviour and interactions. Now I think he just likes to talk about himself. I've always been forgiving of his apparent passiveness, assuming his experience was somehow reflected in his few words, and defended his behaviour with family members who also used his services.

It isn't often that I get pissed off like that but boy oh boy.

So - next steps:

I took my capsule last night before bed. There were no general overall bodily side effects. Certainly I won't see any improvement (if this works) for a few weeks. But this morning a strange thing happened as I was getting ready for work having my morning - well - 'tinkle'.

I will use an analogy so that you will not blush and so that I will not blush. Imagine that you were watering the garden - perhaps the geraniums - with a rubbber water hose. And instead of simply turning the water off at the spigot once you were done, you instead - just prior to when you were ready to finish - suddenly squeezed the hose at the base. And now imagine that the hose itself for some odd reason has sensory nerves that can register pain due to unintended premature constriction before the water had fully run out.

Well, that happened. And not in the analogous world. In the bathroom. Nothing to worry too much about, but it was a weird experience. It has happened a couple of times this morning at work too, as I decided to 'water the geraniums'.

I am going to blog daily (if I can) about my observations. I will try not to dwell on the rubber hose analogy. Really. I will try to observe my behaviours, and will endeavor to be quite dispassionate and scientific about my observations.

Cheers,

Mungo

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June 1, 2010

Oigles, Oiks, Harumph, and Pthhtptphtphtpth

The last week or so has been difficult. At various times I have uttered (under my breath) expletives like oigles, oiks, harumph, and pthhtptphtphtpth. I have also used much stronger language, but I will keep this a family friendly blog and leave it to your imagination.

Work has been especially taxing - we are in the midst of a high visibility technical audit from one of the big audit firms, and I am playing a key role in wrangling up the information that the auditor needs. On top of that several team members have been having rather difficult weeks amongst one another, and on their own. I have been needing to keep on top of this set of situations, plus my own regular work - managing the group and managing my own set of overwhelmesque-flavoured projects.

Correspondingly, my inattentive symptoms have decided to show some attention to me and shake me about like a rag doll. My living space in my office at home is slowly becoming cluttered - like a swamp infested with kudzu vine on radioactive fertilizer. You may remember a scene in one of the Aliens movie where humans have been incorporated into a larger organism and they are moaning and enveloped by some great special-effects slime against a strange wall of warped body parts. I fear this may happen to me if I don't declutter quickly and diligently.

I am trying hard to take into account the mindfulness exercises in "The Mindful Way through Depression - Freeing Yourself from Chronic Unhappiness". Now, I'm not depressed, but the psychiatrist who gave me my diagnosis suggested I look into mindfulness exercises as a way to developing effective coping skills for ADHD.


(Preview this book).

The bottom line is that I feel in the grips of strong perseverative paralysis. At home in the evenings I just stay on the web reading news feeds, drinking no-caffeine, no-sugar Coke, and feel like a zombie. I am an absolute pleasure to be around.

In the background of this is my doctor's appointment scheduled for this Thursday afternoon - where I expect I will finally get a prescription for Strattera. I have had some terrific e-mail feedback (which I'll respond personally to - as soon as I get around to it...) about my previous posts about Strattera. While I didn't question the psychiatrist in great detail about why he prescribed Strattera, I did ask a fair bit about the medication and how it would work for me. Because of my comorbid anxiety (which sounds so wonderfully dark), and because of a close family member diagnosed with a tic disorder, and for a few other reasons, the doctor decided on Strattera. It generally takes 4 to 6 weeks for full effects to kick in (much like the SSRIs have done for me in the past). If there is something ADHD has taught me, paradoxically, it is to be patient. And I can wait for a couple of months, as long as I know I'm doing something to help.

I'm not too worried about side effects that sound like those of SSRIs. Been there, experienced that, expecting that, can cope with that. I figure it is part of the deal.

As I've read (in one of my books), it is possible that the longer time of action the NRIs take versus the stimulants is related to the homeostatis feedback loops of normal neurotransmitter communications between the limbic and the cortical system - the prefrontal cortex where the executive functions mostly reside are re-adjusted, or brought back into harmony by using a Norepinephrine Reuptake Inhibitor (NRI) - and that this simply takes some time:
"A norepinephrine reuptake inhibitor (NRI, NERI) or adrenergic reuptake inhibitor (ARI), is a type of drug which acts as a reuptake inhibitor for the neurotransmitters norepinephrine (noradrenaline) and epinephrine (adrenaline) by blocking the action of the norepinephrine transporter (NET). This in turn leads to increased extracellular concentrations of norepinephrine and epinephrine and therefore an increase in adrenergic neurotransmission."
Dr. Kenny Handelman has a page about Strattera where he explains in simple language how Strattera works:

"Strattera selectively blocks the reuptake of norepinephrine (or noradrenaline) in the brain. This, in and of itself, can increase the ability to pay attention and improve hyperactivity. The interesting thing is that Strattera gradually has a downstream effect on the dopamine in the brain, specifically in the frontal lobe. Now, I am throwing around a lot of medical terms very quickly here. Allow me to explain:

The frontal lobe is the ‘command center’ of the brain. This is the area that new brain imaging studies show is most affected in individuals with ADHD. This command center allows people to use their ‘executive functions’, which are the thinking skills which allow for: sustained concentration, impulse control, delayed gratification, etc.

Norepinephrine and Dopamine are called ‘neurotransmitters’. These are little brain chemicals which jump from one nerve cell to the next in the brain to carry a message through the brain.

In individuals with ADHD, research shows that they have ‘under-activity’ of the dopamine and norepinephrine in the frontal lobes.

ADHD medication generally increases the activity of the brain chemicals dopamine and norepinephrine in the frontal lobe, and in so doing, they increase the attention, and decrease hyperactivity and impulsivity (i.e. they increase these ‘executive functions’)."

The publication Canadian ADHD Practice Guidelines from CADDRA contains policies & approaches to treating ADHD. It seems to support Strattera in my case. In fact, my psychiatrist was (before his untimely passing) the chair of this group:

"The Canadian Attention Deficit Hyperactivity Disorder Resource Alliance (CADDRA) is a national independent not-for-profit association whose members are drawn from Family Practice, Pediatrics, Psychiatry and Child Psychiatry. We support individuals with Attention Deficit Hyperactivity Disorder (ADHD) and their families.

The Canadian ADHD Practice Guidelines (CAP-G) were constructed to help Canadian physicians diagnose and treat ADHD. The CAP-G Committee is part of CADDRA and is composed of experts selected to represent different specialties from across Canada based on their contributions to treatment, education and research in the area of ADHD.

These guidelines are unique in that they:

a) have been produced by a multidisciplinary team
b) are specific to Canadian practice
c) include the entire lifespan of this disorder
d) speak to diagnosis and treatment in real life conditions of practice where resources are limited (Section 1)
e) recognize that ADHD is a disorder which will require treatment using a shared care model between specialists and primary care practitioners. For this reason the guidelines stipulate both what can be handled in primary care as well as guidelines for referral to specialists."

Well, I think I've been rambling a little - so I'll boil it down:
  1. Tough week - feeling especially paralyzed and unfocused and unable to take the initiative, despite a few wins (mowing the lawns at home, being quite productive in short spurts at work around this audit process).

  2. Reading about and using Mindfulness exercises to help me move away from ruminative and perseverative thinking and behaviours. This seems to help.

  3. Finally going to the medical appointment where I expect I will get a prescription for Strattera. It seems to have been a long time and I am anxious to get started on it. I want to see focus and attention and motivation return.
Hope you all have a good week, I'll fill in more details once I get through Thursday's appointment!

Cheers,

Mungo

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May 27, 2010

Hiking & Photography - One of my Antidotes to Adult ADHD Stimulus Junky Conduct

In a slight departure from posts exclusively about Adult Attention Deficit Hyperactivity Disorder, I thought I would write a little bit about what I believe calms my mind and restores order to help me cope with my ADHD symptoms. I am currently reading an AMAZING book entitled "You Mean I'm Not Lazy, Stupid, or Crazy?". Now I've read the series of books by Dr. Hallowell, and they are very good. I've read a few others that all have their own emphasis - but this book is wonderful. It speaks specifically to how symptoms manifest themselves in our lives, provides some theoretical structure as to how the disorder's many facets contribute/cause these symptoms, and finally discusses in wonderful, clear language how to cope with them.

I can't say enough good things about the book, and I highly recommend you go out to your local bookstore and buy a copy now. You can leave your coffee where it is, you can microwave it later or just make a fresh cup later. It's only coffee. You can also buy it online here, or visit my bookstore at AdultADHDBooks.com to purchase it online.

That said, they have a chapter devoted to meditation and body focus relaxation methods. Sounds a little hippie, I suppose. But keep in mind that ADHDers are 'stimulus junkies' and engage in high-stimulus activities just to keep that ol' epinephrine flowing through our executive-function fulfilling frontal lobes. That's all very well and good, but the downside to that is that the brain has a series of looped connections which ensure homeostasis - i.e. balance. And if one part of the brain is full-on stimulated, then the looped in portions join in. And our limbic system, the seat of our primitive motivations, like sex, hunger, anger, fight or flight, etc... are connected and affected in ADHDers.

Our limbic system when turned on high causes stress hormones to be released, resulting in sympathetic nervous system stimulation. Our immune system (macrophages, white blood cells, and all the T-cells and bits and pieces that comprise our bodily defense system against both external threats like infection, and internal threats like heart disease, abnormal cell growth, gastrointestinal disorders, auto-immune problems like lupus, some arthritis, and perhaps chronic fatigue syndrome) becomes suppressed. We get sick. We get worn out. And the the vicious spiral continues until we fall over with a loud thunk, or find a way to relax.

Anyway, I work in an IT department, and often have some very high pressures affecting me - emergency system outages, and not to mention nearly a couple of dozen people reporting to me who all have their own personalities. I need to be part project manager, crisis manager, counselor, application and system manager, and this can be kinda tiring.

One of my ways to calm myself down is to get into nature. And so last Sunday I went for a hike.

I went for a nice hike up at Whitchurch Conservation Area north of Toronto, just off of the 404 highway near Stouffville on the weekend.


View Larger Map
Above is a map - if you can't see it, you may need to install a Google Earth plugin, or simply use the normal view of Google Maps.



I brought along my military surplus knapsack that I picked up at a thrift shop for a few dollars. It is made of canvas and is a terrific piece of kit - big enough for a day trip, with lots of connection points on the outside for attaching extra gear.


I reached a grassy verge at the edge of a pond, and laid out my wool blanket, my stove, and cooking kit, pulled out my book and sat for a while relaxing and reading.


I brought my Trangia kit - a great compact size, everything fits into the pot. I brought my Mora 510 carbon steel blade knife, and a stainless steel camping cup for eating lunch. It was still early, so I read and watched the birds, and listened to the sounds of nature for a while.


At one end of the pond, last year's growth of cattails are fluffing up and breaking down amongst this year's growth. Had I been especially hungry, I would have pulled up the roots and made a little stew or roasted them over a flame. I wasn't especially hungry.


The grass was full of edible and medicinal plants. Narrow leafed plantain above.


Broad leafed plantain or common plantain. You can cook up the leaves like spinach - and roast the roots for flour.


I was on a grassy spot but most of the area is thick woods, a mix of deciduous and coniferous woods.


The other end of the pond was narrower, and at one point a Great Blue Heron flew in. It got spooked and flew away the second it saw me bumbling with my camera (shaky and blurry shots below).


Fat bumbling tadpoles soaked in the sun in the shallows.


They might make good bait if I were in a fishing mood.


I had the place to myself. Wonderful. And on a Victoria Day long weekend (a Canadian holiday) where traditionally most folks go to cottages or go camping or to wilderness areas to escape the city and to locate the beers.


I'm not sure what this little yellow flower is - anyone?


Ahhh.... Wild Strawberries! The paths through the woods were littered with them. As I crawled along the ground looking for plants (a sight to see), I noticed beneath the strawberry leaves there were little strawberries. I ate a few and they were tart and delicious. Each of them, a tenth of the size of a domesticated strawberry had as much flavour as the latter and a much fresher taste too.


I ate a small handful worth of them.


After nibbling on strawberries, yellow wood sorrel, plantain, and other bits and pieces I found about, I read for a while longer.


Then I figured it was time for curried chicken with rice. I opened my can of curried chicken with my knife, and plopped in some rice. Nothing tastes so good when you are hungry and when you are outdoors in nature.


A rude honking squawking sound emerged from the sky, and I had to scramble to turn on my camera and try to capture pictures of a Great Blue Heron (Ardea herodias). It looked like a gigantic pterodactyl.


It landed but despite my stealthy stumbling, it saw me and flew off as quickly as it could.


Next time I will wear a Ghillie suit and hide in a tree for the day, waiting for the bird to land again.


The bigger and the more unusual the bird, the ruder the sounds they make. That's my theory. The loud, coarse rattle of this irritating bird was a Belted Kingfisher (Ceryle alcyon). Well, it was nice for a while, then it got irritating.


After a few hours, I decided to be on my way. I packed up, ensured the place was cleaner than when I first got there, and started through the woods on the path back to where I had parked my car near the road. As I walked slowly, looking carefully at the various plants scattered along the pathway, I recognized ferns, and wood sorrel, and a couple of Jack in the Pulpits.


And then suddenly, as though I had recognized an old friend, I saw a mushroom standing amongst the leaf litter. I knew instantly that it was a Morel, although I've never seen one in real life before. It is such a recognizable mushroom, much like a giant puffball is unmistakable.


These were highly prized, rare, and exceedingly edible Morchella esculenta. I picked the two that I was able to find, for a dinner treat later that evening.


This is an Ink Cap - I believe. There is a self-digesting enzyme within the cap, that upon maturity emerges to cause deliquescence... Deliquescing is what happens when the cap liquifies, through autolytic action. It is named an Ink Cap, because the black fluid that the cap breaks down into was once used as a writing ink.


Here is a bunch of immature Ink Caps still in their button or egg form. They are edible (always cook mushrooms before eating them), but if you drink alcohol within 72 hours, you will suffer from mild gastric distress, due to an interaction of the metabolites of alcohol and the Ink Cap.


I've always been drawn to the soft, velvety leaves of the first-year growth of Mullein. My mum told me they were known as fairy blankets when she was a child in Ireland. If you pick one up, you'll understand why.


Baby blue coloured Forget Me Nots were scattered at the wood's edge.


They look so nice. By the time I was in the car, carrying two Morel mushrooms in my jacket pocket, lots of pictures in my camera, rice, curry and chicken in my tummy, I was rested and relaxed. I had read a terrific book and was feeling really positive.

There is nothing like nature to restore and to calm the ADHD mind.

Cheers,

Mungo

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May 20, 2010

Goal: Remember So As To Do

The last couple of weeks have been tough, but easier than the hundreds of weeks that went before in my life. I am amazed at how I am becoming aware of how impaired my working memory is. I forget shit all the time. I don't just forget stuff, but I forget shit.

All. The. Time.

Everyone gets distracted. Everyone's attention is diverted by compelling stimuli. If we weren't distracted, we would risk being hit by a car, or be seen as socially inept when someone tried to get our attention, etc.. etc...

And it is our working memory, the theoretical construct within cognitive psychology that refers to the structures and processes used for temporarily storing and manipulating information that allows us to recall that which we were initially doing, and return to it. What differentiates ADHDers and non-ADHDers is the poor quality or deficit of working memory. After a distraction has redirected their attention, ADHDers do NOT return to task, whereas non-ADHDers do return to task - e.g. the document they were writing, or the clothes they were folding, or the food they were cooking.

For example, I go downstairs with the express intent to get a pair of pliers from the tool chest. I notice some batteries on my desk. I remember that my Motorola camping walkie-talkies need new batteries. I insert them and feel good. Then I see a book on camping near where I had stored the walkie-talkies and pick it up, because I intend to read it later on. I come upstairs again with the book, excited at the thought of sitting down later outside in the sunshine and reading through it. But then I recognize a lingering suspicion within me that I've forgotten something. It takes me a minute or so to mentally retrace my steps, and actually talk to myself quietly to figure out what I'm missing: the pliers.

My wife asked me the other day to pop downstairs to grab a print-out from the printer we've networked across the house. She prints a document upstairs and the print-out appears downstairs. I went downstairs. On my way to the printer, I changed my socks quickly, as I had a hole in one of them. I then noticed my garbage can needed emptying so I quickly emptied it into a garbage bag. Then I went to the washroom. Then I thought it would be a good time to trim my goatee with my new fancy trimmer. Then I saw a T-shirt that I wanted to wear. So I returned upstairs with my nice T-shirt, feeling good, and got back to making the tea I'd started on when she'd initially asked me for the print-out.

Now that she is realizing (I believe) that my ADHD plays havoc with my working memory, she sort of smiled, and asked me gently where the print-out was. I told her (thinking quickly on my feet) that I needed my special T-shirt first so that I could go get the print-out. I'm clever that way. I skulked back downstairs and fetched the print-out.
"[...]most patients with ADHD continue to struggle with a substantial number of symptoms and a high level of impairment.

For example, adults with ADHD are thought to have deficits of working memory as exemplified by less ability to attend to, encode, and manipulate information. Such deficits in working memory may decrease the ability to filter out distractions, which contribute to further symptoms of inattention in adults with ADHD. Although less defined within ADHD, organizational difficulties and procrastination also appear common.*"
My new motto and new mantra is something that Dr. Russell Barkley said in a presentation - that a very important goal for ADHDers is to "remember so as to do".

So now when I forget to grab that print-out or grab my T-shirt, or close the garage door, or forget to close the kitchen cupboard, or forget my security pass for work, I am kinder to myself than I've ever been. Normally I have chastised myself and told myself that I'm 'such an idiot', and when appropriate apologize and apologize to whomever is blaming me for leaving something undone.

I now remind myself that I am working hard at developing new habits and coping skills, and learning more and more of the ADHD limitations that I can work to overcome - including with the help of medication. And I remind myself that my new goal is to more effectively "remember so as to do".

Cheers,

Mungo

*Seidman LJ, Biederman J, Faraone SV, Weber W, Ouellette C. Toward defining a neuropsychology of attention deficit-hyperactivity disorder: performance of children and adolescents from a large clinically referred sample. J Consult Clin Psychol. 1997;65(1):150-160.


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May 14, 2010

Video: Dr. Russell A. Barkley - Management of ADHD

Dr. Russell Barkley is a great educator and researcher. If you have an hour and 20 minutes, watch this. Or just watch it in chunks. But watch at least the first 10 minutes... You will learn a lot about ADHD.
"Russell Barkley, Ph.D., discusses the recent advancements in understanding the nature and subtyping of ADHD as well as recent discoveries in what might cause the disorder and medications that might help treat ADHD. Series: M.I.N.D. Institute Lecture Series on Neurodevelopmental Disorders"

Cheers,

Mungo

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Managing My Physical & Mental Health

If I am to find a way to manage my mental health - i.e. find a way to cope with and treat ADHD, I think it is important to have a positive attitude. Having a positive attitude comes with good self-esteem. Years of failures and struggles and frustration in part due to ADHD will lead to low self-esteem.

For many years now - probably since I ditched my bicycle and learned to drive a 4-cylinder internal combustion engine powered automobile (A.K.A. a car), my weight has slowly crept up. I used to be a skinny kid. Then in high school I was a wiry kid. And in the first couple of years of university I was a slightly muscled, thin guy. Then I worked as a butcher for a couple of years in summers and in the year I was put on probation and told to take a year off university. I worked out at a gym and ate meat each day. I remember getting to 200 pounds and was happy - bulk and great strength was required when hoisting sides of beef about a very slippery floor in the shop.

Then that weight became more tipped to the side of fat, as opposed to Herculean man-strength and Sean Conneryesque Mr. Universe tone (the fun thing about a blog is that you don't have to have it peer reviewed or authenticated by any authority).

In 2003, when I was married, I weighed about 220 lbs. My suit was ill-fitting, or at least I was ill-fitted to my suit. I had more chins than an Argentinian, United Kingdom, French, French Canadian or Portuguese toast (Chin Chin).

My Body Mass Index calculation suggested that I would no longer be overweight once I reduced my weight to 184 lbs. Yeah right. That seemed a little outlandish. In November I decided to stop drinking for good. Not that I was reeling drunk all the time, but I was certainly having a few too many drinks on the weekends, and this helped me forget (a) what had happened previously and (b) what was to happen to me - and thus was a nice temporary relief. So I stopped. No twitching, or spasms or shrieks of agony. Just stopped. And I think for all the lack of those calories I began to shrink.

Around the same time I decided to stop drinking the 6 to 10 cans of full calorie Coke that I was drinking to (in retrospect) self-medicate my ADHD and help me focus. I switched to Diet Pepsi. Diet Coke tastes like barely-fizzy diluted cat piss. Diet Pepsi is nicer. And so I shrank more. Then I decided to replace each breakfast with 2% milk with Slim-Fast powder mix - which is really just milk powder, sugar and some Aspartame - and vitamins. Then I stopped snacking during the day.

The longer I've been on this calorie-reduced diet, the less I get urges to binge on food.

So here is my progress since then (graph below) - I want to go down to 180 lbs and stop there. I think I would like my upper range to be 185 lbs.



My point of this rambling post? Well, I feel proud of having done this. I'm not doing this for beauty reasons (despite my Sean Conneryesque appearance), but because I'm nearly 40 and I don't want to be putting extra weight on my heart and joints. I want to be a positive example to my little boy. And I want to be around for a long time.

And doing something I take pride in, makes me feel proud. And feeling proud increases my self-esteem.

Cheers,

Mungo

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Another Step: Blood & Cardiac Function Testing Needed Prior to Medication

I'm writing this and other recent posts in order to give you a sense of what is involved in getting a diagnosis of ADHD, and what is involved in getting treatment, and the steps in between. That is, what has and will be involved for me. Not everyone has to go through so much, and some may have a more tedious and lengthy experience. And of course, I am not just talking about pharmaceutical treatments, but changes involving and that result from the very fact of receiving a diagnosis, and everything that follows from that (including medication, but also self-help, counseling, lifestyle changes, implemented tips and techniques etc...).

So this morning I left early so that I could make it to a local hospital where a clinic is located so I could get blood-work and an ECG (electrocardiogram). These were needed prior to being put on Strattera. The results will be shipped to my family physician, and I have an appointment booked with him in a couple of weeks to followup. Hopefully (and I expect) everything will turn out well - that my blood will be found to be the purest and most balanced in every respect that the clinic has ever seen and that it will be written about in medical journals and texts for decades hence, and they will need to ask for a release form (with mentions of plush royalties payable to this author) to feature my ECG printout in a world standard cardiac textbook on what a 'perfect' ECG should resemble.

These tests are necessary because Strattera should be prescribed 'with caution' to people with a preexisting condition of tachycardia, and to people with preexisting impaired hepatic function. Since stopping any alcohol intake since November of last year (seemed a wise thing to do, given that it probably didn't help me focus all that well), and since I don't smoke (never have) or inhale solvents from a plastic bag (honestly, never have) in the alley behind my house, I'm assuming I have a lovely, ripe, healthy, delicious and chortling liver. I believe that my heart beats with the regularity and the robustness of a fine - and extremely expensive - Swiss Chronograph.

Since I could go to any clinic to get this testing done, I did a quick web search yesterday, and called a clinic that appeared (on Google Maps) to be along my route to work. They answered, and said that no appointment was necessary - just to come in with my Provincial Health Card (I live in Ontario, Canada) and with the requisition form that my doctor gave to me.

I arrived at the hospital 10 minutes before the clinic opened. I was the first in line, and the policy there was first in, first out. 15 minutes after entering the clinic, I was pressing the elevator button to return to the parking lot. I made it to work a half hour early, missing only a few milliliters of the red stuff, sporting a cute band-aid on my left arm, and with a hearty (no pun intended) kick in my step.

Feelin' good.

Cheers,

Mungo

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