April 4, 2011

Drug Free and Waiting To Go on More Drugs...

Today is my first day without Strattera in my brain and blood for nearly 10 months. This way, I'll be able to go on Vyvanse (hopefully quickly) and be able to discern effectiveness without any conflicts due to another medication. I am very hopeful for this change.

Last week as I was coming off the medication, I have found myself excessively chatty (still happening). I noticed people 'casually' looking at their clocks or even saying "Well, I have some things I have to do now..." as my conversations ran on and on. My conversational skills are surprisingly interesting to me. No matter what others think.

Plus I have been quite fidgety. My right leg shakes up and down almost non stop. I should take up playing the spoons. Shaky shaky shaky. I shift in my chair a lot. I walk about during breaks to help me clarify next steps - which is a deliberate attempt to make explicit some working memory improvement techniques I am trying. I think it helps. I talk to myself quietly - "Okay, I must do X, Y and then Z..." and get it straight in my head before launching into a frenzy of productive energy. Were I not to plan it out, I'd likely launch into a frenzy of frenetic, unguided, unproductive activity...

Tomorrow I'm going to my family doctor to follow up on the psych consult I had recently, where the psychiatrist concluded that I should come off of Strattera and go onto Vyvanse. I have become inured to the fact that delays in my medical treatment will likely keep on happening. Heck, it has taken me 40 years to find out I have ADHD, so what's another few years?

Official prediction: I will go to my family doctor's office tomorrow and he will insist that I take a panoply of tests prior to getting the prescription (despite having had heart and blood tests for Strattera just 10 months ago). This will inevitably lead to a delay, and I won't get the Vyvanse prescription until a period in time when everyone will have their own private flying car, when all you will need to eat in a day is a single condensed pill with a glass of synthetic orange juice, and robots will have replaced the need for us to work.

I would rather lower my expectations and be surprised (i.e. get a prescription for Vyvanse immediately following my appointment tomorrow), than have high expectations and be disappointed, despite the fact that I oughtta know better by now.

I hope I'm wrong.




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April 1, 2011

Feeling Somewhat Irritable and Likely Projecting Upon Others

Next week I have my appointment to get changed over to Vyvanse. I'm looking forward to it, and feeling optimistic and excited. Well, that's what I'm feeling now.

But (I suspect) because I'm coming off the Strattera, and due to lack of sleep (staying up too late, possibly again due to titrating from 80mg to 30mg in less than a week) - I am especially grumpy, grouchy, touchy, irritable, and ever-so-slightly holier-than-thou today. So back the heck up (insert variation of wording as you wish) and get the heck out of my way.

So I wanted to make sure everything was in order for my doctor's appointment next week (and see if you can follow this):

Yesterday I checked in with my family doctor to see if the consulting notes and recommendation to change medications had been sent through to them, just so that I don't waste time driving a long way to another town to my family doctor. The assistant told me that it might have come through, but likely my doctor hadn't gotten to it yet as he'd been away and had a stack of papers on his desk 'this high'. I thanked her and she told me that she was sure he would get to it. But to be sure I phoned again today to confirm and she told me (as she checked my file while I was on the phone) that it had NOT come through. So I phoned the clinic back and the assistant there told me that the fax machine didn't work correctly on Monday so it hadn't gone through. She couldn't see that I wasn't blinking, and forcing a smile over the phone and so I asked her if she could try sending it again and that I'd call back in a few minutes to confirm that it sent okay. She said 'well, hold on... okay, there.' and it was sent. Just like that. Literally in seconds. So I thanked her, checked my family doctor's office and it had indeed gone through. I rolled my eyes and shook my head after hanging up.

And all the while I'm charged up and thinking 'goddammit how incompetent are all the people I'm dealing with this week?'. See, I am also working hard to push a project through in my new job and the third party contact is about as responsive and timely as a sloth on barbiturates. And no doubt, far less adorable.

Sure - I find customer service can be pretty lackadaisical at times, and realistically, most folks reading this would agree with me that at least a few of these situations involve folks who are not moving their derrieres in an effective manner, on time and under budget as it were (I'm a project manager, can you tell?).

And I could begin listing about a dozen more instances of irritating situations where people were taking their time getting things done... but I won't bore you with that. And anyway, it kinda would obscure my purpose for this post.

Here's my point: I obviously recognize that there is a common denominator to these scenarios. Moi. The one person who is consistently engaged in trying to solve a problem with all of these other unrelated people is little ol' cutie-pie me. Could it be that I'm projecting just a little bit?
"Our own projections are difficult to spot, first of all, because we don’t want to identify them as such: the whole point of projecting is to rid ourselves of something unwanted. While there are instances where people project their good qualities into others, ridding oneself of painful or unpleasant experiences is much more common."
Maybe it is because I'm coming to recognize an uncomfortable truth about myself, which is that often I'm the one who doesn't get around to things in a timely manner (if my lovely, and somewhat long-suffering wife is reading this she might agree!).

Charge me up with dopamine, norepinephrine, an intense emergency situation or anything that really commands (for some reason or another) my intense hyper-focused awareness and I'll blow through it like Evil Knievel on a motorbike. Like Han Solo in the Millennium Falcon. Like Chuck Norris in a bar fight. Go orbitofrontal cortex, go!

But so many times I am dimly aware of a set of important to-do tasks I'm leaving on the back burner, undone and unheeded.
"Projection is an unconscious fantasy that we are able to rid ourselves of some part of our psyche by splitting it off and putting it outside ourselves, usually into somebody else. While the initial process occurs outside of awareness, maintaining or insisting upon the reality of that projection often occupies our conscious thoughts. The process is usually distinguished by its focus and intensity."
So I note with considerable discomfort and with some shame that I am projecting to a large extent. I need to remind myself that I too don't always get things done at the speed of light. And that I don't always put other people's priorities on my own priority list. That I don't always empathize and spend my time ensuring others are considered. Or simply put: I am not always that considerate and responsive to the important people around me.

I guess 'owning my projections' means that I need to find a way to reconcile my own conflicting feelings and beliefs about myself and others. That is, why should others have to be completely efficient, competent and effective when dealing with me, but I can been inefficient, incompetent and ineffective when others deal with me? Is there a middle ground? There has to be a middle ground.

But in the meantime, I'm dealing with this in two ways: 1) biting my tongue while dealing with people when I need them to do something , and 2) making sure I diplomatically and considerately ensure my priorities are taken care of in a timely manner. This way I don't end up driving people away, and at the same time, make certain I take care of my needs so that I can get more healthy, grow up, do a good job at work and in other arenas of my life.

Comments are always welcome!


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March 30, 2011

Changing from Strattera to Vyvanse for my Adult ADHD - Very Excited!

In the last year, I have been relentless in my quest to ensure I take care of myself and get effective treatment for my ADHD. But as stubborn and determined as I can be, the medical system's wheels turn slowly. Or at least they were from where I was standing.

The non-stimulant SNRI 'Strattera' worked pretty well for a while. I think I had better control over my impulsiveness. My multiple channels of thoughts seemed to quieten down, and I was able to have two or three things going on in my head at a time - that's quiet for me. I could focus much better. I would take a breath before saying something and often times decide not to say something.

I remember just as I was starting medication becoming aware of how I always had four or five trains of thought going at once - and how I thought this was perfectly normal. I would be thinking of the situation at hand, then something perhaps about a previous situation similar to it, and then something completely unrelated, like a task I needed to do, and maybe a thought about some sort of philosophical point, and perhaps something about the etymology of a word that I had just heard in the conversation, and then maybe what I was going to do next, plus maybe something I wanted to excitedly add to the conversation, even though it was not pertinent.

Looking back, that's a lot of stuff happening all at once. No wonder I got distracted easily, and no wonder I spaced out a lot.

Strattera seemed to calm my thinking down and reduce my impulsiveness, as it relates to interrupting conversations, inserting non sequitors, or adding humour at inappropriate times.

But the spacing out, the perseveration, the procrastination, the difficulty I have with attending to priority tasks - was still a big struggle.

And my family doctor is - uhm - well, he isn't really good at customer service. He isn't the guy in the department store who answers "No, I don't know if we have those widgets, but walk with me and I'll introduce you to an associate who knows the department better than I do, and we'll make sure you leave today with either a widget or knowing where to pick one up in this city - we'll call our competitors as needed". No. My doctor is the type of guy who answers "No, haven't heard of 'widgets' - we don't sell them."

He's never - other than asking me if I am having side-effects - asked me in depth about Strattera, and ADHD.

So I started asking around, and phoning around for someone who could give me some answers. After multiple tries, I still wasn't able to get to a doctor who understands Adult ADHD, someone who specializes or at least has some knowledge of it. But the very helpful doctor I went to (who I found through a different channel) suggested that I return to the clinic where I got my assessment done and inquire there.

Well, that worked. I got a call back after half an hour, and a week later attended an appointment with a psychiatrist who is a very senior member of the Canadian psychiatric community, and specializes in Adult ADHD. He is also trained and specializes in psychoanalysis, which is one of my considerable interests. Best of both worlds.

Anyway, my meeting with him lasted for about 45 minutes. It went as smooth as silk. His recommendation was to come off of Strattera. He was genuinely puzzled as to why they recommended a 'second-line' medication for me. He sent a consult recommendation to my family doctor (groan) to put me on Vyvanse, a psycho-stimulant.

I'm very excited about this turn of events. Finally! So - next steps are as follows:

1) Make an appointment with my family doctor (who is out today) so that he will prescribe me the Vyvanse according to the regime that the psychiatrist recommends (i.e. increasing, titrating to effectiveness)

2) Stop taking Strattera. While most accounts say that there are no discontinuation symptoms, I'd rather taper it off, and given the number of capsules I have left, I'll have completely stopped this coming Monday:

Monday, March 28: 80 mg
Tuesday, March 29: 70 mg
Wednesday, March 30: 50 mg
Thursday, March 31: 40 mg
Friday, April 1: 30 mg
Saturday, April 2: 20 mg
Sunday, April 3: 10 mg
Monday, April 2: No more Strattera

I'll keep an eye on symptoms that emerge after coming off Strattera, and just hope that there won't be much of a gap between coming off Strattera and going on Vyvanse.



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March 18, 2011

Please Visit Blogs on the Blogroll

Good morning everyone!

Just wanted to ask y'all to consider visiting the various blogs on my blogroll located at the bottom right of this page. Each and every one of the people who write blogs there put their hearts and souls into their efforts, and I've learned that building a community of like-minded, understanding people is very important.

Thank you in advance, and I hope you encounter new online connections this way.



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March 14, 2011

Video: Overview on Current Trends and Controversies regarding ADHD

I came across a terrific video about ADHD this weekend. It is very educational, and I highly recommend that you watch it. Dr. Pommer is a Clinical Psychologist, and his primary area of treatment is Attention Deficit Hyperactivity Disorder (ADHD).

In this presentation, Dr. Pommer provides an overview on the current trends and controversies in the diagnosis, misdiagnosis, associated conditions (depression, anxiety, learning disabilities, etc.) and treatment of ADHD.



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March 11, 2011

I'm Forgetful & Freezing Cold

Having forgotten to take my Strattera this morning, I'm finding myself awfully forgetful and - strangely - very cold. I have my winter jacket on, zipped up high. In the office. Could be just a cold coming on.

And the forgetfulness? Well - who knows. I'm not sure what typical effects would be if someone forgets their SNRI for a day. A stimulant, well - the effects of missing a dose is probably quickly evident. But SNRIs are slow to act, and last for 24 hours. Maybe I've still got some in my blood from yesterday. And maybe my nice little orbitofrontal cortex has decided to give me a break and chosen not to completely fall asleep.

Hope everyone is having a nice Friday.


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Whoops, Forgot My Medication Today...

For the first time in nearly 10 months since I've been taking Strattera, I forgot to take my tablets this morning. I was in such a rush because I wanted to get to work nice and early. I got to work at 7:20 am. Grabbed a coffee. Wrote my daily work priority list. Reviewed e-mails. Reviewed my schedule.

Then realized I'd forgotten my Strattera.

I wonder if I will notice any significant effects, i.e. worsening of attention or increased impulsivity or hyperactivity? I wonder.

Let's see how the day goes. Pleased that I'm doing my daily priority list and getting in early to get a productive start on the day, though. That's gotta count for something!


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